BACKGROUND & AIMS: Etoposide produces reversible inhibition of topoisomerase II, leading to cleavage of DNA, and thereby has an antitumor effect. This mechanism suggests that the longer treatment is continued, the greater the antitumor effect will be. In the present study, both therapeutic and adverse effects of long-term treatment with low-dose oral etoposide were studied in 29 patients aged > or = 65 years with non-Hodgkin's lymphoma (NHL) for whom standard chemotherapy was not effective or refractory. These patients received etoposide at a dose of 50 mg/d for as long as possible. Treatment was continued until white blood cell count decreased to < or = 2,000/microL or the platelet count decreased to < or = 5 x 10(4)/microL. According to the World Health Organization (WHO) criteria of therapeutic effects, 6 (20.7%) of the 29 patients achieved complete remission and 13 patients (44.8%) had partial remission, for a response rate of 65.5%. Adverse effects of > or = grade 3 included leukopenia in 24 patients (82.8%) and anemia in 7 (24.1%). Granulocyte colony-stimulating factor (G-CSF) was given in combination with etoposide to eight patients because of leukopenia (granulocyte count < or = 1,000/microL). In view of the excellent subjective tolerance, low incidence of serious adverse effects, and good activity, single agent oral etoposide given continuously over prolonged periods represents a useful treatment for elderly patients with NHL.

背景与目标： 依托泊苷产生拓扑异构酶II的可逆抑制，导致DNA裂解，从而具有抗肿瘤作用。这种机制表明，持续治疗的时间越长，抗肿瘤作用就越大。在本研究中，对29例年龄> 或 = 65岁的非霍奇金淋巴瘤 (NHL) 患者进行了低剂量口服依托泊苷长期治疗的治疗和不良反应的研究，这些患者的标准化疗无效或难治性。这些患者尽可能长时间地接受依托泊苷50 mg/d的剂量。继续治疗直到白细胞计数降低至 <或 = 2,000/microL或血小板计数降低至 <或 = 5 × 10(4)/microL。根据治疗效果的世卫组织标准，29例患者中有6例 (20.7% 例) 完全缓解，13例 (44.8% 例) 部分缓解，缓解率为65.5%。> or = 3级的不良反应包括白细胞减少24例 (82.8%) 和贫血7例 (24.1%)。由于白细胞减少 (粒细胞计数 <或 = 1,000/microL)，将八名患者与依托泊苷联合给予粒细胞集落刺激因子 (g-csf)。鉴于其良好的主观耐受性，低的严重不良反应发生率和良好的活性，长期连续给予单药口服依托泊苷代表了对老年NHL患者的有用治疗。

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：

BACKGROUND & AIMS: :The Z-Scan (ZS) technique in the thermal regime has been used to measure the nonlinear optical response of low-density lipoprotein (LDL). The ZS technique is carried out in LDL from 40 patients with chronic periodontitis before and after three, six, and 12 months of periodontal treatment. Clinical parameters such as probing depths, bleeding on probing, total and differential white blood cells counts, lipid profiles, cytokine levels, and antibodies against oxidized LDL are also determined and compared over time. Before the treatment, the ZS experimental results reveal that the LDL particles of these patients are heavily modified. Only after 12 months of the periodontal treatment, the ZS results obtained reveal behavioral characteristics of healthy particles. This conclusion is also supported by complementary laboratorial analysis showing that the periodontal treatment induces systemic changes in several inflammatory markers.

