para-amino benzoic acid in the assessment of completeness of 24-hour urine collections from hospital outpatients and the effect of impaired renal function.

Eighteen (29%) of 24-h urine collections made by 63 hospital outpatients attending a gastroenterology clinic were incomplete, as judged by 24 h urine recovery of an oral marker, para-amino benzoic acid (PABA), despite more than the usual efforts to obtain complete collections. Incomplete collections contained significantly less sodium, urea and total nitrogen than full collections. Average outputs were 134 mmol and 103 mmol per day for sodium (P less than 0.02); 301 mmol and 223 mmol for urea (P less than 0.001); and 10.1 g and 8.3 g nitrogen (P less than 0.01) in the complete and incomplete collections respectively. In renal outpatients with a plasma creatinine in excess of 125 mumol per litre, urine recoveries of PABA were reduced, but within the expected range in renal patients whose plasma creatinine was normal.     

老年2型糖尿病患者认知功能与血压昼夜节律变化特点

目的探讨老年2型糖尿病(T2DM)患者认知功能与24h动态血压昼夜节律变化特点。方法选择270例老年T2DM患者为糖尿病组,另选择同期健康体检者100例为对照组。对两组行24h动态血压监测,根据夜间血压下降率(ΔMBP)分为杓型(△MBP10%～20%,n=95)、非杓型(△MBP0%～<10%,n=86)、超杓型(△MBP>20%,n=47)和反杓型(△MBP<0%,n=42);用中文版简易智能状态检查表(MMSE)对所有受试者进行认知功能调查,比较各组间MMSE得分的差异。结果糖尿病组患者MMSE得分[(24.34±2.51)分]低于对照组[(28.88±3.02)分],差异有统计学意义(P<0.05)。糖尿病组中非杓型[(24.77±2.53)分]、超杓型[(23.34±2.41)分]和反杓型[(23.03±2.26)分]患者的MMSE得分均低于杓型[(26.03±2.68)分]患者,超杓型和反杓型又低于非杓型患者,差异有统计学意义(P<0.05),但超杓型和反杓型之间的差异无统计学意义。Pearson相关分析显示,糖尿病患者MMSE得分与24hSBP(r=-0.73)、24hDBP(r=-0.60)、...     

老年2型糖尿病患者认知功能与血压昼夜节律变化特点

目的 探讨老年2型糖尿病(T2DM)患者认知功能与24h动态血压昼夜节律变化特点.方法 选择270例老年T2DM患者为糖尿病组,另选择同期健康体检者100例为对照组.对两组行24 h动态血压监测,根据夜间血压下降率(△MBP)分为杓型(△MBP 10%～20%,n=95)、非杓型(△MBP 0%～＜10%,n=86)、超杓型(△MBP＞20%,n=47)和反杓型(△MBP＜0%,n=42);用中文版简易智能状态检查表(MMSE)对所有受试者进行认知功能调查,比较各组间MMSE得分的差异.结果 糖尿病组患者MMSE得分[(24.34±2.51)分]低于对照组[(28.88±3.02)分],差异有统计学意义(P＜0.05).糖尿病组中非杓型[(24.77±2.53)分]、超杓型[(23.34±2.41)分]和反杓型[(23.03±2.26)分]患者的MMSE得分均低于杓型[(26.03±2.68)分]患者,超杓型和反杓型又低于非杓型患者,差异有统计学意义(P＜0.05),但超杓型和反杓型之间的差异无统计学意义.Pearson相关分析显示,糖尿病患者MMSE得分与24hSBP(r=-0.73)、24hDBP(r=-0.60)、24hPP(r=-0.54)、24hMBP(r=-0.56)呈负相关(P＜0.05).结论 24 h动态血压昼夜节律的减弱或消失可能是老年T2DM患者认知功能受损的相关因素.     

The statistical analysis of treatment effects in 24-hour ambulatory blood pressure recordings

This paper presents a statistical analysis of treatment effects in 24-hour ambulatory blood pressure recordings. The statistical models account for circadian rhythms, subject effects, and the effects of treatment with drugs or relaxation therapy. In view of the heterogeneity of the subjects, we fit a separate linear model to the data of each subject, use robust statistical procedures to estimate the parameters of the linear models, and trim the data on a subject by subject basis. We use a meta-analytical method to combine the results of all subjects in the study.     

