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： 已经发现，在多种人类癌症中，处于癌症侵袭性前沿的肿瘤细胞与其余肿瘤细胞有很大的不同。目前对94例口腔鳞状细胞癌（OSCC）的多因素生存分析表明，侵袭性肿瘤细胞的嗜银性核仁组织者区域相关蛋白（AgNOR）含量和多参数组织病理学肿瘤分级均与肿瘤相关死亡显着且独立相关，与常规Broders的肿瘤分级和临床分期无关。因此，在侵袭性OSCC前沿，较高的肿瘤前沿评分和AgNOR含量似乎反映出恶性潜能的增加。通过标准化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。

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。

BACKGROUND & AIMS: :There are numerous analytic and methodological limitations to current measures of drug market activity. This paper explores the structure of markets and individual user behavior to provide an integrated understanding of behavioral and economic (and market) aspects of illegal drug use with an aim toward developing improved procedures for measurement. This involves understanding the social processes that structure illegal distribution networks and drug users' interactions with them. These networks are where and how social behaviors, prices, and markets for illegal drugs intersect. Our focus is upon getting an up close measurement of these activities. Building better measures of consumption behaviors necessitates building better rapport with subjects than typically achieved with one-time surveys in order to overcome withholding and underreporting and to get a comprehensive understanding of the processes involved. This can be achieved through repeated interviews and observations of behaviors. This paper also describes analytic advances that could be adopted to direct this inquiry including behavioral templates, and insights into the economic valuation of labor inputs and cash expenditures for various illegal drugs. Additionally, the paper makes recommendations to funding organizations for developing the mechanisms that would support behavioral scientists to weigh specimens and to collect small samples for laboratory analysis-by providing protection from the potential for arrest. The primary focus is upon U.S. markets. The implications for other countries are discussed.

背景与目标： ：目前对药物市场活动的度量存在许多分析和方法学限制。本文探讨了市场结构和个人用户行为，以提供对非法药物使用的行为和经济（及市场）方面的综合理解，旨在开发改进的测量程序。这涉及了解构成非法分销网络和吸毒者与之互动的社会过程。这些网络是非法毒品的社会行为，价格和市场在何处以及如何相交的地方。我们的重点是仔细衡量这些活动。要建立更好的消费行为衡量标准，就必须与受试者建立更好的融洽关系，这要比一次调查更能实现，以克服扣缴和漏报的情况，并对所涉及的过程有一个全面的了解。这可以通过反复采访和观察行为来实现。本文还描述了可用于指导这一询问的分析进展，包括行为模板，以及对各种非法药物的劳动投入和现金支出的经济估值的见解。此外，该论文还向资助组织提出了建议，以开发机制，以支持行为科学家称量样本并收集小样本进行实验室分析，从而提供保护措施以防止被捕。主要重点是美国市场。讨论了对其他国家的影响。

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： ：非愈合性糖尿病足溃疡（DFU）是糖尿病的常见且代价高昂的并发症。尽管对影响微生物负荷，多样性和/或致病性的临床因素知之甚少，但是微生物负荷或“生物负荷”被认为是延迟愈合的基础。我们使用细菌16S核糖体RNA基因的高通量测序对52例无感染临床症状的神经性非缺血性DFU的微生物群进行了分析。相比之下，伤口培养物（临床上的标准诊断方法）在很大程度上代表了微生物负荷，微生物多样性以及潜在病原体的存在。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，但被分为三类，主要以优势细菌和多样性为特征。溃疡深度与溃疡簇有关，与厌氧菌的数量呈正相关，与葡萄球菌的数量呈负相关。溃疡持续时间与细菌多样性，物种丰富度和变形杆菌相对丰度呈正相关，而与葡萄球菌相对丰度呈负相关。最后，血糖控制不佳与溃疡簇有关，最差的中位血糖控制集中于富含葡萄球菌和富含链球菌的溃疡簇。在前瞻性研究中，对微生物群落组成和结构的分析可能会提供最有用的指标，以从良性定殖中确定有问题的生物负荷，然后将其用于临床治疗。

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

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为追踪几乎所有哺乳动物的饮食习惯提供一种非侵入性的方法。虽然通常收集粪便样本用于宏观和遗传研究，但稳定同位素分析也可用于扩展对物种特定的饮食生态学的了解。尚不清楚消化如何改变动物饮食的同位素比率，因此需要更严格的饮食研究。迄今为止，大多数日粮对粪便控制的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，我分析了杂食性小型猫鼬（Suricata suricatta）的日粮和粪便中碳和氮的稳定同位素比。饮食与粪便之间的碳营养辨别因子（Δ13Cfeces）计算为0.1±1.5‰，与零无显着差异，反过来与饮食投入也无差异。另一方面，氮营养辨别因子（Δ15Nfeces）为1.5±1.1‰，与零显着不同，这意味着它与平均饮食投入不同。根据该实验产生的数据和对已发表文献的评论，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极好快照，可以与其他分析方法结合使用，以更好地了解哺乳动物的生态，饮食和栖息地。

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。

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： 简介：烧伤护理的目标是“结果的质量必须值得生存之苦”。需要更多的研究来了解如何最好地为烧伤患者提供护理以实现该目标。烧伤和照顾者患者失去独立性，功能以及收入损失，在个人和社会层面都造成了沉重的负担。为了提高临床护理领域的知识水平，正在做很多工作。然而，很少有研究探讨社会心理结果。本文描述了一项研究背景和方法，该方法在澳大利亚严重烧伤后心理社会结局队列研究中实施。
方法和分析：在这项队列研究中，医院工作人员确定了230名年龄在18岁或以上，被纳入一个州范围内烧伤中心的烧伤中心的参与者的目标样本。基线调查数据在受伤后28天内亲自或通过电话收集，参与者在烧伤后3、6和12个月进行电话访谈。伤害和烧伤治疗信息是从医疗记录中收集的。社会支持是使用感知的社会支持多维量表作为预测变量来衡量的。通过生活质量（SF-12，EQ-5D，BSHS-B），抑郁症（PHQ-9），创伤后应激障碍（PCL-C，PAS），社区整合等领域的标准化措施收集结果数据（CIQ-R）和质量调整寿命年（EQ-5D）。额外的调查问题可衡量受伤后12个月的生活满意度，重返工作岗位和使用公共服务的情况。数据分析方法将包括方差分析，Pearson相关性和分层多元回归分析。
道德与传播：医院和昆士兰大学人类研究伦理委员会已批准该协议。该研究的结果将在国家和国际会议，同行评审期刊和博士学位论文中进行传播。
试验注册号：澳大利亚新西兰临床试验注册（ACTRN12616000828426）。追溯注册于2016年6月23日;结果。

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。