• 【同种异体骨髓移植后人类细小病毒B19抗体的持久性:先前受体免疫的作用。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Ang HA,Apperley JF,Ward KN
    BACKGROUND & AIMS: Human parvovirus B19 (B19) IgG was studied retrospectively in 66 allogeneic bone marrow transplantation (BMT) patients using an enzyme-linked immunosorbent assay. Recipient and donor sera had been stored pre-BMT together with sequential sera thereafter. Approximately half of donors and recipients had anti-B19 IgG pre-BMT and thus the relative contributions of donor and recipient immunity to antibody production after transplantation could be assessed. For each patient, a serum taken 2 to 3 years after BMT was also tested and the results show that persistence of B19 antibody depends on prior recipient (P = .0003) but not on donor immunity (P = .8). The findings were similar in both sibling and (VUD) BMT volunteer unrelated donor patients. Analysis of sequential post-BMT sera from 41 of the patients, for whom appropriately timed samples were available, showed primary B19 infection in 3 seronegative individuals, whereas 5 others who were seropositive before BMT underwent recurrent infection. Sequential results from the remaining 33 patients without recent B19 infection showed no evidence for donor antibody transfer and confirmed that antibody persistence depends on prior recipient immunity. B19 IgG levels decreased variably with time and some patients eventually became seronegative. It is concluded that this long-term persistence of B19 antibody post-BMT is most probably due to the existence of long-lived recipient plasma cells.

    背景与目标: 使用酶联免疫吸附试验对66名同种异体骨髓移植(BMT)患者进行了人类细小病毒B19(B19)IgG回顾性研究。收件人和供体血清已在BMT之前与随后的顺序血清一起存储。大约一半的供体和受体在BMT前具有抗B19 IgG,因此可以评估移植后供体和受体免疫对抗体产生的相对贡献。对于每位患者,还对BMT后2至3年的血清进行了测试,结果表明B19抗体的持久性取决于先前的接受者(P = .0003),而不取决于供体的免疫力(P = .8)。在同级和(VUD)BMT自愿无关供者患者中,发现相似。对41位患者的BMT后连续血清进行分析,发现有适当定时的样本,在3例血清阴性患者中原发性B19感染,而在BMT之前5例血清阳性的其他患者则进行了复发性感染。其余33例近期未感染B19的患者的顺序结果显示,尚无转移供体抗体的证据,并证实抗体的持久性取决于先前的受体免疫力。 B19 IgG水平随时间而下降,有些患者最终呈血清阴性。结论是BMT后B19抗体的这种长期持久性很可能是由于存在长寿命的受体浆细胞。

  • 【等轴测肌力的历史依赖性:先前拉伸或缩短幅度的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.jbiomech.2006.06.014 复制DOI
    作者列表:Bullimore SR,Leonard TR,Rassier DE,Herzog W
    BACKGROUND & AIMS: :It is well-recognised that steady-state isometric muscle force is decreased following active shortening (force depression, FD) and increased following active stretch (force enhancement, FE). It has also been demonstrated that passive muscle force is increased following active stretch (passive FE). Several studies have reported that FD increases with shortening amplitude and that FE and passive FE increase with stretch amplitude. Here, we investigate whether these trends continue with further increases in shortening or stretch amplitude. Experiments were performed using in situ cat soleus muscles (n=8 for FD; n=7 for FE and passive FE). FD, FE and passive FE were measured after shortening or stretch contractions that covered as wide a range of amplitudes as practically possible without damaging the muscles. FD increased approximately linearly with shortening amplitude, over the full range of amplitudes investigated. This is consistent with the hypothesis that FD arises from a stress-induced inhibition of crossbridges. FE increased with stretch amplitude only up to a point, and then levelled off. Passive FE, and the transient increase in force at the end of stretch, showed relationships to stretch amplitude that were qualitatively very similar to the relationship for FE, increasing only until the same critical stretch amplitude had been reached. We conclude that FE and passive FE do not increase with stretch amplitude under all circumstances. This finding has important consequences for determining the mechanisms underlying FE and passive FE because any mechanism that is proposed to explain them must be able to predict it.
    背景与目标: :众所周知,稳态等距肌肉力量在主动缩短(力量压迫,FD)后降低,而在主动伸展(力量增强,FE)后增加。还已经证明,主动拉伸(被动FE)后,被动肌肉的力量会增加。几项研究报告说,FD随着幅度的减小而增加,而FE和被动FE随拉伸幅度而增加。在这里,我们调查这些趋势是否继续缩短或拉伸幅度的进一步增加。使用原位猫的比目鱼肌进行实验(FD为n = 8; FE和被动FE为n = 7)。 FD,FE和被动FE是在收缩或拉伸收缩后测量的,收缩或拉伸收缩实际上覆盖了尽可能宽的幅度范围,而不会损坏肌肉。在所研究的整个振幅范围内,FD随振幅的减小而近似线性地增加。这与FD是由应力引起的跨桥抑制作用引起的假设相一致的。 FE随拉伸幅度仅增加到一个点,然后趋于平稳。被动有限元,以及拉伸结束时力的瞬时增加,表明与拉伸幅度的关系在质量上与有限元的关系非常相似,仅在达到相同的临界拉伸幅度之前才增加。我们得出结论,在所有情况下,有限元和无源有限元都不会随拉伸幅度的增加而增加。这一发现对确定有限元和被动有限元的机制具有重要意义,因为提议用来解释它们的任何机制都必须能够对其进行预测。
  • 【真空抽吸前对前列腺素E2进行颅内给药。前瞻性双盲随机研究。】 复制标题 收藏 收藏
    DOI:10.1016/0020-7292(85)90050-5 复制DOI
    作者列表:Iversen T,Skjeldestad FE
    BACKGROUND & AIMS: :Two-hundred and ninety-three patients without a previous vaginal delivery were randomized to intracervical/extra-amniotic application of 0.5 mg prostaglandin E2 (PGE2) or to gel only. Of the patients who received PGE2, 18.7% were admitted before the next morning due to spontaneous abortion, bleeding or pains. No other side-effect was observed. A statistically significant dilatation of the cervical canal was found in the prostaglandin group. Thirty percent of the treated patients did not need further dilatation of the cervix 25.4% were non-responders to PGE2 and 7.7% were hyper-responders. The number of uterine perforations, pelvic inflammatory disease (PID) or retained pregnancy products were not influenced by the pretreatment with PGE2.
