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A study of the association between daily mortality and ambient air pollutant concentrations in Pittsburgh, Pennsylvania

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JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION 2000年第8期50卷 1481-1500页

作者： Chock, DP Winkler, SL Ford Motor Co Res Lab Environm Modeling Grp Dearborn MI 48121 USA

We have studied the possible association of daily mortality with ambient pollutant concentrations (PM10, CO, O-3, SO2, NO2, and fine [PM2.5] and coarse PM) and weather variables (temperature and dew point) in the Pittsburgh, PA, area for two age groups-less than 75, and 75 and over-for the 3-year period of 1989-1991. Correlation functions among pollutant concentrations show important seasonal dependence, and this fact necessitates the use of seasonal models to better identify the link between ambient pollutant concentrations and daily mortality. An analysis of the seasonal model results for the younger-age group reveals significant multicollinearity problems among the highly correlated concentrations of PM10, CO, and NO2 (and O-3 in spring and summer), and calls into question the rather consistent results of the single- and multi-pollutant non-seasonal models that show a significant positive association between PM10 and daily mortality. For the older-age group, dew point consistently shows a significant association with daily mortality in all models. Collinearity problems appear in the multi-pollutant seasonal and non-seasonal models such that a significant, positive PM10 coefficient is accompanied by a significant, negative coefficient of another ambient pollutant, and the identity of this other pollutant changes with season. The PM2.5 data set is half that of PM10. Identical-model runs for both data sets reveal instability in the pollutant coefficients, especially for the younger age group. The concern for the instability of the pollutant coefficients due to a small signal-to-noise ratio makes it impossible to ascertain credibly the relative associations of the fine- and coarse-particle modes with daily mortality. In this connection, we call for caution in the interpretation of model results for causal inference when the models use fully or partially estimated PM values to fill large data gaps.

关键词：年龄因素空气污染/分析死亡原因混杂因素(流行病学) 流行病学研究模型理论死亡率/发展趋势粒子大小宾夕法尼亚/流行病学季节青少年成年人老年人儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性中年人

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Knee joint laxity and neuromuscular characteristics of male and female soccer and basketball players

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AMERICAN JOURNAL OF SPORTS MEDICINE 1999年第3期27卷 312-319页

作者： Rozzi, SL Lephart, SM Gear, WS Fu, FH Coll Charleston ATC Dept Phys Educ & Hlth Charleston SC 29424 USA Univ Pittsburgh Neuromuscular Res Lab Pittsburgh PA 15260 USA Univ Pittsburgh Dept Orthopaed Surg Pittsburgh PA 15260 USA

Anterior cruciate ligament injuries are occurring at a higher rate in female athletes compared with their male counterparts. Research in the area of anterior cruciate ligament injury has increasingly focused on the role of joint proprioception and muscle activity in promoting knee joint stability. We measured knee joint laxity, joint kinesthesia, lower extremity balance, the amount of time required to generate peak torque of the knee flexor and extensor musculature, and electromyographically assessed muscle activity in 34 healthy, collegiate-level athletes (average age, 19.6 +/- 1.5 years) who played soccer or basketball or both. Independent t-tests were used to determine significant sex differences. Results revealed that women inherently possess significantly greater knee joint laxity values, demonstrate a significantly longer time to detect the knee joint motion moving into extension, possess significantly superior single-legged balance ability, and produce significantly greater electromyographic peak amplitude and area of the lateral hamstring muscle subsequent to landing a jump. The excessive joint laxity of women appears to contribute to diminished joint proprioception, rendering the knee less sensitive to potentially damaging forces and possibly at risk for injury. Unable to rely on ligamentous structures, healthy female athletes appear to have adopted compensatory mechanisms of increased hamstring activity to achieve functional joint stabilization.

关键词：前交叉韧带/损伤篮球/损伤肌电描记术关节不稳定性/流行病学关节不稳定性/病理生理学膝关节/神经支配膝关节/病理生理学肌肉骨骼平衡宾夕法尼亚/流行病学本体感觉性别因素足球/损伤转矩成年人女(雌)性人类男(雄)性

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Increases in bcl-2 protein in cerebrospinal fluid and evidence for programmed cell death in infants and children after severe traumatic brain injury

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JOURNAL OF PEDIATRICS 2000年第2期137卷 197-204页

