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Objective: To verify the accuracy of the autoregressive integrated moving average (ARIMA) in predicting the incidence of occupational pneumoconiosis (hereinafter referred as pneumoconiosis) and to predict the incidence of pneumoconiosis in Guangdong Province in the next five years. Methods: A follow-up survey was performed to collect data on pneumoconiosis patients reported in Guangdong Province from 1956 to 2021. Collected data from 1956 to 2016 were used as the training set to build an ARIMA model. Collected data from 2017 to 2021 were used as the prediction set to evaluate the predicting result of the ARIMA model. The ARIMA model was used to predict the incidence of pneumoconiosis in Guangdong Province in next five years. Results: The ARIMA (1,1,2) model was set up after model identification and order estimation. The model was used to predict the prediction set, and its result was good. The ARIMA result and actual values in 2021 were 213 and 210 cases, respectively, with a difference of only three cases. The number of pneumoconiosis cases predicted using the ARIMA model in Guangdong Province from 2022 to 2026 was 214, 204, 202, 194, and 191 cases, respectively, showing a trend of low-level prevalence. Conclusion: The ARIMA model demonstrates high accuracy in predicting pneumoconiosis incidence over a long period of time and with large sample sizes. The forecast results of the ARIMA(1,1,2) model indicate that the incidence of pneumoconiosis in Guangdong Province will be around 200 cases in the next five years, indicating a low-level prevalence.
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Objective: To study the survival time and its risk factors of patients with occupational pneumoconiosis. Methods: A total of 11 011 newly diagnosed occupational pneumoconiosis patients in Guangdong Province from 1980 to 2019 were selected as study subjects. The life table method was used for survival analysis. The influencing factors of survival time of occupational pneumoconiosis patients were analyzed using the WilCoxon (Gehan) test and Cox proportional hazards regression model. Results: The median survival time of pneumoconiosis patients was 26.0 years. The median survival period of stage Ⅰpatients was 3.5 years longer than that of stage Ⅱ patients and 10.1 years longer than that of stage Ⅲ patients. The median survival time of patients with an initial diagnosis age under 40.0 years old was 34.8 years longer than that of patients with an initial diagnosis age over 60.0 years old. The median survival time of patients with dust exposure duration under 25.0 years old was 13.6 years longer than patients with dust exposure duration age over 45.0 years old. The results of the Cox proportional hazards regression model showed that the initial diagnosis stage, initial diagnosis age, dust exposure duration, and medical insurance were risk factors of the survival time of occupational pneumoconiosis patients (all P<0.01). The risk of reduced survival time for patients with stage Ⅱ and stage Ⅲ as the initial diagnosis stage was 1.15 and 2.04 times higher, respectively, compared with stage Ⅰ patients (both P<0.01). The risk of reduced survival time for patients without medical insurance was 60.22 times higher than those with medical insurance (P<0.01). Conclusion: The risk factors of the survival time of occupational pneumoconiosis patients in Guangdong Province are initial diagnosis stage, initial diagnosis age, the dust exposure age, and medical insurance. Earlier detection, earlier diagnosis, and improvement of medical insurance coverage for patients can effectively improve the survival time of occupational pneumoconiosis patients.
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Mechanical ventilation has, since its introduction into clinical practice, undergone a major evolution from controlled ventilation to diverse modes of assisted ventilation. Conventional mechanical ventilators depend on flow sensors and pneumatic pressure and controllers to complete the respiratory cycle. Neurally adjusted ventilatory assist (NAVA) is a new form of assisted ventilation in recent years, which monitors the electrical activity of the diaphragm (EAdi) to provide an appropriately level of pressure support. And EAdi is the best available signal to sense central respiratory drive and trigger ventilatory assist. Unlike other ventilation modes, NAVA breathing instructions come from the center. Therefore, NAVA have the synchronous nature of the breaths and the patient-adjusted nature of the support. Compared with traditional ventilation mode, NAVA can efficiently unload respiratory muscles, relieve the risk of ventilator-induced lung injury (VILI), improve patient-ventilator coordination, enhance gas exchange, increase the success rate of weaning, etc. This article reviews the research progress of NAVA in order to provide theoretical guidance for clinical applications.
