The purpose of this study was to investigate age- specific spontaneous fetal loss rates of pregnancies without known chromosomal or structural abnormalities from mid- second trimester onward. The study consisted of 26...The purpose of this study was to investigate age- specific spontaneous fetal loss rates of pregnancies without known chromosomal or structural abnormalities from mid- second trimester onward. The study consisted of 264,653 women screened between October 1995 and September 2000 with available pregnancy outcomes. Pregnancies associated with fetal chromosomal or structural abnormalities, insulin dependent diabetes mellitus, and multiple pregnancies were excluded. Spontaneous fetal losses at or after 15 weeks of gestation were identified. Women were grouped according to maternal age at expected date of delivery. Spontaneous fetal loss rates in each group were evaluated after adjusting fetal losses associated with amniocentesis and identifiable ethnic groups. Fetal loss rates increased in both younger and older women. The lowest rate was seen in women at mid- 20s. Compared with Caucasian and Asian women, black women had higher fetal loss rate at nearly every age group. The results of the study provided a baseline agespecific spontaneous fetal loss rate of pregnancies at a specified gestational window.展开更多
Objectives: To identify asymptomatic boys with X-linked adrenoleukodystrophy who have a normal magnetic resonance image (MRI), and to assess the effect of 4:1 glyceryl trioleate-glyceryl trierucate (Lorenzo’s oil) on...Objectives: To identify asymptomatic boys with X-linked adrenoleukodystrophy who have a normal magnetic resonance image (MRI), and to assess the effect of 4:1 glyceryl trioleate-glyceryl trierucate (Lorenzo’s oil) on disease progression. Method: Eighty-nine boys (mean±SD baseline age, 4.7±4.1 years; range, 0.2-15 years) were identified by a plasma very long-chain fatty acids assay used to screen at-risk boys. All were treated with Lorenzo’s oil and moderate fat restriction. Plasma fatty acids and clinical status were followed for 6.9±2.7 years. Changes in plasma hexacosanoic acid levels were assessed by measuring the length-adjusted area under the curve, and a proportional hazards model was used to evaluate association with the development of abnormal MRI results and neurological abnormalities. Results: Of the 89 boys, 24%developed MRI abnormalities and 11%developed both neurological and MRI abnormalities. Abnormalities occurred only in the 64 patients who were aged 7 years or younger at the time therapy was started. There was significant association between the development of MRI abnormalities and a plasma hexacosanoic acid increase. (For a 0.1-μg/mL increase in the length-adjusted area under the curve for the hexacosanoic acid level, the hazard ratio for incident MRI abnormalities in the whole group was 1.36; P=.01; 95%confidence interval, 1.07-1.72.) Results for patients aged 7 years or younger were similar (P=.04). Conclusions: In this single-arm study, hexacosanoic acidreductionbyLorenzo’s oil was associated with reduced risk of developing MRI abnormalities. We recommend Lorenzo’s oil therapy in asymptomatic boys with X-linked adrenoleukodystophy who have normal brain MRI results.展开更多
Background and Purpose -A relationship between the apolipoprotein E (apoE) genotype and ischemic stroke has been inconsistently reported. We explored this relation in the Atherosclerosis Risk in Communities Study (ARI...Background and Purpose -A relationship between the apolipoprotein E (apoE) genotype and ischemic stroke has been inconsistently reported. We explored this relation in the Atherosclerosis Risk in Communities Study (ARIC). Methods -The ARIC cohort involves 15 792 men and women, aged 45 to 64 years at baseline and sampled from 4 U.S. communities. Between 1987 and 2001, 498 incident ischemic strokes occurred. Results-After stratifying by race and sex and adjusting for other nonlipid risk factors, there was no significant relation between the apoE genotype and incident stroke, except in black women (hazard ratio for ∈2 genotype relative to ∈3/∈3=0.53; 95%CI, 0.28 to 0.99). Conclusions -For the most part, in this middleaged sample, apoE was not a risk factor for incident ischemic stroke.展开更多