作者： Clark, RSB Kochanek, PM Adelson, PD Bell, MJ Carcillo, JA Chen, M Wisniewski, SR Janesko, K Whalen, MJ Graham, SH Childrens Hosp Pittsburgh Div Pediat Crit Care Dept Anesthesiol & Crit Care Med Pittsburgh PA 15213 USA Childrens Hosp Pittsburgh Dept Pediat Pittsburgh PA 15213 USA Childrens Hosp Pittsburgh Dept Neurol Surg Pittsburgh PA 15213 USA Childrens Hosp Pittsburgh Dept Epidemiol Pittsburgh PA 15213 USA Childrens Hosp Pittsburgh Dept Neurol Pittsburgh PA 15213 USA Univ Pittsburgh Sch Med Safar Ctr Resuscitat Res Pittsburgh PA USA VA Pittsburgh Hlth Syst Ctr Geriatr Res Educ & Clin Pittsburgh PA USA

Objectives: To determine whether bcl-2, a protein that inhibits apoptosis, would be increased in cerebrospinal fluid (CSF) in infants and children after traumatic brain injury (TBI) and to examine the association of bcl-2 concentration with clinical variables. Study design: Bcl-2 was measured in CSF from 23 children (aged 2 months-16 years) with severe TBI and from 19 children without TBI or meningitis (control subjects) by enzyme-linked immunosorbent assay CSF oligonucleosome concentration was also determined as a marker of DNA degradation. Brain samples from 2 patients undergoing emergent decompressive craniectomies were analyzed for bcl-2 with Western blot and for DNA fragmentation with TUNEL (terminal deoxynucleotidyl-transerase mediated biotin-dUTP nick-end labeling). Results: CSF bcl-2 concentrations were increased in patients with TBI versus control subjects (P = .01). Bcl-2 was increased in patients with TBI who survived versus those who died (P = .02). CSF oligonucleosome concentration tended to be increased after TBI (P = .07) and was not associated with bcl-2. Brain tissue samples showed an increase in bcl-2 in patients with TBI versus adult brain bank control samples and evidence of DNA fragmentation within cells with apoptotic morphology Conclusions: Bcl-2 may participate in the regulation of cell, death after TBI in infants and children. The increase in bcl-2 seen in patients who survived is consistent with a protective role for this anti-apoptotic protein after TBI.

关键词：年龄因素方差分析细胞凋亡脑损伤/脑脊髓液脑损伤/病因学脑损伤/死亡率脑损伤/病理生理学病例对照研究格拉斯哥昏迷量表线性模型多元分析核小体/代谢宾夕法尼亚/流行病学原癌基因蛋白质c-bcl-2/脑脊髓液存活率分析颞叶/代谢青少年儿童儿童学龄前女(雌)性人类婴儿男(雄)性

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Changes in rates of β-blocker use between 1994 and 1997 among elderly survivors of acute myocardial infarction

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AMERICAN HEART JOURNAL 2000年第4期140卷 663-671页

作者： Heller, DA Ahern, FM Kozak, M Penn State Univ Dept Biobehav Hlth University Pk PA 16802 USA Penn State Univ Hlth Serv 1 PACE Program Harrisburg PA USA Penn State Univ Milton S Hershey Med Ctr Coll Med Dept MedDiv Cardiol Hershey PA 17033 USA

Background Results of recent studies suggest that beta-biockers are underused by elderly acute myocardial infarction (AMI) survivors. The goals of this study were to examine changes in post-AMI beta-blocker use occurring between 1994 and 1997 and to identify factors associated with outpatient use of beta-blockers. Methods Patients included 9534 individuals greater than or equal to 65 years of age who were enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) and who survived AMI between 1994 and 1997. With the use of outpatient prescription claims, beta-blocker usage rates were examined by year, and multivariate logistic regression was used to identify predictors of beta-blocker use. Results Post-AMI beta-blocker use increased from 39.6% in 1994 to 58.6% in 1997. Controlling for AMI year, individuals who had any prescriptions written by a cardiologist were more likely to use a beta-blocker than individuals who received all prescriptions from noncardiologists (odds ratio 1.52, P = .0001). Elderly patients who did not use beta-blockers tended to have greater severity of illness, non-Q-wave infarctions, atrial fibrillation, and comorbidities such as congestive heart failure, chronic obstructive pulmonary disease, and asthma. Use of calcium channel blockers and diuretics was negatively associated with beta-blocker use, but persons using lipid-lowering agents were more likely to use beta-blockers. Conclusions Significant improvements in beta-blocker use by elderly AMI survivors have occurred since 1994. Differences among physician specialties in beta-blocker prescribing appear to remain. Across all prescriber specialities, historic contraindications constitute major factors in the choice of post-AM I therapy. Further efforts should be made to encourage the use of beta-blockers in elderly survivors of AMI, particularly those with heart failure.

