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Association between NNAL and Mortality in U.S. Adults, NHANES 2007-2014 with 2015 Mortality Follow-Up

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Open Journal of Preventive Medicine 2023年第8期13卷 239-255页

作者： Nathan M. Holt Ryan A. Black Qiwei Liang Saul shiffman Regulatory Science Juul Labs Inc. Washington DC USA Pinney Associates Inc. Pittsburgh USA

Cigarette smoking is a leading cause of premature mortality, attributable to chronic exposure to toxic compounds in cigarette smoke, including tobacco-specific nitrosamines, which are known carcinogens. This research aims to assess the association between NNAL, a metabolite of the tobacco-specific nitrosamine NNK, and mortality. Data from 14,766 U.S. adults aged 21 - 79 in the National Health and Nutrition Examination Survey (2007-2014) included smoking status and urinary NNAL concentration at the time of examination. These data were linked to participants’ subsequent mortality status as recorded in the public-use Linked Mortality File (through 2015). Cox proportional hazards regression models assessed the relative risk of all-cause, cancer, cardiovascular disease (CVD), and other-causes mortality for increasing levels of natural log (creatinine-adjusted NNAL). In the whole sample, a unit increase in log (NNAL) is associated with a 20% higher risk of all-cause (HR = 1.20;95% CI: 1.16 - 1.24), cancer (HR = 1.20;95% CI: 1.14 - 1.26), CVD (HR = 1.21;95% CI: 1.12 - 1.31) and other-causes (HR = 1.20;95% CI: 1.15 - 1.25) mortality. Among current smokers, a unit increase in log (NNAL) is associated with 44% higher cancer mortality risk (HR = 1.44;95% CI: 1.08 - 1.92) and a 96% higher CVD mortality risk (HR = 1.96;95% CI: 1.20 - 3.20). Risks of all-cause and other-causes mortality, but neither cancer nor CVD mortality, were positively associated with NNAL among never and former smokers. Inferences are limited by the observational nature of the data, and by the focus on a single biomarker of tobacco-related exposure. The findings suggest that urinary NNAL concentration is acting as a proxy for exposure to the toxicants in cigarette smoke rather than as a biomarker of disease-specific mortality risk.

关键词： NHANES NNAL Mortality Smoking Cigarettes

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全球开始关注卫生体系加强

中国卫生政策研究 2013年第8期6卷 58-68页

作者： Tamara Hafner Jeremy shiffman 美国大学公共管理与政策系美国华盛顿20016

在过去很长一段时间内,某一具体疾病是主要研究对象,但近几十年特别是2005年以来,许多组织开始参与全球卫生研究并关注卫生体系加强。本文对这一关注产生的原因及方式展开研究。研究采用了过程追踪的定性方法,并对政治层面引发和限制其... 详细信息

在过去很长一段时间内,某一具体疾病是主要研究对象,但近几十年特别是2005年以来,许多组织开始参与全球卫生研究并关注卫生体系加强。本文对这一关注产生的原因及方式展开研究。研究采用了过程追踪的定性方法,并对政治层面引发和限制其关注的因素进行分析。研究发现加强卫生体系之所以得到广泛关注,主要是因为:全球卫生的参与者担心卫生体系方面的问题会影响千年发展目标的实现,并担心全球卫生行动可能会给国家卫生体系带来负面影响。此外,许多全球卫生组织已经意识到,薄弱的卫生体系会成为实现组织既定目标的瓶颈。尽管目前有众多的参与者支持加强卫生体系,但这些行动者还未形成有凝聚力的政策联盟。此外,加强卫生体系的概念不清晰,而且加强卫生体系的证据很薄弱。由于全球金融危机、全球卫生政策的不确定性以及一些行动者暂时性地支持等,对加强卫生体系的关注是否具有可持续性,目前尚未有定论。

关键词：卫生体系加强政治优先全球卫生

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脂肪抽吸及术后并发脂肪栓塞的临床分析

中国美容整形外科杂志 2010年第7期21卷 446-448页

作者： Melvin A shiffman 魏峰(译) 高景恒(译) USA Tustin CA 美国塔斯廷医院与医学中心《中国美容整形外科杂志》编辑部

采用真空抽吸器反复抽拉行脂肪抽吸术，使脂肪组织破碎为团状脂肪小球、破碎的脂肪细胞和中性脂肪。脂肪抽吸过程中，血管管腔产生裂隙，为脂肪酸进入血液循环系统提供途径。在肺血管脂肪栓塞中，由于脂肪球具有流动性和可变形性，其并... 详细信息

