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ObjectiveTo construct an evaluation index system for the development of district-level disease prevention and control centers according to the requirements of the modernization of Shanghai’s disease control system and public health work practices， and to comprehensively assess the construction and development of district-level disease prevention and control institutions. MethodsAccording to the national and municipal requirements for the development of disease prevention and control institutions， an index framework was proposed through literature search and expert interviews. 39 representative experts in the field of public health at the national， provincial， and municipal （district） levels were selected to participate in the consultation and construction of the index system. The authority coefficient， the coefficient of variation， etc. were used to carry out quality control and determination of each index on the Delphi method. ResultsThe questionnaire response rate was 100%， the expert authority coefficient was 0.86，the degree of familiarity was 0.79， and the judgment basis was 0.92. The coefficients of variation of the necessary indicators in the index system were all <0.25 in the dimension of importance， and there were statistical differences in the statistical test of Kendall’s W coordination coefficients at all levels and dimensions （all P<0.001）. After multiple rounds of consultation， experts reached a consensus， forming a development evaluation index system of district-level CDCs with 6 first-level indicators， 24 second-level indicators， and 105 third-level indicators （including 63 necessary indicators and 42 recommended indicators）. ConclusionThe evaluation index system of Shanghai district-level CDCs based on the Delphi method has good authority， reliability， sensitivity and operability. This indicator system can effectively support the development of Shanghai district-level CDCs， and can be used for evaluation at multiple levels and in an all-round way in the future. The evaluation results can provide an evidence-based basis for the modernization of the disease prevention and control system and the continuous and dynamic updating of the development goals in the future.
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Objective To retrospectively analyze the clinical characteristics of patients with malignant tumors combined with new coronavirus pneumonia (COVID-19), and to provide a scientific basis for clinical treatment. Methods SPSS 20.0 was used for data analysis. The t-test was used for quantitative data, and chi-square test/Fisher-exact test was used for qualitative data. Binary logistic regression was used for multivariate analysis, and the correlation coefficient was used for multicollinearity test before regression analysis. Results A total of 61 COVID-19 infected cancer patients were included in this study. Their average age was 62.2±12.12. The most common admission symptoms were fever (54.1%), fatigue (39.3%), and cough (37.7%). The rate of the patients with severe COVID-19 was 54.1%. Having 3 or more complications (OR: 2.07, 95%CI: 3.14-2698.12), fever (OR: 12.22, 95%CI: 1.20-86.70), low percentage of lymphocytes (OR: 15.56, 95%CI: 1.78-136.24) and low serum albumin level (OR: 254.64, 95%CI: 8.56-7576.41) were risk factors for COVID-19 severity. The fatality rate of the subjects was 8.2%, and the average hospital stay was 26.7±19.69 days. Furthermore, the severity of COVID-19 had a statistically significant impact on the average hospital stay (t=-3.48, P<0.01). Conclusion Patients with malignant tumors combined with COVID-19 have a higher severity rate, fatality rate, and average hospital stay than ordinary COVID-19 patients. Underlying diseases, fever, low lymphocyte percentage, and low serum albumin levels are the factors for the increase of the illness severity in patients with malignant tumors combined with COVID-19.