关键词：肾上腺素能β受体拮抗剂/治疗应用猝死心脏/预防和控制心电描记术/药物作用随访研究心率/药物作用心率/生理学心肌梗死/药物疗法心肌梗死/死亡率心肌梗死/病理生理学比值比门诊病人宾夕法尼亚/流行病学处方药物/统计学和数值数据预后回顾性研究存活率/发展趋势老年人老年人 80以上女(雌)性人类男(雄)性

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Outcomes in acute orthopaedic trauma: a review of 130,506 patients by age

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INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 1999年第6期30卷 431-437页

作者： Gomberg, BFC Gruen, GS Smith, WR Spott, M W Virginia Univ Dept Orthoped Morgantown WV 26506 USA

There is a paucity of large cohort studies that address outcomes after acute orthopaedic trauma. The regional trauma registry is a powerful tool to study trends of large populations over long periods of time. We used such a regional trauma registry to review retrospectively a large subset of orthopaedic trauma patients over a long period of time and to evaluate the relationship between initial presentation, hospital course, hospital charges, and outcomes as a function of age. A retrospective review of 130,506 level I and II trauma admissions with acute orthopaedic injuries over 10 years (1985-1995) was conducted. Aggregate data were analyzed among five age groups. Descriptive analyses were conducted for mechanism of injury, mortality, time to death, injury type, injury severity score (ISS), Glasgow Coma Scale (CCS) on presentation, length of stay (LOS), discharge destination, and hospital charges. Forty-six percent of the patients were in the 18-35-year-old age group;however, 21% of all patients were older than 65 years of age at the time of injury. There were no differences in GCS or ISS on admission. Injury types were similar across all age groups, mostly extremity fractures. Younger patients were much more likely to be injured in a motor vehicle accident (MVA), whereas older patients were injured in a fall. Penetrating trauma was seen almost exclusively in the young. LOS in the hospital was longer in the elderly;however, LOS in the intensive care units were similar across all age groups. Time to death from initial presentation differed across age groups. Elderly patients who eventually died were much more likely to survive more than 24 h in the hospital as compared with young patients. Hospital charges per hospitalization increased with age, although the total charges to the youngest age group were higher due to the group's high volume. Younger American trauma patients with acute orthopaedic injuries are much more likely than their older counterparts to sustain p

关键词：急性病年龄分布骨折/经济学骨折/流行病学骨折/病因学骨折/治疗医院费用损伤严重度评分住院时间病人出院宾夕法尼亚/流行病学登记/统计学和数值数据回顾性研究存活率青少年成年人老年人女(雌)性人类男(雄)性中年人

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Relationship between coronary angioplasty laboratory volume and outcomes after hospital discharge

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AMERICAN HEART JOURNAL 2002年第5期143卷 833-840页

作者： Kimmel, SE Sauer, WH Brensinger, C Hirshfeld, J Haber, HL Localio, AR Univ Penn Sch Med Ctr Clin Epidemiol & Biostat Philadelphia PA 19104 USA Univ Penn Sch Med Dept Biostat & Epidemiol Philadelphia PA 19104 USA Hosp Univ Penn Dept Med Div Cardiovasc Philadelphia PA 19104 USA

Background Although an inverse association has been established between short-term complications of percutoneous coronary interventions (PCIs) and the volume of angioplasty procedures performed by catheterization laboratories, no data are available on the association between laboratory volume and long-term outcomes. Methods A cohort study of 25,222 patients undergoing PCI in 43 laboratories in Pennsylvania from October 1994 to December 1995 was performed by use of the Pennsylvania Health Care Cost Containment Council database. The association of laboratory volume with inhospital, 1-month, and 6-month events was estimated by use of multivariable analyses adjusting for patient and procedural characteristics. Results Although a higher volume of procedures was associated with reduced inhospital coronary bypass ([CABG] 0.6 odds ratio [OR] for 400 vs <400 PCIs/year;95% CI 0.4, 0.8), it was not associated with CABG occurring within 1 month after discharge (P = .71;OR 1.0, 95% CI 0.6, 1.7). Laboratory volume was also not significantly associated with postdischarge revascularization (PCI or CABG) at 1 month (P = .58;OR 1.1, 95% CI 0.8, 1.4) or 6 months (P = .47;OR 1.04, 95% CI 0.91, 1.19). In addition, laboratory volume was not associated with rates of myocardial infarction (P =.14), death (P =.28), or the combined outcome of PCI, CABG, myocardial infarction, or death (P = .90) at 1 month after hospital discharge. Conclusions Although our study confirmed the volume/complication relationship for inhospital CABG, it did not reveal an association between volume and postdischarge events. These results suggest that inhospital complications will remain the standard for assessing laboratory volume and that selective use of higher-volume laboratories may not improve long-term outcomes.

