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Stress Accumulation, Depressive Symptoms, and Sleep Problems among Black Americans in the Rural South. 南方农村地区美国黑人的压力积累、抑郁症状和睡眠问题。
IF 4.8 Pub Date : 2024-05-01 Epub Date: 2023-05-26 DOI: 10.1177/21677026231170839
Olutosin Adesogan, Justin A Lavner, Sierra E Carter, Steven R H Beach

Centuries of systemic racism in the United States have led to Black Americans facing a disproportionate amount of life stressors. These stressors can have negative effects on mental and physical health, contributing to inequities throughout the lifespan. The current study used longitudinal data from 692 Black adults in the rural South to examine the ways in which neighborhood stress, financial strain, and interpersonal experiences of racial discrimination operate independently and in tandem to impact depressive symptoms and sleep problems over time. Findings provided strong support for univariate and additive stress effects and modest support for multiplicative stress effects. Results underscore how multiple stressors stemming from systemic racism can undermine health among Black Americans and highlight the need for further research on factors that promote well-being in the face of these stressors.

美国数百年的系统性种族主义导致美国黑人面临着过多的生活压力。这些压力会对身心健康产生负面影响,导致整个生命周期的不平等。目前的研究使用了来自南方农村地区 692 名黑人成年人的纵向数据,研究了邻里压力、经济压力和种族歧视的人际交往经历如何随着时间的推移独立或共同影响抑郁症状和睡眠问题。研究结果有力地证明了压力的单变量效应和叠加效应,并适度地证明了压力的倍增效应。研究结果强调了系统性种族主义产生的多重压力如何损害美国黑人的健康,并强调有必要进一步研究在面对这些压力时促进福祉的因素。
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引用次数: 0
Comparative effectiveness of parent-child interaction therapy based on trauma exposure and attrition. 基于创伤暴露和损耗的亲子互动疗法的有效性比较。
IF 6.3 Pub Date : 2024-04-01 Epub Date: 2022-05-05 DOI: 10.1037/tra0001259
Erica P Messer, Emily A Eismann, Alonzo T Folger, Alex Grass, Julie Bemerer, Heather Bensman

Objective: To determine whether Parent-Child Interaction Therapy (PCIT) is as effective at reducing behavior problems for children with a history of trauma and for those who do not complete therapy.

Method: Retrospective chart review of patients between 2.5 and 6.5 years of age who participated in PCIT between January 1, 2012, and December 1, 2019, at a child advocacy center within a large Midwestern children's hospital was performed. Demographics, trauma history, and Eyberg Child Behavior Inventory (ECBI) and parenting confidence scores were collected. Changes in child behavior and parenting confidence over time were compared between patients with and without trauma exposure using separate generalized estimating equation models for those who did and did not complete PCIT.

Results: Of the 212 PCIT participants, 116 (54.72%) had a trauma history and 96 (45.28%) did not, and 98 (46.23%) completed PCIT and 114 (53.77%) did not. Patient demographics were fairly diverse and representative of the region. Patients with trauma exposure were significantly less likely to complete PCIT (38.79%) than patients without trauma exposure (55.21%). ECBI intensity scores significantly decreased over time among both patients who did and did not complete PCIT. The change in ECBI intensity scores over time did not differ between patients with and without trauma exposure regardless of whether or not they completed PCIT. Parenting confidence significantly improved over time regardless of trauma exposure or attrition.

Conclusions: Standard PCIT can be used effectively with children with trauma exposure and results in significant improvement even for those who do not complete therapy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

目的:确定亲子互动疗法(PCIT)是否能有效减少有创伤史的儿童和未完成治疗的儿童的行为问题:确定亲子互动疗法(PCIT)在减少有创伤史的儿童和未完成治疗的儿童的行为问题方面是否同样有效:方法:对2012年1月1日至2019年12月1日期间在美国中西部一家大型儿童医院内的儿童权益保护中心接受PCIT治疗的2.5至6.5岁患者进行回顾性病历审查。研究收集了人口统计学、创伤史、艾伯格儿童行为量表(ECBI)和养育信心评分。使用单独的广义估计方程模型,对完成和未完成 PCIT 的患者进行比较,比较有和没有创伤经历的患者在儿童行为和养育信心方面随时间的变化:在 212 名 PCIT 参与者中,116 人(54.72%)有心理创伤史,96 人(45.28%)没有;98 人(46.23%)完成了 PCIT,114 人(53.77%)没有。患者的人口统计学特征相当多样化,在该地区具有代表性。有外伤经历的患者完成 PCIT 的可能性(38.79%)明显低于无外伤经历的患者(55.21%)。随着时间的推移,完成和未完成 PCIT 的患者的 ECBI 强度评分均明显下降。无论是否完成 PCIT,有心理创伤暴露和没有心理创伤暴露的患者的 ECBI 强度得分随时间的推移没有差异。随着时间的推移,为人父母的信心有了明显的提高,无论是否有心理创伤:结论:标准PCIT可有效用于有创伤暴露的儿童,即使未完成治疗的儿童也能获得显著改善。(PsycInfo Database Record (c) 2022 APA,保留所有权利)。
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引用次数: 0
Orbital Exenteration: Tumour Diversity and Survival-Report from a Cancer Centre of Northeast India. 眼眶摘除:肿瘤多样性和生存——来自印度东北部癌症中心的报告。
IF 0.6 Pub Date : 2023-12-01 Epub Date: 2023-06-20 DOI: 10.1007/s12070-023-03950-8
Kaberi Kakati, Anupam Das, Jyotiman Nath, Kishore Das, Tashnin Rahman, Ashok Kumar Das, Raj Jyoti Das