    背景与目标: :293例以前没有阴道分娩的患者被随机分配至0.5 mg前列腺素E2(PGE2)的脑内/羊膜外给药或仅凝胶化。在接受PGE2的患者中,由于自然流产,出血或疼痛,第二天早上入院的患者为18.7%。没有观察到其他副作用。在前列腺素组中发现了颈管的统计学上显着的扩张。接受治疗的患者中有30%不需要进一步扩张子宫颈,PGE2无反应者为25.4%,高反应者为7.7%。子宫穿孔,盆腔炎(PID)或保留的妊娠产物的数量不受PGE2预处理的影响。
  • 【调整i.v.继续手术前接受血液透析的患者服用铁和EPO剂量:我们能否保护我们的患者接受铁缺乏性贫血的教育?】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Deaver K,Bennington L
    BACKGROUND & AIMS: :Ongoing blood loss and iron-deficiency anemia are common problems in patients on hemodialysis; therefore, nephrology clinicians are particularly concerned with their patients who are scheduled for surgery Surgery can cause significant blood and iron losses, thereby worsening their preexisting anemia. However, patients on hemodialysis can be effectively treated preoperatively by adjusting their continued doses of intravenous (i.v.) iron and recombinant human erythropoietin (EPO) therapy, based on expected blood and iron losses. This valuable strategy can help improve surgical and anemia outcomes as well as decrease EPO requirements and the need for transfusions. This article examines the use of IV iron and EPO therapy as preventive therapy for anemia in patients on hemodialysis prior to invasive surgical procedures, illustrated with an experience from a dialysis unit and patient case studies.
    背景与目标: :持续的失血和缺铁性贫血是血液透析患者的常见问题;因此,肾脏病临床医生特别关心计划进行手术的患者。手术可能会导致大量的血液和铁丢失,从而加剧他们先前的贫血。但是,可以根据预期的血液和铁损失,通过调整静脉注射铁和重组人促红细胞生成素(EPO)治疗的持续剂量,对接受血液透析的患者进行术前有效治疗。这种有价值的策略可以帮助改善手术和贫血结果,并降低EPO需求和输血需求。本文探讨了在进行侵入性外科手术之前,静脉铁剂和EPO疗法作为血液透析患者贫血的预防性疗法的用途,并结合透析部门和患者案例研究的经验进行了说明。
  • 【区域性无定量的定量措施为既往有心肌梗塞的患者的左心室射血分数增加了独立的预后信息。】 复制标题 收藏 收藏
    DOI:10.1016/s0002-8703(97)70165-0 复制DOI
    作者列表:Miller TD,Weissler AM,Christian TF,Bailey KR,Gibbons RJ
    BACKGROUND & AIMS: The purpose of this study was to determine if quantitative measurements of regional asynergy add independent prognostic information to global ejection fraction in patients with chronic coronary artery disease. Four hundred eighty-six patients with a history of Q-wave myocardial infarction who underwent gated-equilibrium radionuclide angiography at least 3 months after infarction were monitored for a median duration of 4.7 years. During follow-up there were 95 deaths. Four of five regional asynergy indexes analyzed were associated with overall mortality. The strength of the association between overall mortality and the index that proved to be optimal (univariate chi2 = 26.4, p < 0.001) was stronger than for global ejection fraction (univariate chi2 = 21.5, p < 0.001). For patients with global ejection fraction <40%, 4-year survival was 87% for those with a low asynergy index versus 65% for those with a high asynergy index (p = 0.016). In conclusion, indexes of regional asynergy add independent prognostic information to global left ventricular ejection fraction.

