• 【鼠疫耶尔森氏菌的毒力因子被强烈的脂多糖反应所克服。】 复制标题 收藏 收藏
    DOI:10.1038/ni1386 复制DOI
    作者列表:Montminy SW,Khan N,McGrath S,Walkowicz MJ,Sharp F,Conlon JE,Fukase K,Kusumoto S,Sweet C,Miyake K,Akira S,Cotter RJ,Goguen JD,Lien E
    BACKGROUND & AIMS: :At mammalian body temperature, the plague bacillus Yersinia pestis synthesizes lipopolysaccharide (LPS)-lipid A with poor Toll-like receptor 4 (TLR4)-stimulating activity. To address the effect of weak TLR4 stimulation on virulence, we modified Y. pestis to produce a potent TLR4-stimulating LPS. Modified Y. pestis was completely avirulent after subcutaneous infection even at high challenge doses. Resistance to disease required TLR4, the adaptor protein MyD88 and coreceptor MD-2 and was considerably enhanced by CD14 and the adaptor Mal. Both innate and adaptive responses were required for sterilizing immunity against the modified strain, and convalescent mice were protected from both subcutaneous and respiratory challenge with wild-type Y. pestis. Despite the presence of other established immune evasion mechanisms, the modified Y. pestis was unable to cause systemic disease, demonstrating that the ability to evade the LPS-induced inflammatory response is critical for Y. pestis virulence. Evading TLR4 activation by lipid A alteration may contribute to the virulence of various Gram-negative bacteria.
    背景与目标: : 在哺乳动物体温下,鼠疫杆菌合成具有低Toll样受体4 (TLR4) 刺激活性的脂多糖 (LPS)-脂质A。为了解决弱TLR4刺激对毒力的影响,我们对鼠疫耶尔森氏菌进行了修饰,以产生有效的TLR4-stimulating LPS。即使在高攻击剂量下,改良的鼠疫耶尔森氏菌在皮下感染后也完全无毒。对疾病的抵抗力需要TLR4,衔接子蛋白MyD88和共受体MD-2,并且CD14和衔接子Mal显着增强。对于针对改良菌株的免疫灭菌,需要先天和适应性反应,并且可以保护恢复期小鼠免受野生型鼠疫耶尔森氏菌的皮下和呼吸攻击。尽管存在其他已建立的免疫逃避机制,但改良的鼠疫耶尔森氏菌无法引起全身性疾病,这表明逃避LPS诱导的炎症反应的能力对于鼠疫耶尔森氏菌的毒力至关重要。通过脂质A改变逃避TLR4激活可能有助于各种革兰氏阴性细菌的毒力。
  • 【公共卫生管理学院: 程序设计和关键成功因素。】 复制标题 收藏 收藏
    DOI:10.1097/00124784-200609000-00002 复制DOI
    作者列表:Orton S,Umble KE,Rosen B,McIver J,Menkens AJ
    BACKGROUND & AIMS: :The Management Academy for Public Health is a team-based training program jointly offered by the School of Public Health and the Kenan-Flagler Business School at the University of North Carolina at Chapel Hill. This 9-month program teaches public health managers how to better manage people, information, and finances. Participants learn how to work in teams with community partners, and how to think and behave as social entrepreneurs. To practice and blend their new skills, teams develop a business plan that addresses a local public health issue. This article describes the program and explains the findings of the process evaluation, which has examined how best to structure and deploy a team-based method to create more effective, more entrepreneurial public health managers. Findings indicate that recruitment and retention are strong, program elements are relevant to learners' needs, and learners are satisfied with and value the program. Several specific benefits of the program model are identified, as well as several elements that support business plan success and skills' application on the job. On the basis of these findings, four success factors critical for developing similar programs are identified.
    背景与目标: : 公共卫生管理学院是由公共卫生学院和北卡罗来纳大学教堂山分校的Kenan-Flagler商学院联合提供的基于团队的培训计划。这个为期9个月的计划教公共卫生经理如何更好地管理人员,信息和财务。参与者将学习如何与社区合作伙伴一起团队合作,以及如何作为社会企业家进行思考和行为。为了实践和融合他们的新技能,团队制定了解决当地公共卫生问题的商业计划。本文介绍了该计划并解释了过程评估的结果,该评估研究了如何最好地构建和部署基于团队的方法,以创建更有效,更具企业家精神的公共卫生经理。研究结果表明,招聘和保留能力很强,课程要素与学习者的需求相关,并且学习者对课程感到满意并重视。确定了计划模型的几个特定好处,以及支持业务计划成功和技能在工作中的应用的几个要素。根据这些发现,确定了开发类似计划的四个成功因素。
  • 【代表性全科样本中晚年失眠的危险因素。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Morgan K,Clarke D
    BACKGROUND & AIMS: BACKGROUND:Insomnia is widely reported and widely treated in general practice, yet relatively little research has focused on the natural history of the condition in primary care settings. As a result, there is at present little information to enable clinicians to assess insomnia risk, or anticipate outcomes in older general practice populations.

