Effort-reward imbalance and relational injustice at work predict sickness absence: the Whitehall II study

OBJECTIVES: Sickness absence is a major occupational health problem, but evidence for associations between potentially modifiable psychosocial work factors and sickness absence is still scarce. We studied the impact of relational justice and effort-reward imbalance on subsequent rates of sickness absence. METHODS: The Whitehall II prospective cohort study of British civil servants, 10,308 men and women, was established between 1985 and 1988. Indicators of effort-reward imbalance and the relational component of organizational justice were constructed from questions included at baseline. Participants were classified into three groups (low, intermediate, and high) for both effort-reward imbalance and relational justice. Short (< or =7 days) and long (>7 days) spells of sickness absence during 1985-1989 and 1991-1995 were used to study immediate and longer term effects of work characteristics. RESULTS: After adjustment for age, employment grade, and baseline health, men and women with low relational justice had increased risks of long spells of sickness absence of 14% and 28% in comparison to men and women experiencing high levels of justice. Similar effect sizes (25% and 21%) were found for high vs. low effort-reward imbalance. Both work measures also predicted short spells of sickness absence. Effort-reward imbalance (men and women) and relational justice (women only) each predicted long spells of sickness absence independently of the other. CONCLUSIONS: Both relational justice and effort-reward imbalance are important determinants of sickness absence. Workplace interventions to improve these aspects of working conditions have the potential to reduce levels of sickness absence.     

Treatment of imbalance with varenicline Chantix(R): report of a patient with fragile X tremor/ataxia syndrome

We describe the case of a man with Fragile X tremor/ataxia syndrome, whose ataxia and imbalance improved with the use of varenicline (Chantix) and reverted to baseline 10 days after varenicline was discontinued. Varenicline was started as part of a smoking cessation program.     

2型糖尿病患者肠道菌群的研究

目的:分析2型糖尿病患者肠道菌群与健康个体的差异,探讨2型糖尿病与肠道菌群的相关性.方法:收集30例2型糖尿病患者(10例空腹血糖>11.1mmoL/L,余20例空腹血糖<9.0mmoL/L)和20例正常人群的新鲜粪便,利用稀释平板计数法和快速细菌鉴定法对双歧杆菌、肠杆菌科细菌、拟杆菌、乳酸杆菌、肠球菌和酵母菌进行定性...     

创伤性完全颈脊髓损伤患者水电解质变化

目的观察创伤性完全颈脊髓损伤患者水电解质变化,探讨其发生机理。方法选择2000年6月-2008年6月骨科住院患者60例,分为颈髓损伤组（32例）和对照组（28例）,在不同时相点检测2组患者血清K^＋、Na^＋、Cl^-、CO2CP和BUN浓度及24h尿量和尿Na^＋排除总量,并采用放射免疫方法测定血浆心钠素浓度。结果颈髓损伤组90.6%出现低钠血症,血Na＋为（129.65±3.13）mml/L,明显低于对照组（P〈0.01）;颈髓损伤组24h尿量为（3809±812）ml/d,尿Na＋排除总量为（491.2±171.6）mmol/d,均明显高于对照组（P〈0.01）;而血浆心钠素浓度（0.297±0.136）ng/ml,显著低于对照组（P〈0.05）。结论创伤性颈脊髓损伤患者常继发低钠血症,其发生机制与颅脑疾病继发低钠血症不同,血浆心钠素浓度降低的主要原因是颈脊髓损伤后交感神经抑制和低钠血症。     

The impact of physical exercise on calcium balance in healthy subjects during prolonged hypokinesia

ObjectiveTo determine whether during hypokinesia (diminished movement) periodic physical exercise affects calcium (Ca²⁺) balance and Ca²⁺ loss.MethodsStudies were conducted on 30 physically healthy male volunteers during the preexperimental period of 30 days and the experimental period of 364 days. They were equally divided into three groups: active control subjects (ACS), hypokinetic subjects (HKS), and periodic training subjects (PTS). The ACS group ran an average distance of 9.3 ± 1.2 km/d; the HKS group walked an average distance of 1.3 ± 0.2 km/d; and PTS group walked and ran average distances of 1.3 ± 0.2 km/d and 9.2 ± 1.2 km/d for 5 and 2 days per week, respectively.ResultsSerum Ca²⁺ level, fecal and urine Ca²⁺ loss, and Ca²⁺ imbalance increased (P < 0.05) in the PTS and HKS groups compared with their preexperimental levels and the values in their respective ACS group. The serum Ca²⁺ concentration, urine and fecal Ca²⁺ loss, and Ca²⁺ imbalance increased more (P < 0.05) in the PTS group than in the HKS group.ConclusionDuring hypokinesia, Ca²⁺ imbalance is more evident with than without physical exercise and Ca²⁺ loss is exacerbated more with higher than lower Ca²⁺ imbalance.     