关键词：队列研究冠状动脉分流术/标准冠状动脉分流术/利用冠状动脉再狭窄/流行病学冠状动脉再狭窄/治疗医院/统计学和数值数据多元分析心肌梗死/流行病学心肌梗死/死亡率比值比宾夕法尼亚/流行病学时间因素治疗结果女(雌)性人类男(雄)性中年人

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Axillary lymph node dissection in breast cancer: An evolving question?

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AMERICAN SURGEON 2000年第1期66卷 66-72页

作者： Lagares-Garcia, JA Garguilo, G Kurek, S LeBlond, G Diaz, F Conemaugh Mem Med Ctr Dept Surg Johnstown PA 15905 USA Conemaugh Mem Med Ctr Laurel Highlands Canc Program Johnstown PA 15905 USA Conemaugh Mem Med Ctr Dept Pathol Johnstown PA 15905 USA

Axillary lymph node dissection (ALND) is performed for staging purposes, Sentinel lymph node biopsy may decrease the cost and morbidity of ALND. Are there patients that the procedure is not indicated avoiding cost and morbidity? We retrospectively studied the incidence of lymph node metastasis in 423 patients with T-1 breast cancer. Thirty-one T-1a, 146 T-1b, and 246 T-1c tumors were seen. The mean age was 61 years. Ten per cent were premenopausal, and 84 per cent were postmenopausal. Tumor size averaged 1.29 cm. Eighty-one per cent of the tumors were node negative and 19 per cent were node positive. One T-1a patient (3 per cent) had an axillary metastasis, 19 T-1b patients (13%), and 61 T-1c patients (25%) were node positive, respectively. Seventy-three per cent were ER positive. Thirty-three patients (8%) died from cancer. Eighty-seven per cent received surgery with axillary lymph node dissection (ALND), and three per cent had surgery without ALND. Younger age, increased tuner size, premenopausal status, and ER negativity affected node positivity rates (P < 0.05). Death from breast cancer was more common among node-positive patients (P < 0.05). No difference was found regarding the performance of ALND and survival (P > 0.05). We feel that ALND can be safely omitted in T-1a to reduce the morbidity and the expense of breast cancer treatment. In T-1b and T-1c tumors, the use of ALND is necessary, but morbidity and cost can be reduced by the use of sentinel lymph node biopsy.

关键词：乳腺肿瘤/流行病学乳腺肿瘤/病理学乳腺肿瘤/外科学决策发病率淋巴结切除术淋巴转移宾夕法尼亚/流行病学回顾性研究成年人老年人老年人 80以上女(雌)性人类中年人

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Has arteriography gotten a bad name? Current accuracy and morbidity of diagnostic contrast arteriography for aortoiliac and lower extremity arterial disease

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ANNALS OF VASCULAR SURGERY 2001年第4期15卷 417-420页

作者： Schindler, N Calligaro, KD Lombardi, J Dougherty, MJ Raviola, CA D'Orazio, E Penn Hosp Vasc Surg Sect Philadelphia PA 19106 USA Penn Hosp Sect Intervent Radiol Philadelphia PA 19106 USA

Recently, contrast arteriography has been challenged as the diagnostic test of choice for lower extremity arterial disease because of its associated morbidity and questionable accuracy in identifying suitable distal outflow arteries. The purpose of this report was to analyze our experience to determine if these concerns were justified. We reviewed 500 consecutive contrast arteriograms performed at our hospital for aortoiliac and lower extremity arterial disease between November 1994 and November 1998. Arteriograms performed in conjunction with therapeutic procedures such as balloon angioplasty, stent placement, and thrombolysis were excluded, leaving 244 diagnostic cases for analysis. Forty-six percent (112) of patients had diabetes mellitus, 14% (34) had an elevated baseline serum creatinine (greater than or equal to1.5 mg/dL), and an additional 7% (17) were dialysis dependent. Radiologists limited contrast volume by imaging only the symptomatic extremity when appropriate and using digital subtraction techniques as indicated. Our results showed that diagnostic contrast arteriography is associated with an acceptably low morbidity, has an accuracy that is unlikely to be surpassed by other modalities, and remains the diagnostic test of choice for lower extremity arterial disease.