    AIM:To estimate, using 8-year longitudinal data, the risk of insomnia onset associated with selected health and lifestyle factors.

    METHOD:Survivors from a nationally representative sample (n = 1042) of elderly people originally interviewed in 1985 were reassessed in 1989 (n = 690) and 1993 (n = 410). At the first follow up in 1989, 84 new cases of insomnia were identified (a weighted incidence rate per person per year at a risk of 3.1%; 95% CI = 2.7-3.5). In logistic regression analyses controlling for age and sex, the risk of insomnia onset was then assessed in relation to the selected factors.

    RESULTS:Three factors assessed in 1985 were significantly and independently related to incident insomnia: psychometric ratings consistent with depressed mood odds ratio (OR) = 4.41; 95% CI = 3.32-5.43); health index scores indicating lower physical health status (OR = 1.19; 95% CI = 1.06-1.31 per unit change in scale score); and moderate and low levels of physical activity (OR = 1.91 and 2.14; 95% CI = 1.91-3.62 and 2.14-3.64 respectively). However, although depressed mood represented a major risk factor, the most likely source of risk was physical rather than mental ill-health.

    CONCLUSIONS:Psychiatric, somatic and lifestyle factors significantly and independently increase the risk of insomnia in older general practice patients. In predicting incident sleep disturbance, these factors exceed in importance the age and sex of patients.

    背景与目标: 背景 : 失眠在一般实践中被广泛报道和广泛治疗,但针对初级保健机构中该病的自然史的研究相对较少。因此,目前几乎没有信息可以使临床医生评估失眠风险,或预测老年全科医生的结果。
    目标 : 使用8年的纵向数据进行估计,失眠发作的风险与选定的健康和生活方式因素有关。
    方法 : 1989年 (n = 690) 和1993 (n = 410) 重新评估了来自1985年最初接受采访的具有全国代表性的老年人样本 (n = 1042) 的幸存者。在第一次随访1989年,发现了84例新的失眠病例 (每人每年加权发病率,风险为3.1%; 95% CI = 2.7-3.5)。在控制年龄和性别的逻辑回归分析中,然后根据所选因素评估失眠发作的风险。
    结果 : 1985年评估的三个因素与失眠事件显着且独立相关: 符合抑郁情绪优势比 (OR) = 4.41; 95% CI = 3.32-5.43); 健康指数得分表明较低的身体健康状况 (OR = 1.19; 95% CI = 1.06-1.31每单位变化的量表得分); 和中等和低水平的体育活动 (OR = 1.91和2.14; 95% CI分别 = 1.91-3.62和2.14-3.64)。但是,尽管情绪低落是主要的危险因素,但最可能的危险来源是身体健康而不是精神健康不良。
    结论 : 精神病学,躯体和生活方式因素显着且独立地增加了老年全科患者的失眠风险。在预测事件睡眠障碍时,这些因素的重要性超过了患者的年龄和性别。
  • 【在口腔鳞状细胞癌的侵袭性肿瘤前沿评估的组织生物学因素 (恶性程度和AgNOR含量) 的预后价值。】 复制标题 收藏 收藏
    DOI:10.1038/bjc.1997.263 复制DOI
    作者列表:Piffkò J,Bànkfalvi A,Ofner D,Bryne M,Rasch D,Joos U,Böcker W,Schmid KW
    BACKGROUND & AIMS: Tumour cells at the invasive front of carcinomas have been found to differ substantially from the rest of tumour cells in a variety of human cancers. The present multivariate survival analysis of 94 oral squamous cell carcinomas (OSCCs) revealed that both the argyrophilic nucleolar organizer regions-associated protein (AgNOR) content of invading tumour cells and a multiparametric histopathological tumour front grade were significantly and independently associated with tumour-related death, irrespective of conventional Broders' grade and clinical stage of the tumours. High tumour front scores and AgNOR content at the invasive OSCC front thus seem to reflect increased malignant potential. Proliferative activity, assessed by standardized AgNOR analysis, most probably represents one of the biological features underlying the usefulness of evaluating the invasive tumour front.

