Epidemiologic background and long-term course of disease in human immunodeficiency virus type 1-infected blood donors identified before routine laboratory screening. Transfusion Safety Study Group

BACKGROUND: The long-term course of human immunodeficiency virus type 1 (HIV-1)-related disease among seropositive blood donors has not been described. The enrollment and epidemiologic background of HIV-1- infected donors in the Transfusion Safety Study and their immunologic and clinical progression are described. STUDY DESIGN AND METHODS: Through the testing of approximately 200,000 sera from donations made in late 1984 and early 1985, 146 anti-HIV-1-positive donors and 151 uninfected matched donors were enrolled. These two cohorts were followed with 6-month interval histories and laboratory testing. RESULTS: Seropositive donors detected before the institution of routine anti-HIV-1 screening disproportionately were first-time donors and men with exclusively male sexual contacts. The actuarial probability of a person's developing AIDS within 7 years after donation was 40 percent; the probability of a person's dying of AIDS was 28 percent. AIDS developed more often when the donor was p24 antigen-positive at donation. Over a 3-year period, significant decreases occurred in CD4+, CD2+CD26+, CD4+CD29+, and CD20+CD21+ counts, but not in CD8+ subsets, CD20+, or CD14+. CONCLUSION: The high proportions of first-time donations and exclusively homosexual men among seropositive donors suggest that test-seeking may have contributed to the high HIV-1 prevalence in the repository. Implementation of alternative test sites when routine donor screening began in 1985 may have averted many high- risk donations. The disease course in HIV-1-infected donors had the same wide spectrum of immunologic and clinical manifestations as were reported for other cohorts.     

Resection of Isolated Pelvic Recurrences after Colorectal Surgery: Long-Term Results and Predictors of Improved Clinical Outcome

Background Recurrence in the pelvis after resection of a rectal or rectosigmoid cancer presents a dilemma. Resection offers the only reasonable probability for cure, but at the cost of perioperative morbidity and potential mortality. Clinical decision making remains difficult. Methods Patients resected with curative intent for isolated pelvic recurrences after curative colorectal surgery from 1988 through 2003 were reviewed retrospectively. Clinical and pathologic factors, salvage operations, and complications were recorded. The primary measured outcome was overall survival. Univariate and multivariate analyses were conducted to identify prognostic factors of improved outcome. Results Ninety patients underwent an attempt at curative resection of a pelvic recurrence with median follow-up of 31 months. Complications occurred in 53% of patients. Operative mortality was 4.4% (4 of 90). Median overall survival was 38 months, and estimated 5-year survival was 40%. A total of 51 of 86 patients had known recurrences (15 local, 16 distant, 20 both). Multivariate analysis revealed that preoperative carcinoembryonic antigen level and final margin status were statistically significant predictors of outcome. Conclusions The resection of pelvic recurrences after colorectal surgery for cancer can be performed with low mortality and good long-term outcome; however, morbidity from such procedures is high. Low preoperative carcinoembryonic antigen and negative margin of resection predict improved survival. Presented at the Society of Surgical Oncology, 58th Annual Cancer Symposium, Atlanta, GA, March 3–6, 2005.     

Epidemiology of Van der Woude syndrome from mutational analyses in affected patients from Pakistan

Malik S, Kakar N, Hasnain S, Ahmad J, Wilcox ER, Naz S. Epidemiology of Van der Woude syndrome from mutational analyses in affected patients from Pakistan. Mutations in IRF6 cause Van der Woude syndrome (VWS), one of the most common syndromes associated with cleft lip (CL) with or without cleft palate (CP). The presence of pits on the lower lip of patients is the most characteristic feature of the syndrome. We have identified three novel and seven previously reported IRF6 mutations in 12 of 16 unrelated families segregating VWS from Pakistan. The three newly identified mutations include a frameshift (c.568delG) and two missense mutations c.295G>A (p.G99S) and c.1219T>C (p.S407P). Recent functional studies on IRF6 and the three‐dimensional structure of IRF5 carboxy (C) terminus, a protein encoded by a paralog of IRF6, shed light on the p.S407P substitution. Additionally, the identification of the same mutations responsible for VWS in Pakistan, as reported in other global populations worldwide, marks these residues as mutational hotspots and indicates their essential role in structural stability or function of IRF6. This is the first study of VWS in Pakistan and we estimate that 1 in 100 patients with CL with or without CP (CL/P) are affected in the Pakistani population predominantly from the Punjab area.     

