BACKGROUND & AIMS: OBJECTIVE:The objective of our study was to evaluate whether 0.3-second cine CT can be used to detect air trapping in the lungs of young children. SUBJECTS AND METHODS:In 30 children (mean age, 25 months), 0.3-second cine CT was performed at six levels during 3 seconds of quiet breathing. The study population was divided into an air trapping group (n = 24) and a no-air trapping group (n = 6). Lung density was measured at an abnormal area (with or without air trapping) and an adjacent normal area on inspiratory and expiratory phase images. Lung density differences between inspiration and expiration were calculated and compared in abnormal areas (with or without air trapping) and in normal areas. Their percentages were calculated and compared between the two groups. In addition, lung density differences between abnormal and adjacent normal areas were calculated and compared between the two groups. RESULTS:Lung density differences between inspiration and expiration were smaller in areas with air trapping (mean +/- SD, -19 +/- 34 H) than in abnormal areas without air trapping (138 +/- 36 H) (p < 0.001) or in normal areas (111 +/- 49 H) (p < 0.001). Their percentages were smaller in the group with air trapping (-27% +/- 54%) than in the group with no air trapping (120% +/- 87%) (p < 0.001). In the group with air trapping, lung density differences were larger at the expiratory phase (260 +/- 77 H) than at the inspiratory phase (129 +/- 69 H) (p < 0.001), but did not change through the respiratory cycle in the group with no air trapping (p > 0.05). CONCLUSION:Air trapping can be accurately detected in the lungs of free-breathing young children using 0.3-second cine CT.

背景与目标： 目的：本研究的目的是评估0.3秒的电影CT是否可用于检测年幼儿童肺部的空气滞留情况。
研究对象和方法：在30名儿童（平均年龄25个月）中，在安静呼吸的3秒内以六个级别进行了0.3秒的电影CT检查。研究人群分为空气诱捕组（n = 24）和无空气诱捕组（n = 6）。在吸气和呼气相位图像上的异常区域（有或没有空气滞留）和相邻的正常区域测量肺密度。计算了吸气和呼气之间的肺密度差异，并在异常区域（有或没有空气滞留）和正常区域中进行了比较。计算他们的百分比，并在两组之间进行比较。此外，计算并比较了正常和邻近正常区域之间的肺密度差异。
结果：有空气滞留的区域（平均/-SD，-19 /-34 H）的吸气和呼气之间的肺密度差异要小于没有空气滞留的异常区域（138 /-36 H）（p <0.001）或在有空气滞留的区域。正常区域（111 /-49 H）（p <0.001）。有空气滞留组的百分比（-27％/-54％）比没有空气滞留组的百分比（120％/-87％）小（p <0.001）。在有空气滞留的组中，呼气阶段（260 /-77 H）的肺密度差异大于吸气阶段（129 /-69 H）的肺密度差异（p <0.001），但在整个呼吸周期中没有变化。没有空气滞留的组（p> 0.05）。
结论：使用0.3秒的电影CT可以准确地检测自由呼吸的幼儿的肺部空气捕获。

BACKGROUND & AIMS: :The incidence of thromboembolism is higher in mitral regurgitation. Mean platelet volume (MPV), which is calculated automatically in the complete blood count tests, indicates platelet production, function and activation. Elevated MPV levels in cardiovascular diseases and some heart valve diseases have been shown before. We aimed to investigate the relationship between MPV and mitral regurgitation, and to evaluate the MPV levels according to the presence of atrial fibrillation or left atrial appendage thrombus in patients with mitral regurgitation for the first time. The study included 57 patients who had undergone transthoracic and transesophageal echocardiography for the classic symptoms and diagnosed with primary (organic) mitral regurgitation. The control group was composed of 46 age, sex and BMI-matched healthy individuals who had undergone transthoracic echocardiography and obtained normal findings. Echocardiographic evaluation was performed according to the recommendations of the American Echocardiography Society. Mean MPV values in patients with mitral regurgitation were significantly higher than the control group (P < 0.001). MPV levels and the thrombus risk were correlated with the severity of the disease. When the patients with mitral regurgitation were classified according to the presence of atrial fibrillation and left atrial appendage thrombus, patients with atrial fibrillation had higher MPV levels compared to patients with normal sinus rhythm (P < 0.001). In addition, highest MPV levels were found in patients with both atrial fibrillation and thrombosis (P < 0.001). In conclusion, measurement of MPV may be considered as a quick and reliable guide in the assessment of mitral regurgitation and thrombus, without any cost or any advanced expensive technology.

背景与目标： ：在二尖瓣关闭不全中血栓栓塞的发生率较高。在全血细胞计数测试中自动计算的平均血小板体积（MPV）表示血小板的产生，功能和激活。以前已经显示出心血管疾病和某些心脏瓣膜疾病中MPV水平升高。我们旨在调查MPV与二尖瓣反流之间的关系，并首次根据二尖瓣反流患者的房颤或左心耳血栓的存在来评估MPV水平。该研究纳入了57例因经典症状接受经胸和经食道超声心动图检查并诊断为原发性（有机）二尖瓣关闭不全的患者。对照组由46名年龄，性别和BMI匹配的健康个体组成，这些个体均接受了经胸超声心动图检查并获得正常结果。超声心动图评估是根据美国超声心动图学会的建议进行的。二尖瓣关闭不全患者的平均MPV值显着高于对照组（P <0.001）。 MPV水平和血栓风险与疾病的严重程度相关。根据房颤和左心耳血栓的存在对二尖瓣返流患者进行分类时，与正常窦性心律患者相比，房颤患者的MPV水平更高（P <0.001）。此外，房颤和血栓形成患者的MPV水平最高（P <0.001）。总之，MPV的测量可被视为评估二尖瓣反流和血栓的快速可靠的指南，而无需任何成本或任何先进的昂贵技术。