    背景与目标: 这项研究的目的是确定是否定量测量区域性无力增加慢性冠状动脉疾病患者总射血分数的独立的预后信息。在梗死后至少3个月接受门控平衡放射性核素血管造影的466例有Q波心肌梗塞病史的患者的中位持续时间为4.7年。在随访期间,有95人死亡。所分析的五个区域无力指数中有四个与总体死亡率相关。总死亡率和被证明是最佳指标(单变量chi2 = 26.4,p <0.001)之间的关联强度要强于整体射血分数(单变量chi2 = 21.5,p <0.001)。对于总体射血分数<40%的患者,低无反应指数的患者的4年生存率为87%,而无高反应指数的患者的4年生存率为65%(p = 0.016)。综上所述,区域无力指标为整体左心室射血分数增加了独立的预后信息。

  • 【怀孕前和产前风疹血清阴性是否持续存在母体免疫学改变的证据?】 复制标题 收藏 收藏
    DOI:10.1111/aji.12727 复制DOI
    作者列表:Lao TT,Hui ASY,Sahota DS
    BACKGROUND & AIMS: PROBLEM:It is unclear if the immunologic alterations induced by pregnancy could persist. METHOD OF STUDY:Antenatal rubella sero-negativity was correlated with gravidity, abortions and parity in 112 083 gravidae managed during 1997-2015, with further analysis stratified for factors known to influence rubella serology. RESULTS:The 10.2% sero-negative gravidae had different characteristics, and the incidence showed significant difference and positive trend (P<.001 for both) with gravidity, abortions and parity. The pattern remained consistent when analysis was stratified for advanced age, high body mass index and medical history, but was negated by hepatitis B virus infection except for abortions, and by high body mass index for parity. For gravidity 2-4, no difference in rubella sero-negativity was found between gravidae with all previous pregnancies ended in abortion vs delivery. CONCLUSION:Prior pregnancies diminished rubella immunity in a dose-dependent manner, which may be a reflection of the cumulative effect of pregnancy-associated maternal immunologic alteration.
    背景与目标: 问题:目前尚不清楚怀孕引起的免疫学改变是否会持续下去。
    研究方法:1997年至2015年期间管理的112 083名孕妇的产前风疹血清阴性与妊娠率,流产和胎次相关,并对已知影响风疹血清学的因素进行了进一步分析。
    结果:10.2%血清阴性的孕妇具有不同的特征,其发病率与妊娠,流产和产后均表现出显着差异和阳性趋势(两者均P <.001)。当对高龄,高体重指数和病史进行分层分析时,该模式保持一致,但被流产除外的乙型肝炎病毒感染和均等的高体重指数所抵消。对于妊娠2-4,在流产与分娩之前所有妊娠结束的妊娠之间,风疹血清阴性没有发现差异。
    结论:早孕以剂量依赖性方式降低风疹免疫力,这可能反映了妊娠相关的母体免疫学改变的累积作用。
  • 【妇女健康倡议的雌激素加孕激素的随机试验中,先前的激素治疗和乳腺癌风险较高。】 复制标题 收藏 收藏
    DOI:10.1016/j.maturitas.2006.05.004 复制DOI
    作者列表:Anderson GL,Chlebowski RT,Rossouw JE,Rodabough RJ,McTiernan A,Margolis KL,Aggerwal A,David Curb J,Hendrix SL,Allan Hubbell F,Khandekar J,Lane DS,Lasser N,Lopez AM,Potter J,Ritenbaugh C
    BACKGROUND & AIMS: OBJECTIVES:To assess the extent to which prior hormone therapy modifies the breast cancer risk found with estrogen plus progestin (E+P) in the Women's Health Initiative (WHI) randomized trial. METHODS:Subgroup analyses of prior hormone use on invasive breast cancer incidence in 16,608 postmenopausal women in the WHI randomized trial of E+P over an average 5.6 years of follow-up. RESULTS:Small but statistically significant differences were found between prior HT users and non-users for most breast cancer risk factors but Gail risk scores were similar. Duration of E+P use within the trial (mean 4.4 years, S.D. 2.0) did not vary by prior use. Among 4311 prior users, the adjusted hazard ratio (HR) for E+P versus placebo was 1.96 (95% confidence interval [CI]: 1.17-3.27), significantly different (p=0.03) from that among 12,297 never users (HR 1.02; 95% CI: 0.77-1.36). The interaction between study arm and follow-up time was significant overall (p=0.01) and among never users (p=0.02) but not among prior users (p=0.10). The cumulative incidence over time for the E+P and placebo groups appeared to cross after about 3 years in prior users, and after about 5 years in women with no prior use. No interaction was found with duration (p=0.08) or recency of prior use (p=0.17). Prior hormone use significantly increased the E+P hazard ratio for larger, more advanced tumors. CONCLUSION:A safe interval for combined hormone use could not be reliably defined with these data. However, the significant increase in breast cancer risk in the trial overall after only 5.6 years of follow-up, initially concentrated in women with prior hormone exposure, but with increasing risk over time in women without prior exposure, suggests that durations only slightly longer than those in the WHI trial are associated with increased risk of breast cancer. Longer-term exposure and follow-up data are needed.
