• 【代表性的全科医学样本中晚期失眠的危险因素。】 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。

  • 【肝移植受者巨细胞病毒感染危险因素的多因素分析。】 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个月内对33例连续肝移植接受者进行了前瞻性研究,以发现巨细胞病毒感染的迹象。鉴定出十六例(48%)巨细胞病毒感染; 9例是原发性感染,7例是复发性感染。从患者8开始,常规对大多数患者进行了γ-球蛋白的预防。对巨细胞病毒感染的十二种潜在危险因素进行了评估,包括供体和受体移植前巨细胞病毒的血清学状况。接受者的年龄,性别,种族和肝脏疾病;输血产品的数量和类型;免疫抑制的类型和强度;和拒绝的发生。 Cox比例风险模型将阳性供体巨细胞病毒血清学确定为随后发展成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血清学状况无关。另外,使用γ-球蛋白预防似乎可以预防弥漫性巨细胞病毒病的发生。
  • 【单侧手臂摆动运动对下肢与受伤风险相关的跑步力学的影响。】 复制标题 收藏 收藏
    DOI:10.1080/14763141.2016.1269186 复制DOI
    作者列表:Agresta C,Ward CR,Wright WG,Tucker CA
    BACKGROUND & AIMS: :Many field sports involve equipment that restricts one or both arms from moving while running. Arm swing during running has been examined from a biomechanical and physiologic perspective but not from an injury perspective. Moreover, only bilateral arm swing suppression has been studied with respect to running. The purpose of this study was to determine the influence of running with one arm restrained on lower extremity mechanics associated with running or sport-related injury. Fifteen healthy participants ran at a self-selected speed with typical arm swing, with one arm restrained and with both arms restrained. Lower extremity kinematics and spatiotemporal measures were analysed for all arm swing conditions. Running with one arm restrained resulted in increased frontal plane knee and hip angles, decreased foot strike angle, and decreased centre of mass vertical displacement compared to typical arm swing or bilateral arm swing restriction. Stride length was decreased and step frequency increased when running with one or both arms restrained. Unilateral arm swing restriction induces changes in lower extremity kinematics that are not similar to running with bilateral arm swing restriction or typical arm swing motion. Running with one arm restrained increases frontal plane mechanics associated with risk of knee injury.
    背景与目标: :许多野外运动都涉及限制一只或两只手臂在跑步时移动的设备。已从生物力学和生理学的角度检查了跑步过程中的手臂摆动,但从伤害的角度未进行检查。此外,关于跑步,仅研究了双侧手臂摆动抑制。这项研究的目的是确定一只手臂被约束跑步对与跑步或运动相关的伤害相关的下肢力学的影响。 15名健康参与者以典型的手臂挥杆,一只手臂被约束和两只手臂被约束的速度以自行选择的速度跑步。分析了所有手臂摆动情况的下肢运动学和时空测量。与典型的手臂摆动或双侧手臂摆动限制相比,用一只手臂约束跑步会导致额平面膝盖和臀部角度增加,脚打击角度减小以及质心垂直位移减小。当一只手或两只手都受约束时,步幅减小,步频增加。单侧手臂摆动限制引起下肢运动学的改变,这与双侧手臂摆动限制或典型手臂摆动运动的跑步不同。一只脚受约束地奔跑会增加与膝盖受伤风险相关的额叶平面力学。
  • 【腰椎骨矿物质密度分布的纵向变化可能会增加楔形骨折的风险。】 复制标题 收藏 收藏
    DOI:10.1016/j.clinbiomech.2012.10.005 复制DOI
    作者列表:Giambini H,Khosla S,Nassr A,Zhao C,An KN
    BACKGROUND & AIMS: BACKGROUND:Trabecular bone strength diminishes as a result of osteoporosis and altered biomechanical loading at the vertebral and spinal levels. The spine consists of the anterior, middle and posterior columns and the load supported by the anterior and middle columns will differ across different regions of the spine. Stress shielding of the anterior column can contribute to bone loss and increase the risk of wedge fracture. There is a lack of quantitative data related to regional spinal bone mineral density distribution over time. We hypothesize that there is an increase in the posterior-to-anterior vertebral body bone mineral density ratio and a decrease in whole-body bone mineral density over time. METHODS:Bone mineral density was measured in 33 subjects using quantitative computed tomography scans for L1-L3 vertebrae, region (anterior and posterior vertebral body), and time (baseline and 6 years after). FINDINGS:Lumbar bone mineral density decreased significantly (Δ: ~15%) from baseline to the 6th year visit. Individual vertebra differences over time (L1: ~14%, L2: ~14%, L3: ~17%) showed statistical significance. Anterior bone mineral density change was significantly greater than in the posterior vertebral body region (Δ anterior: ~18%; Δ posterior: ~13%). Posterior-to-anterior bone mineral density ratio was significantly greater in the 6th year compared to baseline values (mean (SD), 1.33 (0.2) vs. 1.23 (0.1)). INTERPRETATION:This study provides longitudinal quantitative measurement of bone mineral density in vertebrae as well as regional changes in the anterior and posterior regions. Understanding bone mineral density distribution over time may help to decrease the risk of wedge fractures if interventions can be developed to bring spine loading to its normal state.
    背景与目标: 背景:由于骨质疏松症以及椎体和脊柱水平的生物力学负荷改变,小梁的骨强度降低。脊柱由前,中和后柱组成,由前柱和中柱支撑的载荷在脊柱的不同区域会有所不同。前柱的应力屏蔽可能会导致骨质流失并增加楔形骨折的风险。缺乏与区域脊柱骨矿物质密度随时间分布有关的定量数据。我们假设随着时间的推移,椎体前后骨矿物质密度比增加,而全身骨矿物质密度降低。