Genomic Alterations Associated with Early Stages of Breast Tumor Metastasis

Background  Molecular studies suggest that acquisition of metastatic potential occurs early in the development of breast cancer; mechanisms by which cells disseminate from the primary carcinomas and successfully colonize foreign tissues are, however, largely unknown. Thus, we examined levels and patterns of chromosomal alterations in primary breast tumors from node-negative (n = 114) and node-positive (n = 115) patients to determine whether specific genomic changes are associated with tumor metastasis. Methods  Fifty-two genetic markers representing 26 chromosomal regions commonly altered in breast cancer were examined in laser microdissected tumor samples to assess levels and patterns of allelic imbalance (AI). Real time-PCR (RT-PCR) was performed to determine expression levels of candidate genes. Data was analyzed using exact unconditional and Student’s t-tests with significance values of P < 0.05 and P < 0.002 used for the clinicopathological and genomic analyses, respectively. Results  Overall levels of AI in primary breast tumors from node-negative (20.8%) and node-positive (21.9%) patients did not differ significantly (P = 0.291). When data were examined by chromosomal region, only chromosome 8q24 showed significantly higher levels (P < 0.0005) of AI in node-positive primary tumors (23%) versus node-negative samples (6%). c-MYC showed significantly higher levels of gene expression in primary breast tumors from patients with lymph node metastasis. Conclusions  Higher frequencies of AI at chromosome 8q24 in patients with positive lymph nodes suggest that genetic changes in this region are important to the process of metastasis. Because overexpression of c-MYC has been associated with cellular dissemination as well as development of the premetastatic niche, alterations of the 8q24 region, including c-MYC, may be key determinants in the development of lymph node metastasis. Contact for reprints: Ms. Kerri Cronin, Clinical Breast Care Project, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW Washington, DC 20307, Tel.: +1 (202) 782-0002, E-mail: kerri.cronin@amedd.army.mil.     

Chromosomal Alterations Associated with the Transition from In Situ to Invasive Breast Cancer

Background  Ductal carcinoma in situ (DCIS) is a preinvasive lesion of the breast with an inherent but nonobligatory tendency for progression to invasive breast cancer. Although the transition from in situ to invasive disease is critical to the development of breast cancer, molecular and biological changes responsible for this transition are not well characterized. Methods  Chromosomal alterations at 26 regions were assayed in 66 DCIS lesions and 111 invasive ductal carcinomas. Levels and patterns of allelic imbalance (AI) were compared between grade 1 DCIS and well-differentiated breast carcinomas, and between grade 3 DCIS and poorly differentiated invasive breast carcinomas, using Fisher’s exact and Student’s t-tests. Results  Levels of AI were significantly lower (P < 0.01) in grade 1 DCIS (11.9%) compared to well-differentiated carcinomas (19.2%), but were not significantly different between grade 3 DCIS and poorly differentiated tumors. No significant differences were detected at any of the 26 chromosomal regions between low-grade DCIS and invasive tumors; however, AI events at chromosomes 1p36, 11q23, and 16q11–q22 could discriminate high-grade in situ from invasive disease. Conclusion  Lower levels of AI in low-grade in situ compared with invasive disease may reflect the protracted time to progression associated with low-grade DCIS. Increased levels of AI at chromosomes 1p36 and 11q23 in poorly differentiated carcinomas may harbor genes associated with invasiveness, while loss of chromosome 16q11–q22 may prevent the transition from in situ to invasive disease. Further characterization of these changes may provide molecular assays to identify DCIS lesions with invasive potential as well as targets for molecular therapeutics. Address reprints requests to: Ms. Kerri Cronin, Clinical Breast Care Project, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Washington, DC 20307, USA; E-mail: kerri.cronin@amedd.army.mil.     

