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BACKGROUND@#Family clustering of esophageal cancer (EC) has been found in high-risk areas of China. However, the relationships between cancer family history and esophageal cancer and precancerous lesions (ECPL) have not been comprehensively reported in recent years. This study aimed to provide evidence for identification of high-risk populations.@*METHODS@#This study was conducted in five high-risk areas in China from 2017 to 2019, based on the National Cohort of Esophageal Cancer. The permanent residents aged 40 to 69 years were examined by endoscopy, and pathological examination was performed for suspicious lesions. Information on demographic characteristics, environmental factors, and cancer family history was collected. Unconditional logistic regression was applied to evaluate odds ratios between family history related factors and ECPL.@*RESULTS@#Among 33,008 participants, 6143 (18.61%) reported positive family history of EC. The proportion of positive family history varied significantly among high-risk areas. After adjusting for risk factors, participants with a family history of positive cancer, gastric and esophageal cancer or EC had 1.49-fold (95% confidence interval [CI]: 1.36-1.62), 1.52-fold (95% CI: 1.38-1.67), or 1.66-fold (95% CI: 1.50-1.84) higher risks of ECPL, respectively. Participants with single or multiple first-degree relatives (FDR) of positive EC history had 1.65-fold (95% CI: 1.47-1.84) or 1.93-fold (95% CI: 1.46-2.54) higher risks of ECPL. Participants with FDRs who developed EC before 35, 45, and 50 years of age had 4.05-fold (95% CI: 1.30-12.65), 2.11-fold (95% CI: 1.37-3.25), and 1.91-fold (95% CI: 1.44-2.54) higher risks of ECPL, respectively.@*CONCLUSIONS@#Participants with positive family history of EC had significantly higher risk of ECPL. This risk increased with the number of EC positive FDRs and EC family history of early onset. Distinctive genetic risk factors of the population in high-risk areas of China require further investigation.@*TRIAL REGISTRATION@#ChiCTR-EOC-17010553.
Subject(s)
Humans , Case-Control Studies , China/epidemiology , Esophageal Neoplasms/pathology , Precancerous Conditions/pathology , Risk Factors , Stomach NeoplasmsABSTRACT
In the emergency department, open endotracheal suctioning for mechanically ventilated patients with endotracheal intubation will lead to the spread of respiratory droplets and aerosols, polluting the surrounding environment and medical staff. The traditional heat-and-moisture exchanger has the effect of warming and humidifying, and can block pathogenic microorganisms, but it does not have the function of inserting a sputum suction tube. When the heat-and-moisture exchanger is pulled out for sputum suction, it is easy to cause sputum splash, which pollutes the surrounding environment and medical personnel. The addition of closed sputum suction devices will increase the economic burden on patients. Thus, the medical staff of emergency department of the First People's Hospital of Tongxiang City of Zhejiang Province designed a new type of heat-and-moisture exchanger with anti-splash sputum suctioning function and obtained the National Utility Model Patent of China (ZL 2021 2 0017615.0). The new heat-and-moisture exchanger is mainly composed of a receiving cavity, a connecting tube, a sputum suction tube intubation tube, a sealing valve, etc. The disposable sputum suction tube can be used to insert sputum suction, and at the same time, it can prevent the secretion from splashing to ensure sealing. The patent combines the humidification and pathogen blocking functions of the heat-and-moisture exchanger with the anti-splash sputum suctioning function, which is suitable for use in the emergency and critical care medicine departments and has clinically practical value.
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Objective:To compare the biomechanical properties of dynamic hip screw (DHS), traditional cannulated compression screw (CCS) configuration, traditional CCS configuration+medial locking plate and compression buttress screw (CBS) in the treatment of femoral neck fracture by finite element analyses.Methods:A simulation model of Pauwels type Ⅲ femoral neck fracture with discontinuous medial cortex was established by the finite element method. The maximum displacement, maximum principal stress, normal form equivalent stress, hip varus angle and fracture end stress were compared between DHS (group A), traditional CCS configuration (group B), traditional CCS configuration+medial locking plate (group C) and CBS (group D) in the simulation model.Results:In the internal fixation model in groups A, B, C and D, respectively, the maximum displacement of the femur was 0.41 mm, 2.04 mm, 0.94 mm and 0.30 mm; the maximum displacement of internal fixation 0.34 mm, 1.18 mm, 0.84 mm and 0.22 mm; the peak normal form stress of internal fixation 83.6 MPa, 231.4 MPa, 259.8 MPa and 194.8 MPa; the maximum principal stress of internal fixation 52.3 MPa, 216.3 MPa, 151.7 MPa and 74.6 MPa; the maximum normal form stress of the femur 101.1 MPa, 282.3 MPa, 100.5 MPa and 181.2 MPa; the maximum principal stress 99.7 MPa, 201.0 MPa, 60.9 MPa and 56.1 MPa; the axis angle of the femoral neck after loading 179.55°, 176.97°, 179.66° and 179.64°; the normal form equivalent stress at the fracture end ranged from 42.0 to 50.0 MPa, from 258.7 to 282.3 MPa, from 50.8 to 58.1 MPa, and from 45.3 to 60.4 MPa.Conclusion:Considering stability, stress distribution and prevention of hip varus and femoral neck shortening, CBS may be a choice treatment for femoral neck fracture because it is comparable to DHS in mechanical stability.