Orbital exenteration is a mutilating surgery which involves the removal of the entire contents of the bony orbit, including the globe, extraocular muscles and periorbital fat, and many times includes the eyelids. Since it leads to severe disfigurement, it is an infrequent procedure largely indicated in malignant conditions. The current study aims to report the clinicodemographic profile and treatment outcome of orbital exenteration patients done in a cancer care center in Northeast India. This is a hospital-based retrospective study between January 2017 and December 2021, including patients undergoing orbital exenteration. All patient and treatment-related data were retrieved from the record of hospital files. A total of 18 patients were included in the study. The mean age of the patients was 51 ± 18 years and male: female ratio was 1:1. Most patients had primary in orbit (55.6%). The most common histology was squamous cell carcinoma, (8/18, 44.4%), followed by basal cell carcinoma (two patients, 11.1%). After a median follow-up was 25 months (range 3-92), the median DFS of the study population was 31.4 months. The five-year overall survival of the patients was 54%. Orbital exenteration is an infrequent surgery due to the associated disfigurement and hence reserved for conditions where eye preservation is impossible. We tried to report the experience of orbital exenteration from a single cancer center for five years.

眼窝摘除术是一种毁伤性手术,它包括切除整个骨眼窝的内容物,包括眼球、眼外肌肉和眼窝周围脂肪,很多时候还包括眼睑。由于它会导致严重的毁容,它是一种罕见的手术,主要用于恶性疾病。本研究旨在报告印度东北部癌症护理中心眼眶摘除患者的临床人口学概况和治疗结果。这是一项基于医院的回顾性研究,时间为2017年1月至2021年12月,包括接受眶内剜除术的患者。所有患者和治疗相关数据均从医院档案记录中检索。研究共纳入18例患者。患者平均年龄51±18岁,男女比例为1:1。多数患者原发于眶内(55.6%)。最常见的组织学为鳞状细胞癌(8/18,44.4%),其次为基底细胞癌(2例,11.1%)。中位随访时间为25个月(范围3-92),研究人群的中位DFS为31.4个月。患者5年总生存率为54%。由于相关的毁容,眼窝摘除是一种罕见的手术,因此保留在不可能保存眼睛的情况下。我们试图报告在一个癌症中心进行了5年的眼眶切除手术的经验。
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引用次数: 0
Early-life respiratory tract infections and the risk of school-age lower lung function and asthma: a meta-analysis of 150 000 European children. 早年呼吸道感染与学龄期肺功能下降和哮喘的风险:对 15 万名欧洲儿童的荟萃分析。
Pub Date : 2022-10-06 Print Date: 2022-10-01 DOI: 10.1183/13993003.02395-2021
Evelien R van Meel, Sara M Mensink-Bout, Herman T den Dekker, Tarunveer S Ahluwalia, Isabella Annesi-Maesano, Syed Hasan Arshad, Nour Baïz, Henrique Barros, Andrea von Berg, Hans Bisgaard, Klaus Bønnelykke, Christian J Carlsson, Maribel Casas, Leda Chatzi, Cecile Chevrier, Geertje Dalmeijer, Carol Dezateux, Karel Duchen, Merete Eggesbø, Cornelis van der Ent, Maria Fantini, Claudia Flexeder, Urs Frey, Fransesco Forastiere, Ulrike Gehring, Davide Gori, Raquel Granell, Lucy J Griffiths, Hazel Inskip, Joanna Jerzynska, Anne M Karvonen, Thomas Keil, Cecily Kelleher, Manolis Kogevinas, Gudrun Koppen, Claudia E Kuehni, Nathalie Lambrechts, Susanne Lau, Irina Lehmann, Johnny Ludvigsson, Maria Christine Magnus, Erik Mélen, John Mehegan, Monique Mommers, Anne-Marie Nybo Andersen, Wenche Nystad, Eva S L Pedersen, Juha Pekkanen, Ville Peltola, Katharine C Pike, Angela Pinot de Moira, Costanza Pizzi, Kinga Polanska, Maja Popovic, Daniela Porta, Graham Roberts, Ana Cristina Santos, Erica S Schultz, Marie Standl, Jordi Sunyer, Carel Thijs, Laura Toivonen, Eleonora Uphoff, Jakob Usemann, Marina Vafeidi, John Wright, Johan C de Jongste, Vincent W V Jaddoe, Liesbeth Duijts

