ABSTRACT
Objective To assess the prevalence of female breast cancer in the city using data from the Wuhan Disease and Cause of Death Surveillance System for the past 10 years to provide a reference for breast cancer prevention and control. Methods The incidence case data from 2013 to 2017 and death case data from 2010 to 2019 in all districts of Wuhan city were collected. The incidence and mortality and their age-standardized rates were calculated. The joinpoint linear regression model was used to analyze the average annual percentage change (AAPC) , and the Bayesian age-period-cohort model (BAPC) was used to predict the mortality and age-standardized mortality of breast cancer among women in Wuhan from 2020 to 2024. Results The incidence and age-standardized incidence were 56.56/100 000 and 45.37/100 000 in 2013, and 67.46/100 000 and 52.01/100 000 in 2017, respectively. The changes showed an upward trend, but the difference was not statistically significant (P>0.05). The mortality and age-standardized mortality were 9.80/100 000 and 8.07/100 000 in 2010, and 10.47/100 000 and 7.13/100 000 in 2019, respectively. Although the rough mortality increased, the age-standardization mortality declined significantly (AAPC=2.13%, P<0.05). BAPC prediction results show that the standardized mortality rate of female breast cancer in Wuhan will drop to 6.33/100 000 in 2024. The peak age of incidence was in the age groups of 45-74 years and the peak age of mortality was in the age group of 85 years or older. In addition , the morbidity and mortality rates in the central urban area were higher than those in the distant urban area , and the difference decreased year by year. The BAPC predicted that the age-standardized mortality for breast cancer in women in Wuhan will decrease to 6.33 per 100 000 in 2024. Conclusion Breast cancer incidence and mortality rates in females in Wuhan show an increasing trend . However , the age-standardized mortality is on a significant downward trend due to the delay in the age of death. The elderly and those in central urban areas are the high-risk groups, so we should pay more attention to these groups , analyze the related risk factors , and take targeted prevention and control measures.
ABSTRACT
Objective:To investigate the relationship between excessive daytime sleepiness and freezing of gait in Parkinson′s disease (PD).Methods:A total of 136 participants with PD were consecutively recruited between August 2017 and January 2018 at the Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The patients were divided into freezers with 50 patients and nonfreezers with 86 patients. The clinical characteristics of freezers and nonfreezers in PD patients were assessed. In the longitudinal study, a cohort of nonfreezers with 86 patients at baseline clinical visit for a maximum of 18 months were prospectively followed. The patients were divided into the excessive daytime sleepiness group ( n=14) and the non-excessive daytime sleepiness group ( n=72). Then a Cox regression analysis was performed to further investigate the relationship between excessive daytime sleepiness and freezing of gait in PD, and explore risk factors for freezing of gait. Results:The freezers had significantly worse sleep compared with the nonfreezers. The proportion of patients with excessive daytime sleepiness in freezers was higher than nonfreezers [40% (20/50) vs 16% (14/86), χ2=9.49, P=0.002]. The proportion of freezers in the patients with excessive daytime sleepiness was significantly higher than that in the patients without excessive daytime sleepiness [59% (20/34) vs 29% (30/102), χ2 =9.49, P=0.002]. During a maximum of 18-month follow-up, freezing of gait incidence (6/7) in the excessive daytime sleepiness group was significantly higher than that in the non-excessive daytime sleepiness group [21% (8/39) , χ2 =9.04, P=0.003]. Excessive daytime sleepiness ( HR=8.03, 95% CI 2.58-24.99, P<0.01) and high L-dopa equivalent daily dose ( HR=5.92, 95% CI 1.95-17.93, P=0.002) were significantly associated with an increased hazard of freezing of gait. Conclusion:Excessive daytime sleepiness and high L-dopa equivalent daily dose may be risk factors for the development of freezing of gait in PD in the future.
