BACKGROUND & AIMS: OBJECTIVE:The mechanism behind the epidemiologically evident inverse relation between Helicobacter pylori seropositivity and risk of oesophageal adenocarcinoma (OAC) remains obscure. Severe corpus gastritis is unlikely to be in the causal pathway. With the hypothesis of a uniformly low risk, the associations of OAC with duodenal ulcer and gastric ulcer were explored, both linked to H pylori infection but with different patterns of bacterial colonisation and intragastric acidity. Possible associations of oesophageal squamous cell carcinoma (OSCC) with these ulcer types were also addressed. DESIGN AND PATIENTS:Retrospective cohorts of 61,548 and 81,379 unoperated patients with duodenal ulcer and gastric ulcer, respectively, recorded in the Swedish Inpatient Register since 1965, were followed from the first hospitalisation until the date of any cancer, death, emigration, definitive surgery, or 31 December 2003. Standardised incidence ratios (SIRs), with 95% CIs, expressed relative risk of oesophageal cancer, compared with the Swedish population matched for age, sex and calendar period. RESULTS:Contrary to expectation, patients with duodenal ulcer had a significant 70% excess risk of OAC (SIR 1.7, 95% CI 1.1 to 2.5). Gastric ulcer was unrelated to OAC (SIR 1.1, 95% CI 0.6 to 1.7). Although duodenal ulcer was non-significantly associated with a small excess of OSCC (SIR 1.3, 95% CI 0.96 to 1.8), gastric ulcer was linked to 80% increased risk (SIR 1.8, 95% CI 1.4 to 2.3). CONCLUSION:The inverse association between H pylori and OAC does not pertain to all infections. The pattern of gastric colonisation and/or impact on acidity may be important. With the reservation for the possibility of confounding, this study also provides some support for the importance of intragastric environment in the aetiology of OSCC.

背景与目标： 目的：幽门螺杆菌血清阳性与食管腺癌（OAC）风险之间的流行病学证据呈负相关。严重的胃炎胃炎不太可能在因果关系中。假设风险均一，探讨了OAC与十二指肠溃疡和胃溃疡的相关性，二者均与幽门螺杆菌感染有关，但细菌定植和胃内酸度不同。食管鳞状细胞癌（OSCC）与这些溃疡类型的可能关联也得到了解决。
设计与患者：自1965年以来在瑞典住院患者登记表中记录的分别有61,548和81,379例未手术的十二指肠溃疡和胃溃疡患者的回顾性队列，从首次住院治疗直至癌症，死亡，移民，定型手术，或2003年12月31日。与年龄，性别和日历时期相匹配的瑞典人群相比，具有95％CI的标准发生率（SIR）表示食道癌的相对风险。
结果：与预期相反，十二指肠溃疡患者发生OAC的风险显着增加70％（SIR 1.7，95％CI 1.1至2.5）。胃溃疡与OAC无关（SIR 1.1，95％CI 0.6至1.7）。尽管十二指肠溃疡与少量过量的OSCC无显着相关性（SIR 1.3，95％CI 0.96至1.8），但胃溃疡与80％的风险增加相关（SIR 1.8，95％CI 1.4至2.3）。
结论：幽门螺杆菌与OAC之间的负相关并不适用于所有感染。胃定植的模式和/或对酸度的影响可能很重要。由于保留了混淆的可能性，本研究还为胃内环境在OSCC病因中的重要性提供了一些支持。

BACKGROUND & AIMS: To determine the efficacy of endoscopic variceal ligation (EVL) in prophylaxis on the rate of first esophageal variceal bleeding, we conducted a prospective, randomized trial in 126 cirrhotic patients with no history of previous upper gastrointestinal bleeding and with esophageal varices endoscopically judged to be at high risk of hemorrhage. The end-points of the study were bleeding and death. Life-table curves showed that prophylactic EVL significantly diminished the rate of variceal hemorrhage (12/62 [19%] vs. 38/64 [60%]; P = .0001) and overall mortality (17/62 [28%] vs. 37/64 [58%]; P = .0011). The 2-year cumulative bleeding rate was 19% (12/ 62) in the EVL group and 60% (38/64) in the control group. The 2-year cumulative mortality rate was 28% (17/62) in the EVL group and 58% (37/64) in the control group. Comparison of Kaplan-Meier estimates of the time to death of both groups showed significantly lower mortality in the ligation group (P = .001). Patients undergoing EVL had few treatment failures and died mainly of hepatic failure. The lower risk in the EVL group was attributed to a rapid reduction of variceal size. Prophylactic EVL was more efficient in preventing first bleeding in patients with good condition (Child A) than in those with decompensated disease (Child B and C). We conclude that prophylactic EVL can decrease the incidence of first variceal bleeding and death over a period of 2 years in cirrhotic patients with high-risk esophageal varices.

