Background Undernutrition is common in patients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients’outcomes at 6 months. Methods The FOOD t...Background Undernutrition is common in patients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients’outcomes at 6 months. Methods The FOOD trials consist of thre e pragmatic multicentre randomized controlled trials, two of which included dysp hagic stroke patients. In one trial, patients enrolled within 7 days of admissio n were randomly allocated to early enteral tube feeding or no tube feeding for m ore than 7 days (early versus avoid). In the other, patients were allocated perc utaneous endoscopic gastrostomy (PEG) or nasogastric feeding. The primary outcom e was death or poor outcome at 6 months. Analysis was by intention to treat.Find ings Between Nov 1, 1996, and July 31, 2003, 859 patients were enrolled by 83 ho spitals in 15 countries into the early versus avoid trial. Early tube feeding wa s associated with an absolute reduction in risk of death of 5.8%(95%CI -0.8 t o 12.5, p=0.09) and a reduction in death or poor outcome of 1.2%(-4.2 to 6.6, p=0.7). In the PEG versus nasogastric tube trial, 321 patients were enrolled by 47 hospitals in 11 countries. PEG feeding was associated with an absolute increa se in risk of death of 1.0%(-10.0 to 11.9, p=0.9) and an increased risk of dea th or poor outcome of 7.8%(0.0 to 15.5, p=0.05). Interpretation Early tube feed ing might reduce case fatality, but at the expense of increasing the proportion surviving with poor outcome. Our data do not support a policy of early initiatio n of PEG feeding in dysphagic stroke patients.展开更多
Background & Aims: Although diabetes occurs frequently in pancreatic cancer, the value of new-onset diabetes as a marker of underlying pancreatic cancer is unknown. Methods: We assembled a population-based cohort ...Background & Aims: Although diabetes occurs frequently in pancreatic cancer, the value of new-onset diabetes as a marker of underlying pancreatic cancer is unknown. Methods: We assembled a population-based cohort of 2122 Rochester, Minnesota, residents age ≥ 50 years who first met standardized criteria for diabetes between January 1, 1950, and December 31, 1994, and identified those who developed pancreatic cancer within 3 years of meeting criteria for diabetes. We compared observed rates of pancreatic cancer with expected rates based on the Iowa Surveillance Epidemiology and End Results registry. In a nested case control study, we compared body mass index (BMI) and smoking status in diabetes subjects with and without pancreatic cancer. Results: Of 2122 diabetic subjects, 18 (0.85% ) were diagnosed with pancreatic cancer within 3 years of meeting criteria for diabetes; 10 of 18 (56% ) were diagnosed < 6 months after first meeting criteria for diabetes, and 3 were resected. The observed-to-expected ratio of pancreatic cancer in the cohort was 7.94 (95% CI, 4.70- 12.55). Compared with subjects without pancreatic cancer, diabetic subjects with pancreatic cancer were more likely to have met diabetes criteria after age 69 (OR = 4.52, 95% CI, 1.61- 12.74) years but did not differ significantly with respect to BMI values (29.2 ± 6.8 vs 26.5 ± 5.0, respectively). A larger proportion of those who developed pancreatic cancer were ever smokers (92% vs 69% , respectively), but this did not reach statistical significance. Conclusions: Approximately 1% of diabetes subjects aged < 50 yearswill be diagnosed with pancreatic cancer within 3 years of first meeting criteria for diabetes. The usefulness of new-onset diabetes as marker of early pancreatic cancer needs further evaluation.展开更多
