Development and internal validation of a clinical prediction model for spontaneous abortion risk in early pregnancy

Abstract Objective: This study aimed to develop and internally validate a prediction model for estimating the risk of spontaneous abortion in early pregnancy. Methods: This prospective cohort study included 9,895 pregnant women who received prenatal care at a maternal health facility in China from January 2021 to December 2022. Data on demographics, medical history, lifestyle factors, and mental health were collected. A multivariable logistic regression analysis was performed to develop the prediction model with spontaneous abortion as the outcome. The model was internally validated using bootstrapping techniques, and its discrimination and calibration were assessed. Results: The spontaneous abortion rate was 5.95% (589/9,895) 1. The final prediction model included nine variables: maternal age, history of embryonic arrest, thyroid dysfunction, polycystic ovary syndrome, assisted reproduction, exposure to pollution, recent home renovation, depression score, and stress score 1. The model showed good discrimination with a C-statistic of 0.88 (95% CI 0.87‒0.90) 1, and its calibration was adequate based on the Hosmer-Lemeshow test (p = 0.27). Conclusions: The prediction model demonstrated good performance in estimating spontaneous abortion risk in early pregnancy based on demographic, clinical, and psychosocial factors. Further external validation is recommended before clinical application.

HLA-B27 did not protect against COVID-19 in patients with axial spondyloarthritis - data from the ReumaCov-Brasil Registry

Abstract Background Some studies have suggested the HLA-B27 gene may protect against some infections, as well as it could play a benefit role on the viral clearance, including hepatitis C and HIV. However, there is lack of SARS-CoV-2 pandemic data in spondyloarthritis (SpA) patients. Aim To evaluate the impact of HLA-B27 gene positivity on the susceptibility and severity of COVID-19 and disease activity in axial SpA patients. Methods The ReumaCoV-Brasil is a multicenter, observational, prospective cohort designed to monitor immunemediated rheumatic diseases patients during SARS-CoV-2 pandemic in Brazil. Axial SpA patients, according to the ASAS classification criteria (2009), and only those with known HLA-B27 status, were included in this ReumaCov-Brasil's subanalysis. After pairing them to sex and age, they were divided in two groups: with (cases) and without (control group) COVID-19 diagnosis. Other immunodeficiency diseases, past organ or bone marrow transplantation, neoplasms and current chemotherapy were excluded. Demographic data, managing of COVID-19 (diagnosis, treatment, and outcomes, including hospitalization, mechanical ventilation, and death), comorbidities, clinical details (disease activity and concomitant medication) were collected using the Research Electronic Data Capture (REDCap) database. Data are presented as descriptive analysis and multiple regression models, using SPSS program, version 20. P level was set as 5%. Results From May 24th, 2020 to Jan 24th, 2021, a total of 153 axial SpA patients were included, of whom 85 (55.5%) with COVID-19 and 68 (44.4%) without COVID-19. Most of them were men (N = 92; 60.1%) with mean age of 44.0 ± 11.1 years and long-term disease (11.7 ± 9.9 years). Regarding the HLA-B27 status, 112 (73.2%) patients tested positive. There were no significant statistical differences concerning social distancing, smoking, BMI (body mass index), waist circumference and comorbidities. Regarding biological DMARDs, 110 (71.8%) were on TNF inhibitors and 14 (9.15%) on IL-17 antagonists. Comparing those patients with and without COVID-19, the HLA-B27 positivity was not different between groups (n = 64, 75.3% vs. n = 48, 48%, respectively; p = 0.514). In addition, disease activity was similar before and after the infection. Interestingly, no new episodes of arthritis, enthesitis or extra-musculoskeletal manifestations were reported after the COVID-19. The mean time from the first symptoms to hospitalization was 7.1 ± 3.4 days, and although the number of hospitalization days was numerically higher in the B27 positive group, no statistically significant difference was observed (5.7 ± 4.11 for B27 negative patients and 13.5 ± 14.8 for B27 positive patients; p = 0.594). Only one HLA-B27 negative patient died. No significant difference was found regarding concomitant medications, including conventional or biologic DMARDs between the groups. Conclusions No significant difference of COVID-19 frequency rate was observed in patients with axial SpA regarding the HLA-B27 positivity, suggesting a lack of protective effect with SARS-CoV-2 infection. In addition, the disease activity was similar before and after the infection. Trial registration This study was approved by the Brazilian Committee of Ethics in Human Research (CONEP), CAAE 30186820.2.1001.8807, and was registered at the Brazilian Registry of Clinical Trials - REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.