背景与目标： 为了确定内镜下静脉曲张结扎术（EVL）预防第一次食道静脉曲张破裂出血的疗效，我们对126例无既往有上消化道出血史且经内镜检查认为是食管静脉曲张的肝硬化患者进行了一项前瞻性随机试验。高出血风险。研究的终点是出血和死亡。生命表曲线表明，预防性EVL显着降低了曲张静脉出血的发生率（12/62 [19％] vs. 38/64 [60％]； P = .0001）和总死亡率（17/62 [28％] vs 37/64 [58％]； P = 0.0011）。 EVL组的2年累积出血率为19％（12/62），对照组为60％（38/64）。 EVL组的2年累积死亡率为28％（17/62），对照组为58％（37/64）。 Kaplan-Meier对两组死亡时间的估计值的比较表明，结扎组的死亡率显着降低（P = .001）。接受EVL的患者几乎没有治疗失败，主要死于肝功能衰竭。 EVL组中较低的风险归因于曲张静脉大小的迅速减小。预防性EVL预防状况良好的患者（儿童A）比失代偿性疾病的患者（儿童B和C）更有效地防止首次出血。我们得出结论，在高危食管静脉曲张的肝硬化患者中，预防性EVL可以在2年内降低首次静脉曲张破裂出血和死亡的发生率。

BACKGROUND & AIMS: :With currently available combination chemotherapy regimens, the outcome of the patients newly diagnosed with aggressive non-Hodgkin's lymphoma (NHL) identified as 'high' and 'high-intermediate' risk groups according to the international prognostic index (IPI) is still unsatisfactory and a more innovative therapy is urgently required to improve the survival of the patients. The purpose of this study was to compare the efficacy of rituximab given in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) and ESHAP (etoposide, methylprednisolone, high-dose Ara-C, cisplatin) vs CHOP-ESHAP and upfront high-dose therapy (HDT) and autologous stem cell transplantation (ASCT) vs standard CHOP in patients aged < or = 65 years old newly diagnosed with 'high' and 'high-intermediate' risk aggressive lymphoma enrolled onto two consecutive treatment trials at the institute. Between May 1995 - July 2002, 84 patients, aged 15 - 65 years old, with newly diagnosed aggressive NHL and an age-adjusted IPI of 2 or 3 were enrolled. The median age of the patients was 38 years (range 15 - 65). The baseline demographic features, in particular the major prognostic variables, were similar between the treatment groups. Patients treated with rituximab-CHOP-ESHAP received eight cycles of rituximab (375 mg m(-2) on day 1 of cycles 1 - 6 and days 21 and 28 of cycle 7) plus CHOP (day 3 of cycles 1, 3 and 5) and ESHAP (day 3 of cycles 2, 4 and 6 and day 1 of cycle 7) at 21-day intervals. Patients enrolled onto the CHOP-ESHAP-HDT arm (n = 23) were treated with three courses of CHOP and then switched to two or four cycles of ESHAP followed by HDT. Patients treated with CHOP alone (n = 25) were treated with the standard eight cycles of CHOP. The rate of complete remission was significantly improved with rituximab-CHOP-ESHAP compared with either CHOP-ESHAP-HDT or CHOP alone (67% compared with 44% and 36%, respectively; p = 0.043). With a median follow-up time of 53 months, the 5-year overall survival (OS) was improved by the addition of rituximab-61% with rituximab-CHOP-ESHAP, compared with 43% for CHOP-ESHAP-HDT and 24% for CHOP alone (p = 0.088). Significant increases in failure-free survival (FFS) and disease-free survival (DFS) (61% and 96%), compared with CHOP-ESHAP-HDT (34% and 90%) and CHOP (16% and 44%; p = 0.002 and p < 0.001, respectively) were observed. Compared to CHOP, rituximab-CHOP-ESHAP yielded significantly superior OS (p = 0.014), FFS (p < 0.001) and DFS (p < 0.001). The survivals, however, were not significantly different from patients treated with CHOP-ESHAP-HDT. It is concluded that rituximab-ESHAP-CHOP is superior over standard CHOP and fares comparably to upfront HDT/ASCT in previously untreated patients with aggressive lymphoma. A prospective randomized controlled trial is warranted to confirm these results.

