Direct observation of DNA translocation and cleavage by the EcoKI endonuclease using atomic force microscopy

OBJECTIVES: To determine whether antibiotic prophylaxis reduces respiratory tract infections (RTI) and overall mortality in an unselected adults intensive care population. SEARCH STRATEGY: Systematic literature search in peer-reviewed journals indexed in MEDLINE, examination of relevant proceedings of scientific meetings and personal contact with trialists. SELECTION CRITERIA: All randomised clinical trials (RCTs), published and unpublished, comparing different forms of antibiotic prophylaxis used to reduce RTIs and mortality in unselected adult intensive care units (ICUs) populations. DATA COLLECTION AND ANALYSIS: Out of the 32 RCTs eligible for this review data have been extracted from published reports and then complemented with information provided by study investigators for 29 trials. Data were available only from published reports in the remaining three RCTs. For each trial the following information has been sought: a) method of randomisation; b) use of blinding techniques; c) number of randomised patients; d) number of patients with RTIs; e) number of deaths; f) number of patients excluded from the published analysis; g) number of RTIs and number of deaths among excluded patients. Pooled estimates of treatment effects across trials have been calculated after grouping RCTs in two main, mutually exclusive, categories: a) 15 trials testing the effect of a combination of a topical and a systemic antibiotic against no prophylactic treatment; b) 17 trials where the experimental treatment was a topical antimicrobial preparation. Crude proportions of RTIs and mortality were used to calculate the overall treatment effect. We also computed the number of ICU patients who need to be treated in order to prevent one infection and one death. MAIN RESULTS: Overall 32 RCTs including 5639 patients were identified. Pooled estimates of the 15 RCTs (including 3273 patients) testing the effect of the topical and systemic antibiotic combination indicate a strong significant reduction of both RTIs (OR = 0.36, 95% CI = 0.30-0.43) and total mortality (OR = 0.80, 95% CI = 0.68-0.93). Five and 23 patients need to be treated to prevent one infection and one death, respectively, using this treatment. When data on the effect of the combination based on topical antimicrobials were pooled from the 17 available trials (including 2366 patients) a marked reduction on RTIs (OR = 0.57, 95% CI = 0.46-0.69) also emerged but no corresponding effect on overall mortality (OR = 1.01; 95% CI = 0.84-1.22) was found. CONCLUSIONS: After 15 years of clinical research this meta-analysis of 32 RCTs shows that a regimen of antibiotic prophylaxis based on a combination of a systemic and topical antibiotic can reduce both RTIs and overall mortality in ICU patients in a way that is both statistically significant and humanly worthwhile. Over and above their personal opinions intensivists should take this evidence into account when defining their policies.     

Cellular ingrowth and thickness changes in poly-L-lactide and polyglycolide matrices implanted subcutaneously in the rat

BACKGROUND: The purpose of this study was, to identify predictors of quitting following general practitioners' (GP) anti-smoking counseling. METHODS: We studied determinants (characterized following the Precede framework) of successful quitting (1 year sustained abstinence, biochemically confirmed at 6- and 12-month follow-up) among 861 smokers randomized to the intervention groups based on repeated counseling (RC), RC + spirometric testing, and RC + nicotine gum, in a smoking cessation trial carried out in Turin, Italy. RESULTS: GPs' intervention worked best for male (OR = 2.30; 95% CI, 1.13-4.52) and married (OR = 3.63; 95% CI, 1.37-9.59) smokers, for smokers who had maintained abstinence for at least 1 month in the past (OR = 6.78; 95% CI, 1.56-29.52) or at their first quit attempt (OR = 10.91; 95% CI, 2.37-50.13), and for those who spontaneously reduced their coffee consumption (OR = 3.30; 95% CI, 1.59-6.82); heavy smokers (> = 20 cig/day OR = 0.48; 95% CI, 0.24-0.93) and those living with other smokers (> = 1 smokers in the household: OR = 0.44; 95% CI, 0.22-0.90) were less likely to give up. Previous antismoking advice by the GP represented a strong barrier to success for healthy smokers (OR = 0.19; 95% CI, 0.07-0.52), but not for those reporting symptoms of shortness of breath (OR = 0.63; 95% CI, 0.39-9.20). There were no interactions between predictors and treatment conditions. CONCLUSIONS: Assessment of factors influencing quitting would allow GPs to tailor their message to address existing barriers and to help patients utilize their resources for change.     