横断面调查在抗菌药物管理PDCA中的应用

目的：探讨将横断面调查应用于抗菌药物管理PDCA中的成效。方法：通过2012年连续4次横断面调查收集资料,应用于抗菌药物管理PDCA循环的计划与检查环节。结果：调查的8项指标中6项有显著改善（P〈0．01）,其余两项无显著改善（P〉0．05）。结论：将横断面调查应用于抗菌药物管理PDCA的各个环节,能改善抗菌药物临床合理应用状况,是提高抗菌药物管理质量行之有效的方法。     

Nonsteroidal antiinflammatory drugs and bladder cancer: a pooled analysis

Case-control studies have shown that regular use of nonsteroidal antiinflammatory drugs (NSAIDs) decreases bladder cancer risk, but few cohort studies have evaluated this association. The authors investigated NSAID use and bladder cancer in 3 large prospective studies (NIH-AARP Diet and Health Study; Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial; and U.S. Radiologic Technologists Study). Frequency of aspirin and nonaspirin NSAID use 1 year prior to baseline was ascertained using self-administered questionnaires. Study-specific hazard ratios and 95% confidence intervals were estimated using Cox regression models and were combined using a fixed-effects meta-analytic model. Data from all studies were aggregated, and aggregated hazard ratios were estimated. The analysis included 508,842 individuals, with 2,489 incident cases of bladder cancer. A reduction in risk was observed for individuals who reported regular use (>2 times/week) of nonaspirin NSAIDs compared with those who reported no use (hazard ratio (HR) = 0.92, 95% confidence interval (CI): 0.81, 1.04). The risk reduction was limited to nonsmokers (HR = 0.58, 95% CI: 0.41, 0.83) (P(trend) = 0.008) (P(interaction) = 0.02). No association was observed between regular aspirin use and bladder cancer risk (HR = 1.04, 95% CI: 0.94, 1.15). Results suggest that nonaspirin NSAIDs, but not aspirin, are associated with a reduction in risk of bladder cancer, particularly for nonsmokers.     

新疆护理专职教师工作压力现状及影响因素

目的探讨新疆护理教师工作压力现状并分析其影响因素,为提出护理教师队伍建设的相关对策提供实证依据并为护理院校管理和教师人才队伍的可持续发展提出建议。方法采用高职教师工作压力量表对新疆15个地、市、州抽取的10所护理院校在编在岗的256位护理教师进行问卷调查,调查其工作压力现状并分析其影响因素。结果护理专职教师的工作压力得分为（2．436±0．576）分,大于2分,说明教师的工作压力大。教龄、婚姻、兼职情况及教学工作量不同的教师因社会因素而产生的工作压力水平不同,不同婚姻状况的教师因学校管理及制度因素产生的压力水平不同,性别、年龄、学历、婚姻、教学工作量不同的教师个人职业发展所带来的压力水平不同,性别、教龄、每周课时量等在护理院校教师工作压力不同;年龄、婚姻状况、教学工作量不同的教师因人际关系产生的工作压力水平不同,性别、年龄、教龄、职称、婚姻、教学工作量、收入水平及兼职情况不同的教师因工作负荷压力水平不同,性别、职称、婚姻、教学工作量、担任教学课程不同的教师因个人特质因素带来的工作压力不同,差异均有统计学意义（P〈0．05）。结论护理专职教师的工作压力大,来源是多方面的,学校管理制度和社会因素带来的压力最大,因此应尽快改变社会各界对护理教育认识上的不足和偏见,明确护理教育的定位,加大国家对护理教育的投入,同时护理教师应提高对自己职业的认识,合理制定自己的职业生涯发展规划。     

Amyotrophic lateral sclerosis presenting as upper limb weakness in a 35 year old female: a case report

Chiropractors regularly assess and provide treatment for a variety of neuromuscular complaints. Many of these respond well to conservative care however some represent conditions that must be referred for further evaluation. This article chronicles the management of a patient who presented with upper limb weakness and was subsequently diagnosed with amyotrophic lateral sclerosis (ALS). Chiropractors should be informed of the nature and presentation of this disease to facilitate early diagnosis and treatment.     

Effects of subchronic exposure of early life stages of white sturgeon (Acipenser transmontanus) to copper, cadmium, and zinc

Populations of sturgeon (Acipenseridae) are declining in many places in the world because of several potential factors, including overharvesting, habitat alteration, and pollution. In North America, populations of the white sturgeon (Acipenser transmontanus) have been experiencing poor annual recruitment in major river systems for more than three decades. Metal pollution has been hypothesized as a potential contributing factor to the poor recruitment in some of the water bodies. In general, little is known about the toxicity of metals such as Cu, Cd, and Zn to white sturgeon and their potential influence on survival of embryos and juveniles. The present study was conducted to establish baseline toxicity data for the subchronic exposure of early life stages of white sturgeon to Cu, Cd, and Zn that can be used in metal-related risk assessments. Embryos, larvae, and fry were exposed to increasing concentrations of dissolved Cu, Cd, or Zn for 66 d using laboratory-based flow-through exposure systems. Hatching success was greater than 79% for all controls, and no significant differences were observed among treatment groups or between treatments and controls. Chronic lethal concentrations at which 20% mortality occurred (LC20s) for Cd (1.5 μg/L), Cu (5.5?μg/L), and Zn (112?μg/L) obtained for white sturgeon in the present study were comparable to those of sensitive salmonid species. Based on LC20 values for 19 or 58 d posthatch white sturgeon, the United States national ambient water quality criteria and the Canadian water quality guidelines for the protection of aquatic life that have been established for Cd, Cu, and Zn protect white sturgeon early life stages.