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ObjectiveTo develop and validate a predictive risk model for vision-threatening diabetic retinopathy in patients with type 2 diabetes using readily accessible clinical data， which may provide a convenient and effective prediction tool for early identification and referral of at-risk populations. MethodsA nomogram model was developed using a dataset obtained from patients with T2DM who participated in the Guangzhou Diabetic Eye Study from November 2017 to December 2020. Logistic regression was used to construct the model， and model performance was evaluated using receiver operating characteristic curve， Hosmer-Lemeshow test， calibration curve and decision curve analysis. The model underwent internal validation through the mean AUC of k-fold cross-validation method， and further external validation was conducted in the Dongguan Eye Study. ResultsA total of 2 161 individuals were included in the model development dataset， of whom 135 （6.25%） people were diagnosed with VTDR. Age （P＜0.001，OR=0.927，95%CI：0.898~0.957） and body mass index （P＜0.001，OR =0.845，95%CI：0.821~0.932） were found to be negatively correlated with VTDR， whereas diabetes duration （P＜0.001，OR=1.064，95%CI：1.035~1.094）， insulin use （P =0.045，OR =1.534，95%CI：1.010~2.332）， systolic blood pressure （P＜0.001，OR =1.019，95%CI：1.008~1.029）， glycated hemoglobin （P＜0.001，OR =1.484，95%CI：1.341~1.643）， and serum creatinine （P＜0.001，OR =1.017，95%CI：1.010~1.023） were positively correlated with VTDR. All these variables were included in the model as predictors. The model showed strong discrimination in the development dataset with an area under the receiver operating characteristic curve （AUC） of 0.797 and in the external validation dataset （AUC 0.762）. The Hosmer-Lemeshow test（P＞0.05）and the calibration curve displayed good agreement. Decision curve analysis showed that the nomogram produced net benefit in the two datasets. ConclusionsIndependent factors influencing VTDR include age， duration of diabetes mellitus， insulin use， body mass index， systolic blood pressure， glycosylated hemoglobin， and serum creatinine. The nomogram constructed using these variables demonstrates a high degree of predictive validity. The model can serve as a valuable tool for early detection and referral of VTDR in primary care clinics. Therefore， its application and promotion are highly recommended.
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OBJECTIVE: Choice of hysterectomy and adjuvant treatment for International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrioid endometrial cancer (EEC) is still controversial. Aims of this study were to evaluate survival benefits and adverse effects of different hysterectomies with or without adjuvant radiotherapy (RT), and to identify prognostic factors. METHODS: The patients at 14 member hospitals of the Taiwanese Gynecologic Oncology Group from 1992 to 2013 were retrospectively investigated. Patients were divided into simple hysterectomy (SH) alone, SH with RT, radical hysterectomy (RH) alone, and RH with RT groups. Endpoints were recurrence-free survival (RFS), overall survival (OS), disease-specific survival (DSS), adverse effects and prognostic factors for survival. RESULTS: Total of 246 patients were enrolled. The 5-year RFS, OS, DSS and recurrence rates for the entire cohort were 89.5%, 94.3%, 96.2% and 10.2%, respectively. Patients receiving RH had more adverse effects including blood loss (p < 0.001), recurrent urinary tract infections (p = 0.013), and leg lymphedema (p = 0.038). Age over 50-year (HR = 9.2; 95% confidence interval [CI], 1.2–70.9) and grade 3 histology (HR = 7.28; 95% CI, 1.45–36.6) were independent predictors of OS. Grade 3 histology was an independent predictor of RFS (HR = 5.13; 95% CI, 1.38–19.1) and DSS (HR = 5.97; 95% CI, 1.06–58.7). Patients receiving adjuvant RT had lower locoregional recurrence (p = 0.046), but no impact on survival. CONCLUSION: Different treatment modalities yield similar survival outcomes. Patients receiving SH with RT had lower locoregional recurrent with acceptable morbidity. Age and tumor grading remained significant predictors for survival among patients with FIGO 2009 stage II EEC.
Subject(s)
Female , Humans , Cohort Studies , Endometrial Neoplasms , European Union , Gynecology , Hysterectomy , Leg , Lymphedema , Neoplasm Grading , Obstetrics , Radiotherapy , Radiotherapy, Adjuvant , Recurrence , Retrospective Studies , Urinary Tract Infections , Uterine NeoplasmsABSTRACT
Objective To investigate the value of adenosine triphosphate(ATP)bioluminescence assay for assessing object surface contamination degree in intensive care unit(ICU).Methods 30 groups of high frequency contact object(including ventilator panel,bedside table and computer keyboard)in ICU from January to December 2016 were enrolled for the study. Each object was sampled and evaluated before and after disinfection,and their surface was divided into two areas,whose sur-face contamination degree was evaluated by ATP bioluminescence assay and bacterial culture method that were classified as ATP group and control group.The fluorescence detection value and colony number were compared between two groups be-fore and after disinfection.The correlation between the fluorescence detection value and colony number was analyzed by Pearson correlation in the same sample,and the Kappa consistency test was used for the qualification rates of two detections. Results ①The fluorescence detection value and colony number of ventilator panel,bedside table and computer keyboard af-ter disinfection in two groups were significantly lower than that before disinfection(t=8.107~26.393,all P<0.05).②Pearson analysis result showed that both before and after disinfection,the fluorescence detection value had no significant cor-relation with colony number of ventilator panel,bedside table and computer keyboard(r=0.199~0.338,all P>0.05).③There were no significant differences in the qualification rate between two groups of ventilator panel,bedside table and com-puter keyboard before and after disinfection(χ2=0.000~1.404,all P>0.05).The qualification rate before the disinfection of ATP group and control group were 0 and 8.9%,and that after disinfection were 86.7% and 91.1%,whose Kappa consis-tency test result showed that the Kappa value was 0.776(95%CI:0.575~0.978)>0.75,so the consistency was quite sat-isfied.Conclusion ATP bioluminescence assay could be used as a rapid and handy preliminary screening to assist bacterial culture method to evaluate the object surface contamination in ICU,and the result was satisfactory and it would be worthy of clinical application.