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Objective To investigate the incidence rate of parastomal hernia (PH) among patients who have received laparoscope radical cystectomy and ileal conduit diversion and to discover the risk factors for PH.Methods Data of 162 patients who underwent surgery of laparoscope radical cystectomy and ileal conduit diversion for bladder cancer between Jan 2012 and Dec 2017 were studied.The patients who had suffered other tumors before surgery or without follow-up data were excluded.At last,148 patients were enrolled in this retrospective study.According to the occurrence of PH,the patients were divided into two groups:PH group and non-PH group.There were 21 patients (12 males and 9 females) in PH group.The mean age was (66.5 ± 8.6) years old,and mean body mass index (BMI) was (33.4 ± 5.2) kg/m2.11 patients with synchronous disease and 10 patients without synchronous disease before operation in PH group.Postoperative T stage ＜T3 in 17 cases,≥T3 in 4 cases.4 Cases received neoadjuvant chemotherapy and 5 cases received adjuvant chemotherapy.Tumor recurrence was found in 6 cases.16 cases had hypoproteinemia.Ileal conduit was made through abdominal incision in 9 cases,and 12 cases was made with laparoscopy.After the surgery,there was severe cough in 7 cases and abdominal distension in 7 cases.3 cases had previous abdominal operation,and 5 cases had history of glucocorticoid use.The mean size of the stoma was (3.0±0.6) cm.The mean length of the outflow tract was (11.2 ±1.3) cm.We did trans-rectus stoma in 4 cases,and para-rectus stoma in 17 cases.There were 127 patients (82 males and 45 females) in non-PH group.The mean age was (71.4 ±7.4) years,and the mean BMI was (28.8 ±4.1)kg/m2.60 patients with synchronous disease and 67 patients without.Postoperative T stage ＜ T3 in 96 cases,≥T3 in 31 cases.29 patients received neoadjuvant chemotherapy and 39 cases received adjuvant chemotherapy.Tumor recurrence was found in 38 cases.66 cases had hypoproteinemia.Ileal conduit was made through abdominal incision in 55 cases,under laparoscopy in 72 cases.There was severe cough in 34 cases and abdominal distension in 38 cases.21 cases had previous abdominal operation,and 35 cases had history of glucocorticoid use.The mean size of the stoma was (2.3 ± 0.4) cm.The mean length of the outflow tract was (12.2 ± 1.6) cm.4 cases had trans-rectus stoma,and 17 cases had para-rectus stoma.Postoperative rate of PH was estimated using the Kaplan-Meier methods.Chi-square test were used for the univariate analysis between group of PH and the normal one.Multivariate Logistic regression analysis was used to judge the independent risk factors of PH.Results Patients were followed up for 24 months.PH occurred in 21 cases,the 1,2,5 year cumulative incidence of PH was 9.9％,5.4％ and 16.7％ respectively.Clinical characteristics,including age at surgery (x2 =4.018,P =0.045),obesity (x2 =3.949,P =0.047),perioperative hypoproteinemia (x2 =4.279,P =0.039),chronic constipation(x2 =5.416,P =0.020),stoma location (x2 =6.464,P =0.011),stoma size (x2 =3.915,P =0.048),were significantly different between the PH group and the normal group (P ＜ 0.05).Multivariate Logistic regression analysis shows that obesity (OR =1.326,95％ CI =1.102-1.548,P =0.043),stoma location (OR =0.892,95 ％ CI =0.854-0.931,P =0.028),stoma size (OR =1.365,95％ CI =1.089-1.631,P =0.028) were the independent risk factors for PH.Conclusion We demonstrated that most of PH usually develop in 2 years after undergoing radical cystectomy with ileal conduit diversion.Obesity,stoma location and stoma size are independent risk factors.Preoperative counseling and preventative measures regarding PH formation should be emphasized,particularly in those patients with risk factors.
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Objective@#To investigate the incidence rate of parastomal hernia(PH) among patients who have received laparoscope radical cystectomy and ileal conduit diversion and to discover the risk factors for PH.@*Methods@#Data of 162 patients who underwent surgery of laparoscope radical cystectomy and ileal conduit diversion for bladder cancer between Jan 2012 and Dec 2017 were studied. The patients who had suffered other tumors before surgery or without follow-up data were excluded. At last, 148 patients were enrolled in this retrospective study. According to the occurrence of PH, the patients were divided into two groups: PH group and non-PH group. There were 21 patients (12 males and 9 females) in PH group. The mean age was (66.5±8.6) years old, and mean body mass index (BMI) was (33.4±5.2) kg/m2. 11 patients with synchronous disease and 10 patients without synchronous disease before operation in PH group. Postoperative T stage <T3 in 17 cases, ≥T3 in 4 cases. 4 Cases received neoadjuvant chemotherapy and 5 cases received adjuvant chemotherapy. Tumor recurrence was found in 6 cases. 16 cases had hypoproteinemia. Ileal conduit was made through abdominal incision in 9 cases, and 12 cases was made with laparoscopy. After the surgery, there was severe cough in 7 cases and abdominal distension in 7 cases. 