    背景与目标: 在各种人类癌症中,已发现位于癌侵袭性前沿的肿瘤细胞与其他肿瘤细胞有很大不同。目前对94例口腔鳞状细胞癌 (oscc) 的多变量生存分析显示,侵袭性肿瘤细胞的嗜银核仁组织区相关蛋白 (AgNOR) 含量和多参数组织病理学肿瘤前等级均与肿瘤相关死亡显着且独立相关,与肿瘤的常规broders等级和临床分期无关。因此,侵袭性OSCC前沿的高肿瘤前沿得分和AgNOR含量似乎反映了恶性潜能的增加。通过标准化的AgNOR分析评估的增殖活性,很可能代表了评估侵袭性肿瘤前沿有用性的生物学特征之一。
  • 【肝移植受者巨细胞病毒感染危险因素的多变量分析。】 复制标题 收藏 收藏
    DOI:10.1016/0016-5085(90)90352-2 复制DOI
    作者列表:Gorensek MJ,Carey WD,Vogt D,Goormastic M
    BACKGROUND & AIMS: :Thirty-three consecutive liver-transplant recipients were prospectively studied over a 37-mo period for evidence of cytomegalovirus infection. Sixteen (48%) episodes of cytomegalovirus infection were identified; 9 were primary infections and 7 were recurrent infections. Beginning with patient 8, gamma-globulin prophylaxis was routinely administered to most patients. Twelve potential risk factors for cytomegalovirus infection were evaluated and included pretransplant cytomegalovirus serological status of donor and recipient; recipient's age, sex, race, and liver disease; number and type of blood products transfused; type and intensity of immunosuppression; and occurrence of rejection. The Cox proportional hazards model identified positive donor cytomegalovirus serology as the single most important risk factor for subsequent development of cytomegalovirus infection, regardless of recipient cytomegalovirus serological status. In addition, use of gamma-globulin prophylaxis seemed to be protective against the occurrence of disseminated cytomegalovirus disease.
    背景与目标: : 在37个月的时间内,对33位连续的肝移植受者进行了前瞻性研究,以寻找巨细胞病毒感染的证据。确定了16 (48%) 例巨细胞病毒感染; 9例为原发感染,7例为复发性感染。从患者8开始,大多数患者常规使用丙种球蛋白预防。评估了巨细胞病毒感染的十二个潜在危险因素,包括供体和受者的移植前巨细胞病毒血清学状态; 受者的年龄,性别,种族和肝脏疾病; 输血的血液制品的数量和类型; 免疫抑制的类型和强度; 和排斥的发生。Cox比例风险模型确定阳性供体巨细胞病毒血清学是随后发生巨细胞病毒感染的唯一最重要的危险因素,而与受体巨细胞病毒的血清学状况无关。此外,使用丙种球蛋白预防似乎可以预防弥漫性巨细胞病毒疾病的发生。
  • 【神经性糖尿病足溃疡微生物组与临床因素有关。】 复制标题 收藏 收藏
    DOI:10.2337/db12-0771 复制DOI
    作者列表:Gardner SE,Hillis SL,Heilmann K,Segre JA,Grice EA
    BACKGROUND & AIMS: :Nonhealing diabetic foot ulcers (DFUs) are a common and costly complication of diabetes. Microbial burden, or "bioburden," is believed to underlie delayed healing, although little is known of those clinical factors that may influence microbial load, diversity, and/or pathogenicity. We profiled the microbiomes of neuropathic nonischemic DFUs without clinical evidence of infection in 52 individuals using high-throughput sequencing of the bacterial 16S ribosomal RNA gene. Comparatively, wound cultures, the standard diagnostic in the clinic, vastly underrepresent microbial load, microbial diversity, and the presence of potential pathogens. DFU microbiomes were heterogeneous, even in our tightly restricted study population, but partitioned into three clusters distinguished primarily by dominant bacteria and diversity. Ulcer depth was associated with ulcer cluster, positively correlated with abundance of anaerobic bacteria, and negatively correlated with abundance of Staphylococcus. Ulcer duration was positively correlated with bacterial diversity, species richness, and relative abundance of Proteobacteria, but was negatively correlated with relative abundance of Staphylococcus. Finally, poor glycemic control was associated with ulcer cluster, with poorest median glycemic control concentrating to Staphylococcus-rich and Streptococcus-rich ulcer clusters. Analyses of microbial community membership and structure may provide the most useful metrics in prospective studies to delineate problematic bioburden from benign colonization that can then be used to drive clinical treatment.