Cost finding in the diagnostic imaging service

Antibiotic prophylaxis after basilar skull fractures remains controversial. Previous studies have not clearly delineated the utility of prophylactic antibiotics in this setting. We undertook this study to determine if antibiotic prophylaxis after basilar skull fractures prevented meningitis. We performed a formal systematic review of previously published studies after a computerized search with use of the MEDLINE data base (1970-1996). Fourteen studies were identified, and 12 studies met the criteria for inclusion. Study design and quality were assessed by two independent investigators with use of a predetermined protocol. A total of 1,241 patients with basilar skull fractures were included; 719 patients received antibiotics, and 522 patients did not receive antibiotics. Overall results suggest that antibiotic prophylaxis did not prevent meningitis among patients with basilar skull fractures (odds ratio [OR] = 1.15; 95% confidence interval [CI] = 0.68-1.94; P = .678). Patients with basilar skull fractures and cerebrospinal fluid leakage were analyzed separately (OR = 1.34; 95% CI = 0.75-2.41; P = .358), as were children (OR = 1.04; 95% CI = 0.07-14.90; P = 1.000). Antibiotic prophylaxis after basilar skull fractures does not appear to decrease the risk of meningitis.     

Alcohol, smoking, and cataracts: the Blue Mountains Eye Study

OBJECTIVE: To investigate the associations between alcohol consumption, tobacco smoking, and cataract. DESIGN: A population-based, cross-sectional study. SETTING: An urban community in the Blue Mountains, close to Sydney, Australia. PARTICIPANTS: Three thousand six hundred fifty-four people aged 49 to 97 years. The participation rate was 82%. MAIN OUTCOME MEASURES: Smoking history and details of current alcohol consumption were assessed by questionnaire. Lens photographs were taken and graded for presence and severity of cortical, nuclear, and posterior subcapsular cataracts. RESULTS: After adjusting for multiple potential confounders, people who had ever smoked cigarettes had a higher prevalence than nonsmokers of more severe nuclear (adjusted odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6) and posterior subcapsular (adjusted OR, 1.5; 95% CI, 1.1-2.1) cataracts. The association between pipe smoking and nuclear cataract (adjusted OR, 3.1; 95% CI, 1.5-8.2) was stronger than the association with cigarette smoking. Alcohol consumption was associated with a reduced prevalence of cortical cataract: compared with people who did not drink, the adjusted OR for cortical cataract among people who drank at least 1 drink a day was 0.7 (95% CI, 0.6-0.9). Heavy alcohol consumption (> or =4 drinks a day) was associated with nuclear cataract in current smokers (adjusted OR compared with nondrinkers, 3.9; 95% CI, 0.9-16.6) but not in never smokers. CONCLUSIONS: Consistent with other studies, smoking was associated with a higher prevalence of nuclear and posterior subcapsular cataracts. The only adverse effect of alcohol was among smokers: people who smoked and drank heavily had an increased prevalence of nuclear cataract.     

Is access to medical care associated with receipt of HIV testing and counselling?

Lack of timely HIV testing leads to missed prevention opportunities and poor prevention counselling may be related to further disease spread. We examined the association of self-reported access to medical care with receiving HIV testing and preventive counselling services among a sample of patients with HIV disease prior to hospitalization. We conducted a cross-sectional interview of 217 Los Angeles patients hospitalized with HIV-related illness between 1992 and 1993 and abstracted clinical data from the medical record. Eighty-four per cent of patients received HIV testing prior to hospitalization, but only 33% received preventive counselling services. Only 48% of all patients rated outpatient medical care as somewhat or very easy to obtain. Controlling for severity of illness, better access to outpatient medical care (OR = 1.48; 95% CI = 1.02-2.15), having a regular source of care (OR = 3.40; 95% CI = 1.29-8.97) and non-homosexual mode of HIV transmission (OR = 0.31; 0.12-0.83) were associated with receiving HIV testing services prior to hospitalization. Having a regular source of care (OR = 3.55; 95% CI = 1.37-9.22), being VA (Veterans' Administration) insured (OR = 6.16; 1.46-26.05), older age (OR = 0.95; 95% CI = 0.90-0.99) and having a CD4 count between 101-200 (OR = 0.19; 95% CI = 0.06-0.63) were associated with receiving HIV counselling. Limited self-reported access to medical care is associated with fewer patients receiving HIV testing and counselling. Improving timeliness of HIV testing may require removing the barriers to medical care.     