Purpose: To describe the 14-year incidence of age-relatedmaculopathy (ARM) lesions and the related visual loss. Design: Population-based cohort study. Participants: Nine hundred forty-six residents (age range, 60-80 y...Purpose: To describe the 14-year incidence of age-relatedmaculopathy (ARM) lesions and the related visual loss. Design: Population-based cohort study. Participants: Nine hundred forty-six residents (age range, 60-80 years) of Copenhagen participated in the study from 1986 through 1988. Excluding participants who had died since baseline, 359 persons (97.3%of survivors)were reexamined from 2000 through 2002. Methods: Participants underwent extensive ophthalmologic examinations. Age-related maculopathy lesions were determined by grading color fundus photographs from the examinations using a modified Wisconsin Age-Related Maculopathy Grading System. Main Outcome Measures: Incidence of drusen type and size, pigmentary abnormalities, pure geographic atrophy, exudative ARM, visual impairment, and blindness. Results: The 14-year incidences of early and late ARM were 31.5%and 14.8%, respectively. Individuals 75 to 80 years of age at baseline had significantly (P≤0.05) higher 14-year incidences of the following lesions than those aged 60 to 64 years: medium or large drusen (≥125 μm; 34.2%vs. 12.8%, respectively), soft drusen (45.2%vs. 21.4%), pigmentary abnormalities (31.4%vs. 17.0%), pure geographic atrophy (17.4%vs. 1.0%), and exudative ARM (23.3%vs. 5.7%). Severe drusen type, large drusen, and retinal pigmentary abnormalities at baseline were important predictors of incident late ARM. The 14-year incidences of visual impairment (< 20/40 but > 20/200) or legal blindness from late ARM were 6.0%and 3.4%, respectively. Late ARMcaused 35.7%of all visual impairment and 66.7%of all blindness. Conclusions: There is a high incidence of ARM lesions in this elderly white population. Severe drusen type and size or a combination of drusen and pigmentary abnormalities significantly increases the risk of developing late ARM, the most frequent cause of legal blindness in this population.展开更多
Purpose: To examine incident relationships between elevated intraocular pressure (IOP), open-angle glaucoma (OAG), and use of glaucoma medications with 5- year incident cataract. Design: Population-based cohort study....Purpose: To examine incident relationships between elevated intraocular pressure (IOP), open-angle glaucoma (OAG), and use of glaucoma medications with 5- year incident cataract. Design: Population-based cohort study. Participants: The Australian Blue Mountains Eye Study examined 3654 participants <50 years old at baseline (82.4% response; 1992- 1994)- ; 2335 eligible participants were reexamined after 5 years (75.1% response; 1997- 1999). Methods: A detailed medical and ocular history, including current medications, was taken, and a comprehensive eye examination, including applanation tonometry, automated perimetry, and lens photography, was performed at each examination. The Wisconsin system was used to grade lens photographs in assessing incident nuclear, cortical, and posterior subcapsular cataract (PSC). Data from both eyes were assessed using generalized estimating equation analyses. Main Outcome Measures: Elevated IOP was defined as < 21 mmHg. Open-angle glaucoma was diagnosed from typical glaucomatous field loss with matching optic disc cupping, without reference to IOP. Subjects without OAG or secondary or angle-closure glaucoma with IOP > 21 mmHg in either eye were classified as having ocular hypertension (OH), as were non-OAG subjects with IOP < 22 mmHg using glaucoma medications. Wisconsin levels 4 to 5 were graded as nuclear cataract, at least 5% lens involvement was graded as cortical cataract, and any PSC defined its presence. Results: The 5- year incidence of nuclear cataract was 23.4% (592/2532), or 23.1% (574/2486) after excluding subjects using glaucoma medication. A marginally significant association was found for elevated IOP or OH at baseline and incident nuclear cataract (odds ratio [OR] 1.93 95% confidence interval (CI), 0.97- 3.89, and OR, 1.83 95% CI, 0.96- 3.48, respectively) in subjects not using glaucoma medications, after multivariate adjustment. Age-and gender-adjusted analyses showed similar but statistically significant associations. The association between elevated IOP or OH and nuclear cataract was signifi-cant in multivariate analyses (OR, 2.07 95% CI, 1.04- 3.12, and OR, 1.78 95% CI, 1.05- 3.01 , respectively). Use of glaucoma medications was associated with nonsignificantly increased adjusted odds for incident nuclear cataract (OR, 1.90 95% CI, 0.92- 3.92). No associations, however, were found with incident cortical cataract or PSC. Conclusions: Elevated IOP may increase the risk of nuclear cataract, but not that of other types. The use of glaucoma medications could magnify this risk.展开更多