背景与目标： : 热状态下的Z扫描 (ZS) 技术已用于测量低密度脂蛋白 (LDL) 的非线性光学响应。ZS技术是在牙周治疗3、6和12个月之前和之后对40例慢性牙周炎患者的LDL进行的。还可以确定临床参数，例如探测深度，探测出血，白细胞总数和差异计数，脂质分布，细胞因子水平以及针对氧化LDL的抗体，并随时间进行比较。治疗前，ZS实验结果表明，这些患者的LDL颗粒已被严重修饰。仅在牙周治疗12个月后，获得的ZS结果才显示出健康颗粒的行为特征。该结论也得到补充实验室分析的支持，该分析表明牙周治疗可引起几种炎症标志物的全身变化。

BACKGROUND & AIMS: :Repetitive transcranial magnetic stimulation (rTMS), a non-invasive form of brain stimulation, has shown experimental and clinical efficacy in a range of neuromodulatory models, even when delivered at low intensity (i.e. subthreshold for action potential generation). After central nervous system (CNS) injury, studies suggest that reactive astrocytes and microglia can have detrimental but also beneficial effects; thus modulating glial activity, for example through application of rTMS, could potentially be a useful therapeutic tool following neurotrauma. Immunohistochemistry was used to measure the effect of low intensity rTMS (LI-rTMS) on GFAP (astrocyte), IBA1 (microglial), and CS56 (proteoglycan) expression in a unilateral penetrating cortical stab injury model of glial scarring in young adult and aged male and female C57BL6/J mice. Mice received contralateral low frequency, ipsilateral low frequency, ipsilateral high frequency or sham LI-rTMS (4-5mT intensity), for two weeks following injury. There was no significant difference in the overall volume of tissue containing GFAP positive (+) astrocytes, IBA1+ microglia, or proteoglycan expression, between sham and LI-rTMS-treated mice of all ages and sex. Importantly however, the density of GFAP+ astrocytes and IBA1+ microglia immediately adjacent to the injury was significantly reduced following ipsilateral low and high frequency stimulation in adult and aged females (p≤0.05), but was significantly increased in adult and aged males (p≤0.05). LI-rTMS effects were generally of greater magnitude in aged mice compared to young adult mice. These results suggest that sex differences need to be factored into therapeutic rTMS protocols. In particular, more work analyzing frequency and intensity specific effects, especially in relation to age and sex, is required to determine how rTMS can best be used to modify glial reactivity and phenotype following neurotrauma.

背景与目标： 重复经颅磁刺激 (rTMS) 是一种非侵入性的脑刺激形式，即使在低强度 (即动作电位产生的亚阈值) 下，也已在一系列神经调节模型中显示出实验和临床功效。中枢神经系统 (CNS) 损伤后，研究表明反应性星形胶质细胞和小胶质细胞可能具有有害但有益的作用; 因此，例如通过应用rTMS调节神经胶质活性，可能是神经创伤后有用的治疗工具。免疫组织化学用于测量低强度rTMS (LI-rTMS) 对年轻成年和老年C57BL6/J小鼠单侧穿透性皮质瘢痕损伤模型中GFAP (星形胶质细胞)，IBA1 (小胶质细胞) 和CS56 (蛋白聚糖) 表达的影响。损伤后两周，小鼠接受对侧低频，同侧低频，同侧高频或假LI-rTMS (4-5mT强度)。在所有年龄和性别的sham和LI-rTMS治疗的小鼠之间，含有GFAP阳性 () 星形胶质细胞，IBA1小胶质细胞或蛋白聚糖表达的组织的总体积均无显着差异。然而，重要的是，在同侧低频和高频刺激后，与损伤紧邻的GFAP + 星形胶质细胞和IBA1 + 小胶质细胞的密度在成年和老年女性中显著降低 (p ≤ 0.05)，但在成年和老年男性中显著增加 (p ≤ 0.05)。与年轻的成年小鼠相比，老年小鼠的LI-rTMS效应通常更大。这些结果表明，需要将性别差异纳入治疗性rTMS方案。特别是，需要更多的工作来分析频率和强度的特定影响，尤其是与年龄和性别有关的影响，以确定rTMS如何最好地用于改变神经创伤后的神经胶质反应性和表型。