3 cases had previous abdominal operation, and 5 cases had history of glucocorticoid use. The mean size of the stoma was (3.0±0.6) cm. The mean length of the outflow tract was (11.2 ±1.3) cm. We did trans-rectus stoma in 4 cases, and para-rectus stoma in 17 cases. There were 127 patients (82 males and 45 females) in non-PH group. The mean age was (71.4 ±7.4) years, and the mean BMI was (28.8±4.1)kg/m2. 60 patients with synchronous disease and 67 patients without. Postoperative T stage <T3 in 96 cases, ≥T3 in 31 cases. 29 patients received neoadjuvant chemotherapy and 39 cases received adjuvant chemotherapy. Tumor recurrence was found in 38 cases. 66 cases had hypoproteinemia. Ileal conduit was made through abdominal incision in 55 cases, under laparoscopy in 72 cases. There was severe cough in 34 cases and abdominal distension in 38 cases. 21 cases had previous abdominal operation, and 35 cases had history of glucocorticoid use. The mean size of the stoma was (2.3±0.4) cm. The mean length of the outflow tract was (12.2±1.6) cm. 4 cases had trans-rectus stoma, and 17 cases had para-rectus stoma. Postoperative rate of PH was estimated using the Kaplan-Meier methods. Chi-square test were used for the univariate analysis between group of PH and the normal one. Multivariate Logistic regression analysis was used to judge the independent risk factors of PH.@*Results@#Patients were followed up for 24 months. PH occurred in 21 cases, the 1, 2, 5 year cumulative incidence of PH was 9.9%, 5.4% and 16.7% respectively. Clinical characteristics, including age at surgery(χ2=4.018, P=0.045), obesity(χ2=3.949, P=0.047), perioperative hypoproteinemia(χ2=4.279, P=0.039), chronic constipation(χ2=5.416, P=0.020), stoma location(χ2=6.464, P=0.011), stoma size(χ2=3.915, P=0.048), were significantly different between the PH group and the normal group(P<0.05). Multivariate Logistic regression analysis shows that obesity(OR=1.326, 95%CI=1.102-1.548, P=0.043), stoma location(OR=0.892, 95%CI=0.854-0.931, P=0.028), stoma size(OR=1.365, 95%CI=1.089-1.631, P=0.028) were the independent risk factors for PH.@*Conclusion@#We demonstrated that most of PH usually develop in 2 years after undergoing radical cystectomy with ileal conduit diversion. Obesity, stoma location and stoma size are independent risk factors. Preoperative counseling and preventative measures regarding PH formation should be emphasized, particularly in those patients with risk factors.
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Objective To explore the clinical characteristic,level of plasma renin angiotensin (PRA),plas-ma angiotensin Ⅱ(Ang Ⅱ)and plasma aldosterone(Aldo)in the sleep apnea hypopnea syndrome (SAHS)patients, and to investigate the association between SAHS and hypertension.Methods The patients were selected for the study who were monitored with polysomnography.They were divided into SAHS group and non-SAHS group according to apea-hypopnea index(AHI),and there were 180 patients in the SAHS group,175 patients in the non-SAHS group. The systolic blood pressure(SBP),diastolic blood pressure(DBP)and the level of PRA,plasma Ang II and plasma Aldo were compared by variance analysis.Results The gender composition was different between the two groups,and had statistically significant difference(χ2 =16.30,P <0.01).The data of age,body mass index,neck circumference, waistline,DBP,SBP in SAHS group were significantly higher than those in non-SAHS group,and the differences were statistically significant(t =6.84,8.19,9.84,6.63,7.08,5.45,all P <0.01 ).The prevalence of hypertension in SAHS group was 46.58%,which was higher than 18.20% in non-SAHS group,and the difference had statistically significant(χ2 =46.71,P <0.01).The AHI had positive correlation with SBP,DBP,and they had statistically signifi-cant differences (rs =0.162,0.228,all P <0.01).The levels of PRA and plasma Ang Ⅱ were lower in SAHS group than those in non-SAHS group,while the level of plasma Aldo was higher in SAHS group than that in non-SAHS group,and had statistically significant differences(F =15.41,14.21,17.67,all P <0.01).In the SAHS group,the levels of PRA and plasma Ang Ⅱ were lower in hypertension group than those in non-hypertension group,while the level of plasma Aldo was higher in hypertension group than that in non-hypertension group,and had statistically signif-icant differences (F =15.41,14.21,17.67,all P <0.01).Also,the levels of PRA and plasma Ang Ⅱ were lower in SAHS group with hypertension than those in non-SAHS group with hypertension,while the level of plasma Aldo was higher in SAHS group with hypertension than that in non-SAHS group with hypertension,and the differences were sta-tistically significant(F =15.41,14.21,17.67,all P <0.01).Conclusion The occurrence of SAHS is correlated with the gender composition,age,body mass index,neck circumference,waistline,DBP and SBP.In SAHS complica-tions in each system,the highest incidence is hypertension.And the AHI has positive correlation with SBP,DBP,and the difference is significant.In the SAHS group,if the AHI is higher,the risk of hypertension is greater.In the SAHS patients with hypertension,the level of plasma Aldo is significantly elevated,while the levels of PRA and plasma AngⅡ are decreased significantly.