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Objective:To compare the complications in young adults with femoral neck fracture after internal fixation with compression buttress screws (CBS) versus 3 parallel partially threaded cannulated screws (PTS).Methods:A prospective study was conducted of the 120 young adults with femoral neck fracture who had been treated from July 2016 to December 2017 at Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital. Of them, 60 were subjected to PTS fixation (control group) and 60 to CBS fixation (observation group) according to their will. In the control group, there were 38 males and 22 females with an age of (46.1±7.6) years, and 17 cases of types Ⅰ-Ⅱ and 43 cases of type Ⅲ by the modified Pauwels classification; in the observation group, there were 42 males and 18 females with an age of (44.8±8.1) years, and 11 cases of types Ⅰ-Ⅱ and 49 cases of type Ⅲ. The 2 groups were compared in postoperative complications. A stratified analysis was performed according to the modified Pauwels classification.Results:Comparability was indicated between the 2 groups because there was no significant difference in their baseline demographic information ( P>0.05). The incidences of fixation failure (8.3%, 5/60), nonunion (5.0%, 3/60), femoral neck shortening<10 mm(10.0%, 6/60) and lateral withdrawal (11.7%, 7/60) in the observation group were significantly lower than those in the control group [38.3% (23/60), 28.3% (17/60), 41.7% (25/60) and 71.7% (43/60), respectively] ( P<0.05). There was no significant difference in the incidence of avascular necrosis of the femoral head or of medial migration between the 2 groups ( P>0.05). The stratified analysis showed that the incidences of fixation failure and nonunion in the observation group were significantly lower than in the control group for fractures of the modified Pauwels type Ⅲ ( P<0.05). The incidences of femoral neck shortening<10 mm and fixation loosening in the control group were significantly higher than in the observation group for fractures of all the modified Pauwels types ( P<0.05). Conclusion:Compared with conventional PTS fixation, CBS fixation can significantly reduce postoperative complications in young adults with femoral neck fracture, especially those with high energy fracture of the modified Pauwels type Ⅲ.
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The medical literature contains a wealth of valuable medical knowledge. At present, the research on extraction of entity relationship in medical literature has made great progress, but with the exponential increase in the number of medical literature, the annotation of medical text has become a big problem. In order to solve the problem of manual annotation time such as consuming and heavy workload, a remote monitoring annotation method is proposed, but this method will introduce a lot of noise. In this paper, a novel neural network structure based on convolutional neural network is proposed, which can solve a large number of noise problems. The model can use the multi-window convolutional neural network to automatically extract sentence features. After the sentence vectors are obtained, the sentences that are effective to the real relationship are selected through the attention mechanism. In particular, an entity type (ET) embedding method is proposed for relationship classification by adding entity type characteristics. The attention mechanism at sentence level is proposed for relation extraction in allusion to the unavoidable labeling errors in training texts. We conducted an experiment using 968 medical references on diabetes, and the results showed that compared with the baseline model, the present model achieved good results in the medical literature, and F1-score reached 93.15%. Finally, the extracted 11 types of relationships were stored as triples, and these triples were used to create a medical map of complex relationships with 33 347 nodes and 43 686 relationship edges. Experimental results show that the algorithm used in this paper is superior to the optimal reference system for relationship extraction.