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Humans , Interactive Ventilatory Support , Respiration, Artificial , Positive-Pressure Respiration , Diaphragm/physiology , Respiratory Muscles/physiologyABSTRACT
Objective@#To investigate the association of sleep quality, depressive symptoms and their interaction with non suicidal self injury (NSSI) among rural middle school students, so as to provide a reference for early prevention and control of NSSI among rural middle school students.@*Methods@#A multi stage cluster sampling method was used to randomly select four rural middle schools in Xuzhou, Jiangsu Province. A total of 1 723 middle school students were investigated according to the principle of grade stratification and class random selection. Paper questionnaires (including demographic factors, Non Suicidal Self Injury Short Scale, Pittsburgh Sleep Quality Index, Patient Health Questionnare-9) were used to conduct the questionnaire survey. Logistic regression model was used to analyze the association of sleep quality, depressive symptoms and their interaction with NSSI among rural middle school students.@*Results@#Totally 30.5% of middle school students had NSSI. Univariate results showed that girls (33.0%) had a higher incidence of NSSI than boys(27.3%), and those with sleep disorders and depressive symptoms had a higher incidence of NSSI, which was 46.8%, 43.6%. The results of multivariate Logistic regression showed that the risk of NSSI in students with sleep disorder was 1.80 times that in those without sleep disorder( OR 95%CI=1.42-2.28, P <0.01). The risk of NSSI in students with depressive symptoms was 3.32 times higher than that in those without depressive symptoms( OR 95%CI=2.60-4.24, P <0.01). The interaction results showed that there was additive interaction between sleep disturbance and depressive symptoms on the occurrence of NSSI behavior in rural middle school students, and the relative excess risk, attributable proportion and synergy index were 1.80, 0.30 and 1.57, respectively.@*Conclusion@#Sleep disorder and depressive symptoms are risk factors for NSSI among rural middle school students, and there is additive interaction between them.
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BACKGROUND@#There has been minimal research on the role of benevolent childhood experiences (BCEs) and how such events may offer protection from the insidious effects of adverse childhood experiences (ACEs) or later in life.@*OBJECTIVES@#This research aims to learn how BCEs and ACEs interact to affect adolescents' psychological distress.@*METHODS@#Cross-sectional survey was conducted in three cities (Xuzhou, Nanjing, and Wuhan) in China from March 2021 to May 2021. Latent class analysis (LCA) was used to classify the patterns of ACEs and BCEs. We adopted hierarchical multivariable regression to examine the influences of ACEs and BCEs on depression and suicidal ideation.@*RESULTS@#To explore the relationship between childhood experience and suicidal ideation and depression, LCA revealed three patterns of ACEs: (1) emotional abuse (10.57%); (2) high ACEs (0.55%); and (3) low ACEs classes (88.88%). Adolescents with emotional abuse (depression: OR = 3.82, 95%CI = 2.80-5.22, P < 0.001; suicidal ideation: OR = 5.766, 95%CI = 3.97-8.38, P < 0.001) and high ACEs class (suicidal ideation: OR = 5.93, 95%CI = 1.19-29.66, P < 0.05) had an increased risk of psychological distress (reference: low ACEs). LCA revealed four patterns of BCEs: (1) relationship support (14.54%); (2) low BCEs (4.85%); (3) high BCEs (55.34%); and (4) high quality of life classes (25.28%). Adolescents with a high quality of life (depression: OR = 0.09, 95%CI = 0.05-0.16, P < 0.001; suicidal ideation: OR = 0.22, 95%CI = 0.12-0.40, P < 0.001) and high BCEs (depression: OR = 0.05, 95%CI = 0.03-0.09, P < 0.001; suicidal ideation: OR = 0.15, 95%CI = 0.09-0.26, P < 0.001) protected the mental health of adolescents (reference: low BCEs).@*CONCLUSIONS@#High ACEs and emotional abuse classes were significantly associated with poorer mental health symptoms, including suicidal ideation and depression. In contrast, high BCEs and high quality of life classes were associated with better mental health. These findings point out that it is more necessary to identify and support victims of ACEs, and it is urgent to increase BCEs in early childhood.
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Adolescent , Humans , Cross-Sectional Studies , Depression , East Asian People , Latent Class Analysis , Quality of Life , Suicidal Ideation , Adverse Childhood ExperiencesABSTRACT
Prostate cancer has become the one of the most common urinary tract malignant tumor in men in China. Convolutional neural network is one of the representative model and promising deep learning algorithm in artificial intelligence. It has shown superior performance and application value in the diagnosis of prostate cancer. For multi-parameter magnetic resonance and pathological images, it can achieve diagnostic performance equivalent to that of radiologists and pathologists, and could obtain more disease information. There are also important applications of it in identification of disease-causing genes and Raman spectroscopy-based laboratory diagnosis. This article reviews the research progress of convolutional neural networks in the diagnosis of prostate cancer in radiology, pathology, genetics and laboratory.