    背景与目标: 目的:在妇女健康倡议(WHI)随机试验中,评估先前的激素治疗在多大程度上改变了雌激素加孕激素(EP)的乳腺癌风险。
    方法:在平均5​​.6年的WHI随机对照试验中,对16608名绝经后女性进行既往激素使用对浸润性乳腺癌发病率的亚组分析。
    结果:在大多数乳腺癌风险因素中,既往HT使用者与非HT使用者之间存在很小但统计学上的显着差异,但Gail风险评分相似。在试验中使用E P的持续时间(平均4.4年,S.D。2.0)没有因以前的使用而异。在4311位既往使用者中,EP与安慰剂的调整后危险比(HR)为1.96(95%置信区间[CI]:1.17-3.27),与12,297个从未使用过的使用者(HR 1.02; 95)相比有显着差异(p = 0.03)。 %CI:0.77-1.36)。研究组与随访时间之间的相互作用总体上是显着的(p = 0.01),从未使用者中的相互作用(p = 0.02),以前使用者中没有显着性(p = 0.10)。 E P组和安慰剂组随时间的累积发生率在之前的使用者中大约3年后出现交叉,而在没有事先使用的妇女中大约5年后出现交叉。持续时间(p = 0.08)或先前使用的新近度(p = 0.17)未发现相互作用。先前使用激素会显着增加较大,更晚期肿瘤的E P风险比。
    结论:这些数据不能可靠地确定激素联合使用的安全间隔。然而,在仅5.6年的随访中,该试验总体上使乳腺癌风险显着增加,最初集中于曾接受过激素的女性,但随着时间的推移,未曾接受过激素的女性的风险随着时间的推移而增加,这表明持续时间仅长于接受过激素的女性。 WHI试验中的那些与乳腺癌风险增加相关。需要长期暴露和随访数据。
  • 【在放置血液透析之前,超声测量肱动脉的弹性:一项前瞻性研究。】 复制标题 收藏 收藏
    DOI:10.7863/jum.2012.31.10.1581 复制DOI
    作者列表:Sorace AG,Robbin ML,Umphrey H,Abts CA,Berry JL,Lockhart ME,Allon M,Hoyt K
    BACKGROUND & AIMS: OBJECTIVES:Successful hemodialysis requires reliable vascular access that can deliver adequate blood flow. An arteriovenous fistula is preferred for access because of its longevity and low frequency of complications, but up to 60% of arteriovenous fistulas created surgically are never suitable for hemodialysis because of nonmaturation (insufficient vascular dilatation). Decreased arterial elasticity may impair dilatation, thereby affecting fistula maturation. This study evaluated the feasibility of brachial artery elasticity measurement in patients with chronic kidney disease obtained during routine pre-operative mapping ultrasound (US) imaging before hemodialysis access placement and compared the measurements to those obtained in healthy volunteers. METHODS:Brachial artery functional US studies were collected from 75 patients undergoing routine preoperative mapping for hemodialysis access and 50 healthy volunteers. Vascular strain was calculated from the change in intima-media thickness between end systole and end diastole, and vascular stress was estimated from the pulse pressure. Assuming a linear elastic medium, the elastic modulus was estimated as the ratio of vascular stress to strain. RESULTS:Elastic modulus measurements were significantly higher in patients than in volunteers (130 versus 100 kPa; P = .01). With combined volunteer and patient data, there was a significant correlation between elasticity and systolic blood pressure (R2 = 0.23; P < .001). Elasticity was correlated with age in volunteers but not in patients (R2 = 0.14; P = .017; R2 < .001; P = .829, respectively). CONCLUSIONS:This analysis of clinical arterial vessel biomechanics shows that a noninvasive US measurement can detect elastic modulus differences between patients with chronic kidney disease and healthy individuals. Future studies will correlate the elastic modulus with histologic characteristics and eventual arteriovenous fistula maturation, which may provide supplemental information on arterial biomechanical properties as a useful addition to current predictors of fistula success.
    背景与目标: 目的:成功的血液透析需要可靠的血管通路,以提供足够的血流量。动静脉瘘的使用寿命长且并发症发生频率低,因此首选进入,但由于不成熟(血管扩张不足),外科手术产生的动静脉瘘中多达60%永远不适合进行血液透析。动脉弹性下降可能会损害扩张,从而影响瘘管成熟。这项研究评估了在进行血液透析通路放置之前在常规术前作图超声(US)成像过程中获得的慢性肾脏病患者肱动脉弹性测量的可行性,并将测量结果与健康志愿者的测量结果进行了比较。
    方法:从75例接受常规血液透析的术前作图的患者和50名健康志愿者收集了肱动脉功能性US研究。根据收缩末期与舒张末期之间内膜-中膜厚度的变化计算血管应变,并根据脉压估算血管压力。假设为线性弹性介质,则将弹性模量估计为血管应力与应变之比。
    结果:患者的弹性模量测量值显着高于志愿者(130 vs 100 kPa; P = 0.01)。结合志愿者和患者的数据,弹性与收缩压之间存在显着相关性(R2 = 0.23; P <.001)。志愿者的弹性与年龄相关,而患者与年龄无关(R2 = 0.14; P = .017; R2 <.001; P = .829)。
    结论:对临床血管生物力学的分析表明,无创超声测量可以检测出慢性肾脏病患者与健康个体之间的弹性模量差异。未来的研究将把弹性模量与组织学特征和最终动静脉瘘的成熟联系起来,这可能会提供有关动脉生物力学特性的补充信息,作为目前瘘管成功预测指标的有用补充。
  • 【人格特质与抑郁和焦虑有不同的联系:对大量成年人进行双变量多元二元逻辑回归分析的证据。】 复制标题 收藏 收藏
    DOI:10.24869/psyd.2019.448 复制DOI
    作者列表:Nouri F,Feizi A,Keshteli AH,Roohafza H,Afshar H,Adibi P
    BACKGROUND & AIMS: BACKGROUND:The purpose of this study was to explore the association of five factors personality traits, as predictor variables, with the anxiety and depression as joint dependent variables in an Iranian adult population. SUBJECTS AND METHODS:A total of 3175 subjects living in Isfahan participated in this cross-sectional population-based study (SEPAHAN) and completed self-administered questionnaires about demographic, life style, gastrointestinal disorders, personality traits, social support, and psychological problems. Data was analyzed using bivariate multiple binary logistic regression in R Free statistical software. RESULTS:The results indicated high scores of neuroticisms increase the risk of anxiety and depression after adjustment for the potential confounders in total sample (OR (95% CI): 1.22 (1.19-1.24) and 1.19 (1.17-1.21), respectively) as well as in both male and female. In contrast, joint inverse associations were found between anxiety and depression with high extraversion (OR (95% CI): 0.90 (0.88-0.92) and 0.91 (0.89-0.92), respectively), agreeableness (0.93 (0.91-0.96) and 0.94 (0.92-0.96) respectively) and conscientiousness scores (0.95 (0.93-0.97) and 0.95 (0.94-0.97) respectively) as well as in both male and female. Furthermore, higher scores of openness had significant inverse association with depression in male. CONCLUSION:The present study indicated that higher scores of neuroticism, however lower extraversion, conscientiousness and agreeableness scores are risk factors for both anxiety and depression in Iranian adult population. It is suggested to perform family studies or twin and genetic association studies with considering combinations of personality traits (personality styles), and also measuring personality traits at the facet level.