Role of 24-hour monitoring in assessing blood pressure changes in polycystic ovary syndrome

INTRODUCTION: Polycystic ovary syndrome (PCOS) is associated with higher risk of developing cardiovascular diseases including higher incidence of hypertension later in life. Absence of circadian blood pressure fluctuations is considered as a marker of pre-hypertensive state and correlates highly with target organ damage in hypertension. AIM: Characterization of the circadian blood pressure rhythms as well as comparison of the results from the clinical measurements and Holter-monitored blood pressure data in women with PCOS. MATERIALS AND METHODS: The study comprised 35 women (mean age 22.6 +/- 5.9 years, mean BMI 31.4 +/- 7.1 kg/m2) with proven diagnosis. 24-hour ambulatory Holter-monitoring using Oscar device (Sun Tech Medical Instruments, USA) was performed in parallel with clinical measurements of blood pressure. RESULTS: There were 25.7% of the subjects diagnosed with hypertension according to the criteria of ambulatory monitoring observing discrepancy with the criteria for normal clinically measured blood pressure in 7 cases (20%). The "white coat" effect was observed in 11.4%. Physiological nocturnal drop in the systolic pressure was not observed in 51.4% of the patients and in the diastolic pressure - in 22.9% of the cases. CONCLUSIONS: The results confirm the advantages and the importance of the 24-hour monitoring as a diagnostic and predictive method for assessment of blood pressure alterations even in the absence of overt hypertension. PCOS is characterized by higher incidence of unstable blood pressure that is an additional risk factor for further development of cardiovascular diseases in this relatively young age group.     

Flexibility of working hours in the 24-hour society

The 24-hour Society undergoes an ineluctable process towards a social organisation where time constraints are no more restricting human life. The borders between working and social times are no more fixed and rigidly determined, and the value of working time changes according to the different economic and social effects you may consider. Shift and night work, irregular and flexible working hours, together with new technologies, are the milestone of this epochal passage. What are the advantages and disadvantages for the individual, the companies, and the society? What is the cost/benefit ratio in terms of health and social well-being? Coping properly with this process means avoiding a passive acceptance of it with consequent maladjustments at both individual and social level, but adopting effective preventive and compensative strategies aimed at building up a more sustainable society. Flexible working times now appear to be one of the best ways to cope with the demands of the modern life, but there are different points of view about labour and temporal 'flexibility" between employers and employees. For the former it means a prompt adaptation to market demands and technological innovations; for the latter it is a way to improve working and social life, by decreasing work constraints and increasing control and autonomy. Although it can be easily speculated that individual-based 'flexibility" should improve health and well-being, and especially satisfaction, whereas company-based flexibility" might interfere negatively, the effective consequences on health and well-being have still to be analysed properly.     

Office blood pressure and 24-hour ambulatory blood pressure measurements: high proportion of disagreement in resistant hypertension

ObjectiveTo evaluate the accuracy and quantify the agreement between office blood pressure (BP) and daytime ambulatory BP monitoring in the assessment of BP control of patients with a clinical diagnosis of resistant hypertension.Study Design and SettingOffice BP measurements were done in a cohort of 228 true resistant (TR) or white-coat resistant (WCR) hypertensives classified by ambulatory BP in a hypertension clinic in Rio de Janeiro in this validity study. The agreement between the daytime ambulatory BP and office BP was analyzed using the graphic methods of Altman–Bland and survival–agreement plots.ResultsThe likelihood ratio of a positive test result of office BP was 1.99 for the assessment of uncontrolled BP in TR patients and 1.05 for the WCR hypertensive patients. The Altman and Bland plot showed a significant difference between the two methods, and the presence of a fixed and a proportional bias. The survival–agreement plot showed that a tolerance limit of 20 mm Hg of difference between systolic office BP and systolic daytime ambulatory BP would generate a proportion of disagreement equal to 57.5%.ConclusionThe office BP is still an important tool to monitor BP control of patients with TR hypertension, whereas the monitoring of patients with WCR hypertension requires ambulatory BP.     