ABSTRACT
Objective:To explore the effect of nutritional status on pulmonary infection in patients with severe stroke, and to identify the nutrition-related risk factors of pulmonary infection, so as to provide reference for the prevention and treatment of pulmonary infection from the perspective of nutrition.Methods:The clinical data of 122 patients admitted to the neuro-intensive care unit (NICU) of the First Affiliated Hospital of Chongqing Medical University from August 2019 to February 2020 were retrospectively analyzed. Patients with severe stroke were divided into two groups according to whether they had pulmonary infection during hospitalization in NICU, and there were 25 patients in case group and 97 patients in control group. Nutritional Risk Screening (NRS2002), Nutrition Risk in the Critically ill (NUTRIC) score and malnutrition criteria, combined with anthropometry, clinical comprehensively history and laboratory data were used to evaluate the nutritional status of patients. Logistic regression was used to identify nutrition-related risk factors for pulmonary infection in patients with severe stroke.Results:The incidence of pulmonary infection in severe stroke patients was 20.5% (25/122). Univariate analysis showed that the difference of chronic obstructive pulmonary disease, endotracheal intubation, nasogastric tube use, NUTRIC ≥ 5, the Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ, Sequential Organ Failure Assessment (SOFA), Glasgow Coma Scale (GCS), and creatinine levels, duration of enteral nutrition, length NICU stay, and length of hospital stay between the two groups were statistically significant ( χ2 value was 7.542-34.403, t value was 2.207, Z value was -3.511, 3.083 and 3.115, P<0.05 or 0.01). Multivariate Logistic regression analysis showed that NUTRIC≥5 ( OR= 12.202, 95% CI 2.342-63.568) and nasogastric tube use ( OR=16.990, 95% CI5.343-54.024) were independent risk factors of pulmonary infection in patients with severe stroke ( P<0.01). Conclusions:NUTRIC score≥ 5, high nutritional risk and nasogastric tube use were independent risk factors of pulmonary infection in patients with severe stroke, which should be given early nutritional assessment and individualized care.
ABSTRACT
The intention to treat (ITT) principle is widely applied in the randomized controlled trials (RCTs), which is based on the intention to treat a subject (i.e. the planned treatment regimen) rather than the actual treatment given. With the development and progress of clinical trials, ITT principle needs to be reinterpreted. In the standard definition of ITT principle, the intentional grouping of subjects does not specifically refer to randomization, but rather to planned treatment regimen. In non-randomized clinical trials, that subjects agree to be included in a certain treatment regimen is also a type of intention. ITT principles can be applied to evaluate the effectiveness of treatment regimens under patient/doctor determined intentionality in single-arm clinical trials and non-randomized RWS (real world study, RWS). In the practical application, the grouping strategy based on ITT principle should be considered comprehensively according to the research purpose.
ABSTRACT
Objective:To study the effect of hemolysis on routine biochemical test items.Methods:From January 2018 to October 2018, 150 healthy volunteers who underwent physical examination in the outpatient department of Yuyao Hospital of Traditional Chinese Medicine were selected in this prospective study.In the early morning, 10 mL blood samples of elbow vein were collected from healthy volunteers on an empty stomach.The blood samples of each healthy volunteer were divided into two parts, with 5 mL in each sample, and were set up as control group and observation group respectively.The blood samples of the control group were directly conducted biochemical test without hemolysis treatment.The blood samples of the observation group were biochemical tested after hemolysis treatment.The results of routine biochemical test items of the blood samples of the two groups were compared.Results:In the observation group, the TP, Alb, G, TBIL, DBIL, ALT, AST and CHE were (71.49±1.62)g/L, (48.09±0.85)g/L, (25.18±0.67)g/L, (9.31±1.14)μmol/L, (1.89±0.34)μmol/L, (23.14±1.70)μmol/L, (27.38±2.56)μmol/L, (224.53±5.68)U/L, respectively, which were higher than those in the control group ( t=9.351, 9.235, 8.786, 9.161, 9.309, 8.877, 9.391, 9.878, all P<0.05). The Scr, BUN and UA of the observation group were (87.93±2.76)μmol/L, (5.43±0.47)μmol/L, (249.38±7.52)μmol/L, respectively, which were higher than those of the control group ( t=9.367, 8.744, 9.644, all P<0.05). The TC, TG and LDL-C in the observation group were (4.53±0.49)mmol/L, (1.02±0.26)mmol/L, (1.92±0.40)mmol/L, respectively, which were higher than those in the control group ( t=9.481, 8.795, 8.470, all P<0.05), and the HDL-C in the observation group[(1.49±0.22)mmol/L]was lower than that in the control group ( t=9.085, P<0.05). The CK, HBD and LDH in the observation group were (41.27±1.85)U/L, (116.73±6.24)U/L and (198.94±6.07) U/L, respectively, which were higher than those in the control group ( t=9.433, 9.610, 9.890, all P<0.05). The Na + , K + , Ca 2+ , and Cl - of the observation group were (142.31±2.17)mmol/L, (4.82±0.45)mmol/L, (2.49±0.09)mmol/L, (101.89±1.45)mmol/L, respectively, which were higher than those of the control group ( t=7.412, 9.040, 8.593, 8.359, all P<0.05). Conclusion:Hemolysis reaction of blood sample will affect the results of routine biochemical test items, which will easily lead to the error of biochemical test results.