BACKGROUND & AIMS: BACKGROUND:The relationship between volume and outcomes in bariatric surgery is well established in the literature. However, the analyses were performed primarily in the open surgery era and in the absence of national accreditation. The recent Metabolic Bariatric Surgery Accreditation and Quality Improvement Program proposed an annual threshold volume of 50 stapling cases. This study aimed to examine the effect of volume and accreditation on surgical outcomes for bariatric surgery in this laparoscopic era. METHODS:The Nationwide Inpatient Sample was used for analysis of the outcomes experienced by morbidly obese patients who underwent an elective laparoscopic stapling bariatric surgical procedure between 2006 and 2010. In this analysis, low-volume centers (LVC < 50 stapling cases/year) were compared with high-volume centers (HVC ≥ 50 stapling cases/year). Multivariate analysis was performed to examine risk-adjusted serious morbidity and in-hospital mortality between the LVCs and HVCs. Additionally, within the HVC group, risk-adjusted outcomes of accredited versus nonaccredited centers were examined. RESULTS:Between 2006 and 2010, 277,760 laparoscopic stapling bariatric procedures were performed, with 85% of the cases managed at HVCs. The mean number of laparoscopic stapling cases managed per year was 17 ± 14 at LVCs and 144 ± 117 at HVCs. The in-hospital mortality was higher at LVCs (0.17%) than at HVCs (0.07%). Multivariate analysis showed that laparoscopic stapling procedures performed at LVCs had higher rates of mortality than those performed at HVCs [odds ratio (OR) 2.5; 95% confidence interval (CI) 1.3-4.8; p < 0.01] as well as higher rates of serious morbidity (OR 1.2; 95% CI 1.1-1.4; p < 0.01). The in-hospital mortality rate at nonaccredited HVCs was 0.22% compared with 0.06% at accredited HVCs. Multivariate analysis showed that nonaccredited centers had higher rates of mortality than accredited centers (OR 3.6; 95% CI 1.5-8.3; p < 0.01) but lower rates of serious morbidity (OR 0.8; 95% CI 0.7-0.9; p < 0.01). CONCLUSION:In this era of laparoscopy, hospitals managing more than 50 laparoscopic stapling cases per year have improved outcomes. However, nonaccredited HVCs have outcomes similar to those of LVCs. Therefore, the impact of accreditation on outcomes may be greater than that of volume.

背景与目标： 背景：减肥手术的量与结局之间的关系在文献中已得到很好的确立。但是，分析主要是在开放手术时代进行的，并且没有获得国家认可。最近的代谢性减肥手术认证和质量改进计划提出了每年50例吻合钉病例的门槛。这项研究的目的是检查在这个腹腔镜时代减肥和手术对减肥手术效果的影响。
方法：使用全国住院患者样本分析2006年至2010年间接受选择性腹腔镜吻合钉减肥手术的病态肥胖患者的结局。在该分析中，采用低容量中心（LVC <50例吻合钉/年）与高容量中心相比（HVC≥50例吻合钉病例/年）。进行多变量分析以检查LVC和HVC之间经风险调整的严重发病率和院内死亡率。此外，在HVC组中，对认证中心和非认证中心的风险调整后结果进行了检查。
结果：2006年至2010年，共进行了277,760例腹腔镜吻合钉减肥手术，其中85％的病例是在HVC进行的。每年接受治疗的腹腔镜吻合钉病例的平均数在LVCs为17±14，而在HVCs为144±117。 LVCs（0.17％）的住院死亡率高于HVCs（0.07％）。多变量分析显示，在LVC处进行的腹腔镜吻合术的死亡率高于在HVC处进行的[死亡率比（OR）2.5； 95％置信区间（CI）1.3-4.8； p <0.01]以及更高的严重发病率（OR 1.2； 95％CI 1.1-1.4； p <0.01）。未经认可的HVC的住院死亡率为0.22％，而获得认可的HVC的住院死亡率为0.06％。多变量分析显示，未经认证的中心的死亡率高于经认证的中心（OR 3.6； 95％CI 1.5-8.3； p <0.01），但较低的严重发病率（OR 0.8； 95％CI 0.7-0.9； p <0.01） 。
结论：在腹腔镜时代，每年处理超过50例腹腔镜吻合钉病例的医院可改善结局。但是，未经认证的HVC的结果与LVC相似。因此，认证对结果的影响可能大于结果的影响。