24-hour pH monitoring in the treatment of gastroesophageal reflux

The 24 hour pH monitoring is superior to other methods in assessing chemical activity and quantitative characteristics of gastroesophageal reflux (GER). This technique supported by the pull-through esophageal manometry, reveals and classifies the patients for either medical or surgical treatment. The comparison of the diagrams recorded before and after surgical repair, is a reliable guide in evaluating the efficacy of the anti-reflux procedure.     

Validation of the 24-hour dietary recall in preschool children

The results of the current study indicate that data obtained by the dietary recall correlate highly with the children's weighed food intake if a parent or the primary caretaker providing the child's food responds to the interview. Meredith et al. found parents to be poor reporters of children's consumption outside the home. It is encouraging to note that parents can be reliable reporters of their children's food intake in the home environment. When errors did occur, they were errors in portion size, as 96% of foods eaten by the children were correctly identified by the parents. Parents under-reported only 4% of the time. This slight tendency to under-report is consistent with other reports of the validity of the 24-hour dietary recall. In younger children, parents appear to be reliable reporters of their children's in-home dietary intake. As children become older, they appear to be able to recall their own intake both within and outside the home. There are several possible explanations for these findings. First, several factors could have influenced the accuracy of parental reports of the child's intake during the day that we weighed foods. Because food was weighed in the homes, the parents undoubtedly attended more closely to their child's diet. Additionally, the dietary recalls were collected at the end of the day of observation. This was closer in time than most 24-hour recalls and may have reflected less memory decay than usual. Also, since our sample was primarily middle-class families who were well educated, the correspondence between actual vs. reported dietary intake may have been artificially enhanced.(ABSTRACT TRUNCATED AT 250 WORDS)     

动态血压监测对早发型重度子痫前期的临床价值

目的 观察在动态血压监测下使用硝苯地平对早发型重度子痫前期的治疗效果.方法 将92例早发型重度子痫前期患者随机分为监测组45例和对照组47例,在常规使用硫酸镁的基础上,监测组依照血压监测结果使用硝苯地平,对照组则按常规每日3次给予口服硝苯地平10 mg.比较两组孕妇临床症状、实验室检查结果及新生儿情况.结果 监测组治疗后孕妇血压下降,尿蛋白减少,眼底和自觉症状改善等显著高于对照组;新生儿平均出生体重、出生1 min Apgor评分,均高于对照组.结论 依据动态血压的监测结果及血压波动情况合理调整硝苯地平服药时间和剂量,可提高对妊娠期高血压疾病的疗效,确保母婴安全.     

A randomized trial of 72- versus 24-hour intravenous tubing set changes in newborns receiving lipid therapy.

OBJECTIVE: To compare the microbial contamination rate of infusate in the intravenous tubing of newborns receiving lipid therapy, replacing the intravenous delivery system at 72-hour versus 24-hour intervals. DESIGN: Infants requiring intravenous lipid therapy were randomly assigned to have intravenous sets changed on a 72- or a 24-hour schedule, in a 3:1 ratio, in order to compare the infusate contamination rates in an equivalent number of tubing sets. SETTING: A 35-bed, teaching, referral, neonatal intensive-care unit (NICU). PARTICIPANTS: All neonates admitted to the NICU for whom intravenous lipid was ordered. METHODS: Patients were randomized in pharmacy, on receipt of the order for intravenous lipid therapy, to either 72- or 24-hour administration set changes, and followed until 1 week after discontinuation of lipids or discharge from the NICU. Microbial contamination of the infusate was assessed in both groups at the time of administration set changes. Contamination rates were analyzed separately for the lipid and amino acid-glucose tubing sets. Patient charts were reviewed for clinical and epidemiological data, including birth weight, gestational age, gender, age at start of lipid therapy, duration of parenteral nutrition, and type of intravenous access. RESULTS: During the study period, 1,101 and 1,112 sets were sampled in the 72- and 24-hour groups, respectively. Microbial contamination rates were higher in the 72-hour group than the 24-hour group for lipid infusions (39/1,101 [3.54%] vs 15/1,112 [1.35%]; P=.001) and for amino acid infusions (12/1,093 [1.10%] vs 4/1,103 [0.36%]; P=.076). Logistic regression analysis controlling for birth weight, gestational age, and type of venous access showed that only the tubing change interval was significantly associated with lipid set contaminations (odds ratio, 2.69; P=.0013). The rate of blood cultures ordered was higher in the 72- versus the 24-hour group (6.11 vs 4.99 per 100 patient days of total parenteral nutrition; P=.017), and a higher proportion of infants randomized to the 72-hour group died (8% vs 4%; P=.05), although the excess deaths could not clearly be attributed to bacteremia. CONCLUSION: Microbial contamination of infusion sets is significantly more frequent with 72- than with 24-hour set changes in neonates receiving lipid solutions. This may be associated with an increased mortality rate.     

