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2.57 to 2.72倍 Dementia Associated with Heavy Smoking in Midlife Midlife cigarette smoking of two packs per day or more portends an elevated risk for overall dementia, Alzheimer disease, and vascular dementia in later life. Studies of smoking and dementia risk have yielded mixed results: Some data suggest that the risk for neurodegenerative illness is reduced by smoking, whereas other data suggest a positive correlation between amount of cigarette smoking and risk for Alzheimer disease (AD). In this retrospective analysis of prospectively collected data, more than 20,000 adults completed a survey regarding smoking habits between ages 50 and 60. Approximately 20 years later, they were assessed for dementia; more than 5000 of them received diagnoses of dementia by neurologists, neuropsychologists, or internists. Compared with nonsmokers, those who reported heavy smoking (2 packs of cigarettes per day) in midlife demonstrated an elevated risk for later dementia diagnosis, even after adjust...

減少42%VAP rate, 這一根管子要價多少? 這個study可以顯示出VAP的減少，但無法顯示出2nd endpoint(mortality, MV days, ICU stay的減少) 作者預期case number夠多，大約可減少ICU mortality 1-3% 划算否? Intermittent Subglottic Suction to Prevent Ventilator-Associated Pneumonia? In a randomized, nonblinded study, intermittent subglottic suction reduced the incidence of microbiologically confirmed VAP by 42%. Ventilator-associated pneumonia (VAP) occurs in 9% to 27% of patients receiving mechanical ventilation in intensive care units (ICUs). Because the condition results in part from leakage of secretions around the endotracheal cuff, subglottic secretion drainage (SSD) using a specially designed endotracheal tube has been used to diminish this risk. However, previous studies of this strategy have produced conflicting results. Now, investigators in France, with partial support from the manufacturer of the endotracheal tube, have conducted a multicenter study to shed light on the issue. A total of 333 adults who were admit...

吃兩個capsule, 一個灌漿到口中，一個灌到NG裏 如果有效，比什麼subglottic suction要來得實際多了 下次來試試看，吃益生菌的人PDRAB會不會消失得比較快…! Probiotics and Ventilator-Associated Pneumonia In a blinded, randomized study involving 138 mechanically ventilated patients, Lactobacillus administered to the oropharynx and gastrointestinal tract significantly reduced VAP incidence. Ventilator-associated pneumonia (VAP) develops in up to 30% of patients receiving mechanical ventilation. The pathogenesis is presumed to involve colonization of the aerodigestive tract and subsequent aspiration of contaminated secretions. Probiotics could potentially have a role in reducing VAP incidence by maintaining the aerodigestive microbial balance, but evidence to support this possibility is limited. To explore the issue further, researchers conducted a randomized, double-blind trial among adult patients at a Nebraska hospital who were receiving mechanical ventilation and were likely to require it for >72 hours. The 146 patients rece...

I'll Have a Statin with My Burger Can a single statin dose counteract the cardiovascular risk conferred by an unhealthy meal? Daily doses of statins reduce the relative risk for myocardial infarction by 20% to 70%. In contrast, reductions in cardiovascular risk associated with decreasing dietary fat intake have not always been statistically significant. Interventional studies to examine whether taking statins can mitigate the harmful effects of an unhealthy diet are unlikely to take place. Therefore, investigators used a meta-analysis of seven randomized controlled trials (42,848 patients) of statins for primary prevention of coronary artery disease and data from a cohort study of the effects of dietary fat on cardiovascular risk (43,757 men) to calculate a "neutralization tariff" with the following assumptions: Each unhealthy meal consumed contributes to an increase in cardiovascular risk. Each statin tablet taken contributes to a decrease in risk. No ...

只有女性嗎? 男性應該也一樣吧 You Snooze, You Win A large, longitudinal cohort study demonstrated a convincing association between short sleep duration and hypercholesterolemia in young women. Adequate sleep is critical for optimal health and functioning, yet insufficient sleep remains a widespread public health problem in children and adults worldwide. Cross-sectional studies have suggested that short sleep duration is associated with hyperlipidemia, particularly in older adult women. Now, researchers have conducted the first longitudinal study of this association. They performed a multivariable analysis of data collected during three interviews conducted over a 6-year period from students who were in grades 7 through 12 at baseline. Of 14,257 participants, 618 reported receiving a diagnosis of high cholesterol at the final visit. Shorter self-reported sleep duration at the first or second visit was significantly associated with subsequent hyperlipidemia diagnosis in young women (...