Injury profile in male collegiate rugby union players / 体力科学

The purpose of this study was to describe the incidence, severity, and burden of injuries in Japanese male collegiate rugby union players. Initially, 170 male collegiate rugby union players from one university club were registered in this epidemiological surveillance study. The occurrence of injuries was recorded by a team medical staff during the 2017–2021 playing seasons. The incidence of injuries was 6.87 injuries/1000 h. This incidence was significantly higher during matches (100.37 injuries/1000 h) than that during training (3.63 injuries/1000 h). The severity of injuries was 31.0 days, and there were no significant differences between matches and training, or forwards and backs. The burden of injuries was 213.1 days/1000 h. This burden was significantly higher during matches (2887.8 days/1000 h) compared to training (120.1 days/1000 h). Matches had higher incidence of ankle sprain/ligament injuries (15.80 injuries/1000 h) and concussion (15.36 injuries/1000 h). The most common injury site was the ankle (1.24 injuries/1000 h). However, the greatest severity and burden were observed for knee injuries (severity: 59.1 days, burden: 48.6 days/1000 h). Furthermore, the greatest burden of injury type was knee sprain/ligament injuries (39.4 days/1000 h). In addition, the incidence of acromioclavicular joint injury was significantly higher in forwards, whereas hamstring strain was significantly higher in backs. The common injury mechanisms identified were being tackled (16.0%) and tackling (14.7%), followed by overuse (12.1%). In order to improve the player welfare of the Japanese collegiate rugby union players, it is necessary to work on the prevention strategy considering the injury profile.

Evaluation of Four Predictive Models for Identifying Malignancy of Solitary Pulmonary Nodules in Health Check-up Population / 肿瘤防治研究

Objective To compare and validate the efficiency of four models predicting the malignancy of solitary pulmonary nodules (SPN). Methods Patients diagnosed with SPN during health check-up were selected as the research subjects. Risk assessment was conducted using four predictive models. Outcomes were obtained through prospective follow-up. Statistical description and univariate analysis were performed for all risk factors of the four models. ROC curve was applied to compare the efficiency of the four predictive models. Results A total of 479 cases were included in this study. Among these patients, 82 were diagnosed with lung tumor, and the malignant rate was 17.12%. Age, nodule diameter, smoking, family history of tumor, history of extrapulmonary tumor ≥5 years, upper lobe site, unclear boundary, and spiculation rates were higher in the malignancy group than those in the benign group (P < 0.05). The efficiency of Brock model was the best. Its AUC was 0.833, sensitivity was 80.49%, and specificity was 74.31%. Its Youden index, positive likelihood ratio, positive predictive value, and negative predictive value were the highest, and its negative likelihood ratio was the lowest. The AUC, sensitivity, and specificity of Mayo model were 0.815, 81.71%, and 67.51%, respectively; those of PKUPH model were 0.754, 69.51%, and 73.55%, respectively; and those of VA model were 0.738, 68.29%, and 67.55%, respectively. Conclusion The Brock model might be the most appropriate predictive model for the risk assessment of SPN among the health check-up population, and the VA model is the worst. The combination of Brock, Mayo, and PKUPH models requires further study.

Age differences in the association of physical leisure activities with incident disability among community-dwelling older adults

