다중혈관 관상동맥 환자에서 y-문합을 이용하여 양쪽 내흉동맥만을 사용한 우회술의 조기 성적

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Good sleep is essential to good health. Yet for most of its history, sleep medicine has focused on the definition, identification, and treatment of sleep problems. Sleep health is a term that is infrequently used and even less frequently defined. It is time for us to change this. Indeed, pressures in the research, clinical, and regulatory environments require that we do so. The health of populations is increasingly defined by positive attributes such as wellness, performance, and adaptation, and not merely by the absence of disease. Sleep health can be defined in such terms. Empirical data demonstrate several dimensions of sleep that are related to health outcomes, and that can be measured with self-report and objective methods. One suggested definition of sleep health and a description of self-report items for measuring it are provided as examples. The concept of sleep health synergizes with other health care agendas, such as empowering individuals and communities, improving population health, and reducing health care costs. Promoting sleep health also offers the field of sleep medicine new research and clinical opportunities. In this sense, defining sleep health is vital not only to the health of populations and individuals, but also to the health of sleep medicine itself.

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Sleep health: can we define it? Does it matter?

Mendelian Inheritance in Man

Genetic predisposition to multiple sclerosis (MS) only explains a fraction of the disease risk; lifestyle and environmental factors are key contributors to the risk of MS. Importantly, these nongenetic factors can influence pathogenetic pathways, and some of them can be modified. Besides established MS-associated risk factors - high latitude, female sex, smoking, low vitamin D levels caused by insufficient sun exposure and/or dietary intake, and Epstein-Barr virus (EBV) infection - strong evidence now supports obesity during adolescence as a factor increasing MS risk. Organic solvents and shift work have also been reported to confer increased risk of the disease, whereas factors such as use of nicotine or alcohol, cytomegalovirus infection and a high coffee consumption are associated with a reduced risk. Certain factors - smoking, EBV infection and obesity - interact with HLA risk genes, pointing at a pathogenetic pathway involving adaptive immunity. All of the described risk factors for MS can influence adaptive and/or innate immunity, which is thought to be the main pathway modulated by MS risk alleles. Unlike genetic risk factors, many environmental and lifestyle factors can be modified, with potential for prevention, particularly for people at the greatest risk, such as relatives of individuals with MS. Here, we review recent data on environmental and lifestyle factors, with a focus on gene-environment interactions.

Interactions between genetic, lifestyle and environmental risk factors for multiple sclerosis

Objective: Night-shift work is associated with ischaemic cardiovascular disorders It is not currently known whether it may be causally linked to metabolic syndrome (MS), a risk condition for ischaemic cardiovascular disorders The syndrome presents with visceral obesity associated with mild alterations in glucidic and lipidic homeostasis, and in blood pressure The aim of this study was to assess whether a causal relationship exists between night-shift work and the development of MS Methods: Male and female nurses performing night shifts, free from any component of MS at baseline, were evaluated annually for the development of the disorder during a 4-year follow-up Male and female nurses performing daytime work only, visited during the same time period, represented the control group Results: The cumulative incidence of MS was 90% (36/402) among night-shift workers, and 18% (6/336) among daytime workers (relative risk (RR) 50, 95% CI − 21 to 146) The annual rate of incidence of MS was 29% in night-shift workers and 05% in daytime workers Kaplan–Meier survival curves of the two groups were significantly different (log-rank test; p Conclusions: The risk of developing MS is strongly associated with night-shift work in nurses Medical counselling should be promptly instituted in night-shift workers with the syndrome, and in case of persistence or progression, a change in work schedule should be considered

https://oem.bmj.com/content/oemed/67/1/54.full.pdf

Incidence of metabolic syndrome among night-shift healthcare workers

Aim: To evaluate whether shift work is associated with an increased rate of peptic ulcer in H pylori infected workers Methods: During a two year period, consecutive dyspeptic workers underwent non-invasive evaluation of H pylori status by means of urea 13 C breath test or stool testing Those testing positive were included in the study and divided into two main categories: day-time workers and shift workers An upper gastrointestinal endoscopy was performed in all workers, and biopsy specimens were taken from the stomach to confirm the presence of H pylori infection (culture and histology) Results: A total of 247 day-time workers and 101 shift workers were included The prevalence of duodenal ulcer was significantly higher in shift workers than in day-time workers (29 of 101 v 23 of 247; OR = 392, 95% CI 213 to 721), and persisted after multivariate analysis, taking into account possible confounding factors (OR = 396, 95% CI 210 to 747) Conclusion: Shift work increases the ulcerogenic potential of H pylori infection and should be considered a risk factor for duodenal ulcer in infected shift workers Treatment of infection in this high risk group may improve the health of workers and may reduce the economic impact of peptic ulcer

Shift work increases the frequency of duodenal ulcer in H pylori infected workers.