    背景与目标: 背景:本研究的目的是探讨伊朗成年人口中五项因素的人格特质(作为预测变量)与焦虑和抑郁作为联合因变量之间的关系。
    受试者与方法:总共3175名居住在伊斯法罕的受试者参加了这项基于人群的横断面研究(SEPAHAN),并完成了有关人口统计学,生活方式,胃肠道疾病,人格特质,社会支持和心理问题的自我管理问卷。在R Free统计软件中使用双变量多元二元logistic回归分析数据。
    结果:结果表明,对总样本中潜在的混杂因素进行调整后,高分的神经质增加了焦虑和抑郁的风险(OR(95%CI):1.22(1.19-1.24)和1.19(1.17-1.21))以及男性和女性。相比之下,焦虑和抑郁之间的关节逆向关联具有高外向性(OR(95%CI):0.90(0.88-0.92)和0.91(0.89-0.92)),顺应性(0.93(0.91-0.96)和0.94) (分别为0.92-0.96)和尽责分数(分别为0.95(0.93-0.97)和0.95(0.94-0.97))以及男性和女性。此外,较高的开放度得分与男性抑郁症呈显着的负相关。
    结论:本研究表明,神经质评分较高,但外向性,尽责性和愉悦性评分较低是伊朗成年人口焦虑和抑郁的危险因素。建议进行家庭研究或双胞胎和遗传关联研究,同时考虑人格特质(人格风格)的组合,并在层面上测量人格特质。
  • 【与单独的荟萃分析相比,条件相关的多个结果的联合综合可以更好地利用数据。】 复制标题 收藏 收藏
    DOI:10.1002/jrsm.1380 复制DOI
    作者列表:Anwer S,Ades AE,Dias S
    BACKGROUND & AIMS: BACKGROUND:When there are structural relationships between outcomes reported in different trials, separate analyses of each outcome do not provide a single coherent analysis, which is required for decision-making. For example, trials of intrapartum anti-bacterial prophylaxis (IAP) to prevent early onset group B streptococcal (EOGBS) disease can report three treatment effects: the effect on bacterial colonisation of the newborn, the effect on EOGBS, and the effect on EOGBS conditional on newborn colonisation. These outcomes are conditionally related, or nested, in a multi-state model. This paper shows how to exploit these structural relationships, providing a single coherent synthesis of all the available data, while checking to ensure that different sources of evidence are consistent. RESULTS:Overall, the use of IAP reduces the risk of EOGBS (RR: 0.03; 95% Credible Interval (CrI): 0.002-0.13). Most of the treatment effect is due to the prevention of colonisation in newborns of colonised mothers (RR: 0.08, 95% CrI: 0.04-0.14). Node-splitting demonstrated that the treatment effect calculated using only direct evidence was consistent with that predicted from the remaining evidence (p = 0.15). The findings accorded with previously published separate meta-analyses of the different outcomes, once these are re-analysed correctly accounting for zero cells. CONCLUSION:Multiple outcomes should be synthesised together where possible, taking account of their structural relationships. This generates an internally coherent analysis, suitable for decision making, in which estimates of each of the treatment effects are based on all available evidence (direct and indirect). Separate meta-analyses of each outcome have none of these properties.
