Cohort studies in public health practice and their significance / 上海预防医学

Cohort studies play an important role in elucidating the association between risk factors and diseases， and are widely used in etiology research， the assessment of disease prognosis， understanding the natural history of diseases， and the surveillance following the market release of new drugs. The data produced by cohort studies possess great scientific value and can provide essential evidence for public health practice. A well-conceived scientific design is a prerequisite to conducting a cohort study， and the design should focus on aspects such as sample size， selection of exposed and non-exposed populations， follow-up procedures， outcome assessments， research duration， and the choice of analytical indicators and methods. Cohort studies have become an important way to obtain scientific evidence. Internationally renowned population-based cohorts， such as China Kadoorie biobank and the Framingham heart study cohort， have provided a wealth of scientifically valuable evidence for promoting human health. The quality of data produced by a cohort study is extremely important， and a cohort study should continuously incorporate new technologies and methods to provide objective， accurate， and reliable means to determine exposure and outcomes， as well as control for bias. Cohort studies have great potential for application and will continue to provide abundant high-quality scientific evidence for the development of strategies and measures to enhance human health.

Age-adjusted Charlson comorbidity index predicts mortality in patients with acute type A aortic dissection / 中华急诊医学杂志

Objective:To evaluate the predictive value of age-adjusted Charlson comorbidity index (ACCI) for in-hospital mortality and 1-year mortality in patients with acute type A aortic dissection (ATAAD).Methods:This was a retrospective cohort study, and the clinical data of ATAAD patients admitted to Wuhan Union Hospital from January 1, 1999 to December 31, 2018 were collected for analysis. All the patients were confirmed by computed tomography angiography or magnetic resonance imaging of the aorta and the onset time was less than 14 days. Patients who survived at discharge were followed up to obtain 1-year survival information. The ACCI score was calculated for patients based on their comorbidities and age at admission, and they were divided into three groups of 0, 1 and ≥2 according to the ACCI score. The in-hospital mortality and 1-year mortality of the three groups were compared. Logistic regression analysis was applied to determine the independent predictors for in-hospital mortality and 1-year mortality.Results:Among 1 133 ATAAD patients, 383, 357 and 393 patients had ACCI score of 0, 1, and ≥2, respectively. The in-hospital mortality and 1-year mortality of patients with ACCI score ≥2 were significantly higher than those of patients with ACCI score of 0 (25.4% vs. 17.0%, 30.0% vs. 19.6%, both P<0.05). Multivariate Logistic regression analysis showed that ACCI score ≥2 was an independent risk factor for in-hospital mortality ( OR=1.670, 95% CI: 1.176-2.370, P=0.004) and 1-year mortality ( OR=1.762, 95% CI: 1.264-2.456, P<0.001). Age (per 10-year increase) and cerebrovascular diseases were independent risk factors for in-hospital mortality and 1-year mortality, while diabetes mellitus was a protective factor for in-hospital mortality. Conclusions:ACCI can predict the in-hospital mortality and 1-year mortality of ATAAD patients, and patients with ACCI score ≥2 have a poorer prognosis.

Application of / 中南大学学报(医学版)

Small cell lung cancer belongs to neuroendocrine tumors and is the most malignant one in lung cancer. It possesses clinical features such as rapid growth, easy early metastasis, and poor prognosis. PET/CT is a molecular imaging technique that combines morphological and metabolic imaging. It has been widely used in the diagnosis, staging, treatment planning, efficacy and prognosis evaluation of tumors. This article reviews the efficacy, prognostic parameters, evaluation criteria, possible influencial factors, clinical application and value of

Advances on researches of clinical pathology and pathogenesis in patients with acute alcoholic hepatitis / 中国中西医结合急救杂志

Alcoholic hepatitis (AH) is an acute severe decompensated alcoholic liver disease (ALD), commonly occurring in heavy drinkers. The pathogenesis of AH is still not fully understood, which may be related to the interactions of multiple complex factors such as alcohol metabolism, inflammation and heredity, etc. Under the background of continuous alcoholic exposure, the pathological changes include hepatocyte steatosis, liver inflammation and fibrosis occurring in the body. This paper summarizes the recent research literatures related to the clinicopathological features, pathogenesis and prognosis evaluation of ALD to comprehensively understand the pathogenesis and pathophysiological characteristics of AH in order to provide theoretical basis for clinical diagnosis and treatment of this disease.

