Haemoglobin at time of referral prior to dialysis predicts survival: an association of haemoglobin with long-term outcomes

Haemoglobin (Hgb) levels are known to be associated with numerousadverse outcomes in both chronic kidney disease (CKD) and non-CKDpatients. This analysis evaluates the association of baseline haemoglobinlevels on survival in CKD patients, who are followed by nephrologists,irrespective of glomerular filtration rate (GFR), prior to initiationof renal replacement therapy (RRT) and erythropoietin hormonereplacement therapy. Analysis of data from the provincial database (PROMIS, PatientRegistration and Outcome Management Information System) in BritishColumbia, Canada, was undertaken. Records used for the analysisincluded all CKD patients at first registration: GFR <60ml/min/1.73 m², not yet on dialysis, starting from May 1998to October 2002, and who had complete data (defined as age andgender, diabetic status, eGFR and Hgb levels). The primary objective of this study was to determine the associationof Hgb and survival controlling for eGFR at first registrationvalue, age, gender and diabetic status. Multivariate Cox proportionalhazards analysis with time to death as outcome variable wasperformed. The cohort included 3028 patients: the mean age was 65 years,28% were diabetic, and the mean eGFR in the cohort was 21 ml/min/1.73m². The cohort is representative of the BC CKD and dialysispopulation regarding ethnicity: 64% Caucasian, 32% Asian. Medianfollow-up was 27 months, 1 year survival was 0.92, 2 year survivalwas 0.85. Hgb at initial registration is a statistically independentpredictor of survival (RR = 0.875 for every 10 g/l, 95% CI:0.835–0.917, P = 0.0001), after adjusting for age, gender,diabetic status and baseline eGFR. Further analysis, controllingfor RRT, demonstrated a similar association between Hgb andsurvival (RR = 0.853 for every 10 g/l, 95% CI: 0.799–0.910,P = 0.0001), after adjusting for above variables. Substantialvariation in Hgb values exists at all GFR levels. These findings underscore the importance of evaluating Hgb atall GFR levels, and the need to study the impact of modificationof Hgb at different GFR levels on survival.     

Factors associated with recovery and recurrence of depression in older people: A prospective study

The Liverpool Continuing Health in the Community Study has followed up 1070 elderly community subjects over 6 years. In the first year 123 subjects had case-level depression. Three years later 49 (39.8%) of the previously depressed were recovered, 33 (26.8%) were depressed, 16 (13%) were not available for interview and 25 (20.3%) were dead. This study looks at factors associated with the 3-year outcome of patients who were depressed at year 0. Two outcome groups that were compared were a recovered depression group and a recurrent/persistent depression group. The factors that were significantly associated with a recurrence of depression (or persistent depression) at year 3 were bereavement of a close figure in the 6 months before interview, loneliness and life dissatisfaction at year 3. A variety of traditional risk factors for depression (including age, marital status, physical ill-health and incapacity) failed to attain significance in predicting recurrent or persistent depression. When combined, both recovered and recurrently depressed groups at year 3 had significantly higher levels of pain and a higher number of serious upsets in the past 6 months and 6 weeks compared to a compared to a control group. The depressed at year 0 were more likely to have entered more dependent forms of accommodation by year 3.     

A case-control study of major congenital heart defects in Sweden — 1981–1986

This paper reports the results of a case-control study of major congenital heart defects (CHD) in Sweden. During the period 1981–1986, 1,324 such cases were identified and 2,648 controls were selected. Some common maternal characteristics and exposures were studied using information from prospectively collected data. Possible associations with CHD were found for previous perinatal death, maternal diabetes, epilepsy, hydramnios and disproportion between fetus and pelvis. More specific associations were observed between previous spontaneous abortion, epilepsy, hydramnios and truncus anomalies and between diabetes and septal anomalies. However, no associations were found with involuntary childlessness, contraceptive use, or smoking.Abbreviations ASD atrial septal defect - CHD congenital heart defect - CI confidence interval - CoA coarctation of the aorta - DORY double outlet right ventricle - ECD endocardial cushion defect - HLHS hypoplastic left heart syndrome - IUD intrauterine device - LMP last menstrual period - OC oral contraceptive - OR odds ratio - PDA patent ductus arteriosus - TGV transposition of the great vessels - VSD ventricular septal defect     