Background: Early-life respiratory tract infections might affect chronic obstructive respiratory diseases, but conclusive studies from general populations are lacking. Our objective was to examine if children with early-life respiratory tract infections had increased risks of lower lung function and asthma at school age.

Methods: We used individual participant data of 150 090 children primarily from the EU Child Cohort Network to examine the associations of upper and lower respiratory tract infections from age 6 months to 5 years with forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, forced expiratory flow at 75% of FVC (FEF75%) and asthma at a median (range) age of 7 (4-15) years.

Results: Children with early-life lower, not upper, respiratory tract infections had a lower school-age FEV1, FEV1/FVC and FEF75% (z-score range: -0.09 (95% CI -0.14- -0.04) to -0.30 (95% CI -0.36- -0.24)). Children with early-life lower respiratory tract infections had a higher increased risk of school-age asthma than those with upper respiratory tract infections (OR range: 2.10 (95% CI 1.98-2.22) to 6.30 (95% CI 5.64-7.04) and 1.25 (95% CI 1.18-1.32) to 1.55 (95% CI 1.47-1.65), respectively). Adjustment for preceding respiratory tract infections slightly decreased the strength of the effects. Observed associations were similar for those with and without early-life wheezing as a proxy for early-life asthma.

Conclusions: Our findings suggest that early-life respiratory tract infections affect development of chronic obstructive respiratory diseases in later life, with the strongest effects for lower respiratory tract infections.

背景:早年呼吸道感染可能会影响慢性阻塞性呼吸道疾病,但目前还缺乏针对普通人群的确凿研究。我们的目的是研究早期呼吸道感染的儿童是否会增加学龄期肺功能下降和哮喘的风险:我们利用主要来自欧盟儿童队列网络的 150 090 名儿童的个人参与者数据,研究了 6 个月至 5 岁期间上呼吸道和下呼吸道感染与 1 秒用力呼气容积 (FEV1)、用力肺活量 (FVC)、FEV1/FVC、75% FVC 时的用力呼气流量 (FEF75%) 以及 7(4-15)岁中位数哮喘之间的关系:结果发现:早年患下呼吸道感染而非上呼吸道感染的儿童,其学龄期FEV1、FEV1/FVC和FEF75%均较低(Z值范围:-0.09(95% CI -0.14--0.04)至-0.30(95% CI -0.36--0.24))。与患有上呼吸道感染的儿童相比,早年患有下呼吸道感染的儿童在学龄期患哮喘的风险更高(OR 范围分别为:2.10(95% CI 1.98-2.22)至 6.30(95% CI 5.64-7.04)和 1.25(95% CI 1.18-1.32)至 1.55(95% CI 1.47-1.65))。对之前的呼吸道感染进行调整后,影响的强度略有下降。观察到的相关性在有和没有早期喘息(作为早期哮喘的替代指标)的人群中相似:我们的研究结果表明,早年呼吸道感染会影响日后慢性阻塞性呼吸道疾病的发展,其中下呼吸道感染的影响最大。
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引用次数: 0
[Study of an ocular ptosis in a 13th century illuminated manuscript]. [13世纪彩绘手稿中的眼睑下垂研究]。
IF 0.8 Pub Date : 2022-03-16 DOI: 10.33588/rn.7406.2021383
P E Balcarce

Introduction: The finding of an eyelid ptosis in a manuscript of the xiii century raises the differential diagnosis of injury to the third cranial nerve. This nerve was not differentiated from the other oculomotors until the xvi century and only in the xix century a clinicopathological correlation was established for its paralysis.

Aim: Describe the characteristics and differential diagnoses of an eyelid ptosis illustrated in the Book of Divine Works (1173) by Hildegard of Bingen.

Development: In the mentioned work the nun Richardis of Stade is portrayed with her left eyelid drooping. Two conspicuous signs are described, ptosis and corresponding raising of the eyebrow. The deviation of the eye downward and outward is inferred from the shape that adopts the eyelid by the position of the eye and the curvature of the cornea. The picture is consistent with an isolated paralysis of the oculomotor nerve. The causes of ptosis are discussed: aponeurotic due to levator palpebrae dehiscence; myogenic, congenital and acquired; of the neuromuscular junction, and neuropathic, the latter being the most probable in this case and of a compressive mechanism. The nun's unexpected natural death suggests a ruptured brain aneurysm.