Context: The inverse association between education and cardiovascular disease is well established, but little is known about the relationship between education and subclinical disease, which is free from medical acces...Context: The inverse association between education and cardiovascular disease is well established, but little is known about the relationship between education and subclinical disease, which is free from medical access and treatment-related influences, or about possible mediating pathways for these relationships. Objective: To examine the association of education with coronary artery calcium(CAC), an indicator of subclinical atherosclerosis, and cardiovascular risk factors, and their changes as potential mediators. Design, Setting, and Participants: A population-based, prospective, observational study(Coronary Artery Risk Development in Young Adults[CARDIA]) of 2913 eligible participants(44.9%black; 53.9%women) recruited from 4 metropolitan areas(Birmingham, Ala; Chicago, Ill; Minneapolis, Minn; and Oakland, Calif) in both the baseline(1985-1986, ages 18-30 years) and year 15 examinations(2000-2001, ages 33-45 years). Education(year 15) was classified into less than high school(n=128), high school graduate(n=498), some college(n=902), college graduate(n=764), and more than college(n=621). Main Outcome Measure: Presence of CAC, measured twice by computed tomography(mean total Agatston score >0) at year 15. Results: Overall CAC prevalence in this sample was 9.3%. After adjusting for age, race, and sex, the odds ratios(ORs) for having CAC were 4.14(95%confidence interval[CI], 2.33-7.35) for less than high school education, 1.89(95%CI, 1.23-2.91)for high school graduate, 1.47(95%CI, 0.99-2.19) for some college, and 1.24(95%CI, 0.84-1.85) for college graduate compared with those participants with more than a college education(P for trend< .001). This was also consistent within each of the 4 race-sex groups. Adjustment for baseline systolic blood pressure, smoking, waist circumference, physical activity, and total cholesterol reduced the ORs to 2.61(95%CI, 1.40-4.85) for less than high school, 1.38(95%CI, 0.88-2.17) for high school graduate, 1.17(95%CI, 0.78-1.77) for some college, and 1.13(95%CI, 0.76-1.69) for college graduate compared with more than a college education(P for trend=.01), and only slightly attenuated by further adjustment for 15-year changes in risk factors. Conclusion: Education was inversely associated with the prevalence of CAC, an association partially explained by baseline risk factors and minimally by 15-year changes in risk factors.展开更多
在校正基线年龄、体力活动、种族族裔、腰围、贫困收入比例、可替宁水平以及共病等协变量后的比例风险后,模型分析结果显示,与其他男性相比,勃起功能障碍（ED）患者全因过早死亡风险增加70%。《性医学杂志/The Journal of Sexual Medic...在校正基线年龄、体力活动、种族族裔、腰围、贫困收入比例、可替宁水平以及共病等协变量后的比例风险后,模型分析结果显示,与其他男性相比,勃起功能障碍（ED）患者全因过早死亡风险增加70%。《性医学杂志/The Journal of Sexual Medicine》美国芝加哥大学的研究发现经历连续5夜睡眠限制（每夜仅4小时）受试者的能量摄入增加,且静息代谢率（RMR）明显降低,并最终引起体重增加（5天内平均增加1.3kg）。相比之下,对照组静息代谢率无明显变化。然而,这些受试者在经历1天12小时睡眠恢复后,静息代谢率又可返回到基线水平。展开更多
文摘The purpose of this study was to investigate age- specific spontaneous fetal loss rates of pregnancies without known chromosomal or structural abnormalities from mid- second trimester onward. The study consisted of 264,653 women screened between October 1995 and September 2000 with available pregnancy outcomes. Pregnancies associated with fetal chromosomal or structural abnormalities, insulin dependent diabetes mellitus, and multiple pregnancies were excluded. Spontaneous fetal losses at or after 15 weeks of gestation were identified. Women were grouped according to maternal age at expected date of delivery. Spontaneous fetal loss rates in each group were evaluated after adjusting fetal losses associated with amniocentesis and identifiable ethnic groups. Fetal loss rates increased in both younger and older women. The lowest rate was seen in women at mid- 20s. Compared with Caucasian and Asian women, black women had higher fetal loss rate at nearly every age group. The results of the study provided a baseline agespecific spontaneous fetal loss rate of pregnancies at a specified gestational window.