Serum carotenoids and tocopherols and incidence of age-related nuclear cataract

BACKGROUND: It is not known whether the protective effects of antioxidants on cataract observed in experimental animals are relevant to age-related opacities in humans. OBJECTIVE: The relations of serum carotenoids and tocopherols to the incidence of age-related nuclear cataract were investigated in a random sample of 400 adults, 50-86 y of age, in the Beaver Dam Eye Study. DESIGN: Nuclear opacity was assessed by using lens photographs taken at baseline (in 1988-1990) and follow-up (in 1993-1995). Nonfasting concentrations of individual carotenoids and alpha- and gamma-tocopherol, were determined from serum obtained at baseline. A total of 252 persons were eligible for incident cataract, of whom 57 developed nuclear cataract in at least one eye. Results were adjusted for age, smoking, serum cholesterol, heavy drinking, adiposity, and, in the tocopherol models, dietary linoleic acid intake. RESULTS: Only serum tocopherol (the sum of alpha- and gamma-tocopherol, in micromol/mmol cholesterol) was associated with cataract. For total serum tocopherol, persons in tertile 3 had a lower risk of cataract than persons in tertile 1 [odds ratio (OR): 0.4; 95% CI: 0.2, 0.9; P = 0.03 for linear trend]. Although serum carotenoids were not significantly associated with nuclear cataract, marginal inverse associations with lutein (OR: 0.3; 95% CI: 0.1, 1.2; P = 0.13 for linear trend) and cryptoxanthin (OR: 0.3; 95% CI: 0.1, 1.3; P = 0.11 for linear trend) were suggested in people < or = 65 y of age. CONCLUSIONS: Findings were compatible with the possibility that nuclear cataract may be linked inversely to vitamin E status, but neither strongly supported nor negated the hypothesized inverse association of nuclear cataract with serum carotenoids.     

Patterns of sexual and injecting risk behaviours in French intravenous drug users not reporting HIV and hepatitis C virus seropositivities

AIMS: To characterize and identify determinants of risk behaviour patterns of intravenous drug users (IDUs) independently of changes due to knowledge of HIV or hepatitis C Virus (HCV) seropositivity. DESIGN: A cross-sectional survey using a structured questionnaire concerning sexual, injecting and HIV and HCV antibody testing practices. SETTING: IDUs were interviewed in the Paris region at 10 treatment or psychosocial centres. PARTICIPANTS: Six hundred and twelve consecutive sexually active IDUs over 18 years able to answer the questionnaire. MEASUREMENTS: Five hundred and ninety-five IDUs completed the questionnaire. The risk-behaviour patterns of the 328 IDUs not reporting HIV or HCV seropositivity were analysed by phi correlation. Risk factors for each risk behaviour were determined by regression logistic models yielding odds ratios (OR) and their 95% confidence intervals (95% CI). FINDINGS: Several risk behaviour patterns were suggested: (1) lending, borrowing; (2) not or inconsistently testing HIV and HCV serology and not or inconsistently using condoms; (3) having multiple partners and prostitution; and (4) not using clean equipment. Alcohol abuse was independently and specifically associated with lending (OR = 3.8; 95% CI: 2.1-7.0) and borrowing (OR = 3.3; 95% CI: 1.8-6.1); homelessness with injecting risk behaviours and with prostitution (OR = 2.7; 95% CI: 1.2-6.1); low educational level and having children with not or inconsistently using condom and serology testing; and cocaine use with not or inconsistently using condoms (OR = 0.4; 95% CI: 0.3-0.7) and serology testing and not using clean equipment (OR = 0.4; 95% CI: 0.2-0.8). Having multiple partners and prostitution had no common risk factors. CONCLUSIONS: Identifying specific risk factors could help to target drug harm reduction programmes for each risk behaviour pattern among IDUs not reporting HIV and HCV seropositivity.     

Single- versus multiple-dose antimicrobial prophylaxis for major surgery: a systematic review