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Objective:To study the characteristics of breath sound spectroscopy in chronic obstructive pulmonary disease(COPD) patients with different lung function grades, to preliminarily determine the characteristic parameters and indicators of breath sound spectrograms with different lung function grades of COPD, and to explore the visualization and measurability of the differences in respiratory auscultation in patients with different lung function grades.Methods:Patients diagnosed and treated in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Chongming Branch from October 2018 to December 2020 were selected. Fifty-two patients with COPD (22 patients with moderate to moderate obstructive ventilation dysfunction (mild to moderate group), 30 patients with severe obstructive ventilation dysfunction (severe group)) and 36 normal controls (control group) were selected. The respiratory sounds were sampled with an electronic stethoscope and transmitted to the audit audio software to calculate the relevant data of respiratory sound pressure level (SPL) and the ratio to minute ventilation (VE) of samples with different lung function grades. A retrospective case-control study was used. The data with normal distribution were analyzed by one-way ANOVA, and the pairwise comparison was performed by SNK- q test. Results:The breathing audio frequency of mild-moderate, severe COPD patients and the control group has a sound pressure difference of (-0.5±2.2) dB and (-1.6±6.1) dB, (0.7±4.0) dB, and there was significant difference between each group ( F=2.64, P=0.038). The sound pressure level per minute ventilation (SPL 50-200/VE) of respiratory sound inspiratory phase in COPD patients with mild to moderate and severe obstructive ventilation dysfunction and the control group were (5.7±1.8) dB/L, (6.1±2.3) dB/L and (5.4±0.9) dB/L, respectively. The expiratory SPL 50-200/VE were (5.8±1.7), (6.3±2.2) and (5.3±1.2) respectively. There was significant difference among the three groups ( Finhalation=3.26, P=0.048; Frespiration=2.44, P=0.045). ROC curve results showed that SPL 50-200/VE in the inspiratory phase, SPL 50-200/VE in the expiratory phase, and sound pressure difference to assess different grades of obstructive ventilatory dysfunction had diagnostic value (AUC values were 0.697, 0.725 and 0.686, respectively; and P values were 0.015, 0.005 and 0.022, respectively). In some patients with COPD, abnormally high energy levels may appear in the time-frequency diagram of breath sounds. Conclusion:There are significant differences in respiratory audio spectrum analysis between patients with different degrees of obstructive ventilation dysfunction and those with normal ventilation function, which can provide a basis for auxiliary judgment of obstructive ventilation dysfunction.
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Objective:To investigate the patterns and risk factors of central lymph node metastasis in node-negative neck (cN0) papillary thyroid carcinoma located in the isthmus. To discuss different operation methods and the postoperative complications to find out the appropriate surgical approach and scope.Methods:Forty-eight patients with cN0 papillary thyroid carcinoma located in isthmus for surgery at the First Hospital of Chongqing Medical University from Jan. 2013 to Dec. 2019 were reviewed retrospectively. They were divided into two groups: the lymph node metastatic group and the lymph node non-metastatic group. The metastatic lymph node group was further divided into the group with the number of lymph node metastasis ≤5 and the lymph node metastasis > 5. The clinical features, including gender, age, number and size of tumor, extrathyroidal extension, and whether combined with Hashimoto’s thyroiditis, the incidence of central lymph node metastasis and related factors, the scope of surgery, postoperative complications and recurrence were analyzed. SPSS 21.0 statistical software was used for statistical analysis, t test was used for measurement data, and χ2 test was used for counting data. Results:Among 48 patients, 27 had lymph node metastasis, with a metastatic rate of 56.25% (27/48) . Lymph node metastasis in pretracheal, prelaryngeal, left and right paratracheal lymph node was present in 47.9%, 22.9%, 20.8% and 16.7% of the patients respectively. The proportion and risk of lymph node metastasis were significantly increased in patients with tumor size>1 cm ( P=0.014, OR=6.78, 95% CI:1.59-28.95) . In patients with the number of lymph node metastasis > 5, the incidence of tumor size > 1 cm, prelaryngeal, left and right paratracheal lymph node metastasis was significantly higher than that of patients with lymph node metastasis ≤5 ( P=0.008, P=0.033, P=0.025, P=0.027) . There was a higher proportion of pretracheal or prelaryngeal lymph node metastasis in patients with left paratracheal lymph node metastasis ( ( P=0.008, P=0.007) . Multivariate analyses of risk factors associated with paratracheal lymph node metastasis indicated that the paratracheal lymph node metastasis correlated with the metastasis of pretracheal and (or) prelaryngeal lymph node ( P=0.016, OR=5.92, 95% CI:1.39-25.3) . In 48 patients with cN0 isthmic PTC, 43 cases underwent total thyroidectomy plus bilateral central lymph node dissection, and 5 patients reseived extended isthmus resection plus prelaryngeal and pretracheal lymph node dissection. 21 (41.8%) patients in total thyroidectomy group had PTH reduction, which was a transient hypoparathyroidism. 48 patients were followed up for 1-6 years without recurrence or metastasis. Conclusions:cN0 isthmic papillary thyroid carcinoma has a high incidence of central lymph node metastasis. Pretracheal and prelaryngeal lymph node are the most common metastatic location. For patients with tumor size>1 cm, a total thyroidectomy plus bilateral prophylactic central lymphadenectomy is needed. However, for patients without capsular invasion, tumor size≤1 cm, without pretracheal and prelaryngeal lymph node metastasis confirmed by intraoperative fast-frozen pathology, extended isthmus resection plus prophylactic pretracheal and prelaryngeal lymphadenectomy can be selected for reducing the complications of operation.