Study on the value of the eighth edition of AJCC staging system in evaluating the prognosis of patients with intrahepatic cholangiocarcinoma after radical resection / 中国实用外科杂志

OBJECTIVE: To explore the value of the 8 th edition of the AJCC staging system in evaluating the prognosis of patients with intrahepatic cholangiocarcinoma(ICC) after operation.METHODS: A total of 155 patients with ICC after radical resection in Eastern Hepatobiliary Surgery Hospital,Naval Military Medical University from January 2013 to December 2018 were analyzed retrospectively.All patients were staged according to the 8 th edition of the AJCC staging system.The survival rates were estimated using Kaplan-Meier methods.Multivariate analysis was assessed by Cox proportional hazards regression analysis.The predictive ability of staging systems was evaluated by receiver operating characteristic curve(ROC) and area under curve(AUC).RESULTS:(1) The follow-up rate of 155 patients was 70.3%,and the median follow-up time was 26(1-67) months.The 1-,3-,and 5-year survival rates of patients after surgery were81%,39%,and 25%,respectively.(2) The median survival time of T1 a,T1 b,T2,T3,and T4 stages was 45.5,28.8,19.1,18.9 and 16.2 months,respectively(P<0.001);The median survival time of N0 and N1 stages was 33.4 and 15.8 months,respectively(P<0.001);The median survival time of ⅠA,ⅠB,Ⅱ,Ⅲ A and Ⅲ B stages was 46.8,32.3,21.6,20.3 and 15.6 months,respectively(P<0.001).The ROC curve analysis of T stage,N stage and TNM stage indicated that the AUC were0.704,0.718 and 0.698,respectively.(3) Univariate analysis indicated that CA19-9,tumor number,vascular invasion,intraoperative blood transfusion,T stage,N stage and TNM stage were risk factors for prognosis in patients with ICC(P<0.05).Multivariate analysis indicated that the number of tumors,intraoperative blood transfusion,and N stage were independent risk factors for prognosis in patients with ICC(P<0.05).CONCLUSION: The 8 th edition of the AJCC staging system is of certain value in the evaluation of postoperative prognosis of intrahepatic cholangiocarcinoma.Multiple tumors,intraoperative blood transfusion and N stage are independent prognostic factors for ICC patients.

Application value of fetal echocardiography in diagnosis and prognosis assessment of anomalous pulmonary venous connection (APVC) / 中华超声影像学杂志

Objective To explore the application value of fetal echocardiography for the diagnosis and prognosis assessment of anomalous pulmonary venous connection (APVC),by comparing the results of prenatal diagnosis of APVC by ultrasound and follow-up.Methods Eighty-one APVC fetuses diagnosed by fetal echocardiography were followed up regularly.These results were compared with postnatal ultrasound diagnosis,operation and anatomy.The main points of methodology and differential diagnosis were summarized.Results Eighty-one APVC fetuses included 68 cases of total APVC(31 cases of supracardiac type,15 cases of intracardiac type,22 cases of infracardiac type),13 cases of Partial APVC(2 cases of supracardiac type,10 cases of intracardiac type,1 case of infracardiac type);12 cases of isolated APVC,69 cases of complex APVC(combined with other cardiovascular abnormalities);6 cases were born(4 infants of isolated APVC survived after operation,2 infants of complex APVC died),2 cases were ongoing pregnancy,71 cases were aborted (30 cases were dissected),2 cases were lost to follow-up.Conclusions Fetal echocardiography has important application value in diagnosis and prognosis assessment of APVC and the ones with other cardiovascular abnormalities.

The predictive significance of LVEF and NT-proBNP in early prognosis assess of Untypical NSTE-ACS / 实用医学杂志

Objective To investigate whether echocardiography left ventricular ejection fraction (LVEF) and NT-proBNP could be an early detective marker for patients with untypical NSTE-ACS. Methods A total of 248 ACS cases admitted to the emergency department of our hospital from January 1,2015 to June 31,2016 were retrospectively reviewed. The data included age,gender,past medical history,D-dimer,MB isoenzyme of creatine kinase(CK-MB),cardiac troponin I(cTnI),the precursor of the N-terminal pro-brain natriuretic peptide(NT-proBNP),electrocardiogram(ECG)before treatment,and the CK-MB,cTnI and LVEF,the treatment of percuta-neous coronary intervention(PCI)or thrombolytic by drugs. Survival condition and time from onset to death were recorded. According to the results of multivariate logistic regression analysis ,receiver operating characteristic curve(ROC curve)and fitting curve were drawn. The association between the LVEF and NT-proBNP before the treatment and prognosis of ACS was analyzed. Results NSTE-ACS patients with chief complaint of chest pain were less than those of STE-ACS(33.6% vs. 70.1%,P=0.003). Pre-hospital time was longer than that of STE-ACS group(67.92 ± 116.89 vs. 30.65 ± 55.59,P = 0.006). CTNI(4.37 ± 12.53 vs. 9.62 ± 18.00,P=0.011)and LVEF(53.51 ± 14.51 vs. 56.26 ± 12.30,P=0.019)were less than that of the STE-ACS group. NT-proBNP was higher than that of the STE-ACS group(2288.37 ± 4612.10 vs. 1506.84 ± 1722.51,P=0.038). mortality rates was higher than the STE-ACS group((15.3%vs. 6.8%,P=0.036). Multivariate logistic regression analysis showed that LVEF values was correlated to 28-day death(B =-0.097 ,P=0.022). The ROC curves showed that LVEF values was negative correlated with the 28-day death. However,combination of LVEF and NT-proBNP was better than single LVEF values. LVEF values was negative correlated with the NT-proBNP(r =-0.263,P=0.001), LVEF values had greater and longer survival time(B=0.401,P=0.045)but NT-proBNP was not related to surviv-al time.(B=0.00,P=0.931). Conclusion LVEF and NT-proBNP are correlated with the early risk assessment of patients with ACS,but was not correlated with the time from onset to death. The decrease in LVEF values at the early stage of NSTE-ACS may be helpful to indicate the critical condition of the ACS patients.