BACKGROUND: Single-dose antimicrobial prophylaxis for major surgery is a widely accepted principle; recommendations have been based on laboratory studies and numerous clinical trials published in the last 25 years. In practice, single-dose prophylaxis has not been universally accepted and multiple-dose regimens are still used in some centres. Moreover, the principle has recently been challenged by the results of an Australian study of vascular surgery. The aim of this current systematic review is to determine the overall efficacy of single versus multiple-dose antimicrobial prophylaxis for major surgery and across surgical disciplines. METHODS: Relevant studies were identified in the medical literature using the MEDLINE database and other search strategies. Trials included in the review were prospective and randomized, had the same antimicrobial in each treatment arm and were published in English. Rates of postoperative surgical site infections (SSI) were extracted, 2 x 2 tables prepared and odds ratios (OR) [with 95% confidence intervals (95% CI)] calculated. Data were then combined using fixed and random effects models to provide an overall figure. In this context, a high value for the combined OR, with 95% CI > 1.0, indicates superiority of multiple-dose regimens and a low OR, with 95% CI < 1.0, suggests the opposite. A combined OR close to 1.0, with narrow 95% CI straddling 1.0, indicates no clear advantage of one regimen over another. Further subgroup analyses were also performed. RESULTS: Combined OR by both fixed (1.06, 95% CI, 0.89-1.25) and random effects (1.04, 95% CI, 0.86-1.25) models indicated no clear advantage of either single or multiple-dose regimens in preventing SSI. Likewise, subgroup analysis showed no statistically significant differences associated with type of antimicrobial used (beta-lactam vs other), blinded wound assessment, length of the multiple-dose arm (> 24 h vs 24 h or less) or type of surgery (obstetric and gynaecological vs other). CONCLUSIONS: Continued use of single-dose antimicrobial prophylaxis for major surgery is recommended. Further studies are required, especially in previously neglected surgical disciplines.     

复方黄黛片治疗急性早幼粒细胞白血病的系统评价

目的 评价复方黄黛片( CRNTT)治疗急性早幼粒细胞白血病(APL)的疗效与安全性。方法计算机检索SinoMed、CNKI、VIP、万方、CBA、PubMed、MEDLINE、EMBASE、Cochrane图书馆临床对照试验资料库,并辅以手工检索,收集国内外公开发表的CRNIT治疗APL的随机对照试验(RCT)文献,检索年限截至201 1年3月。按纳入标准与排除标准筛选文献并评价纳入研究的质量,以完全缓解(CR)率、达CR所需时间、复发率、病死率、不良反应率等为评价指标,采用RevMan 5.1软件进行Meta分析。结果纳入6项RCT,包括391例APL患者,其中2项RCT研究目的为CRNIT与三氧化二砷(ATO)的比较,4项RCT研究目的为CRNIT与全反式维甲酸(ATRA)的比较,其中1项RCT增设CRNIT+ ATRA与ATRA的比较。达CR所需时间：CRNIT比ATRA、ATO长[加权均数差(WMD)=3.14,95％CI 0.99 ～5.29,P=0.004];头痛发生率：CRNTT低于ATRA（OR=0.10,95％CI 0.02～0.45,P=0.003）;5年无病生存率：CRNIT优于ATRA（OR= 7.22,95％CI 1.40～37.25,P=0.02）;CR率、复发率、病死率和4项不良反应指标（胃肠道症状、肝肾功能损害、皮肤损害、发热）的Meta分析结果差异无统计学意义。结论服用CRNIT达CR所需时间比ATRA、ATO长,CRNIT近期疗效与ATRA、ATO相近。服用CRNIT的5年无病生存率可能优于ATRA。     

Dental and cardiac risk factors for infective endocarditis. A population-based, case-control study

BACKGROUND: Although antibiotic prophylaxis against infective endocarditis is recommended, the true risk factors for infective endocarditis are unclear. OBJECTIVE: To quantitate the risk for endocarditis from dental treatment and cardiac abnormalities. DESIGN: Population-based, case-control study. SETTING: 54 hospitals in the Philadelphia area. PATIENTS: Persons with community-acquired infective endocarditis not associated with intravenous drug use were compared with community residents, matched by age, sex, and neighborhood of residence. MEASUREMENTS: Information on demographic characteristics, host risk factors, and dental treatment was obtained from structured telephone interviews, dental records, and medical records. RESULTS: During the preceding 3 months, dental treatment was no more frequent among case-patients than controls (adjusted odds ratio, 0.8 [95% CI, 0.4 to 1.5]). Of 273 case-patients, 104 (38%) knew of previous cardiac lesions compared with 17 controls (6%) (adjusted odds ratio, 16.7 [CI, 7.4 to 37.4]). Case-patients more often had a history of mitral valve prolapse (adjusted odds ratio, 19.4 [CI, 6.4 to 58.4]), congenital heart disease (adjusted odds ratio, 6.7 [CI, 2.3 to 19.4]), cardiac valvular surgery (adjusted odds ratio, 74.6 [CI, 12.5 to 447]), rheumatic fever (adjusted odds ratio, 13.4 [CI, 4.5 to 39.5]), and heart murmur without other known cardiac abnormalities (adjusted odds ratio, 4.2 [CI, 2.0 to 8.9]). Among case-patients with known cardiac lesions--the target of prophylaxis--dental therapy was significantly (P = 0.03) less common than among controls (adjusted odds ratio, 0.2 [CI, 0.04 to 0.7] over 3 months). Few participants received prophylactic antibiotics. CONCLUSIONS: Dental treatment does not seem to be a risk factor for infective endocarditis, even in patients with valvular abnormalities, but cardiac valvular abnormalities are strong risk factors. Few cases of infective endocarditis would be preventable with antibiotic prophylaxis, even with 100% effectiveness assumed. Current policies for prophylaxis should be reconsidered.     