    方法:采用定量计算机断层扫描技术对33名受试者的L1-L3椎骨,区域(椎体的前后)和时间(基线及术后6年)进行了骨矿物质密度测量。
    结果:从基线到第6年随访,腰椎骨矿物质密度显着降低(Δ:〜15%)。随时间变化的各个椎骨差异(L1:〜14%,L2:〜14%,L3:〜17%)显示出统计学意义。前骨矿物质密度变化显着大于后椎体区域(Δ前:〜18%;Δ后:〜13%)。与基线值相比,第6年的前后骨矿物质密度比显着更高(平均值(SD)为1.33(0.2)对1.23(0.1))。
    解释:这项研究提供了纵向定量测量椎骨中骨矿物质密度以及前后区域的变化的信息。如果可以采取干预措施使脊柱负荷恢复到正常状态,那么了解随着时间推移的骨矿物质密度分布可能有助于降低楔形骨折的风险。
  • 【对神经性厌食症的全基因组关联研究表明,瘦素信号转导失调可能是一个危险的基因座。】 复制标题 收藏 收藏
    DOI:10.1038/s41598-017-01674-8 复制DOI
    作者列表:
    BACKGROUND & AIMS: :We conducted a genome-wide association study (GWAS) of anorexia nervosa (AN) using a stringently defined phenotype. Analysis of phenotypic variability led to the identification of a specific genetic risk factor that approached genome-wide significance (rs929626 in EBF1 (Early B-Cell Factor 1); P = 2.04 × 10-7; OR = 0.7; 95% confidence interval (CI) = 0.61-0.8) with independent replication (P = 0.04), suggesting a variant-mediated dysregulation of leptin signaling may play a role in AN. Multiple SNPs in LD with the variant support the nominal association. This demonstrates that although the clinical and etiologic heterogeneity of AN is universally recognized, further careful sub-typing of cases may provide more precise genomic signals. In this study, through a refinement of the phenotype spectrum of AN, we present a replicable GWAS signal that is nominally associated with AN, highlighting a potentially important candidate locus for further investigation.
    背景与目标: :我们使用严格定义的表型进行了神经性厌食症(AN)的全基因组关联研究(GWAS)。对表型变异性的分析导致鉴定出一种接近全基因组重要性的特定遗传危险因素(EBF1中的rs929626(早期B细胞因子1); P = 2.04×10-7; OR = 0.7; 95%置信区间( CI)= 0.61-0.8)具有独立复制(P = 0.04),表明瘦素信号传导的变体介导的失调可能在AN中起作用。 LD中带有变体的多个SNP支持名义关联。这表明,尽管AN的临床和病因学异质性得到了普遍认可,但对病例进行进一步的仔细分型可能会提供更精确的基因组信号。在这项研究中,通过完善AN的表型谱,我们提出了名义上与AN相关的可复制GWAS信号,突出了潜在的重要候选基因座,需要进一步研究。
  • 【中国昆明市女性青少年性工作者的脆弱性,健康需求和高风险性行为的预测因素。】 复制标题 收藏 收藏
    DOI:10.1136/sextrans-2012-050690 复制DOI
    作者列表:Zhang XD,Temmerman M,Li Y,Luo W,Luchters S
    BACKGROUND & AIMS: OBJECTIVES:This study assessed social and behavioural predictors for sexual risk taking and sexually transmitted infections (STIs) including HIV among adolescent female sex workers (FSWs) from Kunming, China. Additionally, health services needs and use were assessed. METHODS:A cross-sectional survey was conducted in 2010. Using snowball and convenience sampling, self-identified FSWs were recruited from four urban areas in Kunming. Women consenting to participate were administered a semi-structured questionnaire by trained interviewers identified from local peer-support organisations. Following interview, a gynaecological examination and biological sampling to identify potential STIs were undertaken. Descriptive and multivariable logistic regression analyses were performed. RESULTS:Adolescent FSWs had a mean age of 18.2 years and reported numerous non-paying sexual partners with very low rate of consistent condom use (22.2%). Half (50.3%) the respondents had sex while feeling drunk at least once in the past week, of whom 56.4% did not use condom protection. STI prevalence was high overall (30.4%) among this group. Younger age, early sexual debut, being isolated from schools and family, short duration in sex work, and use of illicit drugs were found to be strong predictors for unprotected sex and presence of an STI. Conversely, having access to condom promotion, free HIV counselling and testing, and peer education were associated with less unprotected sex. The majority reported a need for health knowledge, free condoms and low-cost STI diagnosis and treatment. CONCLUSIONS:There is an urgent need to improve coverage, accessibility and efficiency of existing interventions targeting adolescent FSWs.
    背景与目标: 目的:本研究评估了来自中国昆明市的青春期女性性工作者(FSW)的性行为冒险和性传播感染(STI)(包括HIV)的社会和行为预测因素。此外,还评估了卫生服务的需求和使用。
    方法:2010年进行了横断面调查。通过滚雪球和便利抽样,从昆明的四个市区招募了自我识别的FSW。从当地同支持组织确定的训练有素的访调员对同意参加的妇女进行半结构化问卷调查。采访之后,进行了妇科检查和生物采样以识别潜在的性传播感染。进行了描述性和多变量logistic回归分析。
    结果:青少年FSW的平均年龄为18.2岁,并报告了许多无偿性伴侣,一致使用避孕套的比例很低(22.2%)。在过去的一周中,有一半(50.3%)的被调查者曾发生过性行为,而至少一次醉酒,其中56.4%的人未使用安全套保护。在这一组中,性传播感染的患病率总体较高(30.4%)。人们发现,年龄较小,性行为初次出现,与学校和家庭隔离,性工作时间短以及使用非法药物是无保护性行为和性传播感染的有力预测因素。相反,获得安全套宣传,免费的艾滋病毒咨询和检测以及同伴教育的机会与较少受到保护的性行为有关。大多数人报告需要健康知识,免费避孕套和低成本的STI诊断和治疗。
    结论:迫切需要提高针对青少年FSW的现有干预措施的覆盖面,可及性和效率。
  • 【客观面部皮肤质量分析后,光老化严重程度的自我认知变化和皮肤癌风险。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Bae YC,Bae EJ,Wang JH,Gilchrest BA
    BACKGROUND & AIMS: :