ABSTRACT
Objective@#To evaluate the current status of the prevention and control of coronavirus disease (COVID-19) outbreak in China, establish a predictive model to evaluate the effects of the current prevention and control strategies, and provide scientific information for decision- making departments.@*Methods@#Based on the epidemic data of COVID-19 openly accessed from national health authorities, we estimated the dynamic basic reproduction number R0(t) to evaluate the effects of the current COVID-19 prevention and control strategies in all the provinces (municipalities and autonomous regions) as well as in Wuhan and the changes in infectivity of COVID-19 over time.@*Results@#For the stability of the results, 24 provinces (municipality) with more than 100 confirmed COVID-19 cases were included in the analysis. At the beginning of the outbreak, the R0(t) showed unstable trend with big variances. As the strengthening of the prevention and control strategies, R0(t) began to show a downward trend in late January, and became stable in February. By the time of data analysis, 18 provinces (municipality) (75%) had the R0(t)s less than 1. The results could be used for the decision making to free population floating conditionally.@* Conclusions@#Dynamic R0(t) is useful in the evaluation of the change in infectivity of COVID-19, the prevention and control strategies for the COVID-19 outbreak have shown preliminary effects, if continues, it is expected to control the COVID-19 outbreak in China in near future.
ABSTRACT
Objective:To explore and analyze the characteristics and causes of intensive nursing needs of COVID-19 patients.Methods:This was a cross-sectional study. Critical patients′ treatment and care information were extracted through the HIS system of a designated hospital from critical patients with COVID-19. We used statistical descriptions to analyze patient general information, nursing degree, and therapeutic intensive care needs. The chi-square test or Fisher′s exact test was used to analyze the differences between characteristics of patients and nursing degree.Results:A total of 1 849 cases of critical patients were collected, including special grade nursing care 697(37.70%), grade I nursing care(62.30%). There were 893(48.30%)patients aged≥65 years, and 853(46.13%)patients with one or more complications. All patients required the nursing routine of infection department, and the therapeutic intensive care followed was vein blood collection(99.62%), oxygen inhalation(98.92%), oral medication(98.65%), finger pulse oxygen monitoring(77.07%)and pharyngeal swab collection(71.93%). The nursing degree of the patients with different gender, age, admission mode, body position and complications were statistically significant( P<0.05). Conclusions:The intensive care nursing needs of COVID-19 patients are complex, which are special in treatment, life and psychology, and the tasks of nursing are heavy, difficult and professional. Special attention should be paid to elderly patients and patients with complications. Our hospital has established a provisional nursing department during the COVID-19 outbreak, coordinated nursing manpower and quality of nursing management, and set up a nursing expert consultation team to further enhance the quality of nursing care for critical COVID-19 patients.