BACKGROUND & AIMS: BACKGROUND:Modic changes (MC) are associated with low back pain (LBP). In this study, we compared changes in size and type of MC, after a single intravenous infusion of 5 mg zoledronic acid (ZA) or placebo, among chronic LBP patients with MC on magnetic resonance imaging (MRI), and evaluated whether the MRI changes correlate with symptoms. METHODS:All patients (N = 19 in ZA, 20 in placebo) had MRI at baseline (0.23-1.5 T) and at one year (1.5-3 T). We evaluated the level, type and volume of all the MC. The MC were classified into M1 (M1 (100%)), predominating M1 (M1/2 (65:35%)) or predominating M2 (M1/2 (35:65%)), and M2 (M2 (100%)). The first two were considered M1-dominant, and the latter two M2-dominant. Volumes of M1 and M2 were calculated separately for the primary MC, which was assumed to cause the symptoms, and the other MC. We analysed the one-year treatment differences in M1 and M2 volumes using analysis of covariance with adjustments for age, sex, body mass index, and smoking. The correlations between the MRI changes and the changes in LBP symptoms were analysed using Pearson correlations. RESULTS:In the ZA group, 84.2% of patients had M1-dominant primary MC at baseline, compared to 50% in the placebo group (p = 0.041). The primary MC in the ZA group converted more likely to M2-dominant (42.1% ZA, 15% placebo; p = 0.0119). The other MC (15 ZA, 8 placebo) were on average 42% smaller and remained largely M2-dominant. The M1 volume of the primary MC decreased in the ZA group, but increased in the placebo group (-0.83 cm3 vs 0.91 cm3; p = 0.21). The adjusted treatment difference for M1 volume was -1.9 cm3 (95% CI -5.0 to 1.2; p = 0.22) and for M2 volume 0.23 cm3 (p = 0.86). In the MC that remained M1-dominant, volume change correlated positively with increased symptoms in the placebo group, whereas the correlations were negative and weak in the ZA group. CONCLUSIONS:Zoledronic acid tended to speed up the conversion of M1-dominant into M2-dominant MC and decrease the volume of M1-dominant MC, although statistical significance was not demonstrated. TRIAL REGISTRATION:The registration number in ClinicalTrials.gov is NCT01330238 and the date of registration February 11, 2011.

背景与目标： 背景：Modic change（MC）与下背痛（LBP）相关。在这项研究中，我们比较了在接受磁共振成像（MRI）的MC的慢性LBP患者中，单次静脉注射5 mg唑来膦酸（ZA）或安慰剂后MC的大小和类型的变化，并评估了MRI是否改变与症状相关。
方法：所有患者（ZA中N = 19，安慰剂中20）在基线（0.23-1.5 T）和一年（1.5-3 T）均接受MRI检查。我们评估了所有MC的级别，类型和体积。 MC分为M1（M1（100％）），M1（M1 / 2（65：35％））或M2（M1 / 2（35：65％））以及M2（M2（100％） ）。前两个被认为是M1主导，后两个被认为是M2主导。 M1和M2的体积分别针对假定会引起症状的主MC和其他MC进行计算。我们使用年龄，性别，体重指数和吸烟调整的协方差分析，分析了M1和M2量在一年治疗中的差异。使用Pearson相关性分析MRI变化与LBP症状变化之间的相关性。
结果：在ZA组中，有84.2％的患者在基线时具有M1为主的原发性MC，而在安慰剂组中则为50％（p = 0.041）。 ZA组中的主要MC更有可能转化为M2型（42.1％ZA，15％安慰剂; p = 0.0119）。另一个MC（15 ZA，8个安慰剂）平均缩小了42％，并且仍以M2为主。在ZA组中，主要MC的M1体积减少，但在安慰剂组中增加（-0.83 cm3对0.91 cm3; p = 0.21）。 M1体积的调整后治疗差异为-1.9 cm3（95％CI -5.0至1.2; p = 0.22），M2体积为0.23 cm3（p = 0.86）。在以M1为主的MC中，安慰剂组的体量变化与症状增加呈正相关，而ZA组的相关性为负而微弱。
结论：唑来膦酸具有加速M1主导型向M2主导型MC转化的作用，并降低M1主导型MC的体积，尽管没有统计学意义。
试用注册：ClinicalTrials.gov中的注册号为NCT01330238，注册日期为2011年2月11日。

BACKGROUND & AIMS: :Material properties play a significant role in pharmaceutical processing. In the present study, a novel approach is used to determine solid fraction (SF) based on a direct measurement (DM) of the apparent volume of a sample. The sample was scanned with low intensity laser beams that integrate the sample thickness across the surface (area) and quantitate the apparent volume. The SF by DM method was compared against that obtained by volume displacement (VD) and manual measurement methods. SF was determined by all three methods for formulations of Avicel DG, lactose and a 1:1 mixture of the two. The results from DM method and variability were comparable to that obtained by VD method. The manual method provided lower and more variable results. The DM method was able to differentiate between SF of different ribbon and tablet formulations and at varying force levels. Tracking SF of compacts during tablet development can help in setting acceptable specifications and to understand material deformation behavior during compression. Further, the results of the study indicate that the DM method using laser scan technique was suitable for routine testing of SF of roller compacted ribbons and compressed tablets.

背景与目标： ：材料特性在药物加工中起着重要作用。在本研究中，一种新颖的方法用于基于样品表观体积的直接测量（DM）来确定固体分数（SF）。用低强度激光束扫描样品，该激光束对整个表面（区域）的样品厚度进行积分并确定表观体积。将通过DM方法获得的SF与通过体积位移（VD）和手动测量方法获得的SF进行比较。通过Avicel DG，乳糖和两者的1：1混合物的所有三种方法测定SF。 DM方法和变异性的结果与VD方法可比。手动方法提供的结果更低且更多。 DM方法能够区分不同色带和片剂配方的SF，并以不同的力水平进行区分。在片剂开发过程中跟踪压坯的SF有助于设置可接受的规格并了解压缩过程中的材料变形行为。此外，研究结果表明，使用激光扫描技术的DM方法适用于辊压压实色带和压片的SF的常规测试。