背景与目标： ：在目前可用的联合化疗方案下，根据国际预后指数（IPI）刚被诊断为侵袭性非霍奇金淋巴瘤（NHL）的患者的预后仍然不尽人意，并且迫切需要一种更具创新性的疗法来提高患者的生存率。这项研究的目的是比较利妥昔单抗与CHOP（环磷酰胺，阿霉素，长春新碱，泼尼松）和ESHAP（依托泊苷，甲基泼尼松龙，大剂量Ara-C，顺铂）联合使用时与CHOP-ESHAP和前期高剂量联合治疗的疗效在该研究所进行的两项连续治疗试验中，对新诊断为“高”和“高中度”风险性侵袭性淋巴瘤的年龄≤65岁的患者进行剂量治疗（HDT）和自体干细胞移植（ASCT）与标准CHOP的比较。在1995年5月至2002年7月之间，纳入了84例年龄在15至65岁之间，新诊断为侵袭性NHL且年龄调整后的IPI为2或3的患者。患者的中位年龄为38岁（范围15-65）。治疗组之间的基线人口统计学特征，尤其是主要的预后变量相似。接受利妥昔单抗-CHOP-ESHAP治疗的患者接受了八个周期的利妥昔单抗（第1-6周期的第1天以及第7周期的第21和28天为375 mg m（-2））加CHOP（第1、3和5周期的第3天） ）和ESHAP（周期2、4和6的第3天和周期7的第1天），间隔为21天。入组CHOP-ESHAP-HDT组（n = 23）的患者接受了三个疗程的CHOP治疗，然后切换到ESSHAP的两个或四个周期，然后进行HDT。单独接受CHOP治疗的患者（n = 25）接受了标准的八个CHOP周期治疗。与单独使用CHOP-ESHAP-HDT或CHOP相比，利妥昔单抗-CHOP-ESHAP的完全缓解率显着提高（分别为67％，44％和36％； p = 0.043）。中位随访时间为53个月，利妥昔单抗-CHOP-ESHAP加利妥昔单抗-61％改善了5年总生存（OS），相比之下，CHOP-ESHAP-HDT和43％改善了5年总生存率仅适用于CHOP（p = 0.088）。与CHOP-ESHAP-HDT（34％和90％）和CHOP（16％和44％）相比，无失败生存率（FFS）和无病生存率（DFS）显着增加（61％和96％）；分别观察到= 0.002和p​​ <0.001）。与CHOP相比，利妥昔单抗-CHOP-ESHAP产生显着优越的OS（p = 0.014），FFS（p <0.001）和DFS（p <0.001）。但是，其存活率与用CHOP-ESHAP-HDT治疗的患者无明显差异。结论是，对于先前未经治疗的侵袭性淋巴瘤患者，利妥昔单抗-ESHAP-CHOP优于标准CHOP，且其费用可与前期HDT / ASCT相提并论。必须进行前瞻性随机对照试验来证实这些结果。

BACKGROUND & AIMS: PURPOSE:To understand the prospective relationship between depressive symptoms and sexual risk behavior among a community sample of African American adolescents. METHODS:African American adolescents (n = 415) who participated in a larger multi-site human immunodeficiency virus (HIV) prevention program provided baseline data on demographics, psychosocial context and depressive symptoms. At six-month follow-up, data were collected regarding sexual activity in the past 90 days. Multivariate logistic regression was conducted to determine the prospective relationship between depressive symptoms and proportion of condom use while controlling for relevant demographic and contextual factors. RESULTS:The odds that African American adolescents who reported depressive symptoms at baseline would report inconsistent condom use at six-month follow-up was approximately four times greater than that of their peers who did not report depressive symptoms. Older adolescents and females were less likely to use condoms consistently and certain contextual factors, such as less pleasurable expectations about condom use, and living with a partner also heightened HIV/STI risk. CONCLUSIONS:Clinicians should assess for depression symptoms in African American adolescent patients as an indicator of future sexual risk. Prevention interventions that address depressed mood could have a significant impact on later HIV/STI sexual risk behaviors. Further research is needed to understand the effect of depressive symptoms on sexual risk among adolescents of other race/ethnicities and to examine the potential cultural forces that affect this relationship.