ABSTRACT
Objective To observe any effect of pulmonary rehabilitation in preventing ventilator-associated pneumonia (VAP) among patients receiving invasive mechanical ventilation (MV). Methods A total of 117 a-dults who had be receiving mechanical ventilation for at least 48 hours were randomly divided into an observation group and a control group. Both groups were given routine drug treatment and nursing, but the observation group al-so received comprehensive and individualized pulmonary rehabilitation interventions including airway clearance, respiration training, electrical stimulation of the sacral nerve, lung expansion and early mobilization. The main indi-cators were the incidence of VAP, mortality, MV duration, ICU stay time, and total hospital stay. Results At the end of the treatment the average clinical pulmonary infection score, the acute physiology and chronic health e-valuation Ⅱ score, SpO2 level and oxygenation index of the observation group were all significantly better than those of the control group. The incidence of VAP within one month after leaving the ICU was 47. 5％ in the observation group and the mortality rate was 44.1％, both significantly lower than in the control group. The average MV dura-tion, total hospitalization time and the ICU stay of the observation group were also significantly shorter than those of the control group. Conclusion Early and comprehensive pulmonary rehabilitation can prevent VAP and shorten the length of hospital stays, ICU stays and time on a mechanical ventilator, improving patients' survival chances and prognoses.
ABSTRACT
Objective To explore the prognostic role of laminin (LN ) as a tumor biological marker in predicting the recurrence of hepatocellular carcinoma (HCC) related with HBV infection after liver transplantation (LT ) .Methods Tissue samples from 251 HBV-related HCC patients undergoing LT were immunohistochemically stained with anti-LN antibody .The relevant prognostic factors were analyzed using Spearman's rank test , Kaplan-Meier method , log-rank test and multivariate step-wise Cox regression analysis .Results The expressions of LN in tumor tissues were significantly positively correlated with tumor number (P=0 .00) ,microsatellite (P=0 .02) ,venous invasion (P=0 .048) ,pTNM tumor stage (P=0 .00) ,pre-LT serum α-fetoprotein (AFP) level (P=0 .00) ,HBV DNA level (P= 0 .02) ,HBeAg level (P= 0 .02) and tumor recurrence (P= 0 .00) respectively .Significant differences existed in 1/3/5-year overall survival or tumor recurrence-free survival rate post-LT among LN different expression (-,+ ,≥ + + ) in HBV-related HCC patients (P< 0 .05 ) . Multivariate analysis indicated that LN was a significantly independent predictor in predicting poor tumor recurrence-free survival post-LT (P=0 .01) .Conclusions LN may be a feasible marker in predicting HCC recurrence post-LT for HBV-related HCC patients .
ABSTRACT
Confounders are difficult to avoid in studies on observational comparative effectiveness. It is often unclear whether the confounders have been completely eliminated after controlling the measured or unmeasured potential confounding effects or if sensitivity analysis is needed when using the specific statistical methods, under given circumstances. This manuscript summarizes and evaluates the confounding sensitivity analysis methods. Based on different studies, sensitivity analyses need to use different approaches. The traditional sensitivity analysis can be applied for the measured confounders. Currently, the relatively systematic sensitivity analyses for unmeasured confounders would include confounding function, bounding factor and propensity score calibration. Additionally, more investigations are associated with Monte Carlo and Bayesian sensitivity analysis. Reliability of the research conclusion thus may largely be improved when the sensitivity analysis results are consistent with the main analysis.
ABSTRACT
Observational comparative effectiveness studies have been widely conducted to provide evidence on additional effectiveness and to support randomized controlled findings in research. Although this type of study becomes more important over time, challenges related to the common biases which stemmed from confounders, are difficult to control. This manuscript summarizes some statistical methods used on adjusting measured confounders that often noticed in research, regarding the observational comparative effectiveness. Useful traditional methods would include stratified analysis, paired analysis, covariate model and multivariable model, etc.. Unconventional adjustment approaches such as propensity score and disease risk score methods may also be used in studies, for matching, stratification and adjustment. A good study design should be able to control confounders. The limitations of all the post hoc statistical adjustment methods should also be fully understood before being appropriately applied in practical events.
ABSTRACT
Propensity score method, as an analytical strategy for adjusting multiple covariates, has been widely used in observational comparative effectiveness research. This paper introduces this method covered basic principles, case illustration and software implementation, in order to help readers understand propensity score method, apply it correctly in their researches, improve the efficiency of data utilization, and enhance the level of statistical analysis.
