HS Code Reference
Personal Projective Equipment
Maternal age is a known risk factor for stillbirth and delayed childbearing is a societal norm in developed country settings. The timing and reasons for age being a risk factor are less clear. This study aimed to document the gestational specific risk of maternal age throughout pregnancy and whether the underlying causes of stillbirth differ for older women.
Using linkage of state maternity and perinatal death data collections the authors assessed risk factors for antepartum stillbirth in New South Wales Australia for births between 2002 – 2006 (n = 327,690) using a Cox proportional hazards model. Gestational age specific risk was calculated for different maternal age groups. Deaths were classified according to the Perinatal Mortality Classifications of the Perinatal Society of Australia and New Zealand.
Maternal age was a significant independent risk factor for antepartum stillbirth (35 – 39 years HR 1.4 95% CI 1.12 – 1.75; ≥ 40 years HR 2.41 95% CI 1.8 – 3.23). Other significant risk factors were smoking HR 1.82 (95% CI 1.56 -2.12) nulliparity HR 1.23 (95% CI 1.08 – 1.40), pre-existing hypertension HR 2.77 (95% CI 1.94 – 3.97) and pre-existing diabetes HR 2.65 (95% CI 1.63 – 4.32). For women aged 40 or over the risk of antepartum stillbirth beyond 40 weeks was 1 in 455 ongoing pregnancies compared with 1 in 1177 ongoing pregnancies for those under 40. This risk was increased in nulliparous women to 1 in 247 ongoing pregnancies. Unexplained stillbirths were the most common classification for all women, stillbirths classified as perinatal infection were more common in the women aged 40 or above.
Women aged 35 or older in a first pregnancy should be counselled regarding stillbirth risk at the end of pregnancy to assist with informed decision making regarding delivery. For women aged 40 or older in their first pregnancy it would be reasonable to offer induction of labour by 40 weeks gestation.
Stillbirth, Maternal age, Risk factors, Population-based, Data linkage
Risk factors for antepartum stillbirth and the influence of maternal age in New South Wales Australia: A population based study
Adrienne Gordon,corresponding author1,2 Camille Raynes-Greenow,corresponding author2 Kevin McGeechan,2 Jonathan Morris,3,4 and Heather Jeffery1,2
The carbohydrate-to-fiber ratio is a recommended measure of carbohydrate quality; however, its relation to incident coronary heart disease (CHD) is not currently known.
We aimed to assess the relation between various measures of carbohydrate quality and incident CHD.
Data on diet and lifestyle behaviors were prospectively collected on 75,020 women and 42,865 men participating in the Nurses’ Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS) starting in 1984 and 1986, respectively, and every 2-4 y thereafter until 2012. All participants were free of known diabetes mellitus, cancer, or cardiovascular disease at baseline. Cox proportional hazards regression models were used to assess the relation between dietary measures of carbohydrate quality and incident CHD.
After 1,905,047 (NHS) and 921,975 (HPFS) person-years of follow-up, we identified 7,320 cases of incident CHD. In models adjusted for age, lifestyle behaviors, and dietary variables, the highest quintile of carbohydrate intake was not associated with incident CHD (pooled-RR = 1.04; 95% CI: 0.96, 1.14; P-trend = 0.31). Total fiber intake was not associated with risk of CHD (pooled-RR = 0.94; 95% CI: 0.85, 1.03; P-trend = 0.72), while cereal fiber was associated with a lower risk for incident CHD (pooled-RR = 0.80; 95% CI: 0.74, 0.87; P-trend < 0.0001). In fully adjusted models, the carbohydrate-to-total fiber ratio was not associated with incident CHD (pooled-RR = 1.04; 95% CI: 0.96, 1.13; P-trend = 0.46). However, the carbohydrate-to-cereal fiber ratio and the starch-to-cereal fiber ratio were associated with an increased risk for incident CHD (pooled-RR = 1.20; 95% CI: 1.11, 1.29; P-trend < 0.0001, and pooled-RR = 1.17; 95%CI: 1.09, 1.27; P-trend < 0.0001, respectively). Conclusion Dietary cereal fiber appears to be an important component of carbohydrate quality. The carbohydrate-to-cereal fiber ratio and the starch-to-cereal fiber ratio, but not the carbohydrate-to-fiber ratio, was associated with an increased risk for incident CHD. Future research should focus on how various measures of carbohydrate quality are associated with CHD prevention. This trial was registered at clinicaltrials.gov as NCT03214861.