Application of ISS and CRAMS score for the assessment of the prognosis of patients with multiple trauma / 中华急诊医学杂志

Objective To compare the clinical value of injury severity score (ISS) and CRAMS (circulation,respiration,abdomen,motor,speech) score in the prognosis of patients with severe multiple trauma in emergency department.Methods A total of 93 severe multiple trauma patients with 69 male and 24 female and age ranged from 21 to78 years with mean age (43.4 ± 14) years admitted in the emergency department from March 2014 to December 2015 were enrolled into this study.All of them were evaluated by using ISS and CRAMS score respectively and their survival during hospitalization was observed.Then,the predictive capabilities of ISS and CRAMS score for the mortality of patients were assessed by using receiver operator characteristic (ROC) curves.Results The mean ISS was (25.59 ± 5.37) and mean CRAMS score was (6.75 ± 1.26) in 93 patients with severe multiple trauma.Compared with the survival group (n =75),the ISS in the death group (n =18) was significantly higher (t =7.13,P ＜0.01) and CRAMS score was significantly lower (t =-6.03,P ＜0.01).In the ROC curve analysis,the AUCROC of predicting mortality of multiple trauma patients by ISS score was 0.897 and CRAMS score was 0.891,respectively.There was no significant difference in accuracy of predicting mortality between the two scoring systems (Z =0.718,P ＞ 0.05).When the death was chosen as the prediction target,the optimal cut-off point for ISS was 27 and CRAMS score was 6,respectively.Conclusions CRAMS score in comparison with ISS score has the likewise predictive value for the prognosis of severe multiple trauma patients in emergency department.However,the CRAMS score is simple and easy in practice.The changes of CRAMS score demonstrate the severity of trauma timely and reliably,which is in favor of the diagnosis and treatment of hospitalized trauma patients in early stage.

Timing of evoked potentials forecasting the prognosis of patients with severe cerebrovascular disease / 中华危重病急救医学

Objective To investigate the effectiveness and the best assessment time of the short-latency somatosensory evoked potential (SLSEP) and brainstem auditory-evoked potential (BAEP) in the prognosis prediction of patients with severe cerebrovascular disease. Methods A prospective trial was conducted. The patients with severe cerebrovascular disease and Glasgow coma scale (GCS) ≤ 8 and admitted to the neurological intensive care unit (NICU) of Armed Police Logistics College Affiliated Brain Hospital from December 2014 to May 2015 were enrolled. The patients received SLSEP and BAEP nerve electrophysiological examinations within 24 hours and on 3, 7, 15 days after admission respectively and were graded according to Cant method. GCS was evaluated within 24 hours and on 15 days after admission. The prognosis was evaluated by Glasgow outcome scale (GOS) at six months after the onset of the disease. At different time windows after the onset of the disease, the correlations between different predictive indexes (GCS, SLSEP and BAEP) and outcome (GOS) were analyzed using spearman rank correlation; in the mean time, the efficacy for predicting the prognosis by single index or combined indexes was compared by receiver operator characteristic (ROC) curve. Results Seventy-eight patients were enrolled [men 46, women 32, age range (60.79±12.50) years old]. There were 78, 64, 44 and 19 patients observed at 24 hours and on 3, 7, 15 days after admission because the short-term death of some patients. The graded abnormal rate of SLSEP was 75.64%, 82.81%, 79.55% and 73.98% respectively; and the graded abnormal rate of BAEP was 82.05%, 84.38%, 85.94% and 73.68% respectively. ① Correlation analysis: all the predictors were correlated with GOS within 24 hours and on 3, 7, 15 days after admission, and SLSEP and BAEP grading were moderately correlated with GOS (0.4≤|R| < 0.7). ② The accuracy of the predicting prognosis: the area under the curve (AUC) of GCS on 15 days after admission [AUC = 0.772, 95% confidence interval (95%CI) = 0.561-0.984, P = 0.045] was the maximum when predicting survival. AUC of SLSEP (AUC = 0.825, 95%CI = 0.695-0.955, P = 0.000) and BAEP (AUC = 0.786, 95%CI = 0.646-0.927, P = 0.002) were the maximum on 7 days after admission when predicting death. ③ The effectiveness of the prognosis prediction: the sensitivity of SLSEP grading and BAEP grading were 92.6% and 96.3% respectively, while the sensitivity, specificity and accuracy of SLSEP and BAEP combined prediction were 100% on 7 days after admission. The specificity of GCS was 100% on 15 days after admission. Conclusions SLSEP and BAEP have more close correlation with prognosis compared with the GCS; Continuous dynamic combined evaluation of SLSEP and BAEP has important clinical value for patients with severe cerebrovascular disease possess in the prognosis assessment, the accuracy and the effectiveness of SLSEP and BAEP combined prediction were higher on 7 days especially.