Background: Positive patch-test results to nickel, cobalt, and chromate alone and in combinations with one another are well known to occur. Patient factors that may play a role in isolated and concurrent sensitization...Background: Positive patch-test results to nickel, cobalt, and chromate alone and in combinations with one another are well known to occur. Patient factors that may play a role in isolated and concurrent sensitization to these allergens have not been studied in the US population. Objective: We sought to determine the prevalence of isolated and concurrent nickel, cobalt,and chromate sensitizations and to investigate the impact of various patient factors on their development. Methods: A retrospective analysis was carried out on patch-test data of 1187 patients evaluated at one US center from January 1, 1995, to December 31, 2004, 208 of whom had a positive reaction to at least one metal. Statistical analyses to evaluate associations of metal contact allergy with patient factors were performed using the χ 2 test and conditional odds ratio. Results: All patients who reacted to metal had increased odds of cosensitization to another metal. Patients who reacted to nickel were more likely to be female. Those who reacted to chromate were more likely to be male and to have an occupational cause for their dermatitis. There was a strong trend for patients who reacted to cobalt to be non-Caucasian. All those who reacted to metal had increased odds of a history of atopic eczema. Chromate reactions and isolated cobalt reactions were less likely to have known relevance than other (nonmetal) allergens. Several metal allergy combinations showed a predilection toward specific dermatitis sites, especially the scalp, eyelids, ears, and lips.Limitations: The study was a retrospective analysis,exploratory in nature, and had relatively small numbers of patients with particular multiple metal allergy combinations. Conclusion:This research confirms the sex predilections toward nickel and chromate allergy and suggests enhanced sensitivity to metals among those with atopic eczema. The results also serve to raise questions regarding occupationally related chromate allergy in men, the relevance of cobalt allergy, exposure patterns resulting in enhanced sensitivity to cobalt in non-Caucasians, and associations between metal allergens and dermatitis site. The answers to these questions require more detailed studies.展开更多
目的：探讨小潮气量通气用于具有急性呼吸窘迫综合征（ARDS）高危因素患者机械通气后的临床疗效。方法选择2014年8月至2016年9月入住本院将重症医学科和传染科监护室的200例急性呼吸衰竭需有创机械通气患者作为研究对象，按单随机化法...目的：探讨小潮气量通气用于具有急性呼吸窘迫综合征（ARDS）高危因素患者机械通气后的临床疗效。方法选择2014年8月至2016年9月入住本院将重症医学科和传染科监护室的200例急性呼吸衰竭需有创机械通气患者作为研究对象，按单随机化法按进行机械通气先后分成研究组和对照组，各100例。研究组给予小潮气量6～8 mL ／kg ，呼吸末正压5～8 mm H2 O ，对照组气管插管后给予潮气量10～12 mL ／kg 、根据病情呼吸末正压0～5 mm H2 O 。比较通气后患者的氧分压、二氧化碳分压、氧合指数、呼吸力学指标、炎症指标、机械通气指标、住院时间、ARDS 发生率、28 d 病死率。结果研究组患者 PaO2和PaO2／FiO2改善效果较对照组更明显（P ＜0．05）。而在 pH 值和 PaCO2指标方面，两组患者治疗后差异无统计学意义（P＞0．05）；肺顺应性增强明显，气道峰压和平台压明显低于对照组，差异有统计学意义（P＜0．05）；治疗后，研究组患者的 IL‐6水平相比较于对照组显著的降低，差异有统计学意义（P＜0．05），研究组患者的 TNF‐α水平也显著低于对照组，差异有统计学意义（P＜0．05）；研究组患者的住院时间、ARDS 发生率和28 d 病死率均显著低于对照组患者，差异具有统计学意义（P＜0．05）。结论小潮气量通气用于具有 ARDS 高危因素患者机械通气后，具有减少肺损伤，降低 ARDS 发生率，降低病死率效果，值得临床广泛应用。展开更多
Objective: The purpose of this study was to identify patient criteria which may affect the outcome of a pessary trial. Study design: Records of 407 patients presenting with symptomatic pelvic organ prolapse who had a ...Objective: The purpose of this study was to identify patient criteria which may affect the outcome of a pessary trial. Study design: Records of 407 patients presenting with symptomatic pelvic organ prolapse who had a trial of pessary management were reviewed. Success was defined both by the initial fitting as well as by whether the patient was using the pessary at the 3-week follow-up visit. Outcomes were compared using chisquare test, 2-sample Student t test, or the Wilcoxon rank sum test, as appropriate. Statistical analysis was carried out at a significance of .05. Results: One hundred sixty-eight patients (41% ) were successfully fitted and continuing to use a pessary at the time of the 3-week follow-up visit. The likelihood of a successful pessary trial was significantly lower in subjects with a past history of hysterectomy (P < .001) or known reconstructive surgery for prolapse (P = .010). There was no association between the stage of prolapse and pessary trial outcome. There was no significance found in the relationship between the predominant location of support loss and the pessary trial outcome at the 3-week follow-up visit. Conclusion: The type and severity of pelvic organ prolapse do not influence the likelihood of a successful pessary fitting, and should not be used as a basis on which to select patients for pessary management.展开更多