    背景与目标: : 无法愈合的糖尿病足溃疡 (DFUs) 是糖尿病的常见且昂贵的并发症。微生物负担或 “生物负荷” 被认为是延迟愈合的基础,尽管对可能影响微生物负荷,多样性和/或致病性的那些临床因素知之甚少。我们使用细菌16s核糖体RNA基因的高通量测序,对52例个体的神经性非缺血性DFUs的微生物群进行了分析,而没有感染的临床证据。相比之下,伤口培养物 (临床上的标准诊断) 大大低估了微生物负荷,微生物多样性和潜在病原体的存在。即使在我们严格限制的研究人群中,DFU微生物群也是异质的,但分为三个簇,主要由优势细菌和多样性区分。溃疡深度与溃疡簇有关,与厌氧菌的丰度呈正相关,与葡萄球菌的丰度呈负相关。溃疡持续时间与细菌多样性,物种丰富度和变形菌的相对丰度呈正相关,但与葡萄球菌的相对丰度呈负相关。最后,血糖控制不佳与溃疡群有关,中位血糖控制最差的集中于富含葡萄球菌和富链球菌的溃疡群。微生物群落成员和结构的分析可能会在前瞻性研究中提供最有用的指标,以从良性定植中描绘出有问题的生物负荷,然后将其用于推动临床治疗。
  • 【退伍军人同时发生自杀意念和暴力冲动的危险因素。】 复制标题 收藏 收藏
    DOI:10.1037/pas0000490 复制DOI
    作者列表:Elbogen EB,Wagner HR,Kimbrel NA,Brancu M,Naylor J,Graziano R,Crawford E,VA Mid-Atlantic MIRECC Workgroup.
    BACKGROUND & AIMS: :Suicide and violence are significant problems in a subset of Iraq/Afghanistan-era veterans. This study investigates how posttraumatic stress disorder (PTSD) and resilience in veterans are associated with suicidal ideation and violent impulses while controlling for known covariates of both adverse outcomes. Structured clinical interviews were conducted of N = 2,543 Iraq/Afghanistan-era U.S. veterans. Compared with veterans denying suicidal ideation or violent impulses (n = 1,927), veterans endorsing both (n = 171) were more likely to meet diagnostic criteria for PTSD, report childhood abuse, combat exposure, physical pain symptoms, and drug misuse, and less likely to endorse self-direction/life purpose. Veterans reporting concurrent suicidal ideation and violent impulses had higher odds of misusing drugs and reporting pain symptoms relative to veterans reporting suicidal ideation only (n = 186) and had lower odds of endorsing self-direction/life purpose compared with veterans reporting violent impulses only (n = 259). The findings underscore the importance of examining drug abuse, physical pain symptoms, and self-direction/life purpose, as well as PTSD and history of trauma, in the context of clinical assessment and empirical research aimed at optimizing risk management of suicide and violence in military veterans. (PsycINFO Database Record
    背景与目标: : 自杀和暴力是伊拉克/阿富汗时代退伍军人的一个重要问题。这项研究调查了退伍军人的创伤后应激障碍 (PTSD) 和韧性如何与自杀意念和暴力冲动相关,同时控制了两种不良结果的已知协变量。对N = 2,543伊拉克/阿富汗时代的美国退伍军人进行了结构化的临床访谈。与否认自杀意念或暴力冲动的退伍军人 (n = 1,927) 相比,支持这两者的退伍军人 (n = 171) 更有可能满足PTSD的诊断标准,报告儿童期虐待,战斗暴露,身体疼痛症状和药物滥用,并且不太可能认可自我指导/生活目标。与仅报告自杀意念的退伍军人相比,报告同时自杀意念和暴力冲动的退伍军人滥用药物和报告疼痛症状的几率更高 (n = 186),并且与仅报告暴力冲动的退伍军人相比,认可自我指导/生活目标的几率更低 (n = 259)。研究结果强调了在旨在优化自杀和暴力风险管理的临床评估和实证研究的背景下,检查药物滥用,身体疼痛症状,自我指导/生活目的以及PTSD和创伤史的重要性。退伍军人。(PsycINFO数据库记录
  • 【猫鼬粪便中碳和氮稳定同位素的判别因子。】 复制标题 收藏 收藏
    DOI:10.7717/peerj.3436 复制DOI
    作者列表:Montanari S
    BACKGROUND & AIMS: :Stable isotope analysis of feces can provide a non-invasive method for tracking the dietary habits of nearly any mammalian species. While fecal samples are often collected for macroscopic and genetic study, stable isotope analysis can also be applied to expand the knowledge of species-specific dietary ecology. It is somewhat unclear how digestion changes the isotope ratios of animals' diets, so more controlled diet studies are needed. To date, most diet-to-feces controlled stable isotope experiments have been performed on herbivores, so in this study I analyzed the carbon and nitrogen stable isotope ratios in the diet and feces of the meerkat (Suricata suricatta), a small omnivorous mammal. The carbon trophic discrimination factor between diet and feces (Δ13Cfeces) is calculated to be 0.1 ± 1.5‰, which is not significantly different from zero, and in turn, not different than the dietary input. On the other hand, the nitrogen trophic discrimination factor (Δ15Nfeces) is 1.5 ± 1.1‰, which is significantly different from zero, meaning it is different than the average dietary input. Based on data generated in this experiment and a review of the published literature, carbon isotopes of feces characterize diet, while nitrogen isotope ratios of feces are consistently higher than dietary inputs, meaning a discrimination factor needs to be taken into account. The carbon and nitrogen stable isotope values of feces are an excellent snapshot of diet that can be used in concert with other analytical methods to better understand ecology, diets, and habitat use of mammals.
