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Objective To construct and appraise a new model for predicting the prognosis of rectal cancer patients using the Lasso-Cox strategy.Methods The clinical pathological data of 599 rectal cancer patients who underwent radical resection were analyzed.Comparison between groups,Lasso and Cox regression were used to select varia-bles and construct a model,and its discrimination,consistency,and clinical benefits were appraised by the receiv-er operating characteristic(ROC),calibration curve,and decision curve analysis.Results Comparison between groups showed that age,body mass index(BMI),preoperational nutrition status,carbohydrate antigen199(CA199),preoperative chemotherapy,intraoperative blood transfusion,vascular or nerve invasion,cancer nod-ules,pathologic T,N,and TNM stages,tumor recurrence or metastasis,radiotherapy and postoperative survival time were associated with grouping of death or survival in rectal cancer patients.Among them,8 variables were se-lected by lasso and contained into the Cox regression model.Age(HR=1.04,P＜0.05),BMI(HR=0.89,P＜0.05),blood transfusion(HR=2.29,P＜0.05),postoperative chemotherapy(HR=0.16,P＜0.01),recur-rence(HR=43.67,P＜0.01),and metastasis(HR=2.75,P＜0.05)were identified as independent prognostic factors,which were used to construct a nomogram model.The area under the curve(AUC)and the 95％confi-dence interval of the receiver operating characteristic(ROC)curve of the predictive model was 0.95(0.91-0.99),P＜0.01.The predicted probability of 1-year and 3-year survival was close to the actual probability.The DCA curve of the model was far away from a decision line parallel to the X-axis and another line with a negative slope.Conclusion The newly established nomogram has good discrimination,consistency and clinical benefits,which help predict the prognosis of rectal cancer after surgery.
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Objective@#To identify the associated factors of peripheral blood lymphocyte counts (PBLC) in gastric cancer patients@*Methods@#In this cross⁃sectional study , data were collected from patients underwent gastric cancer surgery. Univariate analysis , multiple linear regression and variable importance metrics were used to assess factors associating PBLC in pre⁃operative patients. The findings were further investigated by fitting locally weighted regression(loess) and robust linear model (rlm) .@*Results@#Patients with pre⁃operative PBLC < 1 . 1 × 109/L( group A) were 138(20. 72% ) , whereas patients with PBLC ≥ 1. 1 × 109/L ( group B) were 528(79. 28% ) . Compared to group B , patients in group A were older[(64. 61 ± 10. 42 years) vs (62. 18 ± 10. 41 years) , P < 0. 05 ] and showed lower neutrophils [(3. 21 ± 1. 41) × 109/L vs (3. 59 ± 1. 31) × 109/L , P < 0. 01] . Lymphopenia was associated with later stage of gastric cancer, P < 0. 01 . A multiple linear regression model with randomly distributed residuals found that age ( β = - 0. 01 , t = - 3. 70 , P < 0. 01) and tumor stage [ β ( Ⅱ vs Ⅰ ) = - 0. 16 , t =- 2. 79 , P < 0. 01 ; β ( Ⅲ vs Ⅰ ) = - 0. 18 , t = - 3. 86 , P < 0. 01 ; β ( Ⅳ vs Ⅰ ) = - 0. 21 , t = - 2. 16 , P <0. 05] were to be statistically significant factors for lymphopenia. Neutrophil increase (β = 0. 05 , t = 3. 61 , P < 0. 01) was associated with a higher PBLC. The relative importance analysis for continuous independent variables showed that relative importance metric LMGs in variable age , neutrophil and CEA were 55. 55% , 44. 14% and 0. 31% respectively. Loess and rlm models showed that age was the negatively influencing factor of PBLC. @*Conclusion@#PBLC in gastric cancer patients were positively associated with neutrophils , and negatively associated with age and tumor stages.