文摘Background: Positive patch-test results to nickel, cobalt, and chromate alone and in combinations with one another are well known to occur. Patient factors that may play a role in isolated and concurrent sensitization to these allergens have not been studied in the US population. Objective: We sought to determine the prevalence of isolated and concurrent nickel, cobalt,and chromate sensitizations and to investigate the impact of various patient factors on their development. Methods: A retrospective analysis was carried out on patch-test data of 1187 patients evaluated at one US center from January 1, 1995, to December 31, 2004, 208 of whom had a positive reaction to at least one metal. Statistical analyses to evaluate associations of metal contact allergy with patient factors were performed using the χ 2 test and conditional odds ratio. Results: All patients who reacted to metal had increased odds of cosensitization to another metal. Patients who reacted to nickel were more likely to be female. Those who reacted to chromate were more likely to be male and to have an occupational cause for their dermatitis. There was a strong trend for patients who reacted to cobalt to be non-Caucasian. All those who reacted to metal had increased odds of a history of atopic eczema. Chromate reactions and isolated cobalt reactions were less likely to have known relevance than other (nonmetal) allergens. Several metal allergy combinations showed a predilection toward specific dermatitis sites, especially the scalp, eyelids, ears, and lips.Limitations: The study was a retrospective analysis,exploratory in nature, and had relatively small numbers of patients with particular multiple metal allergy combinations. Conclusion:This research confirms the sex predilections toward nickel and chromate allergy and suggests enhanced sensitivity to metals among those with atopic eczema. The results also serve to raise questions regarding occupationally related chromate allergy in men, the relevance of cobalt allergy, exposure patterns resulting in enhanced sensitivity to cobalt in non-Caucasians, and associations between metal allergens and dermatitis site. The answers to these questions require more detailed studies.
文摘目的：探讨小潮气量通气用于具有急性呼吸窘迫综合征（ARDS）高危因素患者机械通气后的临床疗效。方法选择2014年8月至2016年9月入住本院将重症医学科和传染科监护室的200例急性呼吸衰竭需有创机械通气患者作为研究对象，按单随机化法按进行机械通气先后分成研究组和对照组，各100例。研究组给予小潮气量6～8 mL ／kg ，呼吸末正压5～8 mm H2 O ，对照组气管插管后给予潮气量10～12 mL ／kg 、根据病情呼吸末正压0～5 mm H2 O 。比较通气后患者的氧分压、二氧化碳分压、氧合指数、呼吸力学指标、炎症指标、机械通气指标、住院时间、ARDS 发生率、28 d 病死率。结果研究组患者 PaO2和PaO2／FiO2改善效果较对照组更明显（P ＜0．05）。而在 pH 值和 PaCO2指标方面，两组患者治疗后差异无统计学意义（P＞0．05）；肺顺应性增强明显，气道峰压和平台压明显低于对照组，差异有统计学意义（P＜0．05）；治疗后，研究组患者的 IL‐6水平相比较于对照组显著的降低，差异有统计学意义（P＜0．05），研究组患者的 TNF‐α水平也显著低于对照组，差异有统计学意义（P＜0．05）；研究组患者的住院时间、ARDS 发生率和28 d 病死率均显著低于对照组患者，差异具有统计学意义（P＜0．05）。结论小潮气量通气用于具有 ARDS 高危因素患者机械通气后，具有减少肺损伤，降低 ARDS 发生率，降低病死率效果，值得临床广泛应用。
文摘Objective: The purpose of this study was to identify patient criteria which may affect the outcome of a pessary trial. Study design: Records of 407 patients presenting with symptomatic pelvic organ prolapse who had a trial of pessary management were reviewed. Success was defined both by the initial fitting as well as by whether the patient was using the pessary at the 3-week follow-up visit. Outcomes were compared using chisquare test, 2-sample Student t test, or the Wilcoxon rank sum test, as appropriate. Statistical analysis was carried out at a significance of .05. Results: One hundred sixty-eight patients (41% ) were successfully fitted and continuing to use a pessary at the time of the 3-week follow-up visit. The likelihood of a successful pessary trial was significantly lower in subjects with a past history of hysterectomy (P < .001) or known reconstructive surgery for prolapse (P = .010). There was no association between the stage of prolapse and pessary trial outcome. There was no significance found in the relationship between the predominant location of support loss and the pessary trial outcome at the 3-week follow-up visit. Conclusion: The type and severity of pelvic organ prolapse do not influence the likelihood of a successful pessary fitting, and should not be used as a basis on which to select patients for pessary management.