Diagnostic accuracy of HIV-associated central nervous system toxoplasmosis

Our objective was to examine the accuracy of diagnosis of HIV-associated central nervous system (CNS) toxoplasmosis. Individuals diagnosed with HIV-associated CNS toxoplasmosis and controls were ascertained from a population-based database. Diagnosis was confirmed by response to therapy or by histology. Symptoms, results of anti-Toxoplasma serology and use of Pneumocystis carinii pneumonia (PCP) prophylaxis were recorded. Central nervous system toxoplasmosis was confirmed in 54 (76%) of 75 patients. Reactive anti-Toxoplasma serology was associated with CNS toxoplasmosis (OR=20.4, 95% CI 3.1-175.8). Adjusting for CD4 and use of dapsone or aerosolized pentamidine, trimethoprim-sulphamethoxazole (TMP-SMX) for PCP prophylaxis was associated with lower likelihood of CNS toxoplasmosis (OR 0.3, 95% CI 0.1-0.7). Diagnosis of CNS toxoplasmosis is often incorrect. Another diagnosis is most likely in patients who are anti-Toxoplasma seronegative or who are receiving prophylactic TMP-SMX.     

放疗联合手术治疗胃癌的Meta-分析

Objective: We carried out a meta-analysis to assess the effectiveness and safety of radiotherapy combined with surgery for gastric cancer. Methods: Randomized Clinical Trials (RCTs) in which radiotherapy (preoperative, intraoperative and postoperative), was compared with surgery alone in resectable gastric cancer were identified by searching Cochrane Library (Issue 2, 2009), PubMed (Jan 1966-Jun 2009), EMBASE (Jan 1974-Jun 2009), Chinese Biomedical Literature Database (Jan 1978-Jun 2009), Chinese Science and Technology Periodicals Database (Jan 1989-Jun 2009), China National Knowledge Infrastructure (Jan 1994-Jun 2009) and Wanfang database (Jan 1997-Jun 2009) in English and Chinese languang. Two researchers assessed the quality of included randomized controlled trials (RCT) extracted data independently. The RevMan 5.0 software was used for meta-analysis. Our researchers assessed the quality of included randomized controlled trials (RCT) extracted data independently. The RevMan 5.0 software was used for meta-analysis. Results: Nine randomized controlled trials of 1 548 patients were selected for meta-analysis. Five randomized controlled trials were related with comparison of preoperative radiotherapy plus surgery with single surgery. Two randomized controlled trials were the comparative studies between surgery plus postoperative and single surgery. The meta-analysis results showed that: (1) compared with surgery alone, preoperative radiotherapy combined with surgery can increase 3 years (OR = 1.78; 95% CI 1.14-2.78, P = 0.01), 5 years (OR = 1.67; 95% CI 1.22-2.29, P = 0.001), 10 years (OR = 1.64; 95% CI 1.03-2.60, P = 0.04) survival rate and resection rate (OR = 2.15; 95% CI 1.31-3.54, P = 0.003); reduce the of tumor recurrence rate (OR = 0.59; 95% CI 0.37-0.92, P = 0.02) and metastasis rate (OR = 0.44; 95% CI 0.27-0.73, P = 0.001); (2) The tumor recurrent rates (OR = 0.19, 95% CI 0.03-1.14, P = 0.07) and tumor metastasis rate (OR = 0.09; 95% CI 0.00-1.77, P = 0.11) had no difference between single surgery group and peri-operative radiotherapy plus surgery group; (3) Postoperative radiotherapy compared with surgery alone had no significant effects on 1 year (OR = 0.83; 95% CI 0.60-1.15, P = 0.26) and 3 years (OR = 0.75; 95% CI 0.51-1.11, P = 0.15) survival rate compared with single surgery, but the 5-year survival rates (OR = 0.57; 95% CI 0.34-0.95, P = 0.03) of the patients who received surgery alone was higher than those who received combined therapy. No difference of the tumor recurrence rate (OR = 0.59; 95% CI 0.33-1.05, P = 0.07), tumor metestasis rate (OR = 0.90; 95% CI 0.51-1.59, P = 0.71) and anastomotic leak (OR = 0.98; 95% CI 0.25-3.65, P = 0.98) were observed between the two groups. Conclusion: Preoperative radiotherapy combined surgery is more rational and effective than surgery alone of gastric cancer. However, in terms of the clinical effects of perioperarive or postoperative radoiotherapy combined with surgery, much multicenter, largescale, high-quality, double-blind and rigorously designed studies would be needed than currently available in the future.     