BACKGROUND & AIMS: :Despite intensive research, brain tumors remain among the most difficult type of malignancies to treat, due largely to their diffusely invasive nature and the associated difficulty of adequate surgical resection. To migrate through the brain parenchyma and to proliferate, glioma cells must be capable of significant changes in shape and volume. We have previously reported that glioma cells express an amiloride- and psalmotoxin-sensitive cation conductance that is not found in normal human astrocytes. In the present study, we investigated the potential role of this ion channel to mediate regulatory volume increase in glioma cells. We found that the ability of the cells to volume regulate subsequent to cell shrinkage by hyperosmolar solutions was abolished by both amiloride and psalmotoxin 1. This toxin is thought to be a specific peptide inhibitor of acid-sensing ion channel (ASIC1), a member of the Deg/ENaC superfamily of cation channels. We have previously shown this toxin to be an effective blocker of the glioma cation conductance. Our data suggest that one potential role for this conductance may be to restore cell volume during the cell's progression thorough the cell cycle and while the tumor cell migrates within the interstices of the brain.

背景与目标： 尽管进行了深入的研究，脑肿瘤仍然是最难治疗的恶性肿瘤之一，这在很大程度上归因于其弥漫性侵袭性和相应的手术切除困难。为了通过脑实质迁移并增殖，神经胶质瘤细胞必须能够在形状和体积上发生显着变化。我们以前曾报道过，神经胶质瘤细胞表达一种在正常人星形胶质细胞中未发现的对阿米洛利和psalmotoxin敏感的阳离子电导。在本研究中，我们调查了该离子通道介导神经胶质瘤细胞调节体积增加的潜在作用。我们发现阿米洛利和psalmotoxin 1都消除了高渗溶液对细胞收缩后细胞体积调节的能力。这种毒素被认为是酸敏感离子通道（ASIC1）的一种特定的肽抑制剂，它是酸敏感离子通道的成员。阳离子通道的Deg / ENaC超家族。我们以前已经证明这种毒素是神经胶质瘤阳离子电导的有效阻断剂。我们的数据表明，这种电导的一个潜在作用可能是在整个细胞周期的细胞进程中以及肿瘤细胞在大脑间隙内迁移的过程中恢复细胞体积。

BACKGROUND & AIMS: :Intra-luminal thrombus has been suggested to play a role in the progression of abdominal aortic aneurysm (AAA). The aims of this study were twofold. Firstly, to assess the reproducibility of a computer tomography (CT)-based technique for measurement of aortic thrombus volume. Secondly, to examine the determinants of infrarenal aortic thrombus volume in a cohort of patients with aortic dilatation. A consecutive series of 75 patients assessed by CT angiography with maximum aortic diameter > or = 25 mm were recruited. Intra-luminal thrombus volume was measured by a semi-automated workstation protocol based on a previously defined technique to quantitate aortic calcification. Intra- and inter-observer reproducibility were assessed using correlation coefficients, coefficient of variation and Bland-Altman plots. Infrarenal aortic thrombus volume percentage was related to clinical, anatomical and blood characteristics of the patients using univariate and multivariate tests. Infrarenal aortic thrombus volume was related to the severity of aortic dilatation assessed by total aortic volume (r = 0.87, P < 0.0001) or maximum aortic diameter (r = 0.74, P < 0.0001). We therefore examined the clinical determinates of aortic thrombus expressed as a percentage of total aortic volume. Aortic thrombus percentage was negatively correlated with serum high density lipoprotein (HDL, r = -0.31). By ordinal multiple logistic regression analysis serum HDL below median (< or = 1.2 mM: ) was associated with aortic thrombus percentage in the upper quartile adjusting for other risk factors (odds ratio 5.3, 95% CI 1.1-25.0). Infrarenal aortic thrombus volume can be measured reproducibly on CT. Serum HDL, which can be therapeutically raised, may play a role in discouraging aortic thrombus accumulation with implications in terms of delaying progression of AAA.

背景与目标： 提示腔内血栓在腹主动脉瘤（AAA）的进展中起作用。这项研究的目的是双重的。首先，评估基于计算机断层扫描（CT）的技术在测量主动脉血栓量方面的可重复性。其次，检查一群主动脉扩张患者的肾下主动脉血栓量的决定因素。连续征集了75例经CT血管造影评估为最大主动脉直径≥25 mm的患者。腔内血栓量是通过基于先前定义的定量主动脉钙化的技术的半自动化工作站方案进行测量的。使用相关系数，变异系数和Bland-Altman图评估观察者之间和观察者之间的可重复性。肾下主动脉血栓体积百分比与患者的临床，解剖学和血液特征有关，采用单因素和多因素测试。肾下主动脉血栓量与主动脉扩张的严重程度有关，后者通过总主动脉体积（r = 0.87，P <0.0001）或最大主动脉直径（r = 0.74，P <0.0001）评估。因此，我们检查了主动脉血栓的临床测定值，以总主动脉体积的百分比表示。主动脉血栓百分比与血清高密度脂蛋白呈负相关（HDL，r = -0.31）。通过序数logistic回归分析，血清HDL低于中位数（<或= 1.2 mM：）与上四分位的主动脉血栓百分比相关，并调整了其他危险因素（赔率比5.3，95％CI 1.1-25.0）。肾下主动脉血栓体积可在CT上重复测量。可以治疗性升高的血清HDL可能在阻止主动脉血栓积聚方面起作用，可能会延迟AAA的进展。