Comparison of the effectiveness of a telephone 24-hour dietary recall method vs an in-person method among urban African-American women

OBJECTIVE: To examine the comparative accuracy of telephone and in-person 24-hour dietary recall methods. SUBJECTS: One hundred eighty-five African-American females, aged 40 years and older, recruited from Sunday church services in Baltimore City, Md. METHODS: Participants were trained to estimate portion size with plastic food models and a 2-dimensional food recall booklet. Dietary intake was then assessed with 2 in-person 24-hour dietary recalls and 1 telephone 24-hour dietary recall, all using a computer-assisted, multiple pass approach. Results from the 2 in-person recalls were averaged and compared with the results from the telephone recall. STATISTICAL ANALYSES: Cross-tabulation, paired t test, Pearson's correlation, chance-corrected agreement, and stepwise linear regression analyses were performed. RESULTS: There were no significant differences between the telephone and in-person methods for any nutrient. Agreement between methods was moderate for all major dietary components, with corrected correlations between methods ranging from 0.26 to 0.97 (P<.001), and kappas ranging from 0.155 to 0.372 (P<.01). Levels of low-energy reporting were high (88% telephone, 91% in-person), though there were no significant differences between methods. CONCLUSIONS: The telephone 24-hour dietary recall method appears to be comparable to the standard in-person method among older African-American women. Portion-size training in person may make subsequent telephone dietary recalls acceptable in this population.     

抗高血压药物在慢性脑血管病患者中的血压变异性影响

目的探讨不同类的降压药物和不同钙拮抗剂对慢性脑血管病患者中血压变异性的影响。方法入选373例有慢性脑血管病的高血压患者,分别给予钙拮抗剂(CCBs)、(受体阻断剂(BBs)、血管紧张素转换酶抑制剂(ACEIs)和血管紧张素Ⅱ受体拮抗剂(ARBs)治疗后,行24h动态血压计算血压变异性,并进行统计分析。结果 BBs的日间血压变异性明显高于ARB或CCB(P<0.05),相比于其他CCB药物,西尼地平的日间血压变异性最低。结论 ARB和CCB相比于BBs更有利于脑血管疾病患者的高血压管理和治疗。而CCB中,由于较小的血压变异性,优选西尼地平。     

Effect of ethanol on 24-hour hormonal changes in peripubertal male rats.

We analyzed the effect of chronic (4 weeks) ethanol feeding on 24-h variation of pituitary-testicular function in peripubertal male Wistar rats by measuring circulating concentrations of prolactin, follicle-stimulating hormone, luteinizing hormone, testosterone, and thyrotropin. Animals were maintained under a 12-h light: 12-h dark photoperiod and received a liquid diet for 4 weeks, starting on day 35 of life. The ethanol-fed group received a diet similar to that provided to control animals, except that maltose was replaced isocalorically with ethanol. Ethanol replacement provided 36% of the total caloric content of the diet. Rats were killed at one of six times around the clock, beginning at zeitgeber time (ZT) 1 (ZT 0 = lights on). In ethanol-fed rats globally, secretion of prolactin was augmented, whereas secretion of follicle-stimulating hormone, luteinizing hormone, testosterone, and thyrotropin was decreased. Significant changes in the 24-h secretory pattern of circulating hormones occurred in rats receiving ethanol, including the appearance of two peaks (at ZT 1 and ZT 9), rather than one peak, of follicle-stimulating hormone during the inactive phase of the daily cycle, suppression of the maximum plasma luteinizing hormone concentration during the first part of the inactive phase, and appearance of a second peak of testosterone and prolactin during the second part of the inactive phase (at ZT 5 and ZT 9, respectively) and of a second peak of plasma thyrotropin during the first part of the active phase (at ZT 13). The significant positive correlation between testosterone and individual luteinizing hormone and prolactin concentrations in control animals was no longer observed after ethanol administration. Chronic ethanol administration presumably affects the endogenous clock that modulates the circadian variation of the pituitary-gonadal axis and thyrotropin release in growing male rats.     