    背景与目标: 背景:当在不同试验中报告的结果之间存在结构关系时,对每个结果的单独分析不会提供决策所需的单个连贯分析。例如,为防止早发性B组链球菌(EOGBS)疾病而进行的产前抗菌预防(IAP)试验可以报告三种治疗效果:对新生儿细菌定植的影响,对EOGBS的影响以及对有条件的EOGBS的影响在新生儿殖民地。这些结果在多状态模型中有条件地关联或嵌套。本文展示了如何利用这些结构关系,对所有可用数据进行单一连贯的综合,同时检查以确保不同证据来源是一致的。
    结果:总体而言,IAP的使用降低了EOGBS的风险(RR:0.03; 95%可信区间(CrI):0.002-0.13)。大多数治疗效果归因于对定植母亲的新生儿定植的预防(RR:0.08,95%CrI:0.04-0.14)。淋巴结清扫显示仅使用直接证据计算的治疗效果与根据其余证据预测的效果一致(p = 0.15)。一旦正确地重新分析了零细胞,这些结果就与先前发表的不同结果的单独荟萃分析相符。
    结论:在可能的情况下,应综合多种结果,并考虑其结构关系。这会产生适合决策的内部连贯分析,其中对每种治疗效果的估计均基于所有可用证据(直接和间接)。每个结果的单独荟萃分析均不具备这些属性。
  • 【抗精神病长效注射剂先前治疗对随机临床试验治疗结果的影响。】 复制标题 收藏 收藏
    DOI:10.1192/bjp.bp.113.125807 复制DOI
    作者列表:Barnes TR,Drake RJ,Dunn G,Hayhurst KP,Jones PB,Lewis SW
    BACKGROUND & AIMS: BACKGROUND:It is uncertain whether antipsychotic long-acting injection (LAI) medication in schizophrenia is associated with better clinical outcomes than oral preparations. AIMS:To examine the impact of prior treatment delivery route on treatment outcomes and whether any differences are moderated by adherence. METHOD:Analysis of data from two pragmatic 1-year clinical trials in which patients with schizophrenia were randomised to either an oral first-generation antipsychotic (FGA), or a non-clozapine second-generation antipsychotic (SGA, CUtLASS 1 study), or a non-clozapine SGA or clozapine (CUtLASS 2 study). RESULTS:Across both trials, 43% (n = 155) of participants were prescribed an FGA-LAI before randomisation. At 1-year follow-up they showed less improvement in quality of life, symptoms and global functioning than those randomised from oral medication. This difference was confined to patients rated as less than consistently adherent pre-randomisation. The relatively poor improvement in the patients prescribed an LAI pre-randomisation was ameliorated if they had been randomised to clozapine rather than another SGA. There was no advantage to being randomly assigned from an LAI at baseline to a non-clozapine oral SGA rather than an oral FGA. CONCLUSIONS:A switch at randomisation from an LAI to an oral antipsychotic was associated with poorer clinical and functional outcomes at 1-year follow-up compared with switching from one oral antipsychotic to another. This effect appears to be moderated by adherence, and may not extend to switching to clozapine. This has implications for clinical trial design: the drug from which a participant is randomised may have a greater effect than the drug to which they are randomised.
    背景与目标: 背景:目前尚不确定精神分裂症中使用抗精神病药长效注射(LAI)是否比口服制剂具有更好的临床效果。
    目的:检查先前的治疗提供途径对治疗结果的影响,以及是否依从性可以缓解任何差异。
    方法:分析两项实用的一年期临床试验的数据,其中将精神分裂症患者随机分为口服第一代抗精神病药(FGA)或非氯氮平第二代抗精神病药(SGA,CUtLASS 1研究),或非氯氮平SGA或氯氮平(CUtLASS 2研究)。
    结果:在两项试验中,随机分组前,有43%(n = 155)的受试者被处方FGA-LAI。在1年的随访中,与口服药物相比,他们的生活质量,症状和整体功能改善不明显。这种差异仅限于被评定为低于持续坚持的随机分配的患者。如果将患者随机分配给氯氮平而不是另一种SGA,则可以改善LAI预随机化患者的相对较差的改善。从基线时的LAI随机分配到非氯氮平口服SGA而不是口服FGA没有优势。
    结论:与从一种口服抗精神病药转换为另一种口服抗精神病药相比,从LAI随机转为口服抗精神病药与1年随访期的临床和功能结局较差有关。这种作用似乎通过坚持而得到缓解,并且可能不会扩展到使用氯氮平。这对临床试验设计具有影响:与参与者随机分配的药物相比,从参与者中随机分配的药物可能会产生更大的影响。
  • 【COPD诊断之前的经济负担:美国的一项匹配病例对照研究。】 复制标题 收藏 收藏
    DOI:10.1016/j.rmed.2008.07.009 复制DOI
    作者列表:Akazawa M,Halpern R,Riedel AA,Stanford RH,Dalal A,Blanchette CM
    BACKGROUND & AIMS: BACKGROUND:In the United States, chronic obstructive pulmonary disease (COPD) diagnosis is often a lengthy process, and consequently results in delays in treatment in early stages. Disease progression and complication may result in increased levels of healthcare service use. To understand the economic burden of COPD prior to diagnosis in the U.S., trends in utilization and costs during the period before initial COPD diagnosis were compared with matched controls. METHODS:A retrospective case-control study was conducted using medical and pharmacy claims data from a large managed care health plan representing a base population of over 30 million covered lives in the U.S. COPD patients with at least 12 months of continuous enrollment and aged 40 years or older were identified (n=28,968) and matched to up to three random controls (n=81,322) by age, gender, region of plans and index date. Multivariate regression models were used to estimate average incremental service use and cost between COPD patients and controls. Moreover, trends in utilization and costs for the COPD patients were examined over 36 months before diagnosis. RESULTS:COPD patients used 1.5-1.6 times more inpatient/emergency department (IP/ED) services and office visits compared to control patients. The average incremental annual costs for IP/ED services, office visits, and medical and pharmacy services were estimated at $550, $238, $1438 and $401, respectively, after adjusting for age, gender, region and comorbid conditions. The 36-month trend analysis showed that COPD patients' healthcare utilization and costs increased gradually over time, often with a marked increase in the month before COPD diagnosis. CONCLUSIONS:COPD patients in the U.S. consumed substantial healthcare services and costs prior to diagnosis. More timely diagnosis and subsequent treatment may avoid costly healthcare utilization and unnecessary mortality and morbidity post-diagnosis.