关键词：血管造影术/方法主动脉造影术动脉闭塞性疾病/诊断动脉闭塞性疾病/流行病学肌酸酐/血液诊断技术外科学股动脉/放射摄影术髂动脉/放射摄影术腿/血液供给腿/放射摄影术年患病率宾夕法尼亚/流行病学肾动脉/放射摄影术回顾性研究成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Malignant tumors of the nose and paranasal sinuses: Hospital of the University of Pennsylvania experience 1990-1997

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AMERICAN JOURNAL OF RHINOLOGY 1999年第2期13卷 117-123页

作者： Tufano, RP Mokadam, NA Montone, KT Weinstein, GS Chalian, AA Wolf, PF Weber, RS Hosp Univ Penn Dept Otorhinolaryngol Head & Neck Surg Philadelphia PA 19104 USA

We received our experience with sinonasal malignancies, which comprise less than 1% of all cancers, in order to determine the spectrum of disease and outcome after treatment. The medical records of 48 patients with sinonasal malignancies treated between 1990-1997 were reviewed for epidemiologic characteristics, tumor location and histology, treatment modalities, and tumor recurrence. Mean age was 58.5 years and 46% were male. Multiple sites of origin were common, including maxillary sinus (83%), ethmoid sinus (35%), and nasal cavity (40%). The histological spectrum included squamous cell carcinoma (46%), adenoid cystic carcinoma (6%), and miscellaneous others (48%). Treatment included surgery and adjuvant radiotherapy (XRT) (58%), surgery alone (27%), XRT and chemotherapy (6%), surgery and chemotherapy (4%), and XRT alone (4%). Mean follow-up was 15 months (range 2-58). Recurrence was evident in nine patients (19%), 3(33%) of whom had prior treatment before presenting to HUP. Of the six who recurred after initial treatment at HUP, five (83.3%) were treated with surgery and XRT and one (16.7%) was treated with surgery alone. Of the three that recurred after undergoing attempts and salvage (prior treatment and then treatment at HUP), one had received surgery alone followed by surgery and XRT, one had surgery and XRT followed by surgery and one had XRT followed by surgery alone. Our experience reveals surgery and XRT to be the modality of choice, particularly for advanced tumors, whereas surgery alone may be sufficient for small, well localized tumors. Neo-adjuvant chemotherapy may offer improved local control;the future role of endoscopic surgery warrants further investigation.

关键词：年龄分布医院大学发病率鼻肿瘤/流行病学鼻肿瘤/病理学鼻肿瘤/治疗鼻窦肿瘤/流行病学鼻窦肿瘤/病理学鼻窦肿瘤/治疗宾夕法尼亚/流行病学登记危险因素性别分布存活率成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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PTSD in heart transplant recipients and their primary family caregivers

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PSYCHOSOMATICS 1999年第3期40卷 212-221页

作者： Stukas, AA Dew, MA Switzer, GE DiMartini, A Kormos, RL Griffith, BP Univ Pittsburgh Sch Med Dept Psychiat Pittsburgh PA 15260 USA Univ Pittsburgh Sch Med Dept Psychol Pittsburgh PA 15260 USA Univ Pittsburgh Sch Med Dept Epidemiol Pittsburgh PA 15260 USA Univ Pittsburgh Sch Med Dept Med Pittsburgh PA 15260 USA Univ Pittsburgh Sch Med Dept Surg Pittsburgh PA 15260 USA Univ Pittsburgh Med Ctr Pittsburgh PA 15260 USA

Posttraumatic stress disorder associated with transplantation (PTSD-T) is a complication for some heart transplant recipients. By using a structured, standardized interview and DSM-III-R criteria, the authors examined whether recipients (n = 158) and their family caregivers (n = 142) should similar PTSD-T rates and clinical characteristics during the first year posttransplant. Among the recipients, 10.5% met full criteria for the disorder and an additional 5% were probable cases. Among the caregiver, 7.7% met full criteria and an additional 11.0% were probable cases. Severity and duration of disorder were similar across the groups. Being female, having a history of psychiatric illness, and having lower friend support were increased risks for PTSD-T.

关键词：医疗护理提供者/心理学卡方分布家庭卫生随访研究心脏移植/副作用心脏移植/心理学发病率多元分析宾夕法尼亚/流行病学回归分析危险因素应激障碍创伤后/流行病学应激障碍创伤后/病因学成年人女(雌)性人类男(雄)性中年人

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