    背景与目标: : 粪便的稳定同位素分析可以为追踪几乎任何哺乳动物物种的饮食习惯提供一种非侵入性方法。虽然通常收集粪便样本进行宏观和遗传研究,但稳定的同位素分析也可以用于扩展特定物种饮食生态学的知识。目前尚不清楚消化如何改变动物饮食的同位素比率,因此需要进行更多的饮食控制研究。迄今为止,大多数饮食控制的粪便稳定同位素实验都是在食草动物上进行的,因此在这项研究中,我分析了猫鼬 (Suricata suricatta) 的饮食和粪便中的碳和氮稳定同位素比。饮食和粪便之间的碳营养歧视因子 (Δ13Cfeces) 计算为0.1 ± 1.5 ‰,与零没有显着差异,并且反过来与饮食输入没有差异。另一方面,氮营养歧视因子 (Δ15Nfeces) 为1.5 ± 1.1 ‰,与零显着不同,这意味着它不同于平均饮食投入。根据该实验中产生的数据以及对已发表文献的回顾,粪便的碳同位素表征饮食,而粪便的氮同位素比率始终高于饮食投入,这意味着需要考虑歧视因素。粪便的碳和氮稳定同位素值是饮食的绝佳快照,可以与其他分析方法一起使用,以更好地了解哺乳动物的生态,饮食和栖息地使用。
  • 【全膝关节置换术后伤口感染的危险因素。】 复制标题 收藏 收藏
    DOI:10.1093/oxfordjournals.aje.a115580 复制DOI
    作者列表:Gordon SM,Culver DH,Simmons BP,Jarvis WR
    BACKGROUND & AIMS: :Wound infections are an infrequent but serious complication of total knee arthroplasty. Between January 1984 and November 1987, 20 of 243 (8.2%) patients at two affiliated hospitals developed surgical wound infections following 259 total knee arthroplasty procedures performed in clean-air operating rooms. Eighteen (90%) of the patients had deep infections; nine required removal of the prosthesis. A single surgeon (surgeon X) was associated with 18 of the procedures that had subsequent infection (risk ratio (RR) = 9.4, 95% confidence interval (CI) 2.2-39), and an investigation was carried out in an effort to explain the difference in infection rates between surgeon X and other surgeons. In a cohort study, stratified analyses identified a preoperative American Society of Anesthesiologists (ASA) physical status class greater than or equal to 3, surgeon X, and early postoperative use of a continuous passive motion device as risk factors associated with surgical wound infection following total knee arthroplasty procedures. Logistic regression analyses identified being a patient operated on by surgeon X with an ASA class greater than or equal to 3 as the only significant independent risk factor for total knee arthroplasty-associated surgical wound infections (RR = 9.3, 95% CI 2.8-31). The effect due to surgeon X could not be explained by receipt or timeliness of administration of antimicrobial prophylaxis, type of prosthesis inserted, duration of operation, postoperative use of continuous passive motion, or underlying etiology of joint disease. The authors conclude that surgical technique and patient's severity of illness were the primary determinants of surgical wound infection after total knee arthroplasty. This study demonstrates the complexity of epidemiologic investigation of surgical wound infections and the importance of considering patient severity of illness when interpreting surgeon-specific infection rates.