Conclusions: Richardis of Stade's portrait shows an oculomotor paralysis centuries before its anatomy, function, and clinicopathological expression were known. Credit for this original description must go to Hildegard, whose medical vocation has long been recognized.

简介在十三世纪的一份手稿中发现的眼睑下垂引起了第三颅神经损伤的鉴别诊断。该神经直到十六世纪才与其他眼球运动神经区分开来,直到十九世纪才确定了其瘫痪的临床病理相关性。目的:描述宾根的希尔德加德在《神作之书》(1173 年)中描绘的眼睑下垂的特征和鉴别诊断:在上述作品中,修女 Richardis of Stade 的左眼睑下垂。作品中描述了两个明显的征兆:眼睑下垂和相应的眉毛上扬。根据眼睑的形状、眼睛的位置和角膜的弧度,可以推断出眼睛向下和向外的偏差。这种情况与孤立的眼球运动神经麻痹一致。对上睑下垂的病因进行了讨论:上睑提肌开裂导致的肌腱性下垂、先天性和后天性肌源性下垂、神经肌肉接头处的下垂以及神经性下垂,后者在本病例中的可能性最大,而且是一种压迫性机制。修女的意外自然死亡表明是脑动脉瘤破裂:结论:斯泰德的理查德斯的肖像展示的是一种眼球运动麻痹,比人们了解其解剖、功能和临床病理表现早了几个世纪。希尔德加德对这一原始描述功不可没,她的医学使命早已得到认可。
{"title":"[Study of an ocular ptosis in a 13th century illuminated manuscript].","authors":"P E Balcarce","doi":"10.33588/rn.7406.2021383","DOIUrl":"10.33588/rn.7406.2021383","url":null,"abstract":"<p><strong>Introduction: </strong>The finding of an eyelid ptosis in a manuscript of the xiii century raises the differential diagnosis of injury to the third cranial nerve. This nerve was not differentiated from the other oculomotors until the xvi century and only in the xix century a clinicopathological correlation was established for its paralysis.</p><p><strong>Aim: </strong>Describe the characteristics and differential diagnoses of an eyelid ptosis illustrated in the Book of Divine Works (1173) by Hildegard of Bingen.</p><p><strong>Development: </strong>In the mentioned work the nun Richardis of Stade is portrayed with her left eyelid drooping. Two conspicuous signs are described, ptosis and corresponding raising of the eyebrow. The deviation of the eye downward and outward is inferred from the shape that adopts the eyelid by the position of the eye and the curvature of the cornea. The picture is consistent with an isolated paralysis of the oculomotor nerve. The causes of ptosis are discussed: aponeurotic due to levator palpebrae dehiscence; myogenic, congenital and acquired; of the neuromuscular junction, and neuropathic, the latter being the most probable in this case and of a compressive mechanism. The nun's unexpected natural death suggests a ruptured brain aneurysm.</p><p><strong>Conclusions: </strong>Richardis of Stade's portrait shows an oculomotor paralysis centuries before its anatomy, function, and clinicopathological expression were known. Credit for this original description must go to Hildegard, whose medical vocation has long been recognized.</p>","PeriodicalId":10674,"journal":{"name":"Collection of Czechoslovak Chemical Communications","volume":"42 1","pages":"202-206"},"PeriodicalIF":0.8,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86277470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pharmacological agents for adults with acute respiratory distress syndrome. 治疗成人急性呼吸窘迫综合征的药物。
IF 8.8 Pub Date : 2019-07-23 DOI: 10.1002/14651858.CD004477.pub3