Drug-Induced Immune Thrombocytopenia Two dozen drugs are associated with DITP. Patients who take medication often experience low platelet counts. When this occurs, the task for the clinician is to determine whether the thrombocytopenia is disease-related or drug-related. Certain medications can either decrease platelet production or induce antibodies that act against platelet-membrane glycoproteins and, thereby, cause platelet destruction. The latter mechanism is relatively uncommon, but discontinuing a drug that is having this effect might prevent a serious or fatal hemorrhage. An international team of investigators used three sources to identify drugs suspected of inducing thrombocytopenia: case reports of drug-induced immune thrombocytopenia (DITP) published during more than 10 years, adverse drug events reported to the FDA, and data from 14 years of laboratory testing for drug-dependent binding of antibodies to platelets performed at the BloodCenter of Wisconsin...

by Dr. lee https://docs.google.com/leaf?id=0B278nGJMQBk7MTYxZWY2NWQtNWYxMC00MzdiLTg2MTUtNWYzZTI1MzVlMDZi&hl=zh_TW

1950年代做的data是 0.10-0.16 per 100 person-years, which justified LTBI tx 但目前只有0.070-0.099 per 100 person-years, 排除掉HIV病人還更降到0.040-0.058 per 100 person-years, 那我們還做LTBI tx 幹啥? 類似的觀念蘇維鈞主任有講過，台灣似乎花太多資源在LTBI上面，沒有data support LTBI tx 的功效. 應該先有類似baseline data，再說服臨床院所加入LTBI tx 台灣目前的階段，應該還是先抓出病人，治好病人，阻斷感染源為先…特別是越來越沒錢的時候… How Common Is Reactivation Tuberculosis? In a population-based tuberculin skin-test survey, the rate of reactivation TB was 0.070 to 0.099 per 100 person-years. Active tuberculosis (TB) results from recent acquisition of Mycobacterium tuberculosis or, more commonly in the U.S., from reactivation of latent TB infection (LTBI). Knowing the current rate of reactivation TB is important in the drive to implement preventive strategies. The rate was last calculated in the 1950s, when it was found to be 0.10 to 0.16 per 100 person-years. Since then, the epidemiology and management of TB have changed substantially. To calculate today's rate, researchers performed a population-based tu...

Carotid Stenting vs. Endarterectomy: Coming into Focus Findings from a large clinical trial and magnetic resonance imaging substudy strengthen the case for endarterectomy as the preferred treatment for carotid artery stenosis. Although the use of percutaneous stenting for carotid artery stenosis is increasing, the procedure is FDA-approved only in patients at high risk for surgical complications. In direct comparisons with endarterectomy, stenting was associated with increased rates of periprocedural stroke, but questions remain about surgical complications, patient selection, timing of intervention, and operator experience. To address these issues, investigators from 50 centers in Europe, Australia, New Zealand, and Canada randomized 1713 patients with recently symptomatic carotid stenosis to undergo stenting or endarterectomy. Planned follow-up is 3 years; we now have results of an interim safety analysis. At 120 days after randomization, the rate of disabling strok...

在無症狀的病人，做CEA，5年時immediate vs. deferred 3.8% vs. 11% cva risk 10年時，10.8% vs. 16.9%，仍有差異 In Asymptomatic Carotid Stenosis, Endarterectomy Prevents Strokes for at Least 10 Years Benefits seen at 5 years persisted at 10 years. In patients with asymptomatic moderate-to-severe carotid artery stenosis, endarterectomy lowers long-term risk for stroke but carries substantial risk for perioperative stroke or death. In one study, started in 1993, investigators randomized 3120 such patients to immediate endarterectomy or no immediate intervention (with the option to elect endarterectomy at any time and for any reason). In a 2004 report from this international group, immediate endarterectomy carried a 3% perioperative risk for stroke or death, and the 5-year risk for nonperioperative stroke was significantly lower in the endarterectomy group than in the deferred-intervention group (3.8% vs. 11.0%) ( JW Gen Med May 21 2004 ). Investigators now report on these patients 5 years later. ...

GFR Low Glomerular Filtration Rate and Stroke Risk A meta-analysis finds that low GFR can be considered a marker for increased stroke risk. Low glomerular filtration rate (GFR; In a random-effects model of pooled results, the relative risk for incident stroke with a low estimated GFR (eGFR) was 1.43. Asians and those with an eGFR below 40 mL/minute/1.73 m2 had higher risks than others. The effect of low eGFR on the risk for fatal strokes was more profound than for fatal plus nonfatal strokes. Among the 11 studies that reported adjustments for cardiovascular risk factors, the risk was attenuated but remained significant after adjustments. The authors conclude that low eGFR may reasonably be considered a marker for increased stroke risk. Comment: This excellent meta-analysis shows that low GFR should be considered a risk factor for stroke, particularly fatal stroke. As the authors note, compromise of the kidney increases risk factors for generally poor clinical outcomes such as inflammat...