BACKGROUND@#The relationship between leisure activities (LA) in old age and prevention of disability has not been fully investigated, and age and gender differences of these relationships are unknown. This study aimed to investigate whether physical and cognitive LA predicted incident disability among community-dwelling older adults by age and gender.@*METHODS@#We prospectively observed 8,275 residents aged 65 or above without disability at baseline for 3 years. Incident disability was defined as a new certification of the public long-term care insurance system. LA were classified into two types: physical LA and cognitive LA. The frequency of LA was categorized into frequent (i.e., once a week or more), moderate (i.e., monthly or yearly), and non-engagement. Covariates included age, gender, family number, education, perceived economic situation, body mass index, chronic medical conditions, alcohol consumption, smoking status, regular dental visits, depression, cognitive functioning, and social participation. Multivariable Poisson regression models were used to estimate adjusted cumulative incidence ratio (CIR) and 95% confidence interval (CI) for incident disability. We performed stratified analyses by age groups (i.e., the young-old aged 65-74 and the old-old aged 75-97) and gender (i.e., men and women).@*RESULTS@#The 3-year cumulative incidence of disability was 7.5%. After adjustment for covariates and mutual adjustment for both types of LA, a significant dose-response relationship between more frequent LA and lower risk of incident disability was found in young-old physical LA (P-trend < 0.001), in old-old cognitive LA (P-trend = 0.012), in male cognitive LA (P-trend = 0.006), and in female physical LA (P-trend = 0.030). Compared with people without LA, adjusted CIR (95% CI) of frequent LA was 0.47 (0.30-0.74) in young-old physical, 0.75 (0.58-0.96) in old-old cognitive, 0.65 (0.46-0.89) in male cognitive, and 0.70 (0.52-0.95) in female physical. Regarding the effect modification according to age and gender, only interaction between age and physical LA significantly prevented incident disability (P for interaction = 0.019).@*CONCLUSION@#We found age differences in the association of physical LA with incident disability among community-dwelling older adults. An effective measure to prevent long-term care in the community would be to recommend frequent physical LA for the young-old.

Simultaneous integrated boost vs. routine IMRT in limited-stage small-cell lung cancer: an open-label, non-inferiority, randomized, phase 3 trial / 中华放射肿瘤学杂志

Objective:Simultaneous integrated boost radiation technique in limited-stage small cell lung cancer is lack of evidence. This prospective study aims to evaluate whether the simultaneous integrated boost is as efficacious and safe as conventional fractionated radiotherapy.Methods:Patients diagnosed with treatment-naive and confirmed limited-stage SCLC were eligible. Participants were randomly assigned (1: 1) to receive simultaneous integrated boost radiotherapy (PGTV 60.2 Gy/2.15 Gy/28F, PTV 50.4 Gy/1.8 Gy/28F) or conventional fractionated radiotherapy (PTV 60 Gy/2 Gy/30F). The primary endpoint was 2-year progression-free survival, and the secondary endpoints were 2-year overall survival, 2-year local-regional recurrence-free survival and toxicity.Results:Between February 2017 and July 2019, 231 patients were enrolled. We analyzed 216 patients whose follow-up time was more than 2 years or who had died, among whom 106 patients in the conventional fractionated radiotherapy group and 110 patients in the simultaneous integrated boost radiotherapy group. The median follow-up time was 37 months (95% CI: 35.2-38.7). The 2-year progression-free survival rates were 45.2% vs. 38.2%( HR=1.22, 95% CI: 0.87-1.72, P=0.2). The 2-year overall survival rates were 73.5% vs. 60.9%( HR=1.35, 95% CI: 0.90-2.04, P=0.14). The 2-year local-regional recurrence-free survival rates were 68.7% vs. 69.9%( HR=0.98, 95% CI: 0.62-1.56, P=1.0). Multivariate analysis showed that early radiotherapy yielded better 2-year progression-free survival, overall survival and local-regional recurrence-free survival than delayed radiotherapy in two groups ( HR=1.69, 95% CI: 1.18-2.41, P=0.003; HR=1.72, 95% CI: 1.09-2.70, P=0.018; HR=1.66, 95% CI: 1.01-2.73, P=0.046). Tumor staging was an influencing factor of overall survival (stage Ⅲ vs. stage Ⅰ-Ⅱ, HR=3.64, 95% CI: 1.15-11.57, P=0.028). The most common grade 3-4 adverse events were myelosuppression (21.7% vs. 15.4%, P=0.83), radiation pneumonitis (4.7% vs. 2.7%, P=0.44) and radiation esophagitis (3.8% vs. 1.8%, P=0.51). Conclusions:Simultaneous integrated boost radiotherapy yields equivalent efficacy and toxicities to conventional fractionated radiotherapy for limited-stage small cell lung cancer. Early radiotherapy can enhance clinical prognosis.