Sharon R Lewis, Michael W Pritchard, Carmel M Thomas, Andrew F Smith
<p><strong>Background: </strong>Acute respiratory distress syndrome (ARDS) is a life-threatening condition caused by direct or indirect injury to the lungs. Despite improvements in clinical management (for example, lung protection strategies), mortality in this patient group is at approximately 40%. This is an update of a previous version of this review, last published in 2004.</p><p><strong>Objectives: </strong>To evaluate the effectiveness of pharmacological agents in adults with ARDS on mortality, mechanical ventilation, and fitness to return to work at 12 months.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, and CINAHL on 10 December 2018. We searched clinical trials registers and grey literature, and handsearched reference lists of included studies and related reviews.</p><p><strong>Selection criteria: </strong>We included randomized controlled trials (RCTs) comparing pharmacological agents with control (placebo or standard therapy) to treat adults with established ARDS. We excluded trials of nitric oxide, inhaled prostacyclins, partial liquid ventilation, neuromuscular blocking agents, fluid and nutritional interventions and medical oxygen. We excluded studies published earlier than 2000, because of changes to lung protection strategies for people with ARDS since this date.</p><p><strong>Data collection and analysis: </strong>Two review authors independently assessed studies for inclusion, extracted data, and assessed risks of bias. We assessed the certainty of evidence with GRADE.</p><p><strong>Main results: </strong>We included 48 RCTs with 6299 participants who had ARDS; two included only participants with mild ARDS (also called acute lung injury). Most studies included causes of ARDS that were both direct and indirect injuries. We noted differences between studies, for example the time of administration or the size of dose, and because of unclear reporting we were uncertain whether all studies had used equivalent lung protection strategies.We included five types of agents as the primary comparisons in the review: corticosteroids, surfactants, N-acetylcysteine, statins, and beta-agonists. We included 15 additional agents (sivelestat, mesenchymal stem cells, ulinastatin, anisodimine, angiotensin-converting enzyme (ACE) inhibitor, recombinant human ACE2 (palifermin), AP301, granulocyte-macrophage colony stimulating factor (GM-CSF), levosimendan, prostacyclins, lisofylline, ketaconazole, nitroglycerins, L-2-oxothiazolidine-4-carboxylic acid (OTZ), and penehyclidine hydrochloride).We used GRADE to downgrade outcomes for imprecision (because of few studies and few participants), for study limitations (e.g. high risks of bias) and for inconsistency (e.g. differences between study data).Corticosteroids versus placebo or standard therapyCorticosteroids may reduce all-cause mortality within three months by 86 per 1000 patients (with as many as 161 fewer to 19 more deaths); however, the 95% confidence interval (CI) i