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AIM: To evaluate the effect of orthokeratology on progression of juvenile myopia and analysis its influencing factors.METHODS: Totally 97 patients (189 eyes,aging from 8 to 17 years old) who received orthokeratology lenses treatment in our hospital from January 2012 to December 2014,were followed up for 2a.The visual acuity,corneal curvature,diopter,and ocular axial length were observed.Factors of influencing myopia progress in juvenile were analyzed.RESULTS: At 1mo after receiving orthokeratology contact lenses,the visual acuity and corneal curvature were changed compared with that of before(P<0.001).After 2a of receiving orthokeratology contact lenses,the difference was significant compared with baseline: spherical equivalence (-0.51±0.64D,t=10.864,P<0.001),axial length(0.33±0.31mm,t=14.879,P<0.001),corneal astigmatism (-0.25±0.43D,t=5.375,P<0.001).Statistic analysis showed that there was a negative correlation between the spherical equivalence and age,baseline of diopter or ocular axial length(P<0.05).CONCLUSION: Orthokeratology can effectively improve the visual acuity of patients.Although there is slightly progression in diopter and ocular length after 2a of wearing orthokeratology contact lenses.Orthokeratology is an effective treatment on controlling progression of juvenile myopia,especially in the elder children who with the longer basic axial length and the greater diopter.
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OBJECTIVE: The malignant transformation (MT) of ovarian mature cystic teratoma (MCT) to squamous cell carcinoma (SCC) is very rare. This study analyzed cases from multiple medical centers in Taiwan to investigate the clinicopathologic characteristics, treatment, and prognostic factors of this disease and reviewed related literature. METHODS: Pathological reports of 16,001 patients with primary ovarian cancer who were treated at Taiwan medical centers from 1990 to 2011 were reviewed. In total, 52 patients with MT of MCT to SCC were identified. RESULTS: Among all ovarian MCTs, the incidence of MT to SCC is 0.2%. The median age of patients was 52 years (range, 29–89 years), and the mean tumor size was 10.5 cm (range, 1–40 cm). We analyzed the patients in our study and those in the literature and determined that early identification and complete surgical resection of the tumor are essential for long-term survival. In addition, adjuvant chemotherapy or concurrent chemoradiotherapy can be used to treat this malignancy. Old age, large tumor size (≥15.0 cm), and solid components in MCTs are suitable indicators predicting the risk of MT of MCT to SCC. CONCLUSION: Similar to general epithelial ovarian cancers, the early detection of MT of MCT to SCC is critical to long-term survival. Therefore, older patients with a large tumor or those with a tumor containing a solid component in a clinically diagnosed MCT should be evaluated to exclude potential MT to SCC.
Subject(s)
Humans , Carcinoma, Squamous Cell , Cell Transformation, Neoplastic , Chemoradiotherapy , Chemotherapy, Adjuvant , Epithelial Cells , Incidence , Ovarian Neoplasms , Taiwan , TeratomaABSTRACT
OBJECTIVE: To evaluate the clinical outcome and parameters related to coexisting endometrial carcinoma in women with tissue-diagnosed endometrial hyperplasia. METHODS: Between January 1991 and December 2009, three hundred and eighty-six patients with the presumptive diagnosis of endometrial hyperplasia were retrieved. Among these, one hundred and twenty-five patients were identified as having coexisting endometrial carcinoma in hysterectomy specimens. The three hundred and eighty-six patients were divided into two groups: the hyperplasia-benign group (261 cases) and the hyperplasia-malignant group (125 cases). Several clinical parameters including age, menopausal status, history of abnormal uterine bleeding, obstetrical history, medical history of diabetes and hypertension, BMI, and preoperative pathologic results were investigated. RESULTS: Age > or =53 (odds ratio [OR], 2.40; 95% confidence interval [CI], 1.26 to 4.57), menopausal status (OR, 2.07; 95% CI, 1.14 to 3.76), diabetes history (OR, 7.33; 95% CI, 2.79 to 19.26), abnormal uterine bleeding (OR, 3.99; 95% CI, 1.22 to 13.02), atypical endometrial hyperplasia (OR, 7.38; 95% CI, 4.03 to 13.49), and body mass index > or =27 (OR, 3.24; 95% CI, 1.76 to 5.97) were independent risk factors for prediction of endometrial hyperplasia coexisting with endometrial carcinoma. The diagnostic efficacy of atypical endometrial hyperplasia to predict the endometrial hyperplasia coexisting with endometrial carcinoma was better than or similar to those of other independent factors and combinations of these factors. CONCLUSION: Coexisting malignancy should be considered when examining endometrial hyperplasia patients with the related risk factors, especially atypical endometrial hyperplasia.