Synthesis and action of the cyclic AMP antagonist, prostaglandylinositol cyclic phosphate (cyclic PIP), in Dictyostelium discoideum

PURPOSE: To examine the incidence of and risk factors for retinal detachment during a 10-year follow-up on intracapsular cataract extraction (ICCE). METHODS: Retrospective analysis of medical records of 1041 eyes operated on with ICCE in the years 1984-86. A complete follow-up was achieved, and actuarial methods were used in the risk assessment. The risk time averaged 82 months. RESULTS: Twenty-two (2.1%) eyes developed retinal detachment; half of the cases occurred during the first postoperative year, but new cases emerged throughout the period. The cumulative incidence of RD amounted to 2.8%; 95% confidence interval: 1.5-4.2%. Multivariate Cox regression analysis identified younger age at surgery (relative risk for each 10-year increase in age=0.6; 95% confidence interval: 0.39-0.95) and male gender (relative risk=2.5; 95% confidence interval 1.04-6.04) as significant risk factors for RD. Eleven eyes, 50% of eyes with RD and 1% of the total number of eyes, lost useful vision in spite of retinal surgery. CONCLUSION: Even though the risk for both RD and an unfavourable result following retinal surgery may be smaller using contemporary surgical techniques, the present study indicates a substantial morbidity following cataract surgery, when a sufficiently long observation period is considered.     

Medications and cataract. The Blue Mountains Eye Study

PURPOSE: Corticosteroids are known to cause cataracts, but the effects of other medications on the lens are unclear. The aim of this study was to investigate the relationships between cataracts and a range of medications, including allopurinol, aspirin, chloroquine, diuretics, phenothiazines, and simvastatin. DESIGN: Population-based cross-sectional study. PARTICIPANTS: 3654 individuals 49 to 97 years of age (response rate, 82%) from an urban community near Sydney, Australia, were included. TESTING: Lens photography. PRIMARY OUTCOME MEASURE: Lens photographs were graded for the presence and severity of cortical, nuclear, and posterior subcapsular cataract. RESULTS: After adjusting for numerous potential confounders in ordinal regression models, use of phenothiazines was associated with nuclear cataract (adjusted odds ratio [OR], 2.18; 95% confidence interval [CI], 1.01-4.74); long-term aspirin users (> or = 10 years) had higher prevalence of posterior subcapsular cataract than did nonusers and short-term users (test for trend, P = 0.02); and the antimalarial drug mepacrine was associated with posterior subcapsular cataract (adjusted OR, 3.56; 95% CI, 1.56-8.13). There was a suggestion that use of chloroquine-like drugs for more than 1 year (test for trend, P = 0.12) might also be associated with posterior subcapsular cataract. Antihypertensive medications, cholesterol-lowering drugs, and allopurinol were not associated with any type of cataract. Potassium-sparing diuretics were the only diuretic to show any evidence of an association with cataract (test for trend for posterior subcapsular cataract, P = 0.14). Amiodarone was associated with cortical cataract (age- and gender-adjusted OR, 3.84; 95% CI, 1.01-14.81), but there were too few users to do analyses adjusted for multiple confounders. CONCLUSIONS: Most drugs commonly used in the community do not appear to be associated with cataract. The findings of this study do not support the hypothesis that aspirin protects against cataract.     

Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis

OBJECTIVE: To determine the birth prevalence of and risk factors associated with congenital esotropia. DESIGN: Population-based prevalence study with nested case-control study. PARTICIPANTS: All residents of Olmsted County, Minnesota who were diagnosed with congenital esotropia and born between January 1, 1980 and December 31, 1989 (n = 47). Control subjects were chosen by selecting the next two sequential births to parents residing in Olmsted County, Minnesota (n = 94). METHODS: Cases were identified through the Medical Diagnostic Index of Mayo and the Rochester Epidemiology Project. The community medical records were reviewed to confirm case status and ascertain risk factor information. MAIN OUTCOME MEASURE: Birth prevalence of congenital esotropia. RESULTS: Forty-seven cases were identified from 17,536 live births, for a birth prevalence of 27 per 10,000 (95% confidence interval [CI], 20-35). Congenital esotropia was associated with prematurity (odds ratio [OR], 11.5; 95% CI, 3.4-39.2), a birth weight less than 2500 grams (OR, 4.6; 95% CI, 1.7-12.9), a low Apgar score at 1 minute (OR, 4.3; 95% CI, 1.7-11.2) and at 5 minutes (OR, 6.3; 95% CI, 1.3-30.7), and a family history of strabismus (OR, 3.5; 95% CI, 1.5-8.3). CONCLUSIONS: The birth prevalence of congenital esotropia in Olmsted County, Minnesota is lower than previous estimates. Prematurity, low birth weight, low Apgar scores, and a family history of strabismus are significant risk factors for congenital esotropia.     