carbohydrates, carbohydrate quality, diet quality, whole grains, type 2 diabetes, starch, fiber
Carbohydrate quality and quantity and risk of coronary heart disease among US women and men
Hala B AlEssa,1 Randy Cohen,5 Vasanti S Malik,1 Sally N Adebamowo,6 Eric B Rimm,1,2,3 JoAnn E Manson,2,4 Walter C Willett,1,2,3 and Frank B Hu1,2,3
To define the clinical characteristics and prognostic value of pre?retreatment plasma Epstein?Barr virus (EBV) DNA, we investigated EBV status in locoregional recurrent nasopharyngeal carcinoma (lrNPC) patients.
Between April 2008 and August 2016, the data of patients with nonmetastatic lrNPC were retrospectively reviewed. The survival indexes of patients between different pre?retreatment EBV status groups were compared.
A total of 401 patients with nonmetastatic lrNPC were enrolled, and 197 (49.1%) patients had detectable pre?retreatment plasma EBV DNA. Treatment included radiotherapy alone (n = 37 patients), surgery alone (n = 105), radiotherapy (n = 208), surgery combined with radiotherapy (n = 20), chemotherapy and targeted therapy (n = 31). Median follow?up was 32 months. The 3?year locoregional relapse?free survival (LRRFS), distant metastasis?free survival (DMFS), and overall survival (OS) rates for the entire cohort were 64.8%, 89.4%, and 58.8%, respectively. The estimated 3?year LRRFS, DMFS, and OS rates for the pre EBV?positive group vs the pre EBV?negative group were 54.2% vs 75.0% (P < 0.001), 86.6% vs 91.9% (P = 0.05), 51.6% vs 65.9% (P = 0.01), respectively. Among patients in the clinical stage rI/II, there were 17 patients in the radiotherapy alone group and 49 patients in the surgery alone group. And there was no significant difference in overall survival between radiotherapy and surgery, even among the different pre?EBV statuses (P > 0.05). In terms of long?term toxic and side effects, the incidence of radioactive temporal lobe injury in the radiotherapy group was higher than that in the surgery group (35.3% vs 8.2%, P < 0.001), and no statistically significant difference was found in other long?term toxic and side effects. Conclusions The positive rate of pre?retreatment plasma EBV DNA in lrNPC is lower than primary NPC. The prognosis of EBV DNA negative group is better than positive group. For locally early?stage lrNPC, regardless of EBV DNA status, radiotherapy and surgery are available options and both can achieve better long?term survival.
clinical characteristics, Epstein?Barr Virus DNA, prognostic, recurrent nasopharynx
Clinical characteristics and prognostic value of pre?retreatment plasma epstein?barr virus DNA in locoregional recurrent nasopharyngeal carcinoma
Ming?Zhu Liu, 1 , 2 , 3 , 4 Shuo?Gui Fang, 1 , 2 , 3 , 4 Wei Huang, 1 , 2 , 3 , 4 Han?Yu Wang, 1 , 2 , 3 , 4 Yun?Ming Tian, 5 Run?Da Huang, 1 , 2 , 3 , 4 Zhuang Sun, 1 , 2 , 3 , 4 Chong Zhao, 1 , 2 , 3 , 4 Tai?Xiang Lu, 1 , 2 , 3 , 4 Ying Huang,corresponding author 1 , 2 , 3 , 4 and Fei Hancorresponding author 1 , 2 , 3 , 4