采用真空抽吸器反复抽拉行脂肪抽吸术，使脂肪组织破碎为团状脂肪小球、破碎的脂肪细胞和中性脂肪。脂肪抽吸过程中，血管管腔产生裂隙，为脂肪酸进入血液循环系统提供途径。在肺血管脂肪栓塞中，由于脂肪球具有流动性和可变形性，其并未完全阻塞毛细血管血流，因此其栓塞是暂时的或不完全的。脂肪栓塞的初始症状可能是由于一些脂肪球的体积过大不能通过毛细血管，而机械性的阻塞多条血管造成的。肺细胞可以游离脂肪酸，以降低阻塞肺循环的中性脂肪，但游离脂肪酸可对肺实质形成损伤，造成成人呼吸窘迫综合征（ARDS）。脂肪栓塞综合征（FES）表现为：急性低氧血症，呼吸窘迫，中枢神经系统功能障碍，以及头、颈、前胸或腋窝处瘀斑。对肺脂肪栓塞的诊断，主要依靠以上典型症状和体征。而治疗方式多采用支持治疗。

关键词：脂肪抽吸脂肪栓塞并发症临床分析

Isolation and Characterization of Multipotent and Pluripotent Stem Cells from Human Peripheral Blood

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Stem Cell Discovery 2015年第3期5卷 19-32页

作者： Ciro Gargiulo Van Hung Pham Nguyen Thuy Hai Kieu C. D. Nguyen Pham Van Phuc Kenji Abe Veronica Flores Melvin shiffman Division of Internal Medicine The Human Medicine International Clinic Ho Chi Minh City Vietnam Molecular Diagnostics Department Nam Khoa-Biotek Laboratory Ho Chi Minh City Vietnam Division of Pathology The Human Medicine International Clinic Ho Chi Minh City Vietnam Department of Stem Cells and Regenerative Medicine University of Natural Science Ho Chi Minh City Vietnam Department of Pathology National Institute of Infectious Diseases Tokyo Japan Sol Price School of Public Policy University of Southern California Los Angeles USA Section of Surgery Newport Specialty Hospital Tustin USA

Stem cells are commonly classified based on the developmental stage from which they are isolated, although this has been a source of debate amongst stem cell scientists. A common approach classifies stem cells into three different groupings: Embryonic Stem Cells (ESCs), Umbilical Cord Stem Cells (UCBSCs) and Adult Stem Cells (ASCs), which include stem cells from bone marrow (BM), fat tissue (FT), engineered induced pluripotent (IP) and peripheral blood (PB). By definition stem cells are progenitor cells capable of self-renewal and differentiation hypothetically “ab infinitum” into more specialized cells and tissue. The main intent of this study was to determine and characterize the different sub-groups of stem cells present within the human PB-SCs that may represent a valid opportunity in the field of clinical regenerative medicine. Stem cells in the isolated mononucleated cells were characterized using a multidisciplinary approach that was based on morphology, the expression of stem cell markers by flowcytometry and fluorescence analysis, RT-PCR and the capacity to self-renew or proliferate and differentiate into specialized cells. This approach was used to identify the expression of hematopoietic, mesenchymal, embryonic and neural stem cell markers. Both isolated adherent and suspension mononucleated cells were able to maintain their stem cell properties during in-vitro culture by holding their capacity for proliferation and differentiation into osteoblast cells, respectively, when exposed to the appropriate induction medium.

关键词： Human Peripheral Blood Stem Cells Mesenchymal Stem Cells Hematopoietic Stem Cells Embryonic Stem Cells Neural Stem Cells

Autologous Peripheral Blood Stem Cells and <i>γ</i>/<i>δ</i>T Cells May Improve Immunity in Treating Secondary Bacteremic Infection in HIV Infected Patient

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Stem Cell Discovery 2015年第4期5卷 48-61页

作者： Ciro Gargiulo Van Hung Pham Nguyen Thuy Hai Kieu C. D. Nguyen Ngan Duong Kim Thinh Nguyen Van An Luu Tuan Kenji Abe Veronica Flores Melvin shiffman Division of Internal Medicine The Human Medicine International Clinic Ho Chi Minh City Vietnam Molecular Diagnostics Department Nam Khoa-Biotek Laboratory Ho Chi Minh City Vietnam Division of Pathology The Human Medicine International Clinic Ho Chi Minh City Vietnam Department of Pathology National Institute of Infectious Diseases Tokyo Japa Sol Price School of Public Policy University of Southern California Los Angeles CA USA Section of Surgery Newport Specialty Hospital Tustin CA USA

Opportunistic bacteremia in adult HIV-infected patients is a normal co-infectious condition caused by Gram-negative bacilli. Respiratory infections, including cough, shortness of breath, and chest pain and skin infection with eruptions, pustules and itchiness, are common complaints in the setting of late HIV infection. The variety of infections ranges from mild, self-limited viral, bacteremia and fungal infections to severe, life-threatening demanding urgent care and hospitalization. Varicella pneumonia, for instance, is the most severe complication of chickenpox in HIV infected adults, potentially refractory, fulminant respiratory failure can ensue. Patients with impaired immune status and chronic lung disease are at an increased risk. In the United States as well as in Vietnam, bacterial/viral pneumonia and skin infection are the two most common HIV-associated conditions. While globally the incidence of opportunistic infection has decreased since the introduction of highly active antiretroviral therapy during the last 3 decades, HIV-associated diseases remain a significant source of mortality, thus any manifestation must be taken seriously. This study will present the most common HIV-related pulmonary and skin infections and provide an overview of the epidemiology, characteristic clinical and chest radiograph findings, diagnosis, treatment, and prevention globally as well in Vietnam. Though the extensive efforts of the Vietnamese Government during last decade contributed to a valuable decrease, yet epidemic in Vietnam still remains high, ranking Vietnam 5th in the South-East region. The second part of the study focuses on a unique and severe HIV case report of a 35-year-old man, with a rare form of pneumonia caused by Acitenobacter spp. concomitant with a prolonged and disseminating skin infection. The case has been treated with a combination of conventional anti-retroviral medication and autologous peripheral blood stem cells, the results showed that within 5 mon