Clinical value of activin A in early identification of moderate and severe acute pancreatitis: a prospective study / 中华危重病急救医学

Objective:To explore the value of serum activin A (ACT-A) level in early identification of moderate and severe acute pancreatitis (AP).Methods:A prospective case control study was conducted. A total of 120 patients with AP admitted to department of hepatobiliary surgery of Affiliated Nanhua Hospital of Hengyang Medical College of University of South China between October 2020 and April 2022 were recruited. According to the revised Atlanta classification, all patients were classified into mild AP group and moderate-to-severe AP group. The blood samples within 24 hours of onset were drawn, and the serum ACT-A and C-reactive protein (CRP) levels were detected by enzyme-linked immunosorbent assay (ELISA). The Ranson score and the modified CT severity index (MCTSI) were performed. Pearson correlation method was used to analyze the correlation of various parameters. The receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive value of ACT-A and CRP for moderate-to-severe AP.Results:A total of 120 patients with AP were enrolled, including 83 patients with mild AP and 37 patients with moderate-to-severe AP. Serum ACT-A and CRP levels within 24 hours of onset in the moderate-to-severe AP group were significantly higher than those in the mild AP group [ACT-A (ng/L): 140.4±37.7 vs. 53.9±30.5, lg CRP: 1.42±0.91 vs. 0.77±0.70, both P < 0.01], and the Ranson score and MCTSI score were also significantly higher than those in the mild AP group (Ranson score: 5.3±1.3 vs. 1.8±1.6, MCTSI score: 5.5±1.0 vs. 2.7±1.2, both P < 0.01). Correlation analysis showed that the serum ACT-A level was positively correlated with serum CRP level, Ranson score and MCTSI score ( R2 value was 0.272, 0.841, 0.616, respectively, all P < 0.05). ROC curve analysis showed that the serum ACT-A, CRP and Ranson score had predictive value for moderate-to-severe AP. The area under the ROC curve (AUC) was 0.948 [95% confidence interval (95% CI) was 0.909-0.986], 0.711 (95% CI was 0.606-0.815), 0.946 (95% CI was 0.910-0.982), respectively. When serum ACT-A > 112.6 ng/L, the sensitivity and specificity of predicting moderate-to-severe AP were 78.38% and 96.39%, respectively, which was better than serum CRP with sensitivity and specificity of 72.92% and 66.27%, respectively, and the specificity was better than Ranson score (71.08%). Conclusion:ACT-A can be detected in the early stage of AP, and it is positively correlated with the disease severity, which can early identify moderate-to-severe AP.

Cardiometabolic index and metabolic syndrome in the population over 40 years old in Guiyang city: A prospective cohort study / 中华内分泌代谢杂志

Objective:To investigate the relationship between cardiometabolic index and metabolic syndrome in people aged 40 and beyond in Guiyang city.Methods:A total of 4 506 residents over 40 years(including 3 067 females and 1 439 males) were enrolled in the analysis from those who participated in the epidemiological study of cancer risk in Chinese patients with type 2 diabetes in 2011 in Guiyang City. The cardiometabolic index (CMI) is calculated by triglycerides(TG)/high-density lipoprotein-cholesterol(HDL-C)×waist-to-height ratio (WHtR). Multivariable logistic regression was used to analyze the correlation between cardiometabolic index and metabolic syndrome, and ROC was used to analyze the predictive ability of CMI on the incidence of metabolic syndrome. Results:The average follow-up period was 3 years. According to the International Diabetes Federation (IDF) diagnostic criteria for metabolic syndrome in 2005, 985 patients (774 women and 211 males) had metabolic syndrome. The incidence rate of metabolic syndrome in the general population was 21.86%, the incidence rate of male metabolic syndrome was 14.66%, and that of women was 25.24%, and the incidence of CMI increased with the increase of the number of women. After multivariable logistic regression analysis, the odds ratio of CMI for metabolic syndrome in women is 1.303(95% CI 1.263-1.344) and 1.724(95% CI 1.162-2.558) in men, respectively. ROC results showed that CMI had a good ability to predict the incidence (AUC: 0.759 for men and 0.852 for women). Conclusion:CMI is positively associated with the incidence of metabolic syndrome. It supports CMI as a useful method to screen metabolic syndrome in China′s general population.