BACKGROUND & AIMS: :In order to understand the effect of pH on the formation of electrostatic complexes between lysozyme and low methoxyl (LM) pectin, mixtures were prepared at a fixed lysozyme concentration (0.714g.L-1) by progressive addition of LM pectin (from 0 to 4g.L-1). Turbidity analysis allowed to determine specific conditions of pH and lysozyme/LM pectin ratio for optimal complex aggregation. The intrinsic fluorescence enhancement observed upon binding of LM pectin to lysozyme was correlated with the formation of intermolecular aggregates. Conversely, the intrinsic fluorescence decrease observed at higher LM pectin amounts was correlated with the dissociation of intermolecular aggregates. UV absorption spectroscopy showed modifications in lysozyme conformation during both the aggregation phase and the dissociation phase. The role of electrostatic interactions in the formation of lysozyme/LM pectin complexes is discussed in relation to the overall structure and the charge density profile of the two biopolymers.

背景与目标： 为了了解pH对溶菌酶和低甲氧基 (LM) 果胶之间静电复合物形成的影响，通过逐渐加入LM果胶 (0至4g.L-1)，在固定的溶菌酶浓度 (0.714g.L-1) 下制备混合物。浊度分析可以确定pH和溶菌酶/LM果胶比率的特定条件，以实现最佳的复合聚集。LM果胶与溶菌酶结合后观察到的固有荧光增强与分子间聚集体的形成有关。相反，在较高的LM果胶量下观察到的固有荧光降低与分子间聚集体的解离有关。紫外吸收光谱显示，在聚集相和解离相中，溶菌酶构象都发生了变化。讨论了静电相互作用在溶菌酶/LM果胶复合物形成中的作用，涉及两种生物聚合物的整体结构和电荷密度分布。

BACKGROUND & AIMS: :Cognitive dysfunction syndrome is a major disease affecting old cats and is the consequence of severe and irreversible loss of brain cells and brain atrophy. The present study focused on the hypothesis that the optimal strategy for promoting successful brain ageing is to target risk factors associated with brain ageing and dementia. We used a nutritional strategy involving supplementation with a blend of nutrients (antioxidants, arginine, B vitamins and fish oil) to test this hypothesis. Middle-aged and old cats between 5·5 and 8·7 years of age were assigned to cognitively equivalent control or treatment groups based on prior cognitive experience and performance on baseline cognitive tests. The cats in the treatment group were maintained on a diet supplemented with the nutrient blend and the cats in the control group were maintained on the identical base diet without the additional supplementation. After an initial wash-in period, all cats were tested on a battery of cognitive test protocols. The cats fed the test diet showed significantly better performance on three of four test protocols: a protocol assessing egocentric learning, a protocol assessing discrimination and reversal learning and a protocol focused on acquisition of a spatial memory task. The results support the hypothesis that brain function of middle-aged and old cats can be improved by the nutrient blend that was selected to minimise or eliminate the risk factors associated with brain ageing and dementia.

背景与目标： : 认知功能障碍综合征是影响老猫的主要疾病，是严重且不可逆转的脑细胞丧失和脑萎缩的后果。本研究的重点是以下假设: 促进成功的大脑衰老的最佳策略是针对与大脑衰老和痴呆症相关的危险因素。我们使用了一种营养策略，包括补充营养素 (抗氧化剂，精氨酸，b族维生素和鱼油)，以检验这一假设。根据先前的认知经验和基线认知测试的表现，将5·5至8·7岁的中年和老年猫分配到认知上等效的对照组或治疗组。治疗组中的猫维持在补充营养混合物的饮食中，而对照组中的猫维持在相同的基础饮食中，而无需额外补充。在最初的冲洗期后，所有猫都接受了一系列认知测试协议的测试。喂养测试饮食的猫在四个测试协议中的三个协议中表现出明显更好的性能: 评估以自我为中心的学习的协议，评估歧视和逆转学习的协议以及专注于获取空间记忆任务的协议。结果支持以下假设: 可以通过选择营养混合物来改善中老年猫的脑功能，以最大程度地减少或消除与脑衰老和痴呆症相关的危险因素。