    背景与目标: : 伤口感染是全膝关节置换术的罕见但严重的并发症。在1984年1月和1987年11月之间,两家附属医院的243名患者中有20名 (8.2% 名) 在清洁空气手术室中进行了259次全膝关节置换术后发生了手术伤口感染。18 (90%) 名患者患有深部感染; 9名需要移除假体。单个外科医生 (外科医生X) 与18例随后感染的手术相关 (风险比 (RR) = 9.4,95% 置信区间 (CI) 2.2-39),并进行了一项调查,以解释外科医生X与其他外科医生之间感染率的差异。在一项队列研究中,分层分析确定术前美国麻醉医师协会 (ASA) 的身体状况等级大于或等于3,外科医生X,以及术后早期使用连续被动运动装置是与全膝关节置换术后手术伤口感染相关的危险因素。Logistic回归分析确定是由ASA等级大于或等于3的外科医生X手术的患者,是全膝关节置换相关手术伤口感染的唯一重要独立危险因素 (RR = 9.3,95% CI 2.8-31)。不能通过接受或及时施用抗菌药物,插入的假体类型,手术持续时间,术后使用连续被动运动或关节疾病的潜在病因来解释外科医生X的作用。作者得出结论,手术技术和患者的疾病严重程度是全膝关节置换术后手术伤口感染的主要决定因素。这项研究证明了外科伤口感染的流行病学调查的复杂性,以及在解释外科医生特定的感染率时考虑患者疾病严重程度的重要性。
  • 【影响成人严重烧伤后心理、社会和健康结果的因素: 队列研究方案。】 复制标题 收藏 收藏
    DOI:10.1136/bmjopen-2017-017545 复制DOI
    作者列表:Druery M,Newcombe PA,Cameron CM,Lipman J
    BACKGROUND & AIMS: INTRODUCTION:The goal of burn care is that 'the quality of the outcome must be worth the pain of survival'. More research is needed to understand how best to deliver care for patients with burns to achieve this aim. Loss of independence, function as well as loss of income for patients with burns and carers cause a significant burden at both individual and societal levels. Much is being done to advance knowledge in the clinical care field; however, there has been a paucity of research exploring psychosocial outcomes. This paper describes the study background and methods, as implemented in an Australian cohort study of psychosocial outcomes after major burn injuries. METHODS AND ANALYSIS:In this inception cohort study, a target sample of 230 participants, aged 18 years or over, admitted to a single statewide burns centre with a burn injury are identified by hospital staff for inclusion. Baseline survey data are collected either in person or by telephone within 28 days of the injury and participants then followed up with telephone interviews at 3, 6 and 12 months postburn. Injury and burns treatment information is collected from medical records. Social support is measured as a predictor variable using the Multidimensional Scale of Perceived Social Support. Outcome data are collected via standardised measures in the domains of Quality of Life (SF-12, EQ-5D, BSHS-B), depression (PHQ-9), post-traumatic stress disorder (PCL-C, PAS), community integration (CIQ-R) and Quality-Adjusted Life Years (EQ-5D). Additional survey questions measure life satisfaction, return to work and public services utilisation at 12 months postinjury. Data analysis methods will include analysis of variance, Pearson correlation and hierarchical multiple regression analyses. ETHICS AND DISSEMINATION:Hospital-based and University of Queensland Human Research Ethics Committees have approved the protocol. Results from the study will be disseminated at national and international conferences, in peer-reviewed journals and in a doctoral thesis. TRIAL REGISTRATION NUMBER:Australia New Zealand Clinical Trials Registry (ACTRN12616000828426). Retrospectively registered on 23 June 2016; pre-results.
    背景与目标:
  • 【睡眠障碍负担及其相关危险因素: 中国HIV感染者抗逆转录病毒治疗的横断面调查。】 复制标题 收藏 收藏
    DOI:10.1038/s41598-017-03968-3 复制DOI
    作者列表:Huang X,Li H,Meyers K,Xia W,Meng Z,Li C,Bai J,He S,Cai W,Huang C,Liu S,Wang H,Ling X,Ma P,Tan D,Wang F,Ruan L,Zhao H,Wei H,Liu Y,Yu J,Lu H,Wang M,Zhang T,Chen H,Wu H
    BACKGROUND & AIMS: :This study evaluated the prevalence and factors associated with sleep disturbance in a large cohort of HIV-infected patients across China. A cross-sectional study was conducted among HIV-infected patients on antiretroviral therapy at 20 AIDS clinics. The Pittsburgh Sleep Quality Index was self-administered by subjects. Socio-demographic characteristics, medical history and HIV-related clinical data were collected. 4103 patients had complete data for analysis. Sleep disturbances were observed in 43.1% of patients. Associated factors in multivariable analysis included psychological factors: anxiety (odds ratio [OR], 3.13; 95% confidence interval [CI], 2.44-4.00; P < 0.001), depression (OR, 2.09; 95% CI, 1.70-2.57; P < 0.001), and both anxiety and depression (OR, 5.90; 95% CI, 4.86-7.16; P < 0.001); sociodemographic factors: MSM (OR, 1.26; 95% CI, 1.04-1.52; P = 0.018), being single (OR, 1.45; 95%CI 1.21-1.74; P < 0.001), higher education (OR, 1.25; 95% CI, 1.03-1.53; P = 0.025); and clinical factors: suboptimal adherence (OR,1.51; 95% CI,1.23-1.85; P < 0.001), regimen-switching (OR, 1.94; 95% CI, 1.12-3.35; P = 0.018), and antidepressant use (OR, 1.98; 95% CI, 1.47-2.67; P = 0.044). Prevalence of sleep disturbance is high in this large Chinese cohort. Associated factors appear related to psychological and social-demographic factors. Health workers may consider routinely assessing sleep disturbances among HIV-infected patients, especially in the first three months after HIV diagnosis, and referring for mental health services, which may positively impact adherence to treatment.