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The purpose of this study was to investigate the pharmacokinetic interaction between sunitinib and ramipril in rats. Eighteen male SD rats were divided into three groups, with each group being assigned to orally receive sunitinib, ramipril, sunitinib and ramipril, respectively, for ten days. Blood samples were collected at dif-ferent times after first-day and tenth-day administration. The concentrations of ramiprilat and sunitinib in rat plasma were determined by LC/MS/MS and the pharmacokinetic parameters were calculated and statistically analyzed. Compared with the administration of ramipril alone, after a single-dose combined administration, tmax of ramiprilat decreased significantly and t1/2 prolonged, while AUC0-∞ remained unchanged. These results indicated that the ab-sorption rate of ramiprilat increased and the elimination rate decreased, but total absorption degree was not changed. After multiple-dose administrations, CL of ramiprilat decreased and AUC0-∞ increased obviously. It sug-gested that accumulation of ramiprilat occurred in body and the drug elimination became slower. No obvious difference of sunitinib pharmacokinetic behavior was found when it was given in combination with ramipril after a single-dose administration or multiple-dose administration. Sunitinib decreased the elimination of ramiprilat after co-administration in company with drug accumulation in body after multiple-dose co-administration. The study showed that there were pharmacokinetic interactions between sunitinib and ramipril in SD rats.
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@#The aim of this study was to develop a multi-target pharmacokinetic-pharmacodynamic(PK-PD)model for the evaluation of the protective effect of salvianolic acid A(Sal A)on ischemic heart failure based on a metabolic balance model. The rats were assigned to 3 groups: sham-operated group(saline), ischemic heart failure group(saline)and Sal A-treated group(Sal A, 1 mg/(kg ·d), ip). The concentrations of brain natriuretic peptide(BNP), angiotensin II(Ang II), malondialdehyde(MDA), asymmetric dimethylarginine(ADMA)and the activity of glutathione peroxidase(GSH-Px)in rat plasma were determined before and at 1, 2, 3, and 4 weeks after ligation in all the groups. A multi-target PK-PD model was developed based on the change rate of metabolic disruption parameter k and was eventually used to integrally evaluate the protective effect of Sal A on ischemic heart failure. Sal A showed improvement effects on multiple biomarkers and the correlation study demonstrated a good relationship between dynamic parameter k and left ventricular ejection fraction(LVEF). More importantly, the multi-target model well fitted the relationship between AUC and the change rate. The multi-target PK-PD model provides a novel method to integrally evaluate the protective effect of Sal A, which might offer a new strategy for the establishment of a PK-PD model that embodies the characteristics of traditional Chinese medicine.
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@#The successes of therapeutic monoclonal antibodies(mAbs)in clinical practice has drawn more attention to mAbs development. Compared to chemical drugs with small molecules, mAbs have larger molecular weight; besides, they show much higher selectivity and specificity. As a result, new pharmacokinetic(PK)and pharmacokinetic/pharmacodynamic(PK/PD)models have been proposed to guide mAbs development. This article summarizes the unique PK characteristics of mAbs and introduces the models used in PK investigation of mAbs, such as target-mediated drug disposition(TMDD)model and physiologically based pharmacokinetic(PBPK)model. In addition, four different categories of PK/PD models for mAbs in immuno-toxicotherapy, target-cell elimination, alteration of cellular function and drug targeting are also reviewed in the present article.