背景与目标： 目的：了解非裔美国青少年社区样本中抑郁症状与性危险行为之间的预期关系。
方法：参加较大的多站点人类免疫缺陷病毒（HIV）预防计划的非裔美国青少年（n = 415）提供了有关人口统计学，社会心理背景和抑郁症状的基线数据。在六个月的随访中，收集了过去90天内有关性活动的数据。进行多因素logistic回归分析以确定抑郁症状与安全套使用比例之间的预期关系，同时控制相关的人口统计学和背景因素。
结果：在基线时报告抑郁症状的非洲裔美国青少年在六个月的随访中报告使用安全套不一致的几率是未报告抑郁症状的同龄人的四倍。较大的青少年和女性不太可能一贯使用安全套，并且某些情境因素，例如对使用安全套的期望降低，以及与伴侣生活在一起也增加了艾滋病毒/性传播疾病的风险。
结论：临床医生应评估非洲裔美国青少年患者的抑郁症状，作为未来性风险的指标。预防情绪低落的预防干预措施可能会对以后的HIV / STI性风险行为产生重大影响。需要进一步的研究来了解抑郁症状对其他种族/族裔青少年的性风险的影响，并研究影响这种关系的潜在文化力量。

BACKGROUND & AIMS: The accuracy of cervicovaginal fetal fibronectin as a predictor of preterm birth was studied in patients with increased risk for preterm delivery (according to the Creasy-score). In a prospective blind observational study the smear from the posterior fornix vaginae of 56 pregnant patients without PROM was examined using a quantitative immunoassay for the detection of fetal fibronectin. The patients who tested positively for fetal fibronectin had significantly more preterm deliveries than those with a negative result (CHI square-test, p < 0.01, RR 5.1). Overall, sensitivity, specificity, positive and negative predictive values were 56%, 87%, 45% and 91%, respectively. In patients with preterm labor these values were 75%, 87%, 60%, and 93%, respectively. No patient with a negative result delivered preterm during the following two weeks. It is concluded that performing the fetal fibronectin test in patients with preterm labor is useful for the prediction of preterm birth. Routine testing in patients at increased risk (asymptomatic patients) is not recommended for lack of effectiveness.

背景与目标： 宫颈阴道胎儿纤连蛋白作为早产预测指标的准确性已在早产风险增加的患者中进行了研究（根据Creasy评分）。在一项前瞻性盲观察研究中，使用定量免疫测定法检测了56例无PROM的孕妇的后穹vagina阴道涂片，以检测胎儿的纤连蛋白。胎儿纤连蛋白检测阳性的患者比阴性检测的早产明显多（CHI square-test，p <0.01，RR 5.1）。总体而言，敏感性，特异性，阳性和阴性预测值分别为56％，87％，45％和91％。在有早产的患者中，这些值分别为75％，87％，60％和93％。在接下来的两周内，没有阴性结果的患者早产。结论是在早产患者中进行胎儿纤连蛋白测试有助于预测早产。不建议对风险较高的患者（无症状的患者）进行常规检查，因为其缺乏有效性。

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：失眠在一般实践中得到广泛报道和广泛治疗，但相对较少的研究集中在初级保健机构中病情的自然史上。因此，目前尚无足够的信息可帮助临床医生评估失眠风险或预期较老的全科医生人群的结局。

AIM ：使用8年纵向评估数据，与选定的健康和生活方式因素相关的失眠风险。

方法：对来自全国代表性样本（n = 1042）最初在1985年接受采访的老年人的幸存者进行了重新评估。在1989年（n = 690）和1993（n = 410）。在1989年的首次随访中，发现了84例新的失眠病例（加权平均每人每年的发病率，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了失眠的风险。

结果：1985年评估的三个因素具有显着性和独立性发生失眠：心理测验评分与沮丧的情绪几率之比（OR）= 4.41； 95％CI = 3.32-5.43）；健康指数得分，表明身体健康状况较低（OR = 1.19； 95％CI =单位得分变化每单位1.06-1.31）；中度和低度的体育活动（OR分别为1.91和2.14； 95％CI分别为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而不是精神疾病。

结论：精神，躯体和生活方式因素显着且独立增加老年全科患者失眠的风险。在预测事件性睡眠障碍时，这些因素的重要性超过了患者的年龄和性别。