Risk Factors of Perioperative Cardiac Events in Elderly Patients with Coronary Heart Disease Undergoing Non-cardiac Surgery / 中国医学科学院学报

<p><b>OBJECTIVE</b>To identify the incidence and risk factors of perioperative major adverse cardiac events (MACE) in elderly patients with coronary heart disease (CHD) undergoing non-cardiac surgery.</p><p><b>METHODS</b>We prospectively analyzed the clinical data of 360 CHD patients who aged 75 years or older undergoing elective intermediate-to high-risk surgery in five medical centers across China from January 2008 to January 2010. The clinical variables included the 12-lead ECG and Troponin I levels after surgery. The combined outcome was defined as all the perioperative MACE in hospital. The risk factors of MACE and their indexes were analyzed with univariate analysis and multivariable logistic regression in SPSS software,together with a risk scoring and stratification system established.</p><p><b>RESULTS</b>Perioperative MACE occurred in 11.94% of elderly CHD patients undergoing non-cardiac surgery. Seven independent risk factors of perioperative MACE for this population were identified,which included angina within 6 months (P=0.001), hypertension(P=0.014), preoperative haematocrit (HCT) <40% (P=0.050), serum creatinine (Scr)>150 mmol/L (P=0.014), ejection fraction(EF) <50% (P=0.019), intraoperative hyoxemia (P=0.019), and operative time>150 min (P=0.001). The risk indexes of these factors were 4,3,3,6,4,5, and 4, respectively. The rate of perioperative MACE increased significantly as the level of risk stratification elevated.</p><p><b>CONCLUSIONS</b>Elderly CHD patients undergoing non-cardiac surgery are at high risk of perioperative MACE. Angina within 6 months,hypertension, preoperative HCT<40%, Scr>150 mmol/L, EF<50%, intraoperative hyoxemia, and operative time>150 min can increase the risk of MACE. The risk scoring and stratification system based on the risk factor index can be a valuable parameter for assessing the perioperative cardiac risk of noncardiac surgery for elderly CHD patients.</p>

Risk factors for perioperative major cardiac events in Chinese elderly patients with coronary heart disease undergoing noncardiac surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Few studies have investigated perioperative major adverse cardiac events (MACEs) in elderly Chinese patients with coronary heart disease (CHD) undergoing noncardiac surgery. This study examined the incidence and risk factors for perioperative MACE in elderly patients who underwent noncardiac surgery, and established a risk stratification system.</p><p><b>METHODS</b>This retrospective observational clinical study included 482 patients aged ≥60 years with CHD who underwent elective major noncardiac surgery at the Peking Union Medical College Hospital. The primary outcome was MACE within 30 days after surgery. Risk factors were evaluated using multivariate Logistic regression analysis.</p><p><b>RESULTS</b>Perioperative MACE occurred in 61(12.66%) of the study patients. Five independent risk factors for perioperative MACE were identified: history of heart failure, preoperative arrhythmia, preoperative diastolic blood pressure ≤75 mmHg, American Society of Anesthesiologists grade 3 or higher, and intraoperative blood transfusion. The area under the receiver operating characteristic curve for the risk-index score was 0.710±0.037. Analysis of the risk stratification system showed that the incidence of perioperative MACE increased significantly with increasing levels of risk.</p><p><b>CONCLUSIONS</b>Elderly Chinese patients with CHD who undergo noncardiac surgery have a high risk of perioperative MACE. Five independent risk factors for perioperative MACE were identified. Our risk stratification system may be useful for assessing perioperative cardiac risk in elderly patients undergoing noncardiac surgery.</p>

A life-skills-based HIV/AIDS prevention education for rural students of primary schools in China: what changed? What have we learned? / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To evaluate a four-hour life-skills-based HIV/AIDS prevention curriculum among 5th grade students in rural primary schools of Hainan province.</p><p><b>METHODS</b>The study included two stages. Stage one (September 2006-May 2007) was a pre-post-quasi experimental design; a total of 2,413 students aged 9 to 14 years from fifth grade classes of nine primary schools completed a baseline survey (1,720 students were in the intervention group, 693 in the control group), and over 98% of them took part in a short survey. The experimental curriculum was provided to the intervention group. At stage two (September 2008), a cross-sectional questionnaire was administered to 6,923 students in 7th grade classes of eight middle schools in the same study sites. There were 1,437 students in the intervention group when the curriculum was conducted.</p><p><b>RESULTS</b>Students tended to score higher in areas of HIV/AIDS related knowledge and attitudes, if they were younger than average, lived in the county seat, had access to the internet, and their parents had completed higher levels of education. Path analysis showed that, after controlling for characteristics such as family and community factors, the total effects of curriculum on knowledge in the short-term model increased remarkably compared with the baseline, and maintained major contributions to knowledge in the mid-term model. The positive effect of knowledge on attitudes was significantly improved in the short-term model as well.</p><p><b>CONCLUSION</b>A life-skills based curriculum can improve HIV/AIDS related knowledge and self-perceived level of life-skills among primary school students in rural areas in a short time, and these positive effects can still be observed at least 2 years post participation in the curriculum.</p>

Study on the relations between smoking and the risk of age-specific lung cancer deaths in urban and rural areas of China / 中华流行病学杂志

y increased. Control of smoking prevalence should play a vital role in the prevention of the lung cancer death risks in China.