    Background: Despite public education efforts, many people at risk for skin cancer do not practice safe sun behaviors.

    Objective: To determine whether machine-based evaluation of UV-induced alterations (VISIA scan) changes self-assessment of facial photoaging, skin cancer risk, and willingness to improve sun protective habits. In addition, to determine whether VISIA scan analysis reveals differences between those with versus without a history of skin cancer, men versus women, those older than 50 versus less than 50 years of age, and Fitzpatrick skin types I-III versus IV-VI.

    Methods: Volunteers attending a health expo were recruited and queried about their perceived risk of skin cancer and degree of skin photoaging. All participants underwent facial skin quality analysis of both sides of the face, and then completed a follow-up survey.

    Results: Participants' scored self-perceptions of overall skin aging were all statistically significantly worse after VISIA scan analysis. There was no change in perceived skin cancer risk, but most participants expressed intent to improve their sun protection habits.

    Limitations: Limitations to this study include selection bias, recall-misclassification bias, and social desirability bias.

    Conclusion: Intervention with facial skin analysis can positively affect subjects' stated intent to use sun protection, indicating the importance of appearance in these health decisions.

    J Drugs Dermatol. 2017;16(5):453-459.

    .
    背景与目标:

    背景:尽管进行了公众教育,但许多有皮肤癌风险的人仍未进行安全的日晒行为。

    目的:确定是否对紫外线诱发的变化进行基于机器的评估(VISIA扫描)改变面部光老化的自我评估,皮肤癌的风险以及改善防晒习惯的意愿。此外,为了确定VISIA扫描分析是否能揭示出有或没有皮肤癌病史,男性与女性,年龄大于50岁与小于50岁以及Fitzpatrick I-III和IV-VI皮肤类型之间的差异。