    背景与目标: : 这项研究评估了中国大量HIV感染患者的患病率和与睡眠障碍相关的因素。在20个艾滋病诊所对接受抗逆转录病毒治疗的HIV感染患者进行了横断面研究。匹兹堡睡眠质量指数由受试者自行管理。收集了社会人口统计学特征,病史和与HIV相关的临床数据。4103患者有完整的数据进行分析。在43.1% 患者中观察到睡眠障碍。多变量分析的相关因素包括心理因素: 焦虑 (优势比 [OR],3.13; 95% 置信区间 [CI],2.44-4.00; P  <  0.001),抑郁 (OR,2.09; 95% CI,1.70-2.57; P  <  0.001),焦虑和抑郁 (OR,5.90; 95% CI,4.86-7.16; P  <  0.001); 社会人口统计学因素: MSM (OR,1.26; 95% CI,1.04-1.52; P   =   0.018),单身 (OR,1.45; 95% CI 1.21-1.74; P  <  0.001),高等教育 (OR, 1.25; 95% CI,1.03-1.53; P   =   0.025); 和临床因素: 次优依从性 (OR,1.51; 95% CI,1.23-1.85; P <  0.001),方案转换 (OR,1.94; 95% CI,1.12-3.35; P   =   0.018) 和抗抑郁药的使用 (或,1.98; 95% CI,1.47-2.67; P   =   0.044)。在这个庞大的中国人群中,睡眠障碍的患病率很高。相关因素似乎与心理和社会人口因素有关。卫生工作者可以考虑定期评估HIV感染患者的睡眠障碍,尤其是在HIV诊断后的前三个月,并推荐精神卫生服务,这可能会对治疗依从性产生积极影响。
  • 【有或没有肾结石家族史的健康学龄儿童泌尿系结石的危险因素。】 复制标题 收藏 收藏
    DOI:10.1007/s00467-012-2368-5 复制DOI
    作者列表:Sáez-Torres C,Grases F,Rodrigo D,García-Raja AM,Gómez C,Frontera G
    BACKGROUND & AIMS: BACKGROUND:The prevalence of lithiasis is increasing at all ages. This study aimed to assess the crystallization risk in urine from healthy school children and to determine urinary parameters that are most associated with it. METHODS:Urine samples were obtained from 184 children aged 5-12 years: a spot sample collected in the afternoon, and a 12-h overnight sample. Information was obtained regarding family histories of lithiasis. Urine volume, pH, and biochemical parameters of stone risk were measured. Crystallization risk was defined by the presence of specific urine conditions that had previously been associated with stone formation in vitro. RESULTS:Crystallization risk was observed in 15 % of spot urine samples and 54 % of 12-h samples. Metabolic abnormalities and a low urinary volume were more frequently detected in children with crystallization risk. Calcium excretion and calcium/citrate ratio were higher in children with a family history of lithiasis. CONCLUSIONS:We observed a high prevalence of crystallization risk in urine, especially in children with a family history of the disease. Low urinary volume was the factor most associated with increased risk. Adequate fluid intake at an early age may be a simple and effective measure to reduce the incidence of nephrolithiasis.
    背景与目标:
  • 【退行性脊柱疾病不同外科手术中输血的预测因素。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Fosco M,Di Fiore M
    BACKGROUND & AIMS: BACKGROUND AND OBJECTIVES:Spine surgery frequently needs allogeneic blood transfusions to compensate for great blood loss. Autologous blood donations often are indicated to reduce homologous transfusions. In last decades interbody spinal fusion has gained popularity, being frequently performed in many spine procedures. Nevertheless, there are few studies evaluating the risk factors of additional blood transfusions in the postoperative course of degenerative spine surgery and no one concerning patients who underwent interbody fusion. MATERIALS AND METHODS:In 15 consecutive months, in the same Department of Spine Surgery 40 different elective spine surgeries were performed, divided into four groups: laminectomy alone, laminectomy with an instrumented posterolateral fusion, laminectomy with an instrumented posterolateral and interbody fusion, extensive instrumented fusion. All patients surgery-related data were respectively recorded: patient age, gender, diagnosis, preoperative hemoglobin rate, autologous blood availability, number of spinal level decompressed and fused, duration of surgery, type of surgical procedure, duration of hospital stay. These data were statistically analysed to determine whether variables could determine higher risk of blood transfusion. RESULTS:In an univariate analysis of factors influencing the need of blood transfusion, significantly greater risk of blood transfusions was observed in the female, in case of low preoperative Hb rate, longer surgical times, multiple spinal level decompressed or fused and longer duration of hospital stay. Our linear multiple regression modeling showed that patients gender and increased number of levels decompressed and levels surgically fused were significant determinants of need of blood transfusion. CONCLUSIONS:The practical value of this work can be particularly appreciated by those who are used to consider blood predonation. According to our findings blood predonation should preferably be proposed to women supposed to undergo spine instrumented fusion or a more than three levels spine decompression.