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Humans , Algorithms , China , Diabetes Mellitus , Electronic Health Records , Neural Networks, ComputerABSTRACT
Objective@#To investigate the differences of clinicopathological features, diagnosis, treatment and prognosis between patients with extra-gastrointestinal stromal tumors (EGIST) and duodenal gastrointestinal stromal tumors (DGIST).@*Methods@#A retrospective case - control study was performed. Case inclusion criteria: (1) tumor confirmed by histology and pathology; (2) primary tumor locating in the extra - gastrointestinal tract or duodenum; (3) without other synchronous tumors; (4) complete clinical and pathological data. Clinical data of 20 EGIST patients and 32 DGIST patients from March 2011 to September 2016 at Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine were retrospectively collected and analyzed. The observational parameters included clinicopathological characteristics, treatment and prognosis conditions. Continuous data of abnormal distribution were expressed as median (range) and compared using the Mann-Whitney U-test. Survival curves were drawn by the Kaplan-Meier method and compared with the Log-rank test.@*Results@#Of the 20 EGIST patients, 8 were males and 12 were females with age of 61.0 (30.0 to 86.0) years and of the 32 DGIST patients, 12 were males and 20 were females with age of 55.5 (27.0 to 70.0) years. Compared with DGIST patients, EGIST patients were older (U=188.000, P=0.012], had larger tumor size [10.0 (3.0 to 29.0) cm vs. 4.0 (1.5 to 10.0) cm, U=98.500, P<0.001] and higher ratio of high risk classification [85.0% (17/20) vs. 12.5% (4/32), χ2=26.870, P<0.001]. Among the 20 EGIST patients, 5 were diagnosed with distal metastasis and received imatinib (400 mg/d), and the other 15 patients underwent radical resection who were included in survival analysis. All the 32 DGIST patients underwent radical resection. The median follow-up of whole group was 43 (14 to 76) months. The 3-year recurrence/metastasis-free survival rate of 15 cases undergoing radical resection in the EGIST group was 85.6%, which was lower than that of the DGIST group (88.6%), and the difference was not statistically significant (P=0.745). There was no significant difference in the 3-year overall survival rate between the EGIST group (92.9%) and the DGIST group (100%) (P=0.271).@*Conclusions@#As compared to DGIST, EGIST mostly occurs in those with older age, larger tumor size and higher risk grade. The prognosis of EGIST patients after radical resection is similar to that of DGIST patients.
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Objective To evaluate the clinical efficacy of single plate,double plates,and intramedullary nail in treating medial cortical comminuted fractures of the medial distal femur.Methods A retrospective case control study was conducted on 63 cases of medial cortical comminuted fractures of the medial distal femur treated from November 2011 through October 2016.According to the type of internal fixation,19 cases of middle and distal shaft fractures were divided into the single plate group (n =11) comprising four males and seven females,aged averagely 57.5 years,and intramedullary nail group (n =8) comprising five males and three females,aged averagely 56.4 years.Forty-four cases of distal femoral fractures were divided into the single plate group (n =14) comprising six males and eight females,aged averagely 57.6 years,intramedullary nail group (n =9) comprising five males and four females,aged averagely 56.6 years,and double plates group (n =21) comprising 14 males and seven females,aged averagely 55.1 years.The rate and period of racture healing,distal femoral valgus resection (DFVR),femoral angle,change of DFVR and femoral angle,and complications were compared within and between groups.Results All the cases were followed up for 6-37 months (mean,13.4 months).Of 19 cases of middle and distal shaft fractures,there were no statistically significant differences in fracture healing rate and period,DFVR after operation and at the last follow-up,and the amount of change of DFVR between the single plate and double plates group (P ＞ 0.05).With respect to postoperative complications of the two groups,no significant difference was found for the rate of nonunion,infection,internal fixation failure,and mal union (P ＞ 0.05).However,the incidence rate of adverse events in single plate group (46％) was significantly higher than that in intramedullary nail group (0) (P ＜0.05).Of the 44 cases of distal femoral fractures,the pairwise comparisons among three groups showed no statistically significant differences in fracture healing rate,healing period,and the post operative femoral angle (P ＞ 0.05).The femoral angle at the last follow-up in intramcdullary nail group was (80.80 ± 2.93) °,significantly lower than (85.28 ± 5.89) ° in single plate group and (83.55 ± 3.51) ° in double plates group (P ＜ 0.05).Within the intramedullary nail group,no significant difference was found between the femoral angle immediately after operation and at the last follow-up (P ＞ 0.05),but significant difference was detected in both single plate group and double plates group (P ＜ 0.05).The amount of change of the femoral angle in intramedullary nail group [(0.25 ± 1.95) °] was significantly lower than (4.03 ± 3.78) ° in single plate group and (2.60 ± 2.24) ° in double plates group (P ＜ 0.05).With respect to post operative complications in the three groups,no significant difference was found for the rate of nonunion,infection,internal fixation failure,and malunion (P ＞ 0.05).The malunion rate in single plate group (36％) was significantly higher than that in double plates group (14％).The incidence rate of adverse events in single plate group (50％) was significantly higher than that in double plates group (14％) (P ＜ 0.05).Conclusions Three internal fixations have similar clinical results in fracture healing rate and period.For medial cortical comminuted middle and distal shaft fractures,and distal femoral fractures without involving articular surface,intramedullary nail has better results than locking plate.For medial cortical comminuted distal femoral fractures involving articular surface,double plates fixation might be a better option.