ABSTRACT
Objective@#To study the overexpression of protein phosphatase 2 regulatory subunit B''α gene effects on the proliferation and invasion of hepatoma cells.@*Methods@#Immunohistochemistry method was used to analyze the expression of PPP2R3A in cancerous and paracancerous tissues. Hepatocellular carcinoma cell lines (Huh-7 and HepG2) with stably overexpressing PPP2R3A were constructed by lentiviral vector. Biological behavioral transition in hepatocellular carcinoma cell proliferation, cell cycle, apoptosis, invasion and metastasis were detected by cell counting kit-8 assay (CCK-8), flow cytometry, and transwell assay. A subcutaneous nude tumor mice model was constructed to validate the growth of hepatoma cells. Two independent sample t-tests were used to compare the groups.@*Results@#The expression of PPP2R3A gene in human hepatocarcinoma tissues was higher than paracancerous tissues. The absorbance (A value) of hepatoma cells was increased (P < 0.05) after overexpression of PPP2R3A gene. The transition from G1-to-S phase was significantly increased i.e., the G1 phase of the cell cycle was reduced (Huh-7: t = 3.04, P = 0.0384; HepG2: t = 4.06, P = 0.0153), while the S phase was increased (Huh-7: t = 3.47, P = 0.0255; HepG2: t = 4.46, P = 0.0112). Early apoptotic rate was decreased (Huh-7: t = 7.34, P = 0.0018; HepG2: t = 4.06, P = 0.0153). The number of Huh-7 cells migrating to the lower chamber was increased (t = 3.18, P = 0.0334), and after the use of matrigel the number of cells reaching to the lower chamber was also increased (t = 2.84, P = 0.0464). The results of animal experiments showed that the subcutaneous tumor growth (t = 4.31, P = 0.0035) was significantly overexpressed in nude mice group. The results of Western blot showed that the expression of PARP and P53 protein in the spliced forms decreased, while the accumulation of β-catenin protein in the liver cancer cells was increased.@*Conclusion@#Overexpressed PPP2R3A gene may promote proliferation, migration and invasion ability, inhibit apoptosis, induce G1/S phase transition, and participate in the biological behavior of hepatoma cells.
ABSTRACT
Objective@#To introduce the methods for sensitivity analysis, discuss and compare the advantages and disadvantages of different methods.@*Methods@#The difference between confounding function method and bounding factor method in accuracy of identifying unmeasured confounding factors in observational studies through simulation trials and actual clinical data was compared.@*Results@#The results of simulation trials and actual clinical data showed that when there was unmeasured confounding between exposure (X) and outcome (Y), the results of confounding function and the bounding factor analysis were similar in terms of the effect of unmeasured confounding factor to lead to the complete change of the magnitude and direction of the observed effect value. However, the confounding function method needed smaller confounding effect to fully interpret the observed effect value than the bounding factor needed. In addition, the bounding factor method needed to analyze two confounding parameters, while only one parameter was needed in the confounding function method. The confounding function method was simpler and more sensitive than the bounding factor method.@*Conclusion@#For real-world observational data, the sensitivity analysis process is essential in analyzing the causal effects between exposure (X) and outcome (Y). In terms of the calculation process and result interpretation the sensitivity analysis method of confounding function is worth to recommend.
ABSTRACT
Observational study of therapy efficacy comparison has been widely conducted to provide the additional efficacy evidence to support randomized control study. Statistical adjustment for unmeasured confounders is a major challenge in observational study of therapy efficacy comparison. This paper summarizes and evaluates the relative statistical methods. Currently, the most commonly used methods include instrumental variable, difference-in-differences (DiD) model and prior event rate ratio (PERR) adjustment. The instrumental variable method skill fully escapes unmeasured confounders through model structure, but it is not easy to obtain satisfied instrumental variables. Both PERR and DiD require the data prior to exposure which are not always collected in observational studies. Unmeasured confounders could result in new requirements and pose new challenges for statistical methods, which needs further study and improvement.