BACKGROUND & AIMS: PURPOSE:To evaluate if volume or any of the three dimensions of prostate influences cancer detection rate by 12-core transrectal ultrasound (TRUS) guided prostate biopsy. MATERIALS AND METHODS:We have searched our database for patients who underwent 12 core TRUS guided prostate biopsy with PSA values between 4.0 and 9.9 ng/ml, benign digital exam and no suspicious lesions at TRUS. The measurements of three dimensions and volume of the prostate of 99 patients were correlated with cancer detection rates of biopsy. RESULTS:There were no statistically significant differences between patients with prostate cancer or with benign histopathologic result for mean age, PSA and % PSA. Patients without cancer had a significantly higher mean prostate volume (58.88 cc) than patients with cancer (48.85 cc) (P = 0.038). A volume of 48.5 cc was determined as a cut-off value above which cancer detection rate decreases. Of the three dimensions, only the difference for the craniocaudal dimension between benign and malignant groups was marginally significant (P = 0.052). CONCLUSIONS:With 12 core biopsy, cancer detection rate is lower in patients with prostates larger than 48.5 cc. Further studies comparing biopsy results with prostatectomy specimens can clarify whether these results necessitates higher number of cores for such patients.

背景与目标： 目的：通过12芯经直肠超声（TRUS）引导的前列腺活检，评估前列腺的体积或三个维度中的任何一个是否会影响癌症的检出率。
材料和方法：我们已经搜索了数据库，以进行12例TRUS指导的前列腺活检，PSA值在4.0到9.9 ng / ml之间的患者，进行了良性数字化检查，在TRUS时没有可疑的病变。 99例患者的前列腺的三个维度和体积的测量值与活检的癌症检出率相关。
结果：前列腺癌或组织学检查结果良好的前列腺癌患者的平均年龄，PSA和％PSA无统计学差异。没有癌症的患者的平均前列腺体积（58.88 cc）明显高于患有癌症的患者（48.85 cc）（P = 0.038）。确定48.5cc的体积作为临界值，在该临界值以上，癌症检测率降低。在这三个维度中，仅良性和恶性组之间的颅尾尺寸差异很小（P = 0.052）。
结论：经12次核心活检，前列腺癌大于48.5 cc的患者的癌症检出率较低。将活检结果与前列腺切除术标本进行比较的进一步研究可以阐明这些结果是否需要为此类患者提供更多的核心。

BACKGROUND & AIMS: BACKGROUND:Accumulating evidence suggests that hematopoiesis, especially erythropoiesis, is disturbed in heart failure (HF) for many reasons. Low hemoglobin and red blood cell distribution width have emerged as prognostic indicators of HF independent of classic predictors. The prognostic implication of mean corpuscular volume (MCV) in HF, however, is unknown. In this context, we investigated the relationship between MCV and prognosis of acute decompensated HF (ADHF). METHODS AND RESULTS:This retrospective cohort study consisted of 458 consecutive patients with ADHF who had emergency admission to hospital. Patients were divided into 2 groups: MCV ≤100fl (non-macrocytic group, n=400); and MCV >100fl (macrocytic group, n=58). The relationship between MCV and all-cause death was tested using Cox proportional hazard models, adjusting for other predictors. Mean patient age was 72.4 years and mean MCV was 93.0±7.1fl. Hemoglobin was significantly lower in the macrocytic group than the non-macrocytic group. During the mean follow-up of 20.8 months, a total of 173 deaths (37.9%) occurred. Kaplan-Meier analysis showed that all-cause death was significantly higher in the macrocytic group (log-rank P<0.0001). Cox proportional hazards analysis indicated that macrocytosis was an independent predictor of all-cause death (hazard ratio, 2.288; 95% confidence interval: 1.390-3.643; P=0.0015) after adjustment in the multivariate model. CONCLUSIONS:It is proposed for the first time that MCV is an independent predictor of all-cause death in patients with ADHF.

背景与目标： 摘要背景：越来越多的证据表明，由于许多原因，造血功能，尤其是红细胞生成功能在心力衰竭（HF）中受到干扰。低血红蛋白和红细胞分布宽度已成为独立于经典预测因素的HF的预后指标。但是，HF中平均红细胞体积（MCV）对预后的影响尚不清楚。在这种情况下，我们调查了急性失代偿性HF（ADHF）的MCV与预后之间的关系。
方法和结果：这项回顾性队列研究由458名连续住院的ADHF患者组成。将患者分为2组：MCV≤100fl（非大细胞组，n = 400）； MCV> 100fl（大分子组，n = 58）。使用Cox比例风险模型测试了MCV与全因死亡之间的关系，并针对其他预测因素进行了调整。平均患者年龄为72.4岁，平均MCV为93.0±7.1fl。大细胞组的血红蛋白明显低于非大细胞组。在平均20.8个月的随访期间，共发生173例死亡（37.9％）。 Kaplan-Meier分析表明，大细胞组的全因死亡明显更高（log-rank P <0.0001）。 Cox比例风险分析表明，在多变量模型中进行调整后，大细胞增多是全因死亡的独立预测因子（风险比为2.288； 95％置信区间为1.390-3.643； P = 0.0015）。
结论：首次提出MCV是ADHF患者全因死亡的独立预测因子。