BACKGROUND & AIMS: BACKGROUND:The aim of the present study was to evaluate the effects of low-level laser therapy (LLLT) on the healing of bone defects in rats with streptozotocin (STZ)-induced DM. METHODS:28 male Sprague-Dawley rats were used in this study. 14 animals received a single dose of STZ intraperitoneally (65 mg/kg) to induce Type I DM, whereas others were injected only with sterile saline solution. Four weeks later, standard bone defects were created in the tibiae of rats. Surgical wounds in one group from each of the diabetic and non-diabetic animals were irradiated with diode laser for every other day for 4 weeks and they were described as DM + LLLT and CONT + LLLT groups, respectively. Remaining two groups received no laser treatment. New bone formation, osteoblast and blood vessel counts were calculated in histologic sections. RESULTS:DM group had significantly smaller bone area and lower blood vessel count when compared to DM + LLLT, CONT and CONT + LLLT groups (p < 0.05 for each). CONT and CONT + LLLT groups had significantly larger bone area than DM + LLLT group (p < 0.05 for both). CONCLUSIONS:LLLT application promoted vascularization and new bone formation in animals with DM to a limited extent, since it was unable to support the healing process up to the level of non-diabetic animals.

背景与目标：

BACKGROUND & AIMS: :Isolated tomato fruit cuticles were subjected to low dose (80Gy) γ-irradiation, as a potential methodology to prevent harvested fruit and vegetables spoilage. Both irradiated and non-irradiated samples have been morphologically and chemically characterized by scanning electron (SEM), atomic force (AFM), attenuated total reflectance Fourier transform infrared (ATR-FTIR) and X-ray photoelectron (XPS) spectroscopies. Additionally, electrochemical measurements comprising membrane potential and diffusive permeability were carried out to detect modifications in transport properties of the cuticle as the fruit primary protective membrane. It has been found that low dose γ-irradiation causes some textural changes on the surface but no significant chemical modification. Texture modification is found to be due to a partial removal of outermost (epicuticular) waxes which is accompanied by mild changes of electrochemical parameters such as the membrane fixed charge, cation transport number and salt permeability. The modification of such parameters indicates a slight reduction of the barrier properties of the cuticle upon low dose γ-irradiation.

背景与目标： : 对分离的番茄果实角质层进行低剂量 (80Gy) γ 辐照，作为防止收获的水果和蔬菜变质的潜在方法。辐照和未辐照样品均已通过扫描电子 (SEM)，原子力 (AFM)，衰减全反射傅里叶变换红外 (atr-ftir) 和x射线光电子 (XPS) 光谱进行了形态和化学表征。此外，进行了包含膜电位和扩散渗透性的电化学测量，以检测作为水果初级保护膜的角质层的运输特性的变化。已经发现，低剂量的 γ 辐照会在表面上引起一些质地变化，但没有明显的化学修饰。发现纹理修饰是由于部分去除最外层 (表皮) 蜡，并伴随着电化学参数的轻微变化，例如膜固定电荷，阳离子迁移数和盐渗透性。这些参数的修改表明，在低剂量 γ 辐照下，角质层的阻隔性能略有降低。

BACKGROUND & AIMS: BACKGROUND:Accuracy of bone marrow (BM) blast count in low-risk myelodysplastic syndromes (MDS) still remains a challenge though it is essential for prognosis. We investigated whether the enumeration of CD34+ myeloid cells by flow cytometry immunophenotyping (FCI) could be used as a consistent parameter for clinical MDS studies. METHODS:Six clinical centers entered the study and information on their FCI protocols was recorded. Sixty-seven flow cytometry listmodes from BM samples of patients with low-risk MDS with <5% BM blasts were exchanged among participants in two different rounds. Interlaboratory variations on the quantification of CD34+ myeloid cells were calculated and strategies to solve differences were evaluated. RESULTS:An overall "very good" agreement on CD34+ cell count among participants (intraclass correlation coefficient = 0.720) was observed, but agreement was "low" in 22 files. No single parameter could fully explain all discrepancies, but 3 technical issues were identified as relevant: the use of the CD34/CD45/CD117/HLA-DR mAb combination, acquisition of ≥50,000 events and a low percentage of debris/aggregates. The frequency of discordant results increased with the accumulation of pitfalls (none, 16%; 1 pitfall, 40%; 2 pitfalls, 83%; P = 0.006). Finally, the use of a common gating strategy for analysis increased the percentage of files with "very good" agreement to 100%. CONCLUSIONS:Prevention of specific technical pitfalls is mandatory to reach a good reproducibility of CD34+ cell count among centers. These recommendations set the basis for laboratory standardization and enable the use of CD34+ cell enumeration as additional information in low-risk MDS patients. © 2017 International Clinical Cytometry Society.

