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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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OBJECTIVE@#To explore the risk factors for recurrence in first-episode ischemic stroke survivors and establish a model for predicting stroke recurrence using a nomogram.@*METHODS@#We collected the data from a total of 821 first-episode ischemic stroke survivors admitted in the Department of Neurology, West China Hospital, Sichuan University from January, 2010 to December, 2018. R software was used for random sampling of the patients, and 70% of the patients were included in the training set to establish the prediction model and 30% were included in the validation set. Cox proportional risk regression model was used to analyze the factors affecting stroke recurrence, and R software rms package was used to construct the histogram and establish the visual prediction model. C-index and calibration curve were used to evaluate the performance of the model for predicting stroke occurrence.@*RESULTS@#Among the 821 survivors, the recurrence rate was 16.81% at 3 years and 19.98% at 5 years. Multivariate analysis of the training set by Cox regression model showed that an age over 65 years (HR= 2.596, P=0.024), an age of 45-64 years (HR=2.510, P=0.006), a mRS score beyond 3 (HR=2.284, P=0.004) and a history of coronary heart disease (HR=1.353, P=0.034) were all risk factors for stroke recurrence. The C-indexes of the nomogram for the 3-and 5-year relapse prediction model were 0.640 and 0.671, respectively.@*CONCLUSION@#Age, mRS score and peripheral vascular disease are the factors affecting stroke recurrence in first-episode ischemic stroke survivors, and the nomogram has a high discrimination and predictive power for predicting ischemic stroke recurrence.
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Aged , Humans , Middle Aged , Ischemic Stroke , Nomograms , Prognosis , Proportional Hazards Models , Retrospective Studies , Risk Factors , StrokeABSTRACT
Objective:To construct the prediction model of death risk of Stanford type A aortic dissection (AAD) based on Cox proportional risk regression model.Methods:AAD patients who were diagnosed and received surgical treatment admitted to the department of cardiothoracic surgery of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 1st, 2019 to April 30th, 2020 were enrolled. The general situation, clinical manifestations, pre-hospital data, laboratory examination and imaging examination results of the patients were collected. The observation period was up to the death of the patients or ended on April 30th, 2021. They were divided into the model group and the verification group according to the ratio of 7∶3. Lasso method was used to screen prognostic variables from the data of the modeling group, and multivariate Cox regression analysis was included to construct the AAD death risk prediction model, which was displayed by nomogram. The receiver operator characteristic curve (ROC curve) was used to evaluate the discrimination of the model, the calibration curve to evaluate the accuracy of the model, and the clinical decision curve (DCA) to evaluate the effectiveness of the model.Results:A totel of 454 patients with AAD were finally included, and the mortality was 19.4% (88/454). Lasso regression analysis was used to screen out 10 variables from the data of 317 patients in the model group, and the prediction model of death risk was constructed: 0.511×abdominal pain+1.061×syncope+0.428×lower limb pain/numbness-0.365×emergency admission-1.933×direct admission-1.493×diagnosis before referral+0.662×preoperative systolic blood pressure (SBP) < 100 mmHg (1 mmHg = 0.133 kPa)+0.632×hypersensitivity cardiac troponin I (hs-cTnI) > 34.2 ng/L+1.402×De Bakey type+0.641× pulmonary infection+1.472×postoperative delirium. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) of the AAD death risk prediction model were 0.873 (0.817-0.928), and that of the verification group was 0.828 (0.740-0.916). DCA showed that the net benefit value of the model was higher. The calibration curve showed that there was a good correlation between the actual observation results and the model prediction results. Conclusion:The AAD death risk prediction model based on abdominal pain, syncope, lower limb pain/numbness, mode of admission, diagnosis before referral, preoperative SBP < 100 mmHg, hs-cTnI > 34.2 ng/L, De Bakey type , pulmonary infection, and postoperative delirium can effectively help clinicians identify patients at high risk for AAD, evaluate their postoperative survival and timely adjust treatment strategies.
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@#[Abstract] Objective: To investigate the expression of miR-191 in cervical cancer tissues and its effect on the patients' prognosis. Methods: One hundred and seven cervical cancer tissue specimens from patients who underwent surgical treatment and 46 normal cervical tissue specimens from patients who underwent surgical resection of uterine fibroids (the control group) in Xinxiang Central Hospital were collected from December 2012 to December 2014. The expression of miR-191 in cancer tissues was detected by qPCR. All patients were followed up from the first day after surgery, and the follow-up deadline was December 31, 2019. All patients were followed up for 5 years, with death as the end event. The survival time and 5-year survival rate of the patients were recorded. Survival analysis was performed using Kaplan-Meier method and the factors affecting survival prognosis were analyzed using Cox proportional hazard regression model. Results: The expression level of miR-191 in cervical cancer tissues was significantly higher than that in the tissues from control group (P<0.01). There were significant differences in miR-191 expression among patients with different high-risk HPV infection status, different pathological grades and FIGO stages, and different lymph node metastasis status (all P<0.01). The 5-year survival rate of patients in the miR-191 low expression group was significantly higher than those patients in the high expression group (81.48% vs 33.75%, χ 2 =16.905, P<0.01). Pathological grade, FIGO stage, lymph node metastasis and the expression of miR-191 were risk factors affecting the prognosis of cervical cancer patients (HR=0.486, 3.065, 2.339 and 2.755, all P<0.05). Conclusion: miR-191 is highly expressed in cervical cancer tissues, and its expression level increases with the progression of malignancy. It is expected to become a potential biomarker for early diagnosis and prognosis evaluation of cervical cancer.