    方法:招募参加健康博览会的志愿者,并询问他们对皮肤癌的感知风险和皮肤光老化程度。所有参与者都进行了面部两面的面部皮肤质量分析,然后完成了一项后续调查。

    结果:在进行VISIA扫描后,参与者对整体皮肤衰老的自我感觉评分在统计学上均显着变差分析。知觉的患皮肤癌风险没有改变,但大多数参与者表示有意改善其防晒习惯。

    局限性:本研究的局限性包括选择偏见,召回分类错误和社会可取性偏见。 / p>

    结论:进行面部皮肤分析的干预可以正面影响受试者陈述的使用防晒的意图,这表明在这些健康决定中外表的重要性。

    J Dermatol。 2017; 16(5):453-459。

  • 【退伍军人中同时发生自杀念头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中一个重要的问题。这项研究调查了创伤后应激障碍(PTSD)和退伍军人的适应力如何与自杀意念和暴力冲动相关联,同时控制了两种不良结局的已知协变量。对N = 2,543名伊拉克/阿富汗时代的美国退伍军人进行了结构化的临床采访。与否认自杀意念或暴力冲动的退伍军人相比(n = 1,927),同时支持这两种方式的退伍军人(n = 171)更可能符合PTSD的诊断标准,并报告了儿童期虐待,战斗暴露,身体疼痛症状和滥用药物的情况,且更少可能认同自我指导/人生目标。与仅报告有自杀倾向的退伍军人相比,报告同时发生自杀意念和暴力冲动的退伍军人比仅报告有自杀意念的退伍军人滥用药物和报告疼痛症状的几率更高(n = 186),并且认可自我指导/人生目标的几率比仅报告暴力冲动的退伍军人低( n = 259)。这些发现强调了在临床评估和实证研究的背景下,检查药物滥用,身体疼痛症状和自我指导/生活目的,以及创伤后应激障碍和创伤史的重要性,旨在优化自杀和暴力行为的风险管理。退伍军人。 (PsycINFO数据库记录
  • 【评估水痘带状疱疹病毒抗原的皮肤测试,以预测带状疱疹的风险。】 复制标题 收藏 收藏
    DOI:10.1017/S0950268812002671 复制DOI
    作者列表:Okuno Y,Takao Y,Miyazaki Y,Ohnishi F,Okeda M,Yano S,Kumihashi H,Gomi Y,Maeda K,Ishikawa T,Mori Y,Asada H,Iso H,Yamanishi K,Shozu Herpes Zoster (SHEZ) Study Group.
    BACKGROUND & AIMS: :The Shozu Herpes Zoster (SHEZ) Study was designed to clarify the incidence of and predictive and immunological factors for herpes zoster in a defined community-based Japanese population. As part of this series, a total of 5683 residents aged ≥50 years received a varicella-zoster virus (VZV) skin test with VZV antigen, and 48 h later, the erythema and oedema were assessed by measuring the longest diameter. The diameters of both the erythema and oedema decreased with the increasing age of the subject. Sixty-three subjects contracted herpes zoster within a year after receiving the VZV skin test. Analysis of the herpes zoster incidence rate vs. the skin test reaction revealed that the shorter the diameter of erythema or oedema, the greater the likelihood of herpes zoster. These results demonstrated that the VZV skin test is an excellent surrogate marker for predicting the risk of herpes zoster.
    背景与目标: :Shozu疱疹带状疱疹(SHEZ)研究旨在阐明在限定的以社区为基础的日本人群中带状疱疹的发生率以及预测性和免疫学因素。作为该系列的一部分,共有5683名年龄≥50岁的居民接受了带有VZV抗原的水痘-带状疱疹病毒(VZV)皮肤测试,并且在48小时后,通过测量最长直径来评估红斑和浮肿。红斑和水肿的直径随受试者年龄的增加而减小。接受VZV皮肤测试后一年内,六十三名受试者患了带状疱疹。带状疱疹发生率与皮肤试验反应的关系分析表明,红斑或水肿的直径越短,带状疱疹的可能性就越大。这些结果表明,VZV皮肤测试是预测带状疱疹风险的出色替代指标。