背景:急性呼吸窘迫综合征(ARDS)是由肺部直接或间接损伤引起的危及生命的疾病。尽管临床管理有所改善(例如肺保护策略),但该患者组的死亡率约为40%。这是对本综述的上一版本的更新,上次发表于2004年。目的评价药物治疗成人急性呼吸窘迫综合征(ARDS)患者12个月时死亡率、机械通气和恢复工作能力的有效性。检索方法我们于2018年12月10日检索了CENTRAL, MEDLINE, Embase和CINAHL。我们检索了临床试验注册和灰色文献,并手工检索了纳入研究和相关综述的参考文献列表。选择标准我们纳入了比较药物与对照组(安慰剂或标准疗法)治疗已确诊的成人ARDS的随机对照试验(rct)。我们排除了一氧化氮、吸入性前列环素、部分液体通气、神经肌肉阻断剂、液体和营养干预以及医用氧的试验。我们排除了2000年以前发表的研究,因为自2000年以来,ARDS患者的肺保护策略发生了变化。数据收集和分析两篇综述作者独立评估了研究的纳入、提取数据和评估偏倚风险。我们用GRADE评估证据的确定性。我们纳入48项随机对照试验,6299名ARDS患者;其中两项仅包括轻度ARDS(也称为急性肺损伤)的参与者。大多数研究包括ARDS的直接和间接伤害原因。我们注意到研究之间的差异,例如给药时间或剂量大小,并且由于报告不明确,我们不确定是否所有研究都使用了相同的肺保护策略。我们在综述中纳入了五种类型的药物作为主要比较:皮质类固醇、表面活性剂、n -乙酰半胱氨酸、他汀类药物和β受体激动剂。我们纳入了另外15种药物(西维司他、间充质干细胞、乌司他丁、山莨菪碱、血管紧张素转换酶(ACE)抑制剂、重组人ACE2 (palifermin)、AP301、粒细胞-巨噬细胞集落刺激因子(GM-CSF)、左西孟旦、前列环素、异油碱、酮康唑、硝化甘油、l -2-氧噻唑烷-4-羧酸(OTZ)和盐酸戊乙奎醚)。我们使用GRADE来降低结果的不精确性(因为研究和参与者很少)、研究局限性(例如高偏倚风险)和不一致性(例如研究数据之间的差异)。与安慰剂或标准治疗相比,皮质类固醇可使3个月内的全因死亡率每1000名患者降低86例(死亡人数减少161例至19例);然而,95%置信区间(CI)包括死亡增加和减少的可能性(风险比(RR) 0.77, 95% CI 0.57 ~ 1.05;6项研究,574名参与者;确定性的证据)。由于证据的确定性非常低,我们不确定皮质类固醇对晚期全因死亡率(超过3个月)的影响是否很小或没有影响(RR 0.99, 95% CI 0.64至1.52;1项研究,180名受试者),或机械通气持续时间(平均差异(MD) -4.30, 95% CI -9.72至1.12;3项研究,277名参与者)。我们发现皮质类固醇可改善无呼吸机天数(VFD) (MD 4.09, 95% CI 1.74至6.44;4项研究,494名参与者;确定性的证据)。没有研究报告不良事件导致研究药物停药,或12个月后恢复工作(FTR)。表面活性剂与安慰剂或标准治疗相比,我们不确定表面活性剂对早期死亡率的影响是很小还是没有差异(RR 1.08, 95% CI 0.91至1.29;9项研究,1338名受试者),或者是否降低晚期全因死亡率(RR 1.28, 95% CI 1.01 - 1.61;1项研究,418名参与者)。同样,我们不确定表面活性剂是否会缩短机械通气时间(MD -2.50, 95% CI -4.95至-0.05;1项研究,16名参与者),对VFD的影响很小或没有影响(MD -0.39, 95% CI -2.49至1.72;2项研究,344名受试者),或不良事件导致停止研究用药(RR 0.50, 95% CI 0.17 ~ 1.44;2项研究,88名参与者)。我们不确定这些影响,因为我们评估它们的确定性非常低。没有研究报告FTR。n -乙酰半胱氨酸与安慰剂我们不确定n -乙酰半胱氨酸对早期死亡率的影响是否很小或没有影响,因为我们将其评估为非常低确定性的证据(RR 0.64, 95% CI 0.32至1.30;1项研究,36名参与者)。没有研究报告晚期全因死亡率、机械通气持续时间、VFD、导致研究药物停药的不良事件或FTR。他汀类药物与安慰剂相比,他汀类药物对早期死亡率的影响可能很小或没有差异(RR 0.99, 95% CI 0.78 - 1)。 26;3 项研究,1344 名参与者;中度确定性证据)或 VFD(MD 0.40,95% CI -0.71 至 1.52;3 项研究,1342 名参与者;中度确定性证据)。他汀类药物对机械通气持续时间的影响可能很小或没有影响(MD 2.70,95% CI -3.55至8.95;1项研究,60名参与者;低度确定性证据)。我们无法纳入一项研究中导致停药的不良事件数据,因为其报告不明确。β-受体激动剂与安慰剂对照β-受体阻滞剂可能会略微增加早期死亡率,每 1000 例患者中有 40 例死亡(多达 119 例增加或 25 例减少);然而,95% CI 包括死亡率增加或减少的可能性(RR 1.14,95% CI 0.91 至 1.42;3 项研究,646 例参与者;中度确定性证据)。由于证据的确定性很低,我们无法确定β-受体激动剂是否会增加VFD(MD -2.20,95% CI -3.68至-0.71;3项研究,646名参与者),或对导致研究药物停用的不良事件影响很小或没有影响(一项研究报道组间差异很小或没有差异,一项研究报道β-受体激动剂组发生的事件较多)。没有研究报告了后期全因死亡率、机械通气持续时间或 FTR:我们没有发现足够的证据来确定皮质类固醇、表面活性物质、N-乙酰半胱氨酸、他汀类药物或β-受体激动剂是否能有效降低ARDS患者的死亡率、缩短机械通气时间或增加无呼吸机天数。三项有待分类的研究可能会改变本综述的结论。由于 ARDS 潜在的长期后果对幸存者非常重要,因此未来的研究应纳入更长时间的随访,以衡量对生活质量的影响。
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引用次数: 0
Necrotizing Soft Tissue Infection or Sweet Syndrome: Surgery Versus No Surgery?: A Case Report. 坏死性软组织感染或甜综合征:手术还是不手术?:病例报告。
Pub Date : 2017-04-01 DOI: 10.1213/XAA.0000000000000459
Tiffany M N Otero, Samuel R Barber, D Dante Yeh, Sadeq A Quraishi