Seguimiento de pacientes con pie diabético en un hospital de alta complejidad del norte del Perú / Follow-up of patients with diabetic foot in a highly complex hospital in northern Peru

RESUMEN Introducción. El pie diabético es una complicación frecuente de la diabetes. Los datos son escasos en el norte peruano. Objetivo. Describir la evolución clínica del pie diabético en un hospital de Lambayeque-Perú, entre los años 2018 y 2019. Métodos. Estudio descriptivo, prospectivo. Los pacientes fueron captados por emergencia/consulta y seguidos por la unidad de pie diabético mediante visitas diarias y curaciones. Resultados. Seguimiento desde agosto del 2018 a octubre 2019. Hubo 136 pacientes; mediana de edad: 63 años (RIC= 54-86) y 50,38% fueron hombres. La mediana de años con diabetes y tiempo de hospitalización fue 10 años y 10 días; 40% y 21% tuvo trauma y amputación previa. Las frecuencias de hipertensión arterial, nefropatía diabética, enfermedad renal crónica, síndrome coronario agudo y evento cerebrovascular previo fueron: 52,9%, 26,4%, 33,3%, 2,9% y 16,6%, respectivamente; 50,7% tuvo compromiso de pie derecho, 58,1% del izquierdo y 8,6%, de ambos. El Wagner inicial más frecuente fue IV: 30,16%, seguido de II: 25,40% y el final más frecuente fue IV: 42,15% seguido del II: 22,31%. Se amputaron 41,22%, mayores: 28,24% y menores 11,8%; 25,6% fueron supracondíleas; 39,6% tuvo sepsis, evolución desfavorable 38,58% y fallecieron 9,44%. En los amputados, la mediana de días antes de la amputación fue 12. Conclusiones. La frecuencia de amputación y mortalidad fue mayor a la de estudios anteriores. Hubo una alta frecuencia de evolución desfavorable: amputación/muerte o empeoramiento de la gangrena.

ABSTRACT Introduction. Diabetic foot is a frequent complication of diabetes. Data are scarce in northern Peru. Objective. To describe the clinical evolution of the diabetic foot in a hospital in Lambayeque-Peru, between 2018 and 2019. Methods. Descriptive, prospective study. The patients were recruited by emergency/consultation and followed by the diabetic foot unit through daily visits and dressings. Results. Follow-up from August 2018 to October 2019. There were 136 patients; median age: 63 years (IQR = 54-86) and 50.38% were men. The median number of years with diabetes and hospitalization time was 10 years and 10 days; 40% and 21% had trauma and previous amputation. The frequencies of high blood pressure, diabetic nephropathy, chronic kidney disease, previous acute coronary syndrome and cerebrovascular event were: 52.9%, 26.4%, 33.3%, 2.9% and 16.6%, respectively; 50.7% had involvement of the right foot, 58.1% of the left and 8.6% of both. The most frequent initial Wagner was IV: 30.16%, followed by II: 25.40% and the most frequent final was IV: 42.15% followed by II: 22.31%. 41.22% were amputated, mayor amputations: 28.24% and minor amputations 11.8%; 25.6% were supracondylar; 39.6% had sepsis, 38.58% unfavorable evolution and 9.44% died. In amputees, the median number of days before amputation was 12. Conclusions. The frequency of amputation and mortality was higher than in previous studies. There was a high frequency of unfavorable evolution: amputation/death or worsening of gangrene.

Urinary N-terminal pro-B-type natriuretic peptide as a biomarker for cardiovascular events in a general Japanese population: the Hisayama Study

BACKGROUND@#Epidemiological evidence has shown that serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, a diagnostic biomarker for heart failure, are positively associated with cardiovascular risk. Since NT-proBNP in serum is excreted in urine, it is hypothesized that urinary NT-proBNP concentrations are correlated with serum concentrations and linked with cardiovascular risk in the general population.@*METHODS@#A total of 3060 community-dwelling residents aged ≥ 40 years without history of cardiovascular disease (CVD) were followed up for a median of 8.3 years (2007-2015). Serum and urinary concentrations of NT-proBNP at baseline were compared. The hazard ratios (HRs) and their 95% confidence intervals (CIs) for the association between NT-proBNP concentrations and the risk of developing CVD were computed using the Cox proportional hazards model.@*RESULTS@#The median values (interquartile ranges) of serum and urinary NT-proBNP concentrations at baseline were 56 (32-104) pg/mL and 20 (18-25) pg/mL, respectively. There was a strong quadratic correlation between the serum and urinary concentrations of NT-proBNP (coefficient of determination [R@*CONCLUSIONS@#The present study demonstrated that urinary NT-proBNP concentrations were well-correlated with serum concentrations and were positively associated with cardiovascular risk. Given that urine sampling is noninvasive and does not require specially trained personnel, urinary NT-proBNP concentrations have the potential to be an easy and useful biomarker for detecting people at higher cardiovascular risk.