文摘Objectives: To identify asymptomatic boys with X-linked adrenoleukodystrophy who have a normal magnetic resonance image (MRI), and to assess the effect of 4:1 glyceryl trioleate-glyceryl trierucate (Lorenzo’s oil) on disease progression. Method: Eighty-nine boys (mean±SD baseline age, 4.7±4.1 years; range, 0.2-15 years) were identified by a plasma very long-chain fatty acids assay used to screen at-risk boys. All were treated with Lorenzo’s oil and moderate fat restriction. Plasma fatty acids and clinical status were followed for 6.9±2.7 years. Changes in plasma hexacosanoic acid levels were assessed by measuring the length-adjusted area under the curve, and a proportional hazards model was used to evaluate association with the development of abnormal MRI results and neurological abnormalities. Results: Of the 89 boys, 24%developed MRI abnormalities and 11%developed both neurological and MRI abnormalities. Abnormalities occurred only in the 64 patients who were aged 7 years or younger at the time therapy was started. There was significant association between the development of MRI abnormalities and a plasma hexacosanoic acid increase. (For a 0.1-μg/mL increase in the length-adjusted area under the curve for the hexacosanoic acid level, the hazard ratio for incident MRI abnormalities in the whole group was 1.36; P=.01; 95%confidence interval, 1.07-1.72.) Results for patients aged 7 years or younger were similar (P=.04). Conclusions: In this single-arm study, hexacosanoic acidreductionbyLorenzo’s oil was associated with reduced risk of developing MRI abnormalities. We recommend Lorenzo’s oil therapy in asymptomatic boys with X-linked adrenoleukodystophy who have normal brain MRI results.
文摘Background and Purpose -A relationship between the apolipoprotein E (apoE) genotype and ischemic stroke has been inconsistently reported. We explored this relation in the Atherosclerosis Risk in Communities Study (ARIC). Methods -The ARIC cohort involves 15 792 men and women, aged 45 to 64 years at baseline and sampled from 4 U.S. communities. Between 1987 and 2001, 498 incident ischemic strokes occurred. Results-After stratifying by race and sex and adjusting for other nonlipid risk factors, there was no significant relation between the apoE genotype and incident stroke, except in black women (hazard ratio for ∈2 genotype relative to ∈3/∈3=0.53; 95%CI, 0.28 to 0.99). Conclusions -For the most part, in this middleaged sample, apoE was not a risk factor for incident ischemic stroke.
文摘Purpose: To describe the 14-year incidence of age-relatedmaculopathy (ARM) lesions and the related visual loss. Design: Population-based cohort study. Participants: Nine hundred forty-six residents (age range, 60-80 years) of Copenhagen participated in the study from 1986 through 1988. Excluding participants who had died since baseline, 359 persons (97.3%of survivors)were reexamined from 2000 through 2002. Methods: Participants underwent extensive ophthalmologic examinations. Age-related maculopathy lesions were determined by grading color fundus photographs from the examinations using a modified Wisconsin Age-Related Maculopathy Grading System. Main Outcome Measures: Incidence of drusen type and size, pigmentary abnormalities, pure geographic atrophy, exudative ARM, visual impairment, and blindness. Results: The 14-year incidences of early and late ARM were 31.5%and 14.8%, respectively. Individuals 75 to 80 years of age at baseline had significantly (P≤0.05) higher 14-year incidences of the following lesions than those aged 60 to 64 years: medium or large drusen (≥125 μm; 34.2%vs. 12.8%, respectively), soft drusen (45.2%vs. 21.4%), pigmentary abnormalities (31.4%vs. 17.0%), pure geographic atrophy (17.4%vs. 1.0%), and exudative ARM (23.3%vs. 5.7%). Severe drusen type, large drusen, and retinal pigmentary abnormalities at baseline were important predictors of incident late ARM. The 14-year incidences of visual impairment (< 20/40 but > 20/200) or legal blindness from late ARM were 6.0%and 3.4%, respectively. Late ARMcaused 35.7%of all visual impairment and 66.7%of all blindness. Conclusions: There is a high incidence of ARM lesions in this elderly white population. Severe drusen type and size or a combination of drusen and pigmentary abnormalities significantly increases the risk of developing late ARM, the most frequent cause of legal blindness in this population.