BACKGROUND & AIMS: AIMS:Reduced forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) have been associated with increased incidence of cardiovascular diseases. However, whether reduced lung function is also a risk factor for incidence of atrial fibrillation (AF) is still unclear. We aimed to determine whether lung function predicted AF in the Malmö Preventive Project, a large population-based cohort with a long follow-up. METHODS AND RESULTS:The study population consisted of 7674 women and 21 070 men, mean age 44.6 years. The cohort was followed on average for 24.8 years, during which time 2669 patients were hospitalized due to AF. The incidence of AF in relationship to quartiles of FEV1 and FVC and per litre decrease at baseline was determined using a Cox proportional hazards model adjusted for age, height, weight, current smoking status, systolic blood pressure, erythrocyte sedimentation rate, and fasting blood glucose. Forced expiratory volume in one second was inversely related to incidence of AF (per litre reduction in FEV1) hazard ratio (HR): 1.39 [95% confidence interval (CI): 1.16-1.68; P = 0.001] for women, and HR: 1.20 (95% CI: 1.13-1.29; P < 0.0001) for men. Forced vital capacity was also inversely related to incidence of AF (per litre reduction in FVC) HR: 1.20 (95% CI: 1.03-1.41; P = 0.020) for women, and HR: 1.08 (95% CI: 1.02-1.14; P = 0.01) for men. This relationship was consistent in non-smokers as well as smokers, and among individuals younger than the median age of 45.8 years or normotensive subjects. CONCLUSION:Impaired lung function is an independent predictor of AF. This may explain some risk of AF that is currently unaccounted for.

背景与目标： 目的：一秒钟内减少强制呼气量（FEV1）和强制肺活量（FVC）与心血管疾病的发病率增加相关。但是，肺功能下降是否也是心房颤动（AF）发生的危险因素仍不清楚。我们旨在确定在马尔默预防项目中，肺功能是否能预测房颤，该项目是一项以人群为基础的大型队列研究，需要长期随访。
方法与结果：研究人群为7674名女性和21 070名男性，平均年龄44.6岁。该队列平均随访了24.8年，在此期间有2669例因AF住院的患者。使用针对年龄，身高，体重，当前吸烟状况，收缩压，红细胞沉降率和空腹血糖调整的Cox比例风险模型，确定与FEV1和FVC四分位数相关的房颤发生率以及基线时每升的下降。一秒钟的强制呼气量与房颤的发生率（每升FEV1减少）成反比（HR）：1.39 [95％置信区间（CI）：1.16-1.68； P = 0.001]（女性）和HR：1.20（95％CI：1.13-1.29； P <0.0001）。强迫肺活量也与AF的发生率成反比（女性每升FVC降低）HR：女性HR：1.20（95％CI：1.03-1.41； P = 0.020）； HR：1.08（95％CI：1.02-1.14）； P = 0.01）。在非吸烟者和吸烟者中，以及年龄中位数为45.8岁以下或血压正常的受试者之间，这种关系是一致的。
结论：肺功能受损是房颤的独立预测因子。这可以解释目前尚无法解决的房颤风险。

BACKGROUND & AIMS: OBJECTIVES:We aimed to establish which of sitting height (SH) and total height (Ht) is most appropriately used in the scaling of adult body mass (BM), waist circumference (WC), and forced vital capacity (FVC), considering likely explanations and proposing a suitable index for each. METHODS:Data were from the US Third National Health and Nutrition Survey for white and black American women and men aged 20 to 50 years. Statistical analysis involved mainly correlation coefficients, the multiple regression of BM, WC, or FVC on SH and leg length (LL), and fitting of allometric regression equations relating each of BM, WC, and FVC to SH or Ht. RESULTS:BM and WC correlated more strongly with SH than with Ht, and FVC correlated more strongly with Ht. Associations with LL were negative for WC, negative or nonsignificant for BM, and positive for FVC. Using round-number exponents for Ht and SH, the allometric relationships indicated that appropriate indices are BM/SH3 , WC/SH, and FVC/Ht2 . CONCLUSIONS:Contrary to usual practice, BM and WC are better scaled in relation to SH than to Ht. FVC is slightly better scaled in relation to Ht, as is conventional. Interpretations involve the small influence of LL on BM and the influence both of gluteo-femoral fatness on measured SH and of childhood health and nutrition on adult LL, WC, and FVC. It is evident that SH should be measured more often for research purposes.

背景与目标： 目的：考虑到可能的情况，我们旨在确定最适合用于成人体重（BM），腰围（WC）和强迫肺活量（FVC）缩放的坐高（SH）和总身高（Ht）中的哪一个解释并为每个提出合适的索引。
方法：数据来自美国第三次全国健康与营养调查，调查对象为20至50岁的美国白人和黑人。统计分析主要涉及相关系数，BM，WC或FVC在SH和腿长（LL）上的多元回归，以及将BM，WC和FVC分别与SH或Ht相关的异速回归方程的拟合。
结果：BM和WC与SH的相关性比与Ht的相关性强，而FVC与Ht的相关性则更强。与LL的关联对WC呈阴性，对BM呈阴性或不显着，对FVC呈阳性。使用Ht和SH的整数指数，异速关系表明合适的指数是BM / SH3，WC / SH和FVC / Ht2。
结论：与通常的做法相反，相对于SH，BM和WC的缩放比例要好于Ht。与传统技术相比，FVC相对于Ht具有更好的缩放比例。解释涉及LL对BM的影响较小，以及臀股脂肪对测得的SH的影响以及儿童健康和营养对成年LL，WC和FVC的影响。显然，出于研究目的，应更频繁地测量SH。