    背景与目标: 背景:在美国,慢性阻塞性肺疾病(COPD)的诊断通常是一个漫长的过程,因此会导致早期治疗的延迟。疾病进展和并发症可能导致医疗服务使用水平提高。为了了解在美国进行诊断之前COPD的经济负担,我们将COPD初次诊断之前的使用率和成本趋势与匹配的对照进行了比较。
    方法:一项回顾性病例对照研究是使用来自大型管理式医疗保健计划的医疗和药房索赔数据进行的,该数据代表了美国COPD患者中至少有3,000万人的基本生命,他们连续入组至少12个月,年龄40岁。年龄,性别,计划区域和索引日期被确定为≥(28,968)岁或更大(n = 81,322),并与多达三个随机对照匹配(n = 81,322)。多变量回归模型用于估计COPD患者和对照组之间的平均增量服务使用和费用。此外,在诊断前36个月内检查了COPD患者的使用率和费用趋势。
    结果:与对照患者相比,COPD患者使用住院/急诊科(IP / ED)服务和办公室就诊的次数多1.5-1.6倍。在根据年龄,性别,地区和共病条件进行调整后,IP / ED服务,办公室就诊以及医疗和药学服务的平均年度增量成本分别为550美元,238美元,1438美元和401美元。为期36个月的趋势分析显示,COPD患者的医疗保健利用率和费用随着时间的推移逐渐增加,通常在COPD诊断前一个月就显着增加。
    结论:在美国,COPD患者在诊断之前已消耗了大量的医疗保健服务和费用。更及时的诊断和后续治疗可以避免昂贵的医疗保健费用以及诊断后不必要的死亡率和发病率。
  • 【评论:影响决定有条件释放疯狂无罪陪审员的决定的偏见。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Fox PK
    BACKGROUND & AIMS: :The care and management of hospitalized insanity acquittees can be quite challenging. As patients progress in treatment, clinicians must invariably address whether the patient is ready to be returned to the community, balancing the liberty interests of the acquittee with the protection of society. The process by which this determination is made is far from simple and involves review of clinical interview and collateral information, identification of indicators of outcome post-discharge, and the use of structured risk assessment instruments. The decision to release an acquittee conditionally is also influenced by an array of factors that emanate from within the clinician, within the institution, the mental health system, the courts, and the broader society. While such biases affect a clinician's objectivity, they are also a natural part of the evaluation process. Their identification is essential so that the degree to which such biases influence the conditional release decision can be more fully understood and addressed.
    背景与目标: :住院的精神错乱患者的护理和管理可能非常具有挑战性。随着患者治疗的进展,临床医生必须始终解决患者是否准备好返回社区,从而在大法官的自由利益与社会保护之间取得平衡。进行此确定的过程远非简单,需要审查临床访谈和附带信息,确定出院后结果指标以及使用结构化风险评估工具。从临床医生内部,机构内部,精神卫生系统,法院和更广泛的社会中产生的一系列因素也影响有条件释放无罪释放者的决定。尽管这种偏见影响了临床医生的客观性,但它们也是评估过程的自然组成部分。它们的识别是必不可少的,以便可以更充分地理解和解决这种偏见影响条件释放决策的程度。
  • 【诊断前和初始治疗后老年癌症患者的身体机能。】 复制标题 收藏 收藏
    DOI:10.1097/00006199-200107000-00006 复制DOI
    作者列表:Given B,Given C,Azzouz F,Stommel M
    BACKGROUND & AIMS: BACKGROUND AND OBJECTIVES:Using an instrument to measure physical functioning that was normed to the U.S. population, data were obtained from patients with a new diagnosis of breast, colon, lung, and prostate cancer. Two questions were addressed: (a) after controlling for age, and number of comorbid conditions, do site and stage of cancer predict functional limitations prior to diagnosis; (b) using age adjusted national norms on physical functioning, how well do age, number of comorbid conditions, stage, treatment and cluster of symptoms (pain, fatigue, and insomnia) explain changes in physical function between 3 months prior to and 8 weeks following diagnosis? METHODS:Patients 65 years of age and older were accrued from 24 community oncology settings. Consenting patients were interviewed within 8 weeks of initial treatment. The SF-36 was used to measure physical functioning. Comorbidity and symptom experience were assessed through patient report and site and stage of cancer from record audits. RESULTS:Prior to diagnosis of cancer, patients were comparable in physical functioning to the U.S. population aged 55-64, a full decade younger than the sample of cancer patients. Site and stage of disease did not account for variations in physical functioning prior to diagnosis. Compared against national norms, patients with more extensive treatments (surgery plus adjuvant therapy) reported greater loss in functioning. Pain, fatigue, and insomnia had a consistent and significant effect on losses in functioning unrelated to patients' treatments or their comorbid conditions. CONCLUSIONS:Site and stage of cancer prior to diagnosis do not affect functioning. Older cancer patients report higher functioning than their counterparts in the U.S. population. Changes in functioning following diagnosis varied by cancer site. Treatments were related to loss in functioning, but comorbidity was not. Pain, fatigue, and insomnia were significant and independent predictors of change in patient functioning. This underscores the importance of interventions to manage symptoms early in the course of treatment for individuals.