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Objective To investigate the associated factors of complete virological response (CVR) in Entecavir treatment among chronic hepatitis B (CHB) patients with positive HBeAg.Methods Data of 166 CHB patients with positive HBeAg receiving Entecavir treatment in Yantai Infectious Diseases Hospital during December 2009 and May 2014 were collected.Clinical data including age,gender,genotype,baseline alanine aminotransferase (ALT),HBV DNA load,HBsAg and HBeAg levels as well as CVR cumulative rates at different time points during Entecavir treatment were retrospectively analyzed.The cumulative rate of CVR was estimated using Kaplan-Meier method,and the difference in cumulative CVR rates was studied with Log-rank test.Cox's proportional hazards regression model was used to analyze the factors associated with CVR during Entecavir treatment.Results The cumulative rates of CVR during Entecavir treatment in HBeAg positive CHB patients were 54.5％ (87/157),74.3％ (106/129),80.2％ (109/119) and 86.8％ (110/112) at 48,96,144 and 192 weeks,respectively.Log-rank test showed that female patients and patients with genotype B,high baseline ALT level or low baseline HBV DNA load had higher CVR rates (x2 =15.601,11.542,17.021 and 10.094,all P ＜ 0.01).Cox's proportional hazards regression model showed that female was the only associated factor for CVR in Entecavir treatment among HBeAg positive CHB patients [hazard ratio (HR) =3.015,95％ confidence interval (CI):1.875-4.968,P ＜ 0.01].Conclusion CVR rate is increasing with the course of Entecavir treatment in HBeAg positive CHB patients,and CVR is more likely to occur in female patients.
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Objective To explore the recovery time of hepatic function in infants with jaundice type of human cytomega-lovirus (HCMV) hepatitis and its influencing factors. Methods The clinical data of 73 infants with jaundice type of HCMV hepa-titis admitted to hospital from February 2005 to October 2012 were retrospectively analyzed. The effects on hepatic function of nine factors including age, sex, liver size, total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), aspar-tate aminotransferase (AST), total bile acid (TBA) and the loads of HCMV DNA were assessed by Kaplan Meier method, and further analyzed by Cox proportional hazards regression model. Results The results of Cox proportional hazards regression showed that age≤3 month (RR=0.27, 95%CI:0.10-0.70), DBil≤90μmol/L (RR=0.16, 95%CI:0.08-0.32), male (RR=0.49, 95%CI:0.26-0.94) and enlarged liver size<3 cm (RR=0.50, 95%CI:0.27-0.93) were independent factors that shorten the time for TBil back to be normal. Furthermore, AST≤120 U/L (RR=0.16, 95%CI:0.08-0.33) and enlarged liver size<3 cm (RR=0.28, 95%CI:0.15-0.49) were independent factors that shorten the time for AST back to be normal. The time for TBil back to be normal was (2.23 ± 1.54) months, which was significantly shorter than that [(3.63 ± 1.93) months] of AST (t=10.37, P<0.001). Conclusions Jaundice type HCMV hepatitis had good outcome and varied in disease course. The recovery of hepatic function was significantly adversely affected by the degree of cholestasis and hepatomegaly as well as AST level, and early treatment was conducive to the recovery.
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Objective: To identify the clinical features and prognostic factors in relation to extremity osteosarcoma with pathological fracture. Methods: The clinical data from 244 patients with extremity osteosarcoma between October 2003 and October 2011 were retrospectively reviewed. These patients were divided into two groups: patients with pathological fracture group and the patients without pathological fracture group. The differences in the clinical features of the two groups were analyzed. The survival analysis was performed using Kaplan-Meier method. For patients with pathological fracture, a univariate analysis (log-rank) was used to determine the prognostic factors related to the survival, and a COX proportional hazards regression model was used to identify the independent prognostic factors. Results: A higher proportion of patients with larger tumor size (P = 0.012), humeral osteosarcoma (P = 0.004) or local recurrence (P = 0.002) was observed in patients with pathological fracture. Additionally, more patients with pathological fracture received an amputation surgery, as compared with patients without pathological fracture (P = 0.032). The median survival time of patients with pathological fracture was significantly shorter than that of patients without pathological fracture (16 vs 21 months, P = 0.006). The univariate analysis showed that the significant prognosis-related factors were the tumor size, Enneking's surgical staging, KPS (Karnofsky performance status) score, cycles of adjuvant chemotherapy, local recurrence and metastasis (P < 0.05). The multivariate analysis revealed that the factors of KPS score, cycles of adjuvant chemotherapy and metastasis were the independent prognostic factors of extremity osteosarcoma with pathological fracture. Conclusion: Compared with the patients without pathological fracture, a higher proportion of patients receiving amputation surgery or having larger tumor size, humeral osteosarcoma or local recurrence was observed in patients with pathological fracture, and the prognosis of these patients was poor. The KPS score, cycles of adjuvant chemotherapy and metastasis were independent prognostic factors of extremity osteosarcoma with pathological fracture. Copyright © 2012 by TUMOR.