Strategies for monitoring 24-hour intraocular pressure curve: 41 cases of prospective clinical study / 南方医科大学学报

OBJECTIVE@#To investigate accuracy of the currently used strategies for intraocular pressure measurements for reflecting actual 24-hour intraocular pressure fluctuations.@*METHODS@#From September, 2018 to January, 2019, the patients with a suspected diagnosis of primary open angle glaucoma at our hospital were prospectively enrolled to receive 24-hour intraocular pressure monitoring using a Goldmann tonometer. With the intraocular pressure measurements at 0:00, 2:00, 5:00, 7:00, 8:00, 10:00, 11:00, 14:00, 16:00, 18:00, 20:00, and 22:00 as the gold standard (strategy 1), we compared the measurements taken at 5:00, 7:00, 10:00, 14:00, 18:00, and 22:00 (strategy 2) and at 8:00, 11:00, 14:00, and 16:00 (strategy 3) for their accuracy in reflecting 24-h intraocular pressure fluctuations.@*RESULTS@#A total of 41 patients (82 eyes) were enrolled in this study. The peak intraocular pressures measured using the 3 strategies were 21.09±4.15 mmHg, 20.54±4.10 mmHg, and 19.91±4.38 mmHg, respectively, showing significant differences among them (@*CONCLUSIONS@#For suspected cases of glaucoma, intraocular pressure measurements at 4 and 6 time points of a day can not precisely reflect the actual range of intraocular pressure fluctuations, and may lead to a missed diagnosis of glaucoma.

Risk of developing tuberculosis in T-cell spot test of tuberculosis infection positive close contacts of tuberculosis patients in Shanghai: a prospective observational study / 中华传染病杂志

Objective:To investigate the risk and temporal characteristics of tuberculosis (TB) in persons with latent tuberculosis infection (LTBI) among close contacts of TB patients in Shanghai.Methods:This was a prospective observational study, the study subjects were the close contacts of TB patients who tested positive for Mycobacterium tuberculosis infection by T-cell spot test of tuberculosis infection (T-SPOT.TB) among the registered population in seven districts of Shanghai from 2009 to 2010. Questionnaire interview was applied to investigate the basic information and contact history.The LTBI cases during nine consecutive years were identified through the TB registration and reporting system.Cumulative incidence rate and incidence density of TB in tuberculosis-infected close contacts were estimated. Chi-square test was used to compare the incidence rate among different sex and age groups. Results:In total, 376 pulmonary TB patients and their 982 close contacts were enrolled in the baseline survey from 2009 to 2010. Of them, 287 close contacts were tested positive for Mycobacterium tuberculosis infection by T-SPOT.TB.The median age of persons with LTBI at the time of survey was 54 years old, and 36.6%(105/287) were male. By the end of December 2019, five new TB cases were detected among the 287 close contacts with LTBI. The two-year and five-year cumulative incidence were 0.35% and 1.05%, respectively. The nine-year cumulative incidence was 1.74%(95% confidence interval 0.57%-4.02%). The median duration for TB occurrence was 3.67 years. The incidence density of TB was 1.875/1 000 person-years with a total of 2 666.75 observation person-years. There were no significant differences in the nine-year cumulative incidence of TB among close contacts with LTBI by age and sex ( χ2=0.600, <0.001, respectively, both P>0.05). Conclusion:The occurrence of TB among close contacts with LTBI is concentrated in the first five years after TB contact.