    背景与目标:
  • 【脊髓损伤个体生活方式与冠心病危险因素的纵向关联.】 复制标题 收藏 收藏
    DOI:10.1038/sc.2012.153 复制DOI
    作者列表:de Groot S,Post MW,Snoek GJ,Schuitemaker M,van der Woude LH
    BACKGROUND & AIMS: OBJECTIVE:To investigate: (1) the course of coronary heart disease risk factors (lipid profiles and body mass index (BMI)) in the first five years after discharge from inpatient spinal cord injury (SCI) rehabilitation and (2) the association between lifestyle (physical activity, self-care related to fitness, smoking, alcohol, body mass and low-fat diet) and coronary heart disease risk factors during that period. DESIGN:Prospective cohort study. PARTICIPANTS/METHODS:Individuals with SCI (N=130). Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG) and BMI were determined at discharge from inpatient rehabilitation and 1 and 5 years after discharge. Using multilevel regression models, the effects of lifestyle (drinking alcohol, smoking, active lifestyle and self-care) on the lipid profiles and BMI were determined. RESULTS:After correction for lesion and personal characteristics, no changes in lipid profiles in the five years after discharge were seen, whereas the BMI increased significantly with 1.8 kg m(-2). A high percentage was at risk of cardiovascular disease due to high BMI (63-75%) or HDL (66-95%). The individuals who indicated to maintain their fitness level as good as possible and the individuals with a low BMI showed better lipid profiles. Individuals with a more active lifestyle showed higher HDL levels. Individuals who avoid smoking showed a 1.5 kg m(-2) higher BMI. CONCLUSION:Lipid profiles seem to stabilize in the years after discharge from inpatient SCI rehabilitation, whereas the BMI increased. Lifestyle factors associated with a favorable lipid profile and BMI could be identified.
    背景与目标:
  • 【食管鳞状细胞癌中促炎转录因子和非编码rna的分子相互作用。】 复制标题 收藏 收藏
    DOI:10.1177/1010428317705760 复制DOI
    作者列表:Sundaram GM,Veera Bramhachari P
    BACKGROUND & AIMS: :Esophageal squamous cell carcinoma is the sixth most common cancer in the developing world. The aggressive nature of esophageal squamous cell carcinoma, its tendency for relapse, and the poor survival prospects of patients diagnosed at advanced stages, represent a pressing need for the development of new therapies for this disease. Chronic inflammation is known to have a causal link to cancer pre-disposition. Nuclear factor kappa B and signal transducer and activator of transcription 3 are transcription factors which regulate immunity and inflammation and are emerging as key regulators of tumor initiation, progression, and metastasis. Although these pro-inflammatory factors in esophageal squamous cell carcinoma have been well-characterized with reference to protein-coding targets, their functional interactions with non-coding RNAs have only recently been gaining attention. Non-coding RNAs, especially microRNAs and long non-coding RNAs demonstrate potential as biomarkers and alternative therapeutic targets. In this review, we summarize the recent literature and concepts on non-coding RNAs that are regulated by/regulate nuclear factor kappa B and signal transducer and activator of transcription 3 in esophageal cancer progression. We also discuss how these recent discoveries can pave way for future therapeutic options to treat esophageal squamous cell carcinoma.
    背景与目标: 食管鳞状细胞癌是发展中世界第六大最常见的癌症。食管鳞状细胞癌的侵袭性,复发的趋势以及被诊断为晚期患者的生存前景不佳,迫切需要开发针对该疾病的新疗法。已知慢性炎症与癌症倾向有因果关系。核因子 κ B和信号转导和转录激活子3是调节免疫和炎症的转录因子,并已成为肿瘤发生,进展和转移的关键调节剂。尽管食管鳞状细胞癌中的这些促炎因子已在蛋白质编码靶标方面得到了很好的表征,但它们与非编码rna的功能相互作用直到最近才受到关注。非编码rna,尤其是microrna和长型非编码rna显示出作为生物标志物和替代治疗靶点的潜力。在这篇综述中,我们总结了有关非编码rna的最新文献和概念,这些非编码rna受/调节核因子 κ B和信号转导子和转录激活子3在食管癌进展中的调控。我们还讨论了这些最新发现如何为将来治疗食管鳞状细胞癌的治疗选择铺平道路。

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