FISH 1p/19q deletion/imbalance for molecular subclassification of glioblastoma

Glioblastoma is the most malignant and frequent of the glial tumors. A minor fraction of glioblastoma may contain areas showing oligodendroglioma-like tumor cell differentiation. Several authors have described such tumors as glioblastoma with oligodendroglial component (GBMO). GBMO may represent the ultimate level of malignancy in the oligodendroglial lineage. The oligodendroglial component and combined loss of chromosomal arm 1p and 19q in glioblastoma indicate increased survival. In our study, we analyzed 1p and 19q status in a series of 12 glioblastoma and 8 oligodendroglial tumors using fluorescence in situ hybridization (FISH) on paraffin-embedded tissues. In each case, hybridization status was classified as deletion, imbalance, polysomy, amplification, or normal pattern. Other genetic alterations such as CDKN2A (p16), RB, and EGFR were also assessed. On histological review, 2 of 12 glioblastoma (16.7%) were classified as GBMO. Chromosome 1p/19q deletion was detected in 3 of 12 glioblastomas (25%). In contrast, all 8 oligodendroglial tumors showed 1p/19q deletion. All GBMO had 19q deletion with imbalance, whereas 1 of 10 ordinary glioblastoma (10%) demonstrated 19q deletion with imbalance. All but 1 ordinary glioblastoma (90%) showed CDKN2A (p16) deletion, but no GBMO displayed this alteration. Our results indicate that GBMO may be a distinct subtype of glioblastoma harboring a characteristic molecular profile. FISH on paraffin-embedded specimens is a useful method for subclassification of glioblastoma.     

孕康颗粒联合阿司匹林和低分子肝素钠治疗复发性流产的临床研究

目的 探讨孕康颗粒联合阿司匹林及低分子肝素钠治疗复发性流产的临床疗效。方法 选取2019年1月—2020年6月于河南省生殖妇产医院就诊的108例复发性流产患者为研究对象,随机分为对照组和治疗组,每组各54例。对照组口服阿司匹林肠溶片,100 mg/次,1次/d,同时皮下注射低分子肝素钠注射液,3 200 IU/次,1次/d。治疗组在对照组基础上口服孕康颗粒,1袋/次,3次/d。两组患者均连续治疗10周。观察两组患者临床疗效,比较治疗前后两组患者激素雌二醇（E₂）、孕酮（P）和人绒毛膜促性腺激素（HCG）水平,凝血-纤溶系统指标凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、血清纤溶酶原激活抑制剂1（PAI-1）水平和组织型纤溶酶原激活剂（t-PA）,细胞因子白细胞介素-17（IL-17）、白细胞介素-23（IL-23）、转化生长因子-β（TGF-β）和白细胞介素-10（IL-10）水平。结果 治疗后,与对照组相比,治疗组临床有效率显著升高,差异具有统计学意义（P＜0.05）。治疗后,两组E₂、P及HCG、PT、APTT及TGF-β和IL-10水平均显著升高（P＜0.05）,而IL-17、PAI-1和IL-23水平显著降低（P＜0.05）,且治疗组这些指标水平明显好于对照组（P＜0.05）。结论 孕康颗粒联合阿司匹林及低分子肝素钠治疗复发性流产的临床疗效显著且安全性高,其中机制可能与改善复发性流产患者的激素水平、凝血-纤溶系统及调节Th17/Treg细胞失衡有关。     

Variant autonomic regulation during active standing in Swedish and Japanese junior high school children

The present investigation is about cardiovascular responses and relevant autonomic function in Swedish and Japanese pubertal children on active standing using non-invasive continuous beat-to-beat finger arterial pressure (FAP) monitoring and power spectral analysis. Examined were 54 Swedish and 57 Japanese children (13-15 years). FAP and heart rate (HR) was continuously recorded in the supine position and during standing. Supine FAP was significantly higher in Swedish compared with Japanese children (121/62 versus 103/53 mmHg, P < 0.001). Swedish children showed a higher increase in arterial pressure and HR upon uprising, resulting in a higher vasoconstrictor index (5.04 +/- 0.22 versus 2.31 +/- 0.11 mmHg s(-1), P < 0.001, respectively). There were also higher increases in arterial pressure and HR in the following steady state period (1-7 min) between the two groups. These differences were also found after adjustment of body weight and height. Frequency domain analysis of HR and arterial pressure variability indicated significantly higher low/high frequency power of HR and low frequency power of arterial pressure. These results suggest that Swedish pubertal children have higher basal blood pressure and enhanced cardiovascular sympathetic responses. These differences in the two cohorts might be caused by genetic factors.