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Objective@#To explore the factors associated with the distance from the anal verge to rectal cancer (DAVtRC) ．@*Methods@#102 patients with rectal cancer provided the clinicopathological data．Two groups of patients were created : low rectal cancer group ( LRC) for those with DAVtRCs less than 7cm and mid / high rectal cancer group ( M / HRC) for those with DAVtRCs greater than 7 cm． The two groups' clinical and pathological differences were compared．Quantile regression was used to analyze the associations between DAVtRC and the clinicopathological factors. @*Results @#LRC had a lower median DAVtRC (5. 00 cm ［IQR : 4. 00，6. 00 cm］) than that in M / HRC ［10. 00 cm(IQR : 10. 00，11. 00 cm) ］(P＜0. 01) ，but had higher mean monocytes［(0. 41 ± 0. 16) vs (0. 34 ± 0. 11) ，P＜0. 05］．In the model with continuous and categorical variables at 95% quantile，DAVtRC was negatively associated with age ( β = －0. 204 ，P ＜0. 01 ) ，TNM stage ( Ⅲ + Ⅳ vs Ⅰ : β = －6. 623 ，P < 0. 01) ，platelet (PLT，β = －0. 024，P＜0. 01) ，vessel invasion(β = －1. 544，P＜0. 01) ，but positively associat- ed with BMI(β = 0. 278，P＜0. 01) ，tumor diameters(β = 0. 548，P＜0. 01) ，male(β = 1. 421，P＜0. 01) ，low and middle differentiations(β = 4. 727，P＜0. 01) ，T stage(T2 vs T1 : β = 4. 422，P＜0. 01) ，N stage(N1 vs N0 : β = 6. 670，P＜0. 01) ，nerve invasion(β = 1. 825，P ＜0. 01) ，carcinoembryonic antigen( CEA，β = 0. 068，P < 0. 01) ，lymphocyte(L，β = 3. 068，P＜0. 01) ，platelet lymphocyte ratio(PLR , β = 0. 045，P＜0. 01) ，lymphocyte monocyte ratio(LMR , β = 1. 088，P ＜0. 01) ．Quantile regression curves showed that the coefficients of age，body mass index(BMI) ，tumor diameter，PLT，PLR and LMR were different in different quantiles of DAVtRC．@*Conclusion @#DAVtRC is significantly associated with multiple clinicopathological factors in rectal cancer，but in different quantiles，the coefficients are different.
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Objective:To evaluate the post-marketing safety and immunogenicity of a 23-valent pneumococcal polysaccharide vaccine (PPV23).Methods:From September 2020 to June 2021, a clinical trial of single-dose PPV23 was conducted in people ≥3 years old in Centers for Disease Control and Prevention of Guizhou, Hunan and Fujian provinces. Blood samples were collects from the subjects before and 30 d after vaccination. ELISA was used to quantitatively detect IgG antibodies against capsular polysaccharides of 23 Streptococcus pneumoniae serotypes in serum samples. The adverse events (AEs) were monitored within 7 d after vaccination. Results:A total of 409 subjects were enrolled and included in safety analysis. Except for one with antibody level inversion, the other 408 participants were included in immunogenicity analysis. The levels of antibodies against the 23 Streptococcus pneumoniae serotypes were all increased after vaccination by an average of 4.24 folds. The two-fold growth rates of the antibodies ranged from 51.72% to 96.81% with a total two-fold growth rate of 78.59%. The overall rate of AEs was 27.14% (111/409). Local AEs were mainly pain, induration, redness and swollen. No serious adverse events related to vaccination occurred. Conclusions:This study preliminarily demonstrated the good immunogenicity and safety of PPV23 vaccine.