文摘Purpose: To examine incident relationships between elevated intraocular pressure (IOP), open-angle glaucoma (OAG), and use of glaucoma medications with 5- year incident cataract. Design: Population-based cohort study. Participants: The Australian Blue Mountains Eye Study examined 3654 participants <50 years old at baseline (82.4% response; 1992- 1994)- ; 2335 eligible participants were reexamined after 5 years (75.1% response; 1997- 1999). Methods: A detailed medical and ocular history, including current medications, was taken, and a comprehensive eye examination, including applanation tonometry, automated perimetry, and lens photography, was performed at each examination. The Wisconsin system was used to grade lens photographs in assessing incident nuclear, cortical, and posterior subcapsular cataract (PSC). Data from both eyes were assessed using generalized estimating equation analyses. Main Outcome Measures: Elevated IOP was defined as < 21 mmHg. Open-angle glaucoma was diagnosed from typical glaucomatous field loss with matching optic disc cupping, without reference to IOP. Subjects without OAG or secondary or angle-closure glaucoma with IOP > 21 mmHg in either eye were classified as having ocular hypertension (OH), as were non-OAG subjects with IOP < 22 mmHg using glaucoma medications. Wisconsin levels 4 to 5 were graded as nuclear cataract, at least 5% lens involvement was graded as cortical cataract, and any PSC defined its presence. Results: The 5- year incidence of nuclear cataract was 23.4% (592/2532), or 23.1% (574/2486) after excluding subjects using glaucoma medication. A marginally significant association was found for elevated IOP or OH at baseline and incident nuclear cataract (odds ratio [OR] 1.93 95% confidence interval (CI), 0.97- 3.89, and OR, 1.83 95% CI, 0.96- 3.48, respectively) in subjects not using glaucoma medications, after multivariate adjustment. Age-and gender-adjusted analyses showed similar but statistically significant associations. The association between elevated IOP or OH and nuclear cataract was signifi-cant in multivariate analyses (OR, 2.07 95% CI, 1.04- 3.12, and OR, 1.78 95% CI, 1.05- 3.01 , respectively). Use of glaucoma medications was associated with nonsignificantly increased adjusted odds for incident nuclear cataract (OR, 1.90 95% CI, 0.92- 3.92). No associations, however, were found with incident cortical cataract or PSC. Conclusions: Elevated IOP may increase the risk of nuclear cataract, but not that of other types. The use of glaucoma medications could magnify this risk.
文摘Context: The inverse association between education and cardiovascular disease is well established, but little is known about the relationship between education and subclinical disease, which is free from medical access and treatment-related influences, or about possible mediating pathways for these relationships. Objective: To examine the association of education with coronary artery calcium(CAC), an indicator of subclinical atherosclerosis, and cardiovascular risk factors, and their changes as potential mediators. Design, Setting, and Participants: A population-based, prospective, observational study(Coronary Artery Risk Development in Young Adults[CARDIA]) of 2913 eligible participants(44.9%black; 53.9%women) recruited from 4 metropolitan areas(Birmingham, Ala; Chicago, Ill; Minneapolis, Minn; and Oakland, Calif) in both the baseline(1985-1986, ages 18-30 years) and year 15 examinations(2000-2001, ages 33-45 years). Education(year 15) was classified into less than high school(n=128), high school graduate(n=498), some college(n=902), college graduate(n=764), and more than college(n=621). Main Outcome Measure: Presence of CAC, measured twice by computed tomography(mean total Agatston score >0) at year 15. Results: Overall CAC prevalence in this sample was 9.3%. After adjusting for age, race, and sex, the odds ratios(ORs) for having CAC were 4.14(95%confidence interval[CI], 2.33-7.35) for less than high school education, 1.89(95%CI, 1.23-2.91)for high school graduate, 1.47(95%CI, 0.99-2.19) for some college, and 1.24(95%CI, 0.84-1.85) for college graduate compared with those participants with more than a college education(P for trend< .001). This was also consistent within each of the 4 race-sex groups. Adjustment for baseline systolic blood pressure, smoking, waist circumference, physical activity, and total cholesterol reduced the ORs to 2.61(95%CI, 1.40-4.85) for less than high school, 1.38(95%CI, 0.88-2.17) for high school graduate, 1.17(95%CI, 0.78-1.77) for some college, and 1.13(95%CI, 0.76-1.69) for college graduate compared with more than a college education(P for trend=.01), and only slightly attenuated by further adjustment for 15-year changes in risk factors. Conclusion: Education was inversely associated with the prevalence of CAC, an association partially explained by baseline risk factors and minimally by 15-year changes in risk factors.
文摘在校正基线年龄、体力活动、种族族裔、腰围、贫困收入比例、可替宁水平以及共病等协变量后的比例风险后,模型分析结果显示,与其他男性相比,勃起功能障碍（ED）患者全因过早死亡风险增加70%。《性医学杂志/The Journal of Sexual Medicine》美国芝加哥大学的研究发现经历连续5夜睡眠限制（每夜仅4小时）受试者的能量摄入增加,且静息代谢率（RMR）明显降低,并最终引起体重增加（5天内平均增加1.3kg）。相比之下,对照组静息代谢率无明显变化。然而,这些受试者在经历1天12小时睡眠恢复后,静息代谢率又可返回到基线水平。