Background It has been suggested that extended high-frequency audiometry (EHFA) might be more sensitive than conventional audiometry in detecting early signs of hearing impairment. However, this technique has not been adequately tested in an occupational environment. We therefore investigated the usefulness of this method in noise-exposed workers. Methods We compared conventional frequency audiometry (0.25–8 kHz) and EHFA (9–18 kHz) in 184 noise-exposed and 98 non-noise-exposed workers. Results Both methods showed significantly higher threshold levels (P < 0.05) in noiseexposed workers for most of the tested frequencies; however, the differences were more marked for EHFA, especially in young exposed workers. Significant differences in the EHF range were detected also in the subgroup of noise-exposed workers with normal findings at conventional audiometry. Stepwise regression analysis showed that in 21- to 40-year-old workers the noise effect was largely predominant at both conventional audiometry and EHFA, whereas in older subjects the noise effect was predominant up to 6 kHz frequency, the effect of age being significantly greater at higher frequencies. Conclusions These data indicate that EHFA is more sensitive than conventional audiometry in detecting noise induced hearing loss. However, hearing loss in the EHFrange seems an agedependent phenomenon with progression into the lower speech range frequencies with increasing age. These changes seem to be accentuated in the early years by noise exposure, suggesting that EHFA could represent a useful preventive measure in young exposed workers. Am. J. Ind. Med. 51:452–462, 2008. 2008 Wiley-Liss, Inc.

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Extended high-frequency audiometry and noise induced hearing loss in cement workers.

Stress induces autoimmune disorders by affecting the immune response modulation. Recent studies have shown that shift work stress may enhance the onset of the autoimmune Graves hyperthyroidism. On the other hand, the possible association between occupational stress and autoimmune hypothyroidism has not yet been investigated. In order to detect the possible association between shift work and subclinical autoimmune hypothyroidism we investigated the prevalence of isolated anti-peroxidase thyroid (TPO) autoantibodies in 220 shift workers and in 422 day-time workers. Subclinical autoimmune hypothyroidism was diagnosed by the concomitant presence of high anti-TPO values and TSH levels higher than 2.51 mU/l. Anti TPO antibodies were measured by chemiluminescent technology (Advia Centaur) (a value above 60 IU/l was considered altered). Subclinical autoimmune hypothyroidism was diagnosed in 7.7 percent shift workers and in 3.8 percent day-time workers with a statistically significant difference: Odds Ratio (OR) 2.12, 95 percent Confidence Interval (CI) 1.05 to 4.29; p=0.03. The difference persisted after multivariate analysis taking into account age, sex, smoking habits, alcohol intake, familial history of autoimmune thyroid disease and exposure to radiation as possible confounders: OR. 2.24, 95 percent CI.1.01 to 4.94, p 0.05. Altered anti- TPO autoantibodies were found in 13.6 percent shift workers and in 8.6 percent day-time workers OR. 1.64, 95 percent CI.1.03 to 2.74, p=0.05. The significant difference was still detectable after multivariate analysis: OR. 1.95, 95 percent CI. 1.09 to 3.48, p=0.02. Our data show a significant association between shift work and autoimmune hypothyroidism. This finding may have implications in the health surveillance programs.

Shift work and autoimmune thyroid disorders.

To assess the magnitude of COVID-19 spread and the associated risk factors among health care workers (HCWs), we conducted an in-hospital survey in a central Italian COVID Hospital. Participants underwent nasopharyngeal swab and/or serum collection for SARS-CoV-2 IgG examination. We divided participants according to working status, into rotating-night shift workers (r-NSW) and day-workers. We found 30 cases of COVID-19 infection in a total of 1180 HCWs (2.5%). Most COVID-19-positive hospital employees were r-NSWs with significantly higher BMI than that of individuals who tested negative. After adjustment for covariates, night work and BMI > 30 were associated with a markedly greater risk of COVID-19 diagnosis (OR 3.049 [95%CI 1.260–7.380] and OR 7.15 [95%CI 2.91–17.51], respectively). Our results describe a low prevalence of COVID-19 infection among HCWs at a central Italian COVID Hospital. COVID-19 infection risk appears to be associated with obesity and night shift work, thus supporting the need for careful health surveillance among frontline HCWs exposed to COVID-19.

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Luca Coppeta

Papers

Incidence of metabolic syndrome among night-shift healthcare workers

Shift work increases the frequency of duodenal ulcer in H pylori infected workers.

Extended high-frequency audiometry and noise induced hearing loss in cement workers.

Shift work and autoimmune thyroid disorders.

High body mass index and night shift work are associated with COVID-19 in health care workers.