缬沙坦/氨氯地平联合用药对原发性高血压患者24h动态血压的影响

目的 观察缬沙坦及缬沙坦联合氨氯地平治疗老龄高血压患者的疗效,并研究其24h动态血压的变化.方法 经过4周药物洗刷期,90例原发性高血压患者被随机分为缬沙坦160mg及缬沙坦160mg/氨氯地平5mg两组,治疗周期为24周.观察期间测定坐位血压(收缩压和舒张压)和心率,治疗结束后采用动态血压仪同时记录患者的24h动态血压变化,以总有效率及血压下降差值作为观察指标.结果 联合用药组坐位DBP下降值为(12.3 ±5.9)mmHg,达目的血压占64.9％,总有效率为87.8％;单药治疗组坐位DBP下降值为(7.9 ±6.2)mmHg,达目的血压占34.8％,总有效率为64.5％.两组组间比较差异均有统计学意义(P＜0.01).本研究中总共83例完成24h动态血压监测,联合用药组和单药组的舒张压/收缩压(DBP/SBP)的谷/峰比率(T/P)分别为82.8％/75.7％和85.4％/78.8％(P＜0.05).结论 缬沙坦/氨氯地平联合用药治疗原发性高血压患者的降压疗效明显优于缬沙坦单药治疗,并有较少的代谢副作用.     

中国6~13岁儿童24小时活动水平和相关因素分析

了解中国6~13岁儿童24 h活动指南的达标现状,并探讨其社会人口学影响因素,为中国儿童的健康促进提供依据.方法 基于一项全国多中心干预研究,采用分层整群随机抽样方法选取湖南、宁夏、天津、重庆、辽宁、上海和广东7个省市6~13岁儿童共31 362名进行流行病学基线调查.采用问卷调查方式,收集儿童中高强度体力活动(moderate to vigorous physical activity,MVPA)、视屏时间(screen time,ST)和睡眠时长及社会人口学资料.采用广义线性混合模型分析儿童MVPA、ST和睡眠时长达标情况的社会人口学影响因素.结果 被试平均每天MVPA时间为(53.36± 62.28)min.平均每天ST为(1.48±1.46)h,每天睡眠时间<7,7~<9,9~11,>11 h的分别占8.7%,59.6%,30.1%,1.6%.符合MVPA、ST、睡眠指南推荐的比例分别为32.2%,78.5%,30.1%;总达标条数为0,1,2,3条的比例分别为9.6%,47.7%,35.0%,7.7%.年龄、性别、父母文化水平和家庭月收入对体力活动、ST和睡眠是否达标有影响;父母文化程度低与不健康的活动模式有关,父母文化水平越低,达标条数越少(P值均<0.05).结论 中国6~13岁儿童24 h身体活动达标现状不理想,在设计有针对性的干预措施以促进儿童健康时应考虑社会人口学特征.     

Evaluation of alternative statistical methods for linear model analysis to compare two treatments for 24-hour blood pressure response.

This paper evaluates alternative statistical methods for the analysis of 24-hour blood pressure data from a clinical trial which compares two treatments for hypertension. The primary objective of the study discussed here was to determine the time course for the blood pressure lowering effects of a test drug given once daily in the treatment of mild to moderate hypertension when compared with placebo. Thirty-five patients (24 on drug and 11 on placebo) were monitored for 24 hours at baseline and at two weeks post treatment, with diastolic blood pressure (DBP) measurements recorded at 22 time points within each 24-hour visit. The changes in DBP from baseline across the 22 time points are the response variables of interest. Various statistical methods for the assessment of treatment effects over the entire 24-hour dosing interval in a setting with small sample size are discussed and illustrated. The results from a special application of weighted least squares analysis of covariance, which employs a smoothed covariance matrix, support the hypothesis that a once daily dose of the drug significantly reduces DBP over the entire 24-hour dosing interval when compared with placebo. This method has the distinct advantage of enabling evaluation of treatment differences for the change in DBP from baseline at the 22 time points with the corresponding 22 baseline DBP as covariates simultaneously in a situation where the treatment group sample sizes are small.