Reducing pregnancy and induced abortion rates in China: family planning with husband participation

OBJECTIVES: This study assessed the effectiveness of a family planning intervention with and without husband's participation in reducing pregnancy and abortion rates in Shanghai, China. METHODS: In this 3-arm randomized trial among 1800 nonsterilized married women, educational interventions targeting both spouses and targeting the wife only were compared with usual family planning care. RESULTS: Among women not using intrauterine devices (IUDs), the intervention with husband's participation had an effect in reducing pregnancy rates (adjusted odds ratio [OR] = 0.36, 95% confidence interval [CI] = 0.12, 1.1) and abortion rates (adjusted OR = 0.29, CI = 0.09, 0.94) compared with control subjects, and a significant effect in reducing pregnancy rates (adjusted OR = 0.29, CI = 0.10, 0.85) and abortion rates (adjusted OR = 0.24, CI = 0.07, 0.77) compared with wife-only subjects. CONCLUSIONS: Family planning interventions involving husbands may reduce pregnancy and abortion rates among non-IUD users.     

Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality

PURPOSE: This study set out to define the incidence, predictors, and mortality related to acute renal failure (ARF) and acute renal failure requiring dialysis (ARFD) after coronary intervention. PATIENTS AND METHODS: Derivation-validation set methods were used in 1,826 consecutive patients undergoing coronary intervention with evaluation of baseline creatinine clearance (CrCl), diabetic status, contrast exposure, postprocedure creatinine, ARF, ARFD, in-hospital mortality, and long-term survival (derivation set). Multiple logistic regression was used to derive the prior probability of ARFD in a second set of 1,869 consecutive patients (validation set). RESULTS: The incidence of ARF and ARFD was 144.6/1,000 and 7.7/1,000 cases respectively. The cutoff dose of contrast below which there was no ARFD was 100 mL. No patient with a CrCl > 47 mL/min developed ARFD. These thresholds were confirmed in the validation set. Multivariate analysis found CrCl [odds ratio (OR) = 0.83, 95% confidence interval (CI) 0.77 to 0.89, P <0.00001], diabetes (OR = 5.47, 95% CI 1.40 to 21.32, P = 0.01), and contrast dose (OR = 1.008, 95% CI 1.002 to 1.013, P = 0.01) to be independent predictors of ARFD. Patients in the validation set who underwent dialysis had a predicted prior probability of ARFD of between 0.07 and 0.73. The in-hospital mortality for those who developed ARFD was 35.7% and the 2-year survival was 18.8%. CONCLUSION: The occurrence of ARFD after coronary intervention is rare (<1%) but is associated with high in-hospital mortality and poor long-term survival. Individual patient risk can be estimated from calculated CrCl, diabetic status, and expected contrast dose prior to a proposed coronary intervention.     

Differences in risk factors for being either a hepatitis B carrier or anti-hepatitis C+ in a hepatoma-hyperendemic area in rural Taiwan