  • 【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一种罕见但严重的并发症。在1984年1月至1987年11月之间,两家附属医院的243名患者中有20名(8.2%)在清洁空气手术室中进行了259次全膝关节置换手术后出现了手术伤口感染。 18名(90%)患者患有深部感染;九个需要去除假体。一名外科医生(外科医生X)与18例随后感染的手术相关联(风险比(RR)= 9.4,95%置信区间(CI)2.2-39),并进行了调查以解释X外科医师和其他外科医师之间的感染率差异。在一项队列研究中,分层分析将术前美国麻醉师学会(ASA)身体状况等级大于或等于3,X医师和术后早期使用连续被动运动装置作为与总手术后伤口感染相关的危险因素膝关节置换手术。 Logistic回归分析确定是由ASA级大于或等于3的X外科医师手术的患者,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) 。不能通过接受抗生素预防措施的及时性,插入的假体的类型,手术的持续时间,术后持续使用被动运动或关节病的病因来解释外科医生X的影响。作者得出结论,手术技术和患者疾病的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感染率时考虑患者疾病严重性的重要性。
  • 【牙周炎患者牙周治疗前后低密度脂蛋白溶液非线性光学响应的​​测量:心血管危险标志物的评估。】 复制标题 收藏 收藏
    DOI:10.1117/1.jbo.17.11.115004 复制DOI
    作者列表:Monteiro AM,Jardini MA,Giampaoli V,Alves S,Figueiredo Neto AM,Gidlund M
    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: :在热状态下的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40名患有慢性牙周炎的LDL患者中,在进行牙周治疗的三个月,六个月和十二个月之前和之后进行的。还确定并比较了诸如探查深度,探查出血,白细胞总数和差异白细胞计数,脂质分布,细胞因子水平以及抗氧化LDL抗体等临床参数。在治疗之前,ZS实验结果表明这些患者的LDL颗粒已被大量修饰。仅在牙周治疗12个月后,获得的ZS结果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诱导多种炎症标志物的全身性变化。
  • 【睡眠障碍和相关危险因素的负担:中国艾滋病毒感染者抗逆转录病毒疗法的横断面调查。】 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一大批感染HIV的患者的患病率和与睡眠障碍相关的因素。在20个艾滋病诊所中,对接受HIV感染的患者进行了抗逆转录病毒治疗的横断面研究。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,病史和与艾滋病相关的临床数据。 4103例患者有完整的数据需要分析。在43.1%的患者中观察到睡眠障碍。多变量分析中的相关因素包括心理因素:焦虑(赔率[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;病历)。 (P <0.001),以及焦虑和抑郁(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),高等教育程度(OR,1.25; 95%CI,1.03-1.53​​; P = 0.025);临床因素:次最佳依从性(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(OR ,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统计学因素有关。卫生工作者可以考虑常规评估艾滋病毒感染患者的睡眠障碍,尤其是在艾滋病毒确诊后的前三个月,并寻求心理健康服务,这可能会对治疗依从性产生积极影响。
  • 【有和没有肾结石病家族史的健康学童尿结石的危险因素。】 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: 背景:石斑症的患病率在各个年龄段都在增加。这项研究旨在评估健康学童尿液中结晶的风险,并确定与其最相关的尿液参数。
    方法:从184名5-12岁的儿童中获取尿液样本:下午收集现场样本,并收集12小时的过夜样本。获得了有关石尿症家族史的信息。测量尿液体积,pH值和结石风险的生化参数。结晶风险是由以前与体外结石形成有关的特定尿液条件定义的。
    结果:在15%的现货尿液样本和54%的12小时样本中观察到结晶风险。具有结晶风险的儿童更经常检测到代谢异常和尿量低。有结石病家族史的儿童的钙排泄和钙/柠檬酸比更高。
    结论:我们观察到尿液中结晶风险的患病率很高,尤其是在有该病家族史的儿童中。低尿量是与增加风险最相关的因素。早期摄入足够的液体可能是减少肾结石症发生率的一种简单有效的措施。
  • 【缺铁性贫血是台湾骨质疏松症的危险因素:一项基于全国人口的研究。】 复制标题 收藏 收藏
    DOI:10.3390/nu9060616 复制DOI
    作者列表:Pan ML,Chen LR,Tsao HM,Chen KH
    BACKGROUND & AIMS: :The cause-effect relationship between iron deficiency anemia (IDA) and osteoporosis has not been established in the general population. Thus, the current longitudinal study determined the role of IDA as a risk factor for osteoporosis by analyzing a large nationwide population-based sample. In a sample of 1,000,000 randomly sampled individuals from the 1998-2012. Taiwan National Health Insurance Research Database, patients with IDA (case group (n = 35,751)) and individuals without IDA (control