Effect assessment of caries management by risk assessment in children in the Minhang district of Shanghai / 口腔疾病防治

Objective@#To assess the effect of caries management based on risk assessment in children and to provide the basis for the government to develop strategies to prevent and treat oral diseases.@*Methods@# From March 2018 to March 2019, 512 3-year-old children and 502 6-year-old children were selected by cluster sampling from kindergartens and primary schools, respectively, in the Minhang district of Shanghai, and oral examinations and questionnaires were carried out to assess baseline status. Then, the children were divided into 3 groups, including low-, middle- and high-risk groups, according to caries risk assessment. In each caries risk group, the children were randomly divided into an experimental group and a control group. The experimental groups were managed by risk assessment, and the control groups were provided basic oral public health services by the Shanghai government. The effect of caries prevention was evaluated 12 months later.@*Results@#Among the children with a high risk of caries, the incidence of caries was 51.22% in the 3-year-old control group, 34.17% in the experimental group, 51.27% in the 6-year-old control group and 33.15% in the experimental group, with statistical significance (P < 0.05). Among the children with a middle risk of caries, the incidence of caries was 38.71% in the 3-year-old control group and 7.32% in the experimental group, with statistical significance (P < 0.05). However, there was no significant difference in caries incidence between the control group and the experimental group for the children with low risk in the 3-year-old or 6-year-old groups and middle risk caries risk in the 6-year-old group. Both 3-year-old and 6-year-old children in the experimental group had a lower risk of caries than those in the observation group in 2019.@*Conclusion@#The caries prevention effect is remarkable in high-risk children, and caries management by risk assessment is probably recommended for children with high caries risk.

Clinical study of tubectomy and it’s complications

Background: Tubectomy is most accepted method of contraception in India. Female sterilization may be performed in several ways such as abdominal tubal ligation, laparoscopic and hysteroscopic methods. Although considered as minor and safe procedure, complications leading to even death have been reported. So, this study was taken up to study complications of different types of tubal ligation. Objective of this study was to study complications of different types of tubal ligation.Methods: This is a prospective analytical study over the period of 18 months. This study includes all cases that have reported or referred as female sterilization complication.Results: At study institute both laparoscopic tubal ligation (TL) and abdominal tubal ligation are done. During the period of 18 months, 50 cases of tubectomy complications were noted at our institute, out of 40 cases (80%) were of abdominal method and rest 10 (20%) were of laparoscopic method. In 33 cases (66%) sterilization was performed at primary health centre. 3 cases of death reported in this study.Conclusions: At study institute both laparoscopic tubal ligation (TL) and abdominal tubal ligation are done. During the period of 18 months, 50 cases of tubectomy complications were noted at our institute, out of 40 cases (80%) were of abdominal method and rest 10 (20%) were of laparoscopic method. In 33 cases (66%) sterilization was performed at primary health centre. 3 cases of death reported in this study.

Approach for reporting serous effusion fluid in pleural, peritoneal and pericardial cavity and immunohistochemistry

Background: The aim of this study is to make a detailed cytological study of effusion fluids and compare with cell block study of the representative cases and IHC studies were done.Methods: Prospective study of 216 cases effusion fluids from in and around hospitals, Mangalore. This study conducted over a period of 18 months from October-2014 to April-2016. This study scrutinized and approved by Institutional Ethics Committee. The samples were processed by conventional cytology using Papanicolaou-stain and Cell Block (CB) method using 10% Alcohol-formalin fixative and stained with H and E. The cellularity, architectural patterns, morphological details were studied both smears. Ancillary immunohistochemical staining with calretinin and EMA are done.Results: A total of 216 cases of effusion fluids with cell block study were included, age range of 13 years to 93 years. Pleural fluid comprised of 55.09%, peritoneal fluid of 43.51% and pericardial fluid of 1.38%. 71% were clinically diagnosed as non-neoplastic and 29% were neoplastic condition. In CS study, 84.5% cases were benign/reactive effusion and 8.5% were positive for malignancy. In CB study, 84.5% were benign/reactive effusion and 10.2% were positive for malignancy. In comparison authors found an increase in diagnostic efficacy by 18%. IHC EMA for adenocarcinoma cells has sensitivity of 100% and calretinin for reactive mesothelial cells has specificity of 100%.Conclusions: Authors concluded that cell block technique when used as an adjuvant to routine smear examination in effusion fluids has increased the diagnostic yield and better preservation of architectural pattern. IHC is helpful in differentiating between reactive mesothelial and adenocarcinoma cells.