BACKGROUND & AIMS: OBJECTIVES:To investigate volume-outcome relationships in nephrectomy and cystectomy for cancer. MATERIALS AND METHODS:Data were extracted from the UK Hospital Episodes Statistics database, which records data on all National Health Service (NHS) hospital admissions in the England. Data were included for a 5-year period (April 2013-March 2018 inclusive) and data on emergency and paediatric admissions were excluded. Data were extracted on the NHS trust and surgeon undertaking the procedure, the surgical technique used (open, laparoscopic or robot-assisted) and length of hospital stay during the procedure. This dataset was supplemented by data on mortality from the UK Office for National Statistics. A number of volume thresholds and volume measures were investigated. Multilevel modelling was used to adjust for hierarchy and confounding factors. RESULTS:Data were available for 18 107 nephrectomy and 6762 cystectomy procedures for cancer. There was little evidence of trust or surgeon volume influencing readmission rates or mortality. There was some evidence of shorter length of hospital stay for high-volume surgeons, although the volume measure and threshold used were important. CONCLUSIONS:We found little evidence that further centralization of nephrectomy or cystectomy for cancer surgery will improve the patient outcomes investigated. It may be that length of stay can be optimized though training and support for lower-volume centres, rather than further centralization.

背景与目标： 目的：探讨在肾切除术和膀胱切除术中癌症的体积-结果关系。
材料与方法：数据来自英国医院情节统计数据库，该数据库记录了英格兰所有国家卫生服务（NHS）医院的入院数据。纳入了5年期间（2013年4月至2018年3月）的数据，但不包括急诊和儿科入院的数据。数据取自进行该程序的NHS信托人和外科医生，所用手术技术（开放式，腹腔镜或机器人辅助）以及程序期间的住院时间。英国国家统计局的死亡率数据对该数据集进行了补充。研究了许多音量阈值和音量测量。多级建模用于调整层次结构和混杂因素。
结果：有18107例肾脏切除术和6762例膀胱癌切除术的数据可用。几乎没有证据表明信任或外科医生的人数会影响再入院率或死亡率。有证据表明，尽管大手术量和阈值很重要，但大手术量的医生可以缩短住院时间。
结论：我们发现几乎没有证据表明将肾切除术或膀胱切除术进一步集中用于癌症手术将改善所研究的患者预后。可能可以通过培训和支持较小容量的中心来优化住院时间，而不是进一步集中管理。

BACKGROUND & AIMS: :End-expiratory occlusion test (EEOT) has been proposed as a preload responsiveness test that overcomes several limitations of pulse pressure (PPV) and stroke volume (SVV) variations. We compared the ability of EEOT versus SVV and PPV to predict fluid responsiveness during the increase of the vasomotor tone in a rabbit model of hemorrhage. Ten rabbits were anesthetized, paralyzed, and mechanically ventilated during basal load (BL), after progressive blood withdrawal (BW), and after volume replacement. Other two sets of data were obtained during vasomotor increase by phenylephrine (PHE) infusion in BL and BW. We estimated the change of stroke volume (∆SVEEOT) and aortic flow (∆AoFEEOT) during the EEOT. PPV and SVV were obtained by the variation of beat-to-beat PP and SV, respectively. Baseline PPV, SVV, ∆SVEEOT, and ∆AoFEEOT increased significantly after BW, with a decrease of aortic flow (P < 0.05). PHE induced a significant decrease of PPV and SVV, but without affecting ∆SVEEOT, and ∆AoFEEOT. We conclude that ∆SV and ∆AoF during EEOT kept the ability to predict fluid responsiveness during PHE infusion in a rabbit hemorrhage model. This result may suggest the advantage of EEOT with respect to SVV and PPV in predicting fluid responsiveness during vasomotor tone increase.

背景与目标： ：呼气末阻塞试验（EEOT）已被提出作为预负荷响应性试验，它克服了脉压（PPV）和搏动量（SVV）变化的若干限制。我们在兔出血模型中比较了EEOT与SVV和PPV预测在血管舒缩张力增加期间的液体反应性的能力。在基础负荷（BL），进行性采血（BW）和置换体积后，对10只兔子进行麻醉，瘫痪并进行机械通气。其他两组数据是在通过苯肾上腺素（PHE）注入BL和BW引起的血管舒缩过程中获得的。我们估算了EEOT期间的搏动量（∆SVEEOT）和主动脉血流（∆AoFEEOT）的变化。 PPV和SVV分别通过逐拍PP和SV的变化获得。 BW后基线PPV，SVV，∆SVEEOT和∆AoFEEOT显着增加，主动脉血流量减少（P <0.05）。 PHE导致PPV和SVV显着降低，但不影响∆SVEEOT和∆AoFEEOT。我们得出结论，在兔出血模型中，EEOT期间的∆SV和∆AoF保持了预测PHE输液期间液体反应性的能力。这一结果可能表明EEOT相对于SVV和PPV在预测血管舒张压增加期间的液体反应性方面的优势。