The authors report a case of necrotizing Sweet syndrome in a 24-year-old transsexual male who presented with recurrent myonecrosis of the neck/upper chest. On index admission, computer tomography revealed gas and fat stranding of the sternocleidomastoid and pectoralis major muscle-findings suggestive of a necrotizing soft tissue infection. Despite debridement procedures and intravenous antibiotic therapy, myonecrosis of the affected areas persisted. Evaluation of tissue samples by dermatopathology revealed neutrophilic infiltration extending into the dermis and muscle necrosis, findings consistent with necrotizing Sweet syndrome. The initiation of IV corticosteroids, the gold-standard treatment for necrotizing Sweet syndrome, lead to significant clinical improvement. When soft tissue infections do not respond to debridement and broad-spectrum antimicrobial coverage, perioperative care providers should consider necrotizing Sweet syndrome as an underlying cause. By facilitating the early diagnosis and appropriate management of unique conditions such as necrotizing Sweet syndrome, anesthesiologists can not only play a more visible role as leaders in the emerging perioperative surgical home model, but they may also prevent significant patient morbidity and reduce unnecessary utilization of health care resources.

作者报告了一例坏死性Sweet综合征,发生在一位24岁的变性男性,他表现为颈部/上胸部复发性肌坏死。入院时,计算机断层扫描显示胸锁乳突肌和胸大肌的气体和脂肪搁浅-提示坏死性软组织感染。尽管清创手术和静脉抗生素治疗,肌坏死的影响区域持续存在。皮肤病理学组织样本评估显示中性粒细胞浸润延伸到真皮和肌肉坏死,结果与坏死性Sweet综合征一致。静脉注射糖皮质激素,坏死性Sweet综合征的金标准治疗,导致显著的临床改善。当软组织感染对清创和广谱抗菌药物治疗无效时,围手术期护理提供者应考虑坏死性Sweet综合征作为潜在原因。通过促进对坏死性Sweet综合征等特殊疾病的早期诊断和适当管理,麻醉医师不仅可以在新兴的围手术期家庭模式中发挥更明显的领导作用,而且还可以预防重大患者发病率并减少不必要的医疗资源利用。
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引用次数: 7
Academic Research in the 21st Century: Maintaining Scientific Integrity in a Climate of Perverse Incentives and Hypercompetition. 21 世纪的学术研究:在反常激励和过度竞争的环境中保持科学诚信。
IF 1.8 Pub Date : 2017-01-01 DOI: 10.1089/ees.2016.0223
Marc A Edwards, Siddhartha Roy

Over the last 50 years, we argue that incentives for academic scientists have become increasingly perverse in terms of competition for research funding, development of quantitative metrics to measure performance, and a changing business model for higher education itself. Furthermore, decreased discretionary funding at the federal and state level is creating a hypercompetitive environment between government agencies (e.g., EPA, NIH, CDC), for scientists in these agencies, and for academics seeking funding from all sources-the combination of perverse incentives and decreased funding increases pressures that can lead to unethical behavior. If a critical mass of scientists become untrustworthy, a tipping point is possible in which the scientific enterprise itself becomes inherently corrupt and public trust is lost, risking a new dark age with devastating consequences to humanity. Academia and federal agencies should better support science as a public good, and incentivize altruistic and ethical outcomes, while de-emphasizing output.

在过去的 50 年中,我们认为,由于研究经费的竞争、衡量绩效的量化指标的发展以及高等教育本身商业模式的变化,对学术科学家的激励变得越来越不正常。此外,联邦和州一级可自由支配资金的减少,在政府机构(如环保局、国立卫生研究院、疾病预防控制中心)之间,为这些机构的科学家,以及从各种渠道寻求资金的学者,创造了一个超级竞争的环境--不正当的激励机制和资金的减少,共同增加了可能导致不道德行为的压力。如果有足够数量的科学家变得不值得信任,就有可能出现一个临界点,使科学事业本身变得固有的腐败,失去公众的信任,从而有可能进入一个新的黑暗时代,给人类带来毁灭性的后果。学术界和联邦机构应更好地支持作为公益事业的科学,激励利他主义和道德成果,同时不再强调产出。
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引用次数: 0
Interactions of the Immune System with Skin and Bone Tissue in Psoriatic Arthritis: A Comprehensive Review. 银屑病关节炎中免疫系统与皮肤和骨组织的相互作用:全面回顾。
IF 8.4 Pub Date : 2016-08-01 DOI: 10.1007/s12016-016-8529-8
Andrea Sukhov, Iannis E Adamopoulos, Emanual Maverakis

Cutaneous psoriasis (e.g., psoriasis vulgaris (PsV)) and psoriatic arthritis (PsA) are complex heterogeneous diseases thought to have similar pathophysiology. The soluble and cellular mediators of these closely related diseases are being elucidated through genetic approaches such as genome-wide association studies (GWAS), as well as animal and molecular models. Novel therapeutics targeting these mediators (IL-12, IL-23, IL-17, IL-17 receptor, TNF) are effective in treating both the skin and joint manifestations of psoriasis, reaffirming the shared pathophysiology of PsV and PsA. However, the molecular and cellular interactions between skin and joint disease have not been well characterized. Clearly, PsV and PsA are highly variable in terms of their clinical manifestations, and this heterogeneity can partially be explained by differences in HLA-associations (HLA-Cw*0602 versus HLA-B*27, for example). In addition, there are numerous other genetic susceptibility loci (LCE3, CARD14, NOS2, NFKBIA, PSMA6, ERAP1, TRAF3IP2, IL12RB2, IL23R, IL12B, TNIP1, TNFAIP3, TYK2) and geoepidemiologic factors that contribute to the wide variability seen in psoriasis. Herein, we review the complex interplay between the genetic, cellular, ethnic, and geographic mediators of psoriasis, focusing on the shared mechanisms of PsV and PsA.

