Quantitative analysis of risk assessment indicators for re-introduction of imported malaria in China / 中国血吸虫病防治杂志

Objective To quantitatively analyze the risk indicators of re-introduction of imported malaria in China and their weighting coefficients, so as to investigate the difference in the contribution of risk indicators included in the current risk assessment framework for re-introduction of imported malaria in China to the risk assessment of re-introduction of imported malaria. Methods Publications pertaining to the risk assessment framework for re-introduction of imported malaria in China that reported the risk indicators and their weighting coefficients were retrieved in PubMed, Web of Science, CNKI, Wanfang Data, and VIP with terms of “malaria”, “re-introduction/re-transmission/re-establishment”, “risk assessment/risk evaluation/risk prediction” from the inception of the database through 3 August 2023, and literature search was performed in Google Scholar to ensure the comprehensiveness of the retrieval. Basic characteristics of included studies were extracted using pre-designed information extraction forms by two investigators, and data pertaining to risk indicators of re-introduction of imported malaria were cross-checked by these two investigators. The risk indicators included in the risk assessment framework for re-introduction of imported malaria in China and their weighting coefficients were visualized with the Nightingale’s rose diagrams using the software R 4.2.1, and the importance of risk indictors was evaluated with the frequency of risk indicators included in the risk assessment framework and the ranking of weighting coefficients of risk indicators. In addition, the capability of risk indicators screened by different weighting methods was compared by calculating the ratio of the maximum to the minimum of the weighting coefficients of the risk indicators screened by different weighting methods. Results A total of 2 138 publications were retrieved, and following removal of duplications and screening, a total of 8 publications were included in the final analysis. In these 8 studies, 8 risk assessment frameworks for re-introduction of imported malaria in China and 52 risk indicators of re-introduction of imported malaria were reported, in which number of imported malaria cases (n = 8) and species of malaria vectors were more frequently included in the risk assessment frameworks (n = 8), followed by species of imported malaria parasites (n = 6) and population density of local malaria vectors (n = 6), and species of local malaria vectors (n = 6), number of imported malaria cases (n = 5) and species of imported malaria parasites had the three highest weighting coefficients (n = 4). The weighting methods included expert scoring method, combination of expert scoring method and analytic hierarchy process, and combination of expert scoring method and entropy weight method in these 8 studies, and the ratios of the maximum to the minimum of the weighting coefficients of the risk indicators screened by the expert scoring method were 1.143 to 2.241, while the ratios of the maximum to the minimum of the weighting coefficients of the risk indicators screened by combination of the expert scoring method and analytic hierarchy process were 34.970 to 162.000. Conclusions Number of imported malaria cases, species of imported malaria parasites, species of local malaria vectors and population density of local malaria vectors are core indicators in the current risk assessment framework for re-introduction of imported malaria in China. Combination of the expert scoring method and analytic hierarchy process is superior to the expert scoring method alone for weighting the risk indicators.

Risk predictive models of healthcare-seeking delay among imported malaria patients in Jiangsu Province based on the machine learning / 中国血吸虫病防治杂志

Objective To create risk predictive models of healthcare-seeking delay among imported malaria patients in Jiangsu Province based on machine learning algorithms, so as to provide insights into early identification of imported malaria cases in Jiangsu Province. Methods Case investigation, first symptoms and time of initial diagnosis of imported malaria patients in Jiangsu Province in 2019 were captured from Infectious Disease Report Information Management System and Parasitic Disease Prevention and Control Information Management System of Chinese Center for Disease Control and Prevention. The risk predictive models of healthcare-seeking delay among imported malaria patients were created with the back propagation (BP) neural network model, logistic regression model, random forest model and Bayesian model using thirteen factors as independent variables, including occupation, species of malaria parasite, main clinical manifestations, presence of complications, severity of disease, age, duration of residing abroad, frequency of malaria parasite infections abroad, incubation period, level of institution at initial diagnosis, country of origin, number of individuals travelling with patients and way to go abroad, and time of healthcare-seeking delay as a dependent variable. Logistic regression model was visualized using a nomogram, and the nomogram was evaluated using calibration curves. In addition, the efficiency of the four models for prediction of risk of healthcare-seeking delay among imported malaria patients was evaluated using the area under curve (AUC) of receiver operating characteristic curve (ROC). The importance of each characteristic was quantified and attributed by using SHAP to examine the positive and negative effects of the value of each characteristic on the predictive efficiency. Results A total of 244 imported malaria patients were enrolled, including 100 cases (40.98%) with the duration from onset of first symptoms to time of initial diagnosis that exceeded 24 hours. Logistic regression analysis identified a history of malaria parasite infection [odds ratio (OR) = 3.075, 95% confidential interval (CI): (1.597, 5.923)], long incubation period [OR = 1.010, 95% CI: (1.001, 1.018)] and seeking healthcare in provincial or municipal medical facilities [OR = 12.550, 95% CI: (1.158, 135.963)] as risk factors for delay in seeking healthcare among imported malaria cases. BP neural network modeling showed that duration of residing abroad, incubation period and age posed great impacts on delay in healthcare-seek among imported malaria patients. Random forest modeling showed that the top five factors with the greatest impact on healthcare-seeking delay included main clinical manifestations, the way to go abroad, incubation period, duration of residing abroad and age among imported malaria patients, and Bayesian modeling revealed that the top five factors affecting healthcare-seeking delay among imported malaria patients included level of institutions at initial diagnosis, age, country of origin, history of malaria parasite infection and individuals travelling with imported malaria patients. ROC curve analysis showed higher overall performance of the BP neural network model and the logistic regression model for prediction of the risk of healthcare-seeking delay among imported malaria patients (Z = 2.700 to 4.641, all P values < 0.01), with no statistically significant difference in the AUC among four models (Z = 1.209, P > 0.05). The sensitivity (71.00%) and Youden index (43.92%) of the logistic regression model was higher than those of the BP neural network (63.00% and 36.61%, respectively), and the specificity of the BP neural network model (73.61%) was higher than that of the logistic regression model (72.92%). Conclusions Imported malaria cases with long duration of residing abroad, a history of malaria parasite infection, long incubation period, advanced age and seeking healthcare in provincial or municipal medical institutions have a high likelihood of delay in healthcare-seeking in Jiangsu Province. The models created based on the logistic regression and BP neural network show a high efficiency for prediction of the risk of healthcare-seeking among imported malaria patients in Jiangsu Province, which may provide insights into health management of imported malaria patients.