背景与目标：

BACKGROUND & AIMS: :The use of fillers for nonsurgical rhinoplasty has advanced in both materials and methods, and continues to gain popularity in North America. This technique is most often used for secondary revisions, although reports of fillers used in primary rhinoplasty in selected patients have been recently described. The present report details the use of a hyaluronic acid dermal filler in a young Middle Eastern man for a post-traumatic crooked nose deformity. Primary correction of the patient's right-sided nasal bone deviation using hyaluronic acid as a soft tissue filler was achieved with excellent results and patient satisfaction. The current use of fillers in nasal contouring is reviewed.

背景与目标： : 在非手术鼻整形术中使用填充物在材料和方法上都取得了进步，并在北美继续受到欢迎。尽管最近已经描述了在选定患者的初次鼻整形术中使用填充物的报道，但该技术最常用于二次修订。本报告详细介绍了一名中东年轻人在创伤后弯曲鼻子畸形中使用透明质酸皮肤填充剂的情况。使用透明质酸作为软组织填充剂对患者的右侧鼻骨偏斜进行了初步矫正，效果极佳，患者满意。回顾了填充剂在鼻腔轮廓中的当前使用。

BACKGROUND & AIMS: :It was recently suggested that cortisol levels in fingernails reflect cumulative hormone exposure over a relatively long period. This exploratory study cross-sectionally investigated the relationships between fingernail cortisol level and psychosocial stress in a sample of middle-aged workers (94 men and 29 women). The participants were asked to grow their fingernails for ∼2 weeks and then provide fingernail samples from every digit by using nail clippers. Further, they completed questionnaires for assessment of exposure to psychosocial stress in the past (stressful life events in the workplace in the previous year; e.g. change to a different line of work) and in the present (job stress and perceived stress). Results of a regression analysis adjusting for the effects of demographic variables showed that experience of stressful life events, but not job stress and perceived stress, was associated with elevated fingernail cortisol level. These findings indicate the potential of fingernail samples to retrospectively reflect individual differences in cortisol levels related to past psychosocial stress.

背景与目标： : 最近有人提出，指甲中的皮质醇水平反映了相对较长时间内累积的激素暴露。这项探索性研究从横截面上调查了中年工人 (94名男性和29名女性) 样本中指甲皮质醇水平与心理社会压力之间的关系。参与者被要求种植指甲约2周，然后使用指甲钳从每个数字中提供指甲样本。此外，他们完成了调查问卷，以评估过去 (上一年工作场所的压力生活事件; 例如改变工作方式) 和现在 (工作压力和感知压力) 的风险。调整人口统计学变量影响的回归分析结果表明，生活压力事件的经历，而不是工作压力和感知压力，与指甲皮质醇水平升高有关。这些发现表明，指甲样本有可能回顾性地反映与过去的心理社会压力有关的皮质醇水平的个体差异。

BACKGROUND & AIMS: :We describe a rapid particle-enhanced turbidimetric immunoassay for albumin in urine. Intra- and interassay CVs were less than 5% and less than 10%, respectively, the detection limit is 2 mg/L, and the working range extends to 200 mg/L. Mean analytical recovery of albumin added to centrifuged urines was 100% (SD 10.6%), and, when results were compared with those by the Pharmacia RIA, the correlation coefficient was 0.99. The working reagents are stable for at least six months; thus this assay is suited for both batch and urgent analysis.