    背景与目标: 背景与目的:使用一种针对美国人群的生理功能测量仪器,从乳腺癌,结肠癌,肺癌和前列腺癌的新诊断患者中获取数据。解决了两个问题:(a)在控制了年龄和合并症的数量之后,癌症的部位和阶段是否可以在诊断之前预测功能限制? (b)使用经过年龄调整的身体机能国家规范,年龄,合并症数,阶段,治疗和症状(疼痛,疲劳和失眠)的状况如何,可以解释在3个月前和8周之间身体机能的变化以下诊断?
    方法:来自24个社区肿瘤科的患者年龄在65岁及以上。同意患者在初次治疗后8周内接受采访。 SF-36用于测量身体机能。通过患者报告以及记录审核的癌症部位和阶段来评估合并症和症状经验。
    结果:在诊断出癌症之前,患者的身体功能与美国55-64岁的人群相当,比癌症患者的年龄年轻了整整十年。疾病的部位和阶段并未解释诊断前身体机能的变化。与国家标准相比,接受更广泛治疗(手术加辅助治疗)的患者报告功能丧失更大。疼痛,疲劳和失眠对与患者的治疗或合并症无关的功能丧失具有持续而显着的影响。
    结论:诊断前的部位和癌症分期不影响功能。较年长的癌症患者报告说其功能比美国人群中的同行患者更高。诊断后功能的变化因癌症部位而异。治疗与功能丧失有关,但合并症无关。疼痛,疲劳和失眠是患者功能变化的重要且独立的预测因子。这强调了在个体治疗过程中早期管理症状的干预措施的重要性。
  • 【乙炔雌二醇对经过芳香酶抑制剂治疗的绝经后严重转移性乳腺癌患者是有益的:一项前瞻性研究。】 复制标题 收藏 收藏
    DOI:10.1038/bjc.2013.520 复制DOI
    作者列表:Iwase H,Yamamoto Y,Yamamoto-Ibusuki M,Murakami KI,Okumura Y,Tomita S,Inao T,Honda Y,Omoto Y,Iyama KI
    BACKGROUND & AIMS: BACKGROUND:Oestrogens usually stimulate the progression of oestrogen receptor (ER)-positive breast cancer. Paradoxically, high-dose oestrogens suppress the growth of these tumours in certain circumstances. METHODS:We prospectively examined the efficacy and safety of ethinylestradiol treatment (3 mg per day oral) in postmenopausal patients with advanced or recurrent ER-positive breast cancer who had previously received endocrine therapies, especially those with resistance to aromatase inhibitors. RESULTS:Eighteen patients were enrolled with the median age of 63 years and the mean observation time of 9.2 months. Three cases withdrew within 1 week due to oestrogen flare reactions with nausea, fatigue and muscle-skeletal pain. The response rate was 50% (9 out of 18), and the clinical benefit rate was 56% (10 out of 18). The stable disease (<6 months) was 17% (3 out of 18) and another 2 cases were judged as progressive disease. Time-to-treatment failure including 2 on treatment was a median of 5.6 months (range 0.1 to 14.5(+)). Although vaginal bleeding or endometrial thickening was observed in patients receiving long-term treatment, there were no severe adverse events, such as deep venous thrombosis or other malignancies. CONCLUSION:Although the mechanism of this treatment has not been fully understood, our data may contribute to change the common view of late-stage endocrine therapy.
    背景与目标: 背景:雌激素通常刺激雌激素受体(ER)阳性乳腺癌的进展。矛盾的是,大剂量雌激素在某些情况下会抑制这些肿瘤的生长。
    方法:我们前瞻性地研究了乙炔雌二醇治疗(每天口服3 mg)在绝经后患有晚期或复发性ER阳性乳腺癌的绝经后患者中的有效性和安全性,这些患者先前曾接受过内分泌治疗,尤其是那些对芳香酶抑制剂具有抗药性的患者。
    结果:18例患者的中位年龄为63岁,平均观察时间为9.2个月。 1星期内有3例患者因雌激素反响,恶心,疲劳和肌肉骨骼疼痛而退出治疗。缓解率为50%(18个中的9个),临床受益率为56%(18个中的10个)。稳定的疾病(<6个月)为17%(18个中的3个),另外2例被判断为进行性疾病。包括2个治疗在内的治疗失败时间中位数为5.6个月(范围为0.1到14.5())。尽管在接受长期治疗的患者中观察到阴道出血或子宫内膜增厚,但没有发生严重的不良事件,如深静脉血栓形成或其他恶性肿瘤。
    结论:尽管尚未完全了解这种治疗的机制,但我们的数据可能有助于改变晚期内分泌治疗的普遍看法。

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