Property comparison of various skull repair materials / 中国组织工程研究

Different materials for skull repair possess varying properties and clinical effects. Metal materials are the first to be applied, but most of them induce corrosion and heat conduction; Non-metal bone substitutes, such as organic glass, have ever been commonly used, but the poor biocompatibility and high infection rate of subcutaneous exudation limit their application; Bone cement shows good histocompatibility, but the repair scale is not complete; Medical silica gel is cheap and effective, but the appearance is not satisfactory resulting from local infections and material exposures; Titanium possesses good biocompatibility and well junctures with the skull, thus it is a promising materials although the shortages still remain. With the development of bioengineering research, the skull repair materials will open up concerning the study of bone tissue engineering, cartilage tissue engineering and cornea tissue engineering. This paper is aimed to search a well-biocompatible and clinically effective material for the skull repair by the comparison on the property and clinical application of varying materials.

Considerations on Mobilizing the Subjective Activity of Medical Staff in Hospital Cultural Construction / 中国医学伦理学

Hospital cultural construction cant be conducted without the participation of medical staff and shouhl be.assigned with rich ethical connotation.Whether hospital administrators can mobilize the subjective activity of medical staff or not in the hospital cuhural construction is a crucial factor in determining the coustruction outcome. Therefore,the hospital administrators should recognize the staff as masters of the hospital,respect the staff's human dignity,apply specific impulsing mechanisms to meet the staff's need based on concrete conditions,and build proper platforms for medical staff to maximize their potential and talents in order to mobilize their subjective activity in the hospital cultural construction.

Caldwell-Luc's Operation with Middle Meatal Antrostomy / 第二军医大学学报

Fifty-nine patients (62 cases ) with chronic antritis were operated by Caldwell-Luc's operation with middle meatal antrostomy and followed up for 0.5 ~5 years. It was found that curative effect of the oper ation was quite well. Eghty patients treated with Caldwell-Lucs operation were followed up as control at the same time. Caldwell-Luc's operation with middle meatal antrostomy was found safe, easy to operate and not injurious to agger nasi, as well as partially recoverable to sinus function.

RECONSTRUCTION FOR HYpOpHARYNGEAL STENOSIS AND ESOPHAGEAL OBLITERATION FROM ALKALINE CHEMICAL BURNS / 第二军医大学学报

A successful surgical treatment of two cases of hypopharyngeal stenosis and esophageal obliteration caused by alkaline chemical burns is reported.One patient has recovered respiring,swallowing and speaking functions,and the other also recovered all of these functions except the retained tracheal tube.During the modified jejuno-pharyngostomy,the pharyngojejunal anastomotic stoma was expanded to form a piriform fossa without bottom.Besides,the anastomotic stoma was lowered to the level of laryngeal vestibule so as to prevent food from leaking into the trachea.In the course of clinical observation,we found that different signs existed in different patients who took the corrosive.In the accidental cases,esophageal obliteration often appeared,but in the cases of committing suicide,the obliteration was usually accompanied with hypopharyngeal stenosis,which is very difficult to treat.So the authors emphasize that dilatation and dissection should be undertaken in early stage to prevent the occurrence of hypopharyngeal stenosis.

THE GRADIENT OF THE POSTERIOR BONY WALL OF THE EXTERNAL AUDITORY MEATUS & ITS CLINICAL SIGNIFICANCE / 第二军医大学学报

In this investigation measurements of 5 items were taken on 100 skulls (200 temporal bones) kept in stock. The data obtained are as follows: (1) The sphenoidal angle is 117.6?. (2) The inclination of the long diameter of the isthmic part of meatus is 23.26?(3) The gradient of the posterior bony wall is 110.72?. (4) The visibility of the labyrinthine windows are classified into four types: in type 1, both windows are completely visible, 1.5%; in type II, partially invisible, 30.5%; in type III mostly invisible 61.5%; and in type IV, completely invisible, 6.5%. (5) The depth of the posterior tympanum: upper border of the oval window (external) is 3.37mm; lower border of the oval window (external) is 2.47mm and (internal) 2.38mm; upper border of the round window (external) is 2.07mm and (internal) is 3.07mm. From the above mentioned findings, the following conclusions could be drawn: The labyrinthine windows are not related to the inclination of the long diameter of meatus, but is closely related to the sphenoidal angle and the gradient of the posterior bony wall of the meatus, i. e. the greater the sphenoidal angle and the gradient of the posterior bony wall of the meatus, the poorer the visibility of the labyrinthine windows and the deeper the depth of the posterior tympanum except the depth of the lower border of the oval window. So it is considered that more attention should be paid to the gradient of the posterior bony wall when the posterior tympanotomy and transmeatal facial nerve decompression are being performed, and a large gradient is preferable.