关键词： Human Peripheral Blood Stem Cells γ/δ T Cells NK Cells Hematopoietic Stem Cells CD4 CD8 HIV

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卫生政策分析：概念和方法的思考与挑战

中国卫生政策研究 2012年第12期5卷 46-54页

作者： Gill Walt Jeremy shiffman Helen Schneider Susan F Murray Ruairi Brugha Lucy Gilson 伦敦卫生与热带病医学院英国伦敦雪城大学麦克斯韦尔公民与公众事务学院美国纽约威特沃特斯兰德大学卫生政策中心南非约翰内斯堡伦敦国王学院英国伦敦爱尔兰皇家外科医学院爱尔兰都柏林开普敦大学公共卫生与家庭医学学院南非开普敦

许多专家学者就卫生政策分析开展了大量研究,但很少关注如何进行政策分析以及需要什么样的研究设计、理论和方法。本文着眼于卫生政策分析的环境以及面临的挑战,借鉴中低收入国家中一些卫生政策分析的框架、理论、方法和设计,列举了最... 详细信息

许多专家学者就卫生政策分析开展了大量研究,但很少关注如何进行政策分析以及需要什么样的研究设计、理论和方法。本文着眼于卫生政策分析的环境以及面临的挑战,借鉴中低收入国家中一些卫生政策分析的框架、理论、方法和设计,列举了最近的研究案例,并探讨了案例研究的意义以及研究设计的必要性,发现卫生政策研究者的角色、反思和定位在研究过程中非常重要。最后从理论、方法学和研究人员的反思等角度提出了促进卫生政策分析的建议。

关键词：政策分析方法学进程卫生政策

聚乙二醇干扰素α-2a(40kD)/利巴韦林治疗的慢性丙型肝炎患者的持续性病毒应答预测

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世界核心医学期刊文摘（胃肠病学分册） 2005年第12期1卷 48-49页

作者： Ferenci P. FriedM.W. shiffman M.L. 李宏宇 Univ. Klinik für Innere Medizin IV AKH Waehri- nger Guertel 18- 20 A 1090 Wien Austria

Background/Aims: Prediction of sustained virologicalresponse (SVR) during treatment would allow clinicians to identify patients most likely to benefit from therapy. Methods: Retrospective analysis of data from 1121 adults with chronic hepatitis C treated for 48 weeks with peginterferon alfa- 2a (40 KD) 180 μ g/week plus placebo or ribavirin (1000/1200 mg/day), or interferon alfa- 2b 3 MIU three times/week plus ribavirin in a randomized, multinational, study. Results: 67% of patients treated with peginterferon alfa- 2a (40 KD)/ribavirin with early virological responses (HCV RNA negative or ≥ 2 log10 decrease) at week 12 had SVRs at week 72 (HCV RNA < 50 IU/mL). The negative predictive value (NPV) was 97% . The probability of an SVR increased with the rapidity of HCV RNA suppression. The highest SVR rates were achieved in patients with rapid virological responses at week 4, but the corresponding NPV (74% ) is too low for a decision criterion. In patients with early virological responses by week 12, the SVR rate was ≈ 20% lower in those who received< 80% compared with patients who received ≥ 80% of the planned ribavirin dose. Conclusions: Early, sustained suppression of HCV replication portends an SVR. Cessation of treatment may be contemplated in patients without a ≥ 2 log10 reduction in HCV RNA after 12 weeks.

关键词：慢性丙型肝炎 kD 干扰素α 病毒应答病毒学应答持续性丙肝患者病毒学反应丙肝病毒阴性预测值

聚乙二醇干扰素α-2b或α-2a与利巴韦林联合治疗丙型肝炎疗效比较

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中国处方药 2009年第9期8卷 43-43页

作者： McHutchison JG Lawitz EJ shiffman ML 阴慧娟李天星

背景及目的：丙型肝炎的治疗指南推荐聚乙二醇干扰素α-2b或α-2a联合利巴韦林治疗。但是，这两种方案并没有进行充分地比较，本研究通过临床观察对其疗效进行分析探讨。

关键词：聚乙二醇干扰素α-2b 疗效比较丙型肝炎联合治疗利巴韦林 α-2a 治疗指南临床观察

Association between NNAL and Mortality in U.S. Adults,NHANES 2007-2014 with 2015 Mortality Follow-Up

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