Social participation and life-style: A longitudinal and cohort study

This study focuses on changes occurring in one area of life-style, social participation during retirement. The population consisted of four cohorts, born in 1905–06, 1909–10, 1917–18, and 1921–22. In the longitudinal study the members of the oldest cohort were interviewed five times at the ages of 66, 70, 74, 78 and 82 years. In the cohort study the subjects were interviewed at the age of 66. Interests decreased after the age of 78 among men and women. Also, formal social participation declined with age among men and women. There were no cohort differences among men, but among women formal social participation was higher in the younger cohorts than in the older ones. In the longitudinal study education correlated positively with the interests index at almost all ages among both men and women. In the cohort study correlations between interests index and education were lower in the younger cohorts than in the older ones.Paper originally presented at the XIVth International Congress of Gerontology, Acapulo, Mexico 18–23 June 1989.     

^60Co消毒与高温高压消毒胚胎骨的实验研究

在12只健康家兔下颌骨体部的两侧各造成0.7cm×0.5cm×0.3cm的骨缺损区，分别置入^60Co消毒的胚胎骨和高温高压消毒的胚胎骨，发现高温高压消毒可以替代^60Co消毒胚胎骨进行移植，为临床提供了一种新的用作同种异体移植胚胎骨的消毒方法。     

Perception and social consequences of tuberculosis: A focus group study of tuberculosis patients in Sialkot, Pakistan

Treatment defaulting is one of the major causes of the failure of TB control programs. In Bethania Hospital. Sialkot, defaulting rates are high: 72% for the standard 12 months course and 56% for the 8 months course. Attrition is especially important in the first weeks of treatment: < 70% of the patients start the 10th week of treatment. A focus group discussion study has been carried out to gain a better understanding of the impact of social stigmatization, treatment cost and pregnancy on defaulting. The study population consisted of 3 male and 3 female groups each with 8 hospitalized TB patients. The study shows that TB is perceived as a very dangerous, infectious and incurable disease. This perception has many social consequences: stigmatization and social isolation of TB patients and their families; diminished marriage prospects for young TB patients, and even for their family members; TB in one of the partners may lead to divorce. Due to fear patients often deny the diagnosis and reject the treatment. While both male and female TB patients face many social and economical problems, female patients are more affected. Divorce and broken engagements seem to occur more often in female patients. Females are usually economically dependent on their husbands and family in law, and need their cooperation to avail of treatment. The belief that pregnancy enhances the risk for relapse decreases their marriage prospects. Pregnancy is also a reason for stopping TB treatment as both are considered as incompatible. The findings of this study reveal the urgent need for a health education campaign to convince the general population that tuberculosis is curable. All health care providers should act as destigmatizers.     

Lipid metabolism and occurrence of post-percutaneous transluminal coronary angioplasty restenosis: role of cholesteryl ester transfer protein and paraoxonase/arylesterase