BACKGROUND & AIMS: OBJECTIVES:Transcutaneous bowel sonography is a nonionizing imaging modality used in inflammatory bowel disease. Although available in Europe, its uptake in North America has been limited. Since the accuracy of bowel sonography is highly operator dependent, low-volume centers in North America may not achieve the same diagnostic accuracy reported in the European literature. Our objective was to determine the diagnostic accuracy of bowel sonography in a nonexpert low-volume center. METHODS:All cases of bowel sonography at a single tertiary care center during an 18-month period were reviewed. Bowel sonography was compared with reference standards, including small-bowel follow-through, computed tomography, magnetic resonance imaging, colonoscopy, and surgical findings. RESULTS:A total of 103 cases were included for analysis during the study period. The final diagnoses included Crohn disease (72), ulcerative colitis (8), hemolytic uremic syndrome (1), and normal (22). The sensitivity and specificity of bowel sonography for intestinal wall inflammation were 87.8% and 92.6%, respectively. In the subset of patients who had complications of Crohn disease, the sensitivity and specificity were 50% and 100% for fistulas and 14% and 100% for strictures. One patient had an abscess, which was detected by bowel sonography. Abnormal bowel sonographic findings contributed to the escalation of treatment in 55% of cases. CONCLUSIONS:Bowel sonography for inflammatory bowel disease can be performed in low-volume centers and provides diagnostic accuracy for luminal disease comparable with published data, although it is less sensitive for complications of Crohn disease.

背景与目标： 目的：经皮肠超声检查是一种用于炎症性肠病的非电离成像方式。尽管在欧洲有售，但其在北美的使用受到限制。由于肠超声检查的准确性在很大程度上取决于操作员，因此北美的小容量医疗中心可能无法达到欧洲文献中报告的诊断准确性。我们的目标是确定非专业小剂量中心的肠超声检查的诊断准确性。
方法：回顾了18个月内在一家三级护理中心进行肠超声检查的所有病例。将肠超声检查与参考标准进行比较，包括小肠随访，计算机断层扫描，磁共振成像，结肠镜检查和手术结果。
结果：在研究期间共纳入103例病例进行分析。最终诊断包括克罗恩病（72），溃疡性结肠炎（8），溶血性尿毒症综合征（1）和正常（22）。肠超声检查对肠壁炎症的敏感性和特异性分别为87.8％和92.6％。在患有克罗恩病并发症的患者子集中，对瘘管的敏感性和特异性分别为50％和100％，对于狭窄则分别为14％和100％。一名患者脓肿，经肠超声检查发现。肠超声检查结果异常有助于55％的病例升级。
结论：肠超声检查可用于低剂量中心的炎症性肠病，尽管其对克罗恩病的并发症敏感性较低，但可提供与已发表数据相当的腔内疾病诊断准确性。

BACKGROUND & AIMS: :In practice, clinicians generally consider anemia (circulating hemoglobin concentration < 120 g.l-1 in non-pregnant females and < 130 g.l-1 in males) as due to impaired hemoglobin synthesis or increased erythrocyte loss or destruction. Rarely is a rise in plasma volume relative to circulating total hemoglobin mass considered as a cause. But does this matter? We explored this issue in patients, measuring hemoglobin concentration, total hemoglobin mass (optimized carbon monoxide rebreathing method) and thereby calculating plasma volume in healthy volunteers, surgical patients, and those with inflammatory bowel disease, chronic liver disease or heart failure. We studied 109 participants. Hemoglobin mass correlated well with its concentration in the healthy, surgical and inflammatory bowel disease groups (r=0.687-0.871, P<0.001). However, they were poorly related in liver disease (r=0.410, P=0.11) and heart failure patients (r=0.312, P=0.16). Here, hemoglobin mass explained little of the variance in its concentration (adjusted R2=0.109 and 0.052; P=0.11 and 0.16), whilst plasma volume did (R2 change 0.724 and 0.805 in heart and liver disease respectively, P<0.0001). Exemplar patients with identical (normal or raised) total hemoglobin masses were diagnosed as profoundly anemic (or not) depending on differences in plasma volume that had not been measured or even considered as a cause. The traditional inference that anemia generally reflects hemoglobin deficiency may be misleading, potentially resulting in inappropriate tests and therapeutic interventions to address 'hemoglobin deficiency' not 'plasma volume excess'. Measurement of total hemoglobin mass and plasma volume is now simple, cheap and safe, and its more routine use is advocated.

背景与目标： ：在实践中，临床医生通常认为贫血（非妊娠女性的血红蛋白浓度<120 g.l-1，男性的血红蛋白浓度<130 g.l-1）是由于血红蛋白合成受损或红细胞丢失或破坏增加所致。相对于循环的总血红蛋白质量而言，血浆体积的增加很少被认为是原因。但这有关系吗？我们在患者中探索了这个问题，测量了血红蛋白浓度，总血红蛋白量（优化的一氧化碳再呼吸方法），从而计算了健康志愿者，外科手术患者以及患有炎症性肠病，慢性肝病或心力衰竭的患者的血浆容量。我们研究了109名参与者。血红蛋白质量与其在健康，外科和炎症性肠病组中的浓度密切相关（r = 0.687-0.871，P <0.001）。但是，它们在肝病（r = 0.410，P = 0.11）和心力衰竭患者（r = 0.312，P = 0.16）中关系较弱。在这里，血红蛋白质量几乎不能解释其浓度的变化（调整后的R2 = 0.109和0.052； P = 0.11和0.16），而血浆容量却没有改变（心脏和肝脏疾病中R2分别变化0.724和0.805，P <0.0001）。具有相同（正常或升高）总血红蛋白量的典型患者被诊断为严重贫血（或没有），这取决于尚未测量甚至被认为是原因的血浆容量差异。关于贫血通常反映血红蛋白缺乏症的传统推论可能会产生误导，可能会导致针对“血红蛋白缺乏症”而不是“血浆量过多”的不适当的测试和治疗性干预。现在，总血红蛋白质量和血浆体积的测量非常简单，便宜和安全，并且提倡更常规地使用它。