背景与目标： : 我们描述了尿液中白蛋白的快速颗粒增强比浊法免疫测定。测定内和测定间CVs分别小于5% 和小于10%，检出限为2 mg/L，工作范围扩大至200 mg/L。添加到离心尿液中的白蛋白的平均分析回收率为100% (SD 10.6%)，并且当将结果与通过Pharmacia RIA进行比较时，相关系数为0.99。工作试剂至少稳定六个月; 因此，该测定法适用于分批和紧急分析。

BACKGROUND & AIMS: :Dietary protein and amino acid requirement recommendations for normal "healthy" children and adults have varied considerably with 2007 FAO/WHO protein requirement estimates for children lower, but dietary essential AA requirements for adults more than doubled. Requirement estimates as presented do not account for common living conditions, which are prevalent in developing countries such as energy deficit, infection burden and added functional demands for protein and AAs. This study examined the effect of adjusting total dietary protein for quality and digestibility (PDCAAS) and of correcting current protein and AA requirements for the effect of infection and a mild energy deficit to estimate utilizable protein (total protein corrected for biological value and digestibility) and the risk/prevalence of protein inadequacy. The relationship between utilizable protein/prevalence of protein inadequacy and stunting across regions and countries was examined. Data sources (n = 116 countries) included FAO FBS (food supply), UNICEF (stunting prevalence), UNDP (GDP) and UNSTATS (IMR) and USDA nutrient tables. Statistical analyses included Pearson correlations, paired-sample/non-parametric t-tests and linear regression. Statistically significant differences were observed in risk/prevalence estimates of protein inadequacy using total protein and the current protein requirements versus utilizable protein and the adjusted protein requirements for all regions (p < 0·05). Total protein, utilizable protein, GDP per capita and total energy were each highly correlated with the prevalence of stunting. Energy, protein and utilizable protein availability were independently and negatively associated with stunting (p < 0·001), explaining 41 %, 34 % and 40 % of variation respectively. Controlling for energy, total protein was not a statistically significant factor but utilizable protein remained significant explaining~45 % of the variance (p = 0·017). Dietary utilizable protein provides a better index of population impact of risk/prevalence of protein inadequacy than crude protein intake. We conclude that the increased demand for protein due to infections and mild to moderate energy deficits, should be appropriately considered in assessing needs of populations where those conditions still prevail.

背景与目标： : 正常 “健康” 儿童和成人的膳食蛋白质和氨基酸需求建议差异很大，2007粮农组织/世卫组织儿童的蛋白质需求估计值较低，但成人的膳食必需AA需求增加了一倍以上。所提出的需求估计数没有考虑到发展中国家普遍存在的共同生活条件，例如能源短缺，感染负担以及对蛋白质和AAs的功能需求增加。这项研究检查了调整膳食总蛋白质的质量和消化率 (PDCAAS) 以及纠正当前蛋白质和AA对感染和轻度能量不足的影响，以估计可利用的蛋白质 (根据生物学价值和消化率校正的总蛋白质) 和蛋白质不足的风险/患病率。研究了可利用的蛋白质/蛋白质不足的患病率与跨地区和国家的发育迟缓之间的关系。数据来源 (n = 116个国家) 包括粮农组织FBS (粮食供应) 、儿童基金会 (发育迟缓流行率) 、开发署 (国内生产总值) 和统计司 (IMR) 以及USDA营养表。统计分析包括Pearson相关性，配对样本/非参数t检验和线性回归。在使用总蛋白质和当前蛋白质需求与可利用蛋白质和所有区域的调整后蛋白质需求的风险/患病率估计中，观察到统计学上的显着差异 (p <0·05)。总蛋白质，可利用蛋白质，人均GDP和总能量均与发育迟缓的患病率高度相关。能量，蛋白质和可利用的蛋白质利用率与发育迟缓独立且负相关 (p <0·001)，分别解释了变异的41%，34% 和40%。控制能量，总蛋白不是统计学上的显着因素，但可利用的蛋白质仍然显着解释了约45% 的方差 (p = 0.017)。与粗蛋白摄入相比，饮食中可利用的蛋白质提供了更好的人口对蛋白质不足风险/患病率的影响指数。我们得出的结论是，在评估仍然存在这些疾病的人群的需求时，应适当考虑由于感染和轻度至中度能量不足而导致的蛋白质需求增加。