ABSTRACT
Objective To investigate the clinical effect of massage combined with abdominal acupoint sticking therapy in the treatment of constipation after thoracolumbar fractures .Methods 50 thoracolumbar fracture patients with constipation were selected as the research subjects .According to the computer random grouping ,all patients were divided into two groups,25 cases in each group.The control group received phenolphthalein tablets .The observation group underwent abdominal acupoint massage and sticking therapy treatment .The two groups were treated for a course of 7 days.The clinical curative effect,defecation feeling,stool,defecation frequency and number of vector gas were compared between the two groups .Results After treatment,the proportions of defecation and carefree ,laborious and soft,dry in the observation group were 76.00%,24.00%,88.00%,12.00%,respectively,compared with the control group,there were statistically significant differences (χ2 =6.65,6.35,all P <0.01).The total improvement rate after treatment in the observation group was 96.00%,which was significantly higher than 72.00% in the control group (χ2 =5.36,P =0.02).After treatment for 48 hours and 72 hours,the frequency of defecation and the number of vector gas times in the observation group were higher than the control group (t =6.22,22.37,10.29,8.97,all P <0.05).Conclusion Abdominal acupoint massage combined with sticking therapy in the treatment of constipation after thoracolumbar fractures has significant clinical effect .
ABSTRACT
Objective To determine the level of peripheral blood CD34 positive (CD34+) cells in patients with acute cerebral infarction (ACI),and to explore its clinical significance.Methods The level of peripheral blood CD34+ cells was determined by flow cytometry within 72 hours of onset of patients with acute cerebral infarction (infarct group,n=45),cerebrovascular risk factors in patients without cerebral infarction (high risk group,n=27) and healthy subjects (control group,n=20).The neural function defect score,infarction lesion volume and carotid artery intima-media thickness (IMT) were determined in patients with infarction group.Results The percentages of peripheral blood CD34 cells in infarction group (0.034 ±0.012)％ and the high risk group of patients (0.047±0.009)％ were lower than that of control group(0.063±0.009)％,and were lower in infarction group than in high-risk groups (all P＜0.05).The percentages of peripheral blood CD34+cells were significantly decreased compared with control group (P＜0.05) in infarction patients with mild [(0.047±0.009)％],moderate [(0.036±0.009)％],severe [(0.022±0.007)％] infarction nervous function defect score.Wherein,the percentages were lower in severe group than in the moderate group,moderate group was lower than in mild group (all P＜0.05).The percentages of peripheral blood CD34 cells in infarction patients with small,moderate,large infaret lesion volume were lower than in control group (P＜0.05),wherein,were lower in large group than in moderate group,lower in moderate group than in treatment group (all P＜0.05).Infarction patients were confirmed with carotid atherosclerosis (CAS) by carotid ultrasound.The extent of lesion were divided into carotid artery intimal thickening group [(0.043±0.010)％],carotid artery plaque group [(0.036±0.010)％],and carotid artery stenosis group [(0.023±0.009)％].The levels of peripheral blood CD34+ cells in three groups of patients were decreased compared with control group.The levels were lower in carotid artery stenosis group than in carotid artery plaque group,lower in carotid artery plaque group than in carotid artery intimal thickening group (all P＜0.05).Conclusions The level of peripheral blood CD34+ cells in acute cerebral ischemia is reduced,it can become a sensitive and early indicator of cerebral ischemia,and its level is related to neurologic impairment,infarction size and the degree of carotid artery atherosclerosis.
ABSTRACT
OBJECTIVE:To analyze bacterial infection of chronic bacterial prostatitis and to provide reference for clinical therapy. METHODS: Prostatic fluid was collected in sterile condition. Positive results of bacterial culture in 261 cases of chronic bacterial prostatitis were analyzed. RESULTS: Of total 261 cases, gram-postive bacteria accounted for 56.7%, which were mainly staphylococcus bacteria (41.9%) and gram-negative bacteria (43.3%) among which Escherichia coli accounted for 42.5%. CONCLUSION: Culture and drug sensitivity analysis of prostatic fluid and rational use of antibiotics based on results of drug sensitivity test has significance for drug use in the clinic.
ABSTRACT
We carried out the stress relaxation and creep experiments on the aorta ascendens of five fresh dead bodies of normal chinese men who had died from impetuous trauma on the head. The stress relaxation and creep data and curves of the aorta ascendens were obtained. Then regression analysis was performed to get the reduced stress relaxation and creep functions. Finally, we analyzed and discussed the results of the experiment.