Risk factors for chronic kidney disease: a prospective study of 23,534 men and women in Washington County, Maryland

Chronic kidney disease (CKD) is an increasing cause of morbidity and mortality in the United States. Prospective data on risk factors for CKD are limited to men, and few studies examine the importance of smoking. The authors performed a community-based, prospective observational study of 20-yr duration to examine the association between hypertension and smoking on the future risk of CKD in 23,534 men and women in Washington County, Maryland. CKD was identified as end-stage renal disease in the Health Care Financing Administration database or kidney disease listed on the death certificate. All cases were confirmed as CKD by medical chart review. Adjusted relative hazards of CKD were modeled using Cox proportional hazards regression including age as the time variable and baseline BP, cigarette smoking, gender, and diabetes status as risk factors. The adjusted hazard ratio (95% confidence interval) of developing CKD among women was 2.5 (0.05 to 12.0) for normal BP, 3.0 (0.6 to 14.4) for high-normal BP, 3.8 (0.8 to 17.2) for stage 1 hypertension, 6.3 (1.3 to 29.0) for stage 2 hypertension, and 8.8 (1.8 to 43.0) for stages 3 or 4 hypertension compared with individuals with optimal BP. In men, the relationship was similar but somewhat weaker than in women, with corresponding hazard ratios of 1.4 (0.2 to 12.1), 3.3 (0.4 to 25.6), 3.0 (0.4 to 22.2), 5.7 (0.8 to 43.0), and 9.7 (1.2 to 75.6), respectively. Current cigarette smoking was also significantly associated with risk of CKD in both men and women (hazard ratio in women 2.9 [1.7 to 5.0] and in men 2.4 [1.5 to 4.0]). A large proportion of the attributable risk of CKD in this population was associated with stage 1 hypertension (23%) and cigarette smoking (31%). In conclusion, CKD risk shows strong graded relationships to the sixth report of the Joint National Committee (JNC-VI) on Prevention, Detection Evaluation and Treatment of High BP criteria for BP, to diabetes, and to current cigarette smoking that are at least as strong in women as in men.     

Prospective study of antioxidant micronutrients in the blood and the risk of developing prostate cancer

Antioxidant micronutrients may have chemopreventive effects. The authors examined the associations between prediagnostic blood levels of micronutrients and prostate cancer risk in two nested case-control studies of 9,804 and 10,456 male residents of Washington County, Maryland, who donated blood in 1974 (CLUE I) and 1989 (CLUE II), respectively. Until 1996, 182 men for whom adequate serum remained for assays in the CLUE I cohort and 142 men in the CLUE II cohort developed prostate cancer. Each case was matched with two controls by age, gender, race, and date of blood donation. In both cohorts, cases and controls had similar concentrations of alpha-carotene, beta-carotene, total carotene, beta-cryptoxanthin, lutein, lycopene, retinol, and ascorbic acid; serum alpha-tocopherol was weakly associated with prostate cancer risk. Higher retinyl palmitate concentrations were associated with a lower risk in CLUE I but not CLUE II. In CLUE I, cases had lower concentrations of gamma-tocopherol than did controls (p = 0.02), but no dose-response trend was observed. A strong inverse association between gamma-tocopherol and prostate cancer risk was observed in CLUE II. Findings do not replicate previous reports of a protective association between lycopene and prostate cancer, but they suggest potential chemopreventive effects of gamma-tocopherol on prostate cancer.     

Cohort analysis: W.H. Frost's contributions to the epidemiology of tuberculosis and chronic disease

Summary Although Wade Hampton Frost was not the first to develop cohort analysis, it was the post-humous publication of his study of age and time trends of tuberculosis mortality that directed attention to this method of analysis. Frost's developing interest in and contributions to the epidemiology of chronic disease are reviewed in connection with a summary of his professional career.

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Zusammenfassung Obwohl Wade Hampton Frost nicht der erste war, der die Kohortenanalyse entwickelte, war es die posthume Veröffentlichung seiner Studie zu Alter und Zeittrends von Tuberkulose-Mortalität, die die Aufmerksamkeit für diese Analysemethode auf sich zog. Frosts fortschreitendes Interesse an und seine Beiträge zur Epidemiologie von chronischen Krankheiten werden in diesem Artikel zusammen mit einem Überblick über seine berufliche Karriere nachgezeichnet.

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Résumé Bien que Wade Hampton Frost ne fut pas l'inventeur de l'analyse de cohorte, c'est la publication posthume de son étude sur les tendances temporelle et selon l'âge des décès par tuberculose qui a attiré l'attention sur ce type d'analyse. Cet article montre le lien entre la carrière professionnelle de Frost, son intérêt croissant et sa contribution a l'épidémiologie des maladies chroniques.

