Dental caries and erosion status of 12-year-old Hong Kong children

Background

We examined the association of alcohol use disorders (AUD) with adherence to and health-related quality of life (HRQOL) outcomes of antiretroviral treatment (ART) for HIV/AIDS patients.

Methods

A cross-sectional multi-site survey was conducted in 468 drug users and 648 non-drug users (age: 35.4 ± 7.0 years; 63.8% male) in 3 epicentres of Vietnam. AUD, ART adherence, and HRQOL were measured using the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C), the self-reported Visual Analogue Scale (VAS), and the World Health Organization Quality of Life instrument (WHOQOL-HIV BREF).

Results

35.0% of drug users were hazardous drinkers, compared to 25.9% of non-drug users. 22.3% of drug users engaged in binge drinking, and 25.9% reported suboptimal ART adherence. Adjusting for propensity scores of AUD, patients who had either at-risk or binge drinking behaviour were about twice as likely to be treatment non-adherent as those who did not have AUD. Hazardous drinkers reported small to medium decrements in the Performance, Physical, Social, Spirituality, and Environment quality of life domains. Binge drinkers had a slightly higher score in Social dimension.

Conclusion

AUD is prevalent and negatively affecting adherence to and HRQOL outcomes of ART services in injection-driven HIV epidemics. Screening and intervention are recommended for AUD, especially during the stable periods of ART. Other social and psychological interventions might also enhance patients’ responses to and outcomes of ART in Vietnam.     

Multimorbidity and Evidence Generation

Most people with a chronic disease actually have more than one, a condition known as multimorbidity. Despite this, the evidence base to prevent adverse disease outcomes has taken a disease-specific approach. Drawing on a conference, Improving Guidelines for Multimorbid Patients, the goal of this paper is to identify challenges to the generation of evidence to support the care of people with multimorbidity and to make recommendations for improvement. We identified three broad categories of challenges: 1) challenges to defining and measuring multimorbidity; 2) challenges related to the effects of multimorbidity on study design, implementation and analysis; and 3) challenges inherent in studying heterogeneity of treatment effects in patients with differing comorbid conditions. We propose a set of recommendations for consideration by investigators and others (reviewers, editors, funding agencies, policymaking organizations) involved in the creation of evidence for this common type of person that address each of these challenges. The recommendations reflect a general approach that emphasizes broader inclusion (recruitment and retention) of patients with multimorbidity, coupled with more rigorous efforts to measure comorbidity and comorbidity burden and the influence of multimorbidity on outcomes and the effects of therapy. More rigorous examination of heterogeneity of treatment effects requires careful attention to prioritizing the most important comorbid-related questions, and also requires studies that provide greater statistical power than conventional trials have provided. Relatively modest changes in the orientation of current research along these lines can be helpful in pointing to and partially addressing selected knowledge gaps. However, producing a robust evidence base to support patient-centered decision making in complex individuals with multimorbidity, exposed to many different combinations of potentially interacting factors that can modify the risks and benefits of therapies, is likely to require a clinical research enterprise fundamentally restructured to be more fully integrated with routine clinical practice.     

Incidence and Risk of Pneumococcal Pneumonia in Adults with Distinct Underlying Medical Conditions: A Population-Based Study

Lung - This study investigated the incidence of pneumococcal pneumonia requiring hospitalisation among middle-aged and older adults with and without specific underlying medical conditions,...     

胚胎干细胞与胚胎生殖细胞的生物学特性及应用前景

目的:分析胚胎干细胞和胚胎生殖细胞的生物学特性、体外培养条件、周围微环境对其增殖分化的影响,了解胚胎干细胞和胚胎生殖细胞的关系和应用前景。方法:应用计算机检索万方数据库2000/2007有关生殖细胞、胚胎干细胞、胚胎生殖细胞的相关研究文章,检索词:生殖细胞,胚胎干细胞,胚胎生殖细胞,并限定文章语言种类为中文;同时应用计算机检索PUBMED2000/2006相关文章,检索词:Germ Cells,Primordial germ cells,Embryonic stem cells,Embryonic Germ Cells,限定文章语言种类为“English”。对资料进行初审,纳入标准为有关生殖细胞、胚胎干细胞、胚胎生殖细胞的生物学特性、体外培养及生长抑制因子的作用等相关文章,并查找全文。主要选择基础研究类文章,无论有无对照组均纳入。结果:共检索到相关文章59篇,排除比较陈旧的文章,最后纳入38篇进行总结分析。胚胎干细胞与胚胎生殖细胞分别从附置前早期胚胎内细胞团和早期胎儿生殖嵴原始生殖细胞分离克隆出来,均具有自我更新、无限增殖能力及多向分化潜能,在体外培养条件下可保持稳定的二倍体核型,诱导分化后可形成3种胚胎生殖层。饲养层细胞是人胚胎生殖细胞体外培养的必要条件,常用饲养层细胞有鼠STO细胞系、鼠胚胎成纤维细胞,体外生长所需主要细胞因子包括干细胞生长因子、碱性成纤维细胞生长因子和白血病抑制因子,然而只要在培养基中加入鼠成纤维细胞的上清液和碱性成纤维细胞生长因子,胚胎干细胞可在无饲养层的条件下进行体外培养。结论:胚胎干细胞和胚胎生殖细胞具有相似的增殖特性,一定条件下可以分化为包括生殖细胞在内的所有功能细胞,并可相互转变,在胚胎发育、基因治疗、药物筛选、新药开发、生殖医学及人类疾病的移植治疗中具有广泛的应用前景。     

Chondrosarcoma of the jaws: clinical findings, histopathology, and treatment

Three cases of chondrosarcoma involving the jaws are presented, one in the maxilla and two in the mandible. The salient points of clinical presentation elucidated by this series of cases are that a widened periodontal ligament space is present in chondrosarcomas as well as in osteosarcomas, and that a slowly increasing diastema may be the earliest clinical sign. The most important lesson to be learned from the histopathology is that one should not accept a diagnosis of a benign cartilaginous tumor of the jaws. Treatment of these lesions should consist of wide surgical excision and consideration of adjunctive or palliative radiotherapy, especially in the maxilla. It should also be noted that recurrences may develop 10 to 20 years later, and follow-up should be lifelong.