皮肤银屑病(如寻常型银屑病(PsV))和银屑病关节炎(PsA)是复杂的异质性疾病,被认为具有相似的病理生理学。通过全基因组关联研究(GWAS)等遗传学方法以及动物和分子模型,这些密切相关疾病的可溶性和细胞介质正在被阐明。以这些介质(IL-12、IL-23、IL-17、IL-17 受体、TNF)为靶点的新型疗法可有效治疗银屑病的皮肤和关节表现,再次证实了 PsV 和 PsA 的共同病理生理学。然而,皮肤和关节疾病之间的分子和细胞相互作用尚未得到很好的描述。很明显,PsV 和 PsA 的临床表现差异很大,这种异质性可部分归因于 HLA 基因的差异(如 HLA-Cw*0602 与 HLA-B*27)。此外,还有许多其他遗传易感基因位点(LCE3、CARD14、NOS2、NFKBIA、PSMA6、ERAP1、TRAF3IP2、IL12RB2、IL23R、IL12B、TNIP1、TNFAIP3、TYK2)和地理流行病学因素导致了银屑病的巨大差异。在此,我们回顾了银屑病的遗传、细胞、种族和地理介质之间复杂的相互作用,重点是 PsV 和 PsA 的共同机制。
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引用次数: 0
The Unexplored Anticaries Potential of Shiitake Mushroom. 香菇尚未开发的抗癌潜力
Pub Date : 2016-07-01 DOI: 10.4103/0973-7847.194039
J Avinash, S Vinay, Kunal Jha, Diptajit Das, B S Goutham, Gunjan Kumar

Keeping an eye the escalating costs of dental services, the treatment cost of the consequences of dental caries can be reduced to manageable proportions by preventive measures aimed at decreasing the prevalence. One such measure is by increasing the consumption of caries preventive foods. Recently, there has been an upsurge of interest in mushrooms not only as a healthy food but also as a caries preventive food. The most common type of mushroom, Lentinula edodes also called as shiitake, is studied in-depth for its oral health benefits. The cultivation of shiitake dates way back to 1100 A.D. during the rule of Sung dynasty which is replaced by more modern and efficient sawdust substrate log cultures lately. Shiitake mushroom extract can be isolated in various forms such as freeze dried, oil, and ethyl acetate extracts. Various biologically active compounds such as erythritol, copalic acid, adenosine, carvacrol, and many more are responsible for this mushroom's antimicrobial activity. Anticariogenicity can be attributed to the induction of the detachment of cariogenic microorganisms from hydroxyapatite, changes in cell surface hydrophobicity, bactericidal activity, and disruption of signal transduction in Streptococcus mutans as proved through various in vivo and in vitro studies. Apart from these benefits, it has tremendous potential to be used as an antioxidant, anticancer, antigingivitis, antifungal, and antiviral agent. The one and only known adverse reaction due to shiitake mushroom consumption is the eruption of pruritic erythematous papules termed as shiitake dermatitis. This review highlights the unexplored anticaries potential of one such useful bioactive metabolite-shiitake mushroom.

考虑到牙科服务成本的不断攀升,可以通过旨在降低龋齿发病率的预防措施,将龋齿后果的治疗成本降至可控范围。其中一项措施就是增加食用防龋食品。最近,人们对蘑菇的兴趣大增,不仅将其视为一种健康食品,还将其视为一种防龋食品。人们对最常见的一种蘑菇--香菇(Lentinula edodes)--的口腔健康益处进行了深入研究。香菇的栽培历史可追溯到公元 1100 年宋朝统治时期,后来被更现代、更高效的锯屑基质原木栽培所取代。香菇提取物有多种分离形式,如冷冻干燥提取物、油提取物和乙酸乙酯提取物。赤藓糖醇、椰油酸、腺苷、香芹酚等多种生物活性化合物是香菇具有抗菌活性的原因。通过各种体内和体外研究证明,抗龋齿性可归因于诱导致龋微生物从羟基磷灰石上脱离、改变细胞表面疏水性、杀菌活性以及破坏变异链球菌的信号转导。除了这些优点外,它还具有作为抗氧化剂、抗癌剂、抗牙龈炎剂、抗真菌剂和抗病毒剂的巨大潜力。食用香菇唯一已知的不良反应是瘙痒性红斑丘疹,被称为香菇皮炎。本综述强调了香菇这种有用的生物活性代谢物尚未开发的抗生素潜力。
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引用次数: 0
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Collection of Czechoslovak Chemical Communications
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