     

What to expect from routine midtrimester screening for congenital heart disease

The four-chamber view is the standard screening view of the fetal heart. However, it detects only about half of cardiac defects. Because this view does not show the great vessels, only conotruncal abnormalities with substantial septal defects will be seen. Second, septal defects may be too small at the time of screening to be detected. In addition, some defects such as pulmonic stenosis are late appearing. The addition of the aortic outflow tract view increases sensitivity by approximately 20%. Although all components of the four-chamber view may not be seen, there is still considerable information supplied by each of its parts.     

急性淋巴细胞白血病最新治疗策略(上)

利用目前的治疗手段,80%的急性淋巴细胞白血病(acute lymphoblastic leukem ia,ALL)患儿均能得到治愈,尚有部分患者需接受强化治疗,但治疗的副作用也带来了急性或远期的严重并发症。此外,成人ALL病人的生存率依然低于40%。因此,本病需要既可以提高治愈率又能改善生活质量的新治疗方案。本文讨论了新出现的可能会改善ALL病人预后的治疗方法,包括现有常规化疗药物的新剂型、新的抗代谢药和核苷衍生物、白血病相关抗原的单克隆抗体,针对白血病细胞的基因异常及相关信号通路的分子治疗。1常规化疗药物的新剂型化疗药物的脂质体剂型是将药物…     

DIABETES MELLITUS AND ADDISON'S DISEASE IN AN ADOLESCENT FEMALE

Abstract. Matsaniotis, N., Tzortzatou-Stathopoulou, F., Thomaidis, Th., Karakatsani-Kerasioti, Z., Theodoridis, Ch. and Dacou-Voutetakis, C. (First Department of Paediatrics of Athens University, "Aghia Sophia" Children's Hospital, Athens, Greece). Diabetes mellitus and Addison's disease in an adolescent female. Acta Paediatr Scand, 70: 949, 1981.-This short report describes a 16-year-old female who presented with Addison's disease 6 years after diabetes mellitus had been diagnosed. The possibility of both conditions being present should be borne in mind whenever an unexplained reduction of insulin requirements is noted, especially if this is accompanied by cutaneous pigmentation. The metabolic interrelationships of the two conditions are briefly discussed.     

Epidemiologic study of trichomoniasis in normal women

The prevalence of trichomonas vaginalis in a relatively unselected group of 4341 30-45 year old white women from Washington County, Maryland, was examined in Papanicolaou stained smears prepared by the self-administered irrigation smear method. 14.5% of the 4290 satisfactory smears were classified as positive for T. vaginalis. This may have been underestimated since over 1/2 of the group showed few parasites. 2.7% of the total (20% of the positive group) had heavy infestations. There was an insignificant increase between 30-34 and 40-45 year old women (13.6%-15.2%). There was a negative association between the amount of schooling and incidence of infection. Married women had 1/2 the infection incidence of widowed or never married women and one-third the incidence of divorced or separated women, a a pattern which differs from other reports. However, symptomatic unmarried women may have responded to the survey in greater numbers than symptomatic unmarried women, biasing the results. There was a significantly higher incidence of trichomoniasis among women married several times than among women married only once. There was a correlation between age at first marriage and infection incidence. The use of intravaginal contraceptive agents may have an effect on the trichomonads. There was no correlation with religion or size of household. Inverse correlations were noted between income, occupation of husband, crowding and sanitary facilities and trichomoniasis infection with an exception being the low frequency among farm women. Moderate and heavy cigarette smokers had higher infection rates than light and nonsmokers, and there was a high association of trichomoniasis with abnormal cytologic findings. These were all consistent with a venereal mode of transmission.     

急性淋巴细胞白血病(上)

急性淋巴细胞白血病是淋巴前体细胞异常引起的恶性疾病,儿童与成人均可能发生。儿童发病高峰2～5岁。有效治疗的稳步进展使本病在儿童中的治愈率80％以上,同时为新的治疗方案提供了良机,新方案将保留我们在白血病无病生存病例中获得的治疗经验,同时减轻当前强化治疗方案中的毒副作用。     

亮氨酸脑啡肽的电子结构及构效关系研究

对亮氨酸脑啡肽进行了量子化学(INDO)计算,研究其电子结构特征,讨论其活性部位、作用机理及构效关系。同吗啡和R31833进行了活性部位的电子结构与空间结构比较,推断它们的活性药效结构具有共同特点,与阿片受体相互作用时作用方式相同,作用部位有对应关系,因而具有相同的药理性质。