BACKGROUND & AIMS: BACKGROUND:Inconsistent evidence of a higher risk of adverse perinatal outcomes during off-hours compared to office hours necessitated a search for clear evidence of an association between time of birth and adverse perinatal outcomes. METHODS:A cross-sectional study conducted at a tertiary referral hospital compared perinatal outcomes across three working shifts over 24 h. A checklist and a questionnaire were used to record parturients' socio-demographic and obstetric characteristics, mode of delivery and perinatal outcomes, including 5th minute Apgar score, and early neonatal mortality. Risks of adverse outcomes included maternal age, parity, referral status and mode of delivery, and were assessed for their association with time of delivery and prevalence of fresh stillbirth as a proxy for poor perinatal outcome at a significance level of p = 0.05. RESULTS:Off-hour deliveries were nearly twice as likely to occur during the night shift (odds ratio (OR), 1.62; 95% confidence interval (CI), 1.50-1.72), but were unlikely during the evening shift (OR, 0.58; 95% CI, 0.45-0.71) (all p < 0.001). Neonatal distress (O.R, 1.48, 95% CI; 1.07-2.04, p = 0.02), early neonatal deaths (OR, 1.70; 95% CI, 1.07-2.72, p = 0.03) and fresh stillbirths (OR, 1.95; 95% CI, 1.31-2.90, p = 0.001) were more significantly associated with deliveries occurring during night shifts compared to evening and morning shifts. However, fresh stillbirths occurring during the night shift were independently associated with antenatal admission from clinics or wards, referral from another hospital, and abnormal breech delivery (OR 1.9; 95% CI, 1.3-2.9, p = 0.001, for fresh stillbirths; OR, 5.0; 95% CI 1.7-8.3, p < 0.001, for antenatal admission; OR, 95% CI, 1.1-2.9, p < 0.001, for referral form another hospital; and OR 1.6; 95% CI 1.02-2.6, p = 0.004, for abnormal breech deliveries). CONCLUSION:Off-hours deliveries, particularly during the night shift, were significantly associated with higher proportions of adverse perinatal outcomes, including low Apgar score, early neonatal death and fresh stillbirth, compared to morning and evening shifts. Labour room admissions from antenatal wards, referrals from another hospital and abnormal breech delivery were independent risk factors for poor perinatal outcome, particularly fresh stillbirths.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The purpose of the meta-analysis was to estimate the effectiveness and toxicity of low activity radioiodine ablation versus high activity in patients with differentiated thyroid cancer (DTC). DESIGN:A systematic review and meta-analysis was performed by including all randomized trials of low activity versus high activity radioiodine ablation after thyroidectomy. Standard meta-analytic procedures were used to analyze the study outcomes. RESULTS:Ten trials were considered eligible and were further analyzed. The pooled risk ratio (RR) of having a successful ablation for an activity of 1100 MBq versus 3700 MBq (seven trials, 1772 patients) was 0.94 (95% CI 0.85-1.04, p-value = 0.21). The RR for successful ablation when only thyroid hormone withdrawal was used (five trials, 1116 patients) was 0.87 (95% CI 0.72-1.06, p-value = 0.17) and it was comparable to RR when only recombinant-human TSH (rec-hTSH) (two trials, 812 patients) was used (1.00, 95% CI 0.93-1.07, p-value = 0.92). Salivary dysfunction, nausea, and neck pain were significantly more frequent among patients with higher dose for ablation. CONCLUSION:Our meta-analysis provides some evidence from randomized trials that a lower activity of radioiodine ablation is as effective as higher dose after surgery in patients with DTC with lower toxicity.

背景与目标：