Summary.  Plasma lipid metabolic and transfer processes have recently been suggested to play an important role in the development of early restenosis, a major complication of percutaneous transluminal coronary angioplasty (PTCA); in particular, the common variants of genes for cholesteryl ester transfer protein (CETP) and paraoxonase (PONA) have been implicated. We had the opportunity to investigate this question in a large, prospective cohort characterized by quantitative coronary angiography in all subjects. The CETP-Taq IB (intron 1), CETP-Msp I (intron 8), and PONA-Alw I (exon 2) polymorphisms were characterized in a cohort of 779 patients of whom 342 ('cases') had developed restenosis (as defined by > 50% loss of lumen compared with immediate postprocedure results) at repeat angiography at 6 months post PTCA. Selected frequencies for CETP B1 and B2 alleles (absence/presence of Taq IB site) were 0.65 and 0.35 (cases) and 0.65 and 0.35 (controls), respectively; frequencies for CETP M1 and M2 alleles (absence/presence of Msp I site) were 0.20 and 0.80 (cases), 0.21 and 0.79 (controls), respectively; frequencies for PONA A and B alleles (absence/presence of Alw I site) were 0.73 and 0.27 (cases), 0.72 and 0.28 (controls), respectively. All observed genotype frequencies were in Hardy–Weinberg equilibrium. There was no evidence for gene–gene interaction, or an association between genotype and restenosis or degree of lumen loss (adjusted for covariates). Our data, collected in the largest study of its kind so far, indicate that the common variants for CETP and PONA are not associated with incidence of restenosis after PTCA, and are therefore not useful markers for risk assessment.     

避孕措施与细菌性阴道病关系的研究

目的：探讨避孕措施与细菌性阴道病（BV）的关系，为预防BV、指导选择避孕措施提供依据。方法：对某医院妇科门诊接受计划生育服务的育龄妇女非选择性地进行BV筛检。以筛检出的267例BV患者为病例组，其余478例未患BV且无BV史的妇女为对照组进行病例对照研究。结果：与未采用避孕措施者比较，单因素logistic回归分析显示：BV与IUD有正关联，而与避孕套、口服避孕药（OC）无关联。经婚姻状况、性卫生、性行为习惯调整后，BV与IUD的关联仍有统计学意义（OR=2．364，95％C1：1．216～3．620），但与OC及避孕套使用无关。同IUD使用者比较，BV与避孕套使用呈负关联，调整后的OR=0．299（95％C1：0．158～0．566）；BV与OC使用间无关联。结论：使用IUD与未采用避孕措施者比较可能增加BV发生的危险，而避孕套使用者发生BV危险低于IUD使用者。无论从避孕还是预防BV角度，避孕套均是一种较好的选择。     

横窦和窦汇的浅表解剖学标志

目的为神经外科手术准确定位横窦的下缘和窦汇确定出一个可靠的浅表解剖学标志。方法对10例经10%甲醛溶液固定的尸头标本进行逐步解剖,测量各相关解剖结构到横窦下缘的距离。结果实验所收集的数据表明在定位横窦下缘和窦汇时,上项线及枕外隆凸尖不是一个可靠的浅表解剖学标志。而以半脊肌附着点作为浅表解剖学标志比以上项线作为浅表解剖标志更准确、可靠。本组10例标本中,无1例的半脊肌附着点超过横窦下部边界3mm,并且它可以作为一个可靠的浅表解剖学标志用以定位接近中线部分的横窦。结论这些发现可以帮助神经外科医生在治疗后颅窝和颅颈接合处病变而进行的各种中线入路手术时更准确的定位横窦。     

人工食管植入术后影像学检查的实验研究

目的 探讨影像学检查方法在人工食管实验研究中的应用价值。方法 对10只植入胸段记忆合金组合式人工食管的实验动物模型术后所进行X线平片和食管造影检查结果进行观察分析研究。结果 X线平片清晰显示胸内植入记忆合金组合式人工食管植入的位置原位固定〉9个月3只；2—3月内脱管3只；〉3个月内脱管4只；管体全部滑至胃内，食管造影连续摄片显示重度新生食管狭窄3只；轻度新生食管狭窄4只，同期介入安放食管支架2只．全组仅见1只发生吻合口细小瘘。无发现其它胸内并发症。结论 ①X线检查是进行人工食管动物实验研究简单且实用的检查方法．②食管造影连续摄片检查方法可为已建立植入人工食管的猪实验动物模型术后的观察研究及介入治疗提供多方面的支持帮助。