group (n = 178,755)) were compared. Patients who were <20 years of age and who had pre-existing osteoporosis prior to the diagnosis of IDA were excluded. Each patient with IDA was age- and gender-matched to five individuals without IDA. The diagnoses of IDA and osteoporosis (coded using ICD-9CM) were further confirmed with blood test results and X-ray bone densitometry to ensure the accuracy of the diagnoses. Osteoporosis occurred more often among patients with IDA compared to individuals without IDA (2.27% vs. 1.32%, p < 0.001). Cox proportional hazard analysis revealed that the risk for osteoporosis was significantly higher in the case than the control group (hazard ratio (HR) = 1.74; 95% CI = 1.61-1.88) and remained similar after adjustment for covariates (adjusted HR = 1.81; 95% CI = 1.67-1.97). Compared with individuals without IDA, the risk for osteoporosis was even higher for patients with IDA who received intravenous ferrum therapy (adjusted HR = 2.21; 95% CI = 1.85-2.63). In contrast, the risk for osteoporosis was reduced for patients with IDA who received a blood transfusion (adjusted HR = 1.47; 95% CI = 1.20-1.80). As a predictor, prior IDA is a significant and independent risk factor for development of osteoporosis.
    背景与目标: :铁缺乏性贫血(IDA)和骨质疏松症之间的因果关系尚未建立。因此,当前的纵向研究通过分析全国范围内大量的基于人群的样本,确定了IDA作为骨质疏松症危险因素的作用。在1998年至2012年的1,000,000个随机样本中进行抽样。台湾国家健康保险研究数据库比较了IDA患者(病例组(n = 35,751))和无IDA患者(对照组(n = 178,755))。年龄小于20岁且在IDA诊断之前已存在骨质疏松症的患者被排除在外。每名IDA患者的年龄和性别均与5名没有IDA的患者相匹配。通过血液测试结果和X射线骨密度测定法进一步证实了IDA和骨质疏松的诊断(使用ICD-9CM编码),以确保诊断的准确性。与没有IDA的患者相比,IDA患者的骨质疏松症发生率更高(2.27%对1.32%,p <0.001)。 Cox比例风险分析表明,骨质疏松的风险明显高于对照组(风险比(HR)= 1.74; 95%CI = 1.61-1.88),并且在调整协变量后(调整后HR = 1.81; 95%CI = 1.67-1.97)。与没有IDA的个体相比,接受静脉铁素治疗的IDA患骨质疏松症的风险更高(校正后的HR = 2.21; 95%CI = 1.85-2.63)。相比之下,接受输血的IDA患者的骨质疏松症风险降低了(调整后的HR = 1.47; 95%CI = 1.20-1.80)。作为预测因素,先前的IDA是骨质疏松症发展的重要且独立的危险因素。
  • 【无柄锯齿状息肉:癌症风险和适当监测。】 复制标题 收藏 收藏
    DOI:10.3949/ccjm.79a.12034 复制DOI
    作者列表:Makkar R,Pai RK,Burke CA
    BACKGROUND & AIMS: :Sessile serrated polyps are a recently recognized type of neoplastic polyp that develops along a molecular pathway different from that of conventional adenomas. While the clinical significance of the serrated pathway to colorectal cancer is clear, further study is needed to understand a patient's lifetime colorectal cancer risk posed by serrated neoplasms and the optimal postpolypectomy surveillance interval.
    背景与目标: :无锯齿状息肉是一种新近公认的肿瘤性息肉,其发展方向不同于传统的腺瘤。尽管锯齿状途径通往大肠癌的临床意义很明确,但仍需进一步研究以了解锯齿状肿瘤和最佳息肉切除术后监测间隔对患者终生结肠直肠癌的风险。

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