This is a study of the differences in the risk factors for being either hepatitis B surface antigen positive [HBsAg(+)] or antibody to hepatitis C virus positive [Anti-HCV(+)] in A-Lein, a rural area in southern Taiwan, an area which also has a high hepatoma mortality rate. Three hundred eighty-five patients age > or =40 years participated in hepatoma screening at the A-Lein Community Health Center during 1995. Those who were HBsAg(-) and anti-HCV(-) or had coinfection of HBsAg(+) and anti-HCV(+) were excluded, leaving 293 patients: 109 HBsAg(+) and 184 anti-HCV(+). The anti-HCV(+) patients had a lower socioeconomic status (as defined by level of education and type of occupation) and were older than HBsAg(+) patients (P < 0.05). Those with higher alanine aminotransferase levels (ALT) also had a higher anti-HCV(+) to HBsAg(+) odds ratio (OR), and a dose response relationship was found, P < 0.0001. Anti-HCV(+) patients were more likely than HBsAg(+) patients to have a spouse who shared the infection, OR = 5.11; 95% CI, 2.30-11.28. Anti-HCV(+) patients were more likely than HBsAg(+) patients to have had blood transfusions (OR = 2.66; 95% CI, 1.20-5.89), frequent medical injections (OR = 2.64; 95% CI, 1.62-4.31), or injections by non-licensed medical providers (OR = 1.91; 95% CI, 1.18-3.09). Multiple logistic regression analysis showed that the significant factors for anti-HCV(+) patients vs. HBsAg(+) patients are drinking habit (OR = 3.45; 95% CI, 1.02-11.60), age (OR = 6.33; 95% CI, 2.93-13.68), and frequent medical injections (OR = 2.88; 95% CI, 1.65-5.03). The transmission of hepatitis C in A-Lein is closely related to low socioeconomic status, age, alcohol abuse, spouses being anti-HCV(+), and frequent medical injections, especially from non-licensed medical providers, including both pharmacists and those with no medical licensing whatsoever. These nonlicensed medical providers sometimes reuse needles to save money, which is a likely route of infection.     

Clostridium difficile-associated diarrhea: epidemiology, risk factors, and infection control

OBJECTIVES: To evaluate the effectiveness of specific infection control measures on the incidence of Clostridium difficile-associated diarrhea (CDAD) and to identify risk factors for its development. SETTING: 370-bed, tertiary-care teaching hospital with approximately 12,000 to 15,000 admissions per year. METHODS: Several infection control measures were implemented in 1991 and 1992, and the attack rates of CDAD were calculated quarterly. Antibiotic use for 1988 through 1993 was analyzed. A case-control study was conducted from January 1992 to December 1992 to identify risk factors for acquisition of CDAD. RESULTS: From 1989 to 1992, the attack rate of CDAD increased from 0.49% to 2.25%. An increase in antibiotic use preceded the rise in the incidence of CDAD in 1991. Despite implementation of various infection control measures, the attack rate decreased to 1.32% in 1993, but did not return to baseline. Ninety-two cases and 78 controls (patients with diarrhea but with negative toxin assay) were studied. By univariate analysis, history of prior respiratory tract infections (odds ratio [OR], 3.6; 95% confidence interval [CI95], 1.2-10.4), the number of antibiotics, and the duration of exposure to second-generation cephalosporins (OR, 3.55; CI95, 1.47-9.41) and to ciprofloxacin (OR, 7.27; CI95, 1.13-166.0) were related significantly to the development of CDAD. By stepwise logistic regression analysis, only exposure to antibiotics and prior respiratory tract infections (P = .0001 and .0203, respectively) were found to be significant. CONCLUSION: Antibiotic pressure might have contributed to failure of infection control measures to reduce the incidence of CDAD to baseline.     

Routine ultrasound screening in pregnancy and the children's subsequent growth, vision and hearing

OBJECTIVE: To test a hypothesis of no association between ultrasound exposure in early fetal life and growth or impaired vision or hearing during childhood. DESIGN: Follow up of eight to nine year old children born to women who participated in a randomised controlled trial on ultrasound screening during pregnancy. SETTING: Nineteen antenatal care clinics run by three central hospitals in Sweden from 1985 to 1987. POPULATION AND METHODS: Of 4637 eligible singleton pregnancies, 3265 (71%) were followed up through a questionnaire sent to their mothers. Analyses were performed both according to randomised groups and to ultrasound exposure. MAIN OUTCOME MEASURES: Parents' report of vision and hearing tests as recorded on child's record card. Parents' report of their child's weight and height at 1, 4 and 7 years of age. RESULTS: Reduced hearing was reported by 3.4% in the screening group compared with 3.5% in the nonscreening group (odds ratio [OR] 1.0; 95% confidence interval [CI] 0.67-1.41). The same prevalences were found when analysed according to ultrasound exposure (OR 1.0; 95% CI 0.67-1.42). Reduced vision was reported by 6.3% in the screening group compared with 7.8% in the nonscreening group (OR 0.8; 95% CI 0.60-1.03). Corresponding figures for ultrasound exposed and unexposed were 6.2% and 8.0%, respectively (OR 0.8; 95% CI 0.58-1.00). No statistically significant differences in body weight or height at 1, 4 or 7 years of age between screened and not screened children or between exposed and unexposed were found. CONCLUSION: This study found no association between ultrasound exposure in early fetal life and growth or impaired vision or hearing during childhood.