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Objective To understand the awareness level of iodine deficiency (ID) impairments and the attitude on edible iodized salt,and its consumption among doctors and nurses in cities,in order to provide scientific evidence for health education on iodine deficient disorders (IDD) in the future.Methods The questionnaire was self-designed,and spread through the web page of Wenjuanxing,an online server company,from May 6 to June 6,2017.At the end of the survey,a total of 481 valid questionnaires were reclaimed,in which ratio of gender was female 63.8％ (307/481),male 36.2％ (174/481).The data were analyzed by SPSS 22.0,including logistic regression analysis with backward according to the statistical significant level of P ＜ 0.05.Results Among doctors and nurses,90.4％ (435/481) knew ID impairments;72.8％ (350/481) answered intelligent disability as the most serious problem of ID;55.5％ (267/481)misunderstood that the areas in which they lived were not ID areas,although all cities surveyed were ID areas;41.0％ (197/481) of doctors and nurses misunderstood that coastal residents did not need to consume iodized salt.About the evaluation of iodine nutrition status of current population,15.6％ (75/481) of respondents judged as iodine excess.About consuming edible salt,76.3％ (367/481) selected iodized,9.6％ (46/481)non-iodized,and 14.1％ (68/481) both iodized and non-iodized.The results of logistic regression analysis showed the factors that prevents health care workers from choosing iodized salt were:"living in coastal areas","think him or her as iodine adequate","know that iodine deficiency can affect the development of children but still adhere to the consumption of non-iodized salt";the factors that promoted the choice of iodized salt for medical staff were "insist on buying iodized salt,and do not choose non-iodized salt",and 75.8％ (238/314)of them knew that intelligent disability as the most serious problem of ID.Conclusions Most doctors and nurses have high level of knowledge on ID and its control.But lack of information,as well as misunderstanding of "coastal areas iodine adequate" and worry about "excess iodine causes thyroid diseases and cancer",which would hinder the active consumption of iodized salt.Health education for them should be conducted through professional ways,stressing on the threaten of ID environment,sharing the information about national and local progress on control of IDD and iodized salt safety,and clarifying the relationship between iodine salt or iodine and thyroid cancer and nodules.
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Objective To analyze the distribution and influential factors of exam results in medical students' general surgery theory course.Methods 171 medical students were selected as subjects by cluster sampling,and the distribution and influential factors of exam results were analyzed.SPSS 17.0 software was used for statistical analysis,measurement data with (-x) ± s,and normality test with Kolmogorov-Smirnov test.Those quantitative data which do not meet the normal distribution were compared with Mann-Whitney U and Kruskal-Wallis H test.Rank transformation univariate multi-factor variance of LSD (Levene test equal error variance between groups) or Tamhane method (Levene test range error variance between groups) were compared between two groups(3-4) and the influence factors of whether the grade was good was analyzed by single factor and multi factor non conditional Logistic regression model,with the test level of alpha=0.05.Results The distribution of total exam results was normal.77 score was outlier,and the scores of female students were higher than those of male students.Scores of total exam results,multiple-choice questions and essay questions in different classes were significantly different.Data from multivariate logistic regression analysis showed that male students(OR=0.212,95％CI:0.077-0.584) were unfavorable factor for good exam results,while higher scores in noun explanation (OR=12.160,95％CI:1.985-74.495),multiple-choice questions (OR=9.887,95％CI:2.997-32.617),essay questions(OR=18.323,95％CI:6.593-50.928) were favorable factors.Conclusion The cause analysis of score's outlier and sex difference should be strengthened,and the influence of examination items on score should be emphasized.
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According to the characteristics of general surgery class teaching,methods and experiences of the application of associative approach to general surgery class teaching were analyzed,such as word,picture,contrast,comprehensive,analogical and association,which is advantageous to the improvement of class teaching methods,effects and students' study interests and ideation.
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Oestrogen(E), oestrogen receptor (ER) and oestrogen induced proteins form a cellular signal transduction pathway. As a member of this pathway, PS2 protein has close relations with gastric cancer. To elucidate its role in the course of tumourigenesis and advancing may contribute to the insight into the tumourigenic mechanisms and signal-transduction therapy of the gastric cancer.