2013年12月3日至7日,世界贸易组织第九届部长级会议在印度尼西亚巴厘岛举行。会议发表了《巴厘部长宣言》,达成＂巴厘一揽子协议＂,是世界贸易组织成立18年以来首份全球贸易协议,打破多哈回合12年谈判僵局,成为完成多哈回合的重要基石...2013年12月3日至7日,世界贸易组织第九届部长级会议在印度尼西亚巴厘岛举行。会议发表了《巴厘部长宣言》,达成＂巴厘一揽子协议＂,是世界贸易组织成立18年以来首份全球贸易协议,打破多哈回合12年谈判僵局,成为完成多哈回合的重要基石。《巴厘部长宣言》包括总理事会的日常工作、多哈发展议程和后巴厘工作三部分,其中多哈发展议程包括了贸易便利化、农业、棉花、发展与最不发达成员问题四项议题共10份协议，《贸易便利化协议》（Agreement on Trade Facilitation）是其中最重要的协议之一。展开更多
文摘Background Undernutrition is common in patients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients’outcomes at 6 months. Methods The FOOD trials consist of thre e pragmatic multicentre randomized controlled trials, two of which included dysp hagic stroke patients. In one trial, patients enrolled within 7 days of admissio n were randomly allocated to early enteral tube feeding or no tube feeding for m ore than 7 days (early versus avoid). In the other, patients were allocated perc utaneous endoscopic gastrostomy (PEG) or nasogastric feeding. The primary outcom e was death or poor outcome at 6 months. Analysis was by intention to treat.Find ings Between Nov 1, 1996, and July 31, 2003, 859 patients were enrolled by 83 ho spitals in 15 countries into the early versus avoid trial. Early tube feeding wa s associated with an absolute reduction in risk of death of 5.8%(95%CI -0.8 t o 12.5, p=0.09) and a reduction in death or poor outcome of 1.2%(-4.2 to 6.6, p=0.7). In the PEG versus nasogastric tube trial, 321 patients were enrolled by 47 hospitals in 11 countries. PEG feeding was associated with an absolute increa se in risk of death of 1.0%(-10.0 to 11.9, p=0.9) and an increased risk of dea th or poor outcome of 7.8%(0.0 to 15.5, p=0.05). Interpretation Early tube feed ing might reduce case fatality, but at the expense of increasing the proportion surviving with poor outcome. Our data do not support a policy of early initiatio n of PEG feeding in dysphagic stroke patients.
文摘Background & Aims: Although diabetes occurs frequently in pancreatic cancer, the value of new-onset diabetes as a marker of underlying pancreatic cancer is unknown. Methods: We assembled a population-based cohort of 2122 Rochester, Minnesota, residents age ≥ 50 years who first met standardized criteria for diabetes between January 1, 1950, and December 31, 1994, and identified those who developed pancreatic cancer within 3 years of meeting criteria for diabetes. We compared observed rates of pancreatic cancer with expected rates based on the Iowa Surveillance Epidemiology and End Results registry. In a nested case control study, we compared body mass index (BMI) and smoking status in diabetes subjects with and without pancreatic cancer. Results: Of 2122 diabetic subjects, 18 (0.85% ) were diagnosed with pancreatic cancer within 3 years of meeting criteria for diabetes; 10 of 18 (56% ) were diagnosed < 6 months after first meeting criteria for diabetes, and 3 were resected. The observed-to-expected ratio of pancreatic cancer in the cohort was 7.94 (95% CI, 4.70- 12.55). Compared with subjects without pancreatic cancer, diabetic subjects with pancreatic cancer were more likely to have met diabetes criteria after age 69 (OR = 4.52, 95% CI, 1.61- 12.74) years but did not differ significantly with respect to BMI values (29.2 ± 6.8 vs 26.5 ± 5.0, respectively). A larger proportion of those who developed pancreatic cancer were ever smokers (92% vs 69% , respectively), but this did not reach statistical significance. Conclusions: Approximately 1% of diabetes subjects aged < 50 yearswill be diagnosed with pancreatic cancer within 3 years of first meeting criteria for diabetes. The usefulness of new-onset diabetes as marker of early pancreatic cancer needs further evaluation.
文摘2013年12月3日至7日,世界贸易组织第九届部长级会议在印度尼西亚巴厘岛举行。会议发表了《巴厘部长宣言》,达成＂巴厘一揽子协议＂,是世界贸易组织成立18年以来首份全球贸易协议,打破多哈回合12年谈判僵局,成为完成多哈回合的重要基石。《巴厘部长宣言》包括总理事会的日常工作、多哈发展议程和后巴厘工作三部分,其中多哈发展议程包括了贸易便利化、农业、棉花、发展与最不发达成员问题四项议题共10份协议，《贸易便利化协议》（Agreement on Trade Facilitation）是其中最重要的协议之一。