Serum uric acid and risk of incident diabetes in middle-aged and elderly Chinese adults: prospective cohort study / 医学前沿

The association between serum uric acid and the risk of incident diabetes in Chinese adults remains unknown. This study aimed to investigate this association in a community-dwelling population aged ≥ 40 years in Shanghai, China. Oral glucose tole3rance test was conducted during baseline and follow-up visits. Relative risk regression was utilized to examine the associations between baseline gender-specific serum uric acid levels and incident diabetes risk. A total of 613 (10.3%) incident diabetes cases were identified during the follow-up visit after 4.5 years. Fasting plasma glucose, postload glucose, and glycated hemoglobin A1c during the follow-up visit progressively increased across the sex-specific quartiles of serum uric acid (all Ps < 0.05). The incidence rate of diabetes increased across the quartiles of serum uric acid (7.43%, 8.77%, 11.47%, and 13.43%). Multivariate adjusted regression analysis revealed that individuals in the highest quartile had 1.36-fold increased risk of diabetes compared with those in the lowest quartile of serum uric acid (odds ratio (95% confidence interval) = 1.36 (1.06-1.73)). Stratified analysis indicated that the association was only observed in women. Accordingly, serum uric acid was associated with the increased risk of incident diabetes among middle-aged and elderly Chinese women.

A prospective study on effects of treatment of hernia sac stump in laparoscopic transabdominal preperitoneal inguinal hernia repair on postoperative seroma / 中华消化外科杂志

Objective To investigate the effects of treatment of hernia sac stump in laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) on postoperative seroma.Methods The prospective study was conducted.The clinical data of 128 male patients with primary indirect inguinal hernia who were admitted to Fujian Medical University Union Hospital from October 2017 to March 2019 were selected.Patients were divided into two groups by random number method.Patients in experimental group had hernia sac stump sutured and fixed at the lower margin of rectus abdominis after transection of hernia sac in TAPP,and patients in control group had hernia sac stump free in the abdominal cavity after dissection and transection of hernia sac in TAPP.Observation indicators:(1) surgical situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was conducted to detect the incidence of postoperative seroma,incision infection,chronic pain,and hernia recurrence up to June 2019.Measurement data with normal distribution were represented as Mean ±SD,and comparison between groups was done using the t test.Measurement data with skewed distribution were represented as M (range),and comparison between groups was done using the Mann-Whitney U test.Count data were described as absolute numbers and percentages,and comparison between groups was analyzed using the chisquare test.Results A total of 128 male patients were screened for eligibility,including 60 patients in the experimental group and 68 patients in the control group.The 128 patients were aged from 47 to 74 years,with an average age of 61 years.(1) Surgical situations:operation time and hospital expenses were (102±34) minutes and (12 813±2 390)yuan for the experimental group,and (97±30)minutes and (12 125±2 205)yuan for the control group,respectively,showing no significant difference between the two groups (t=0.907,1.685,P＞0.05).(2) Follow-up:all the 128 patients received follow-up.There were 8 cases of seroma in both the experimental group and the control group,with no significant difference between the two groups (x2 =0.072,P＞0.05).The extraction volume of patients with seroma was 20 mL (range,4-31 mL) in the experimental group,and 43 mL (range,23-98 mL) in the control group,showing a significant difference between the two groups (Z=-2.013,P＜0.05).There was no incision infection,chronic pain or hernia recurrence in 3 months after operation in patients with seroma of either experimental group or control group.Conclusions During TAPP,suture and fixation of the hernia sac stump to the lower edge of rectus abdominis and free hernia sac stump in the abdominal cavity after dissection and transection of hernia sac can effectively repair indirect inguinal hernia.The former method can reduce the extraction volume of seroma after operation.

A multicenter prospective study on incidence and risk factors of postoperative pancreatic fistula after radical gastrectomy: a report of 2 089 cases / 中华消化外科杂志

Objective To investigate the incidence of postoperative pancreatic fistula (POPF) and its risk factors after radical gastrectomy.Methods The prospective study was conducted.The clinicopathological data of 2 089 patients who underwent radical gastrectomy in 22 medical centers between December 2017 and November 2018 were collected,including 380 in the Zhongshan Hospital of Fudan University,351 in the Renji Hospital of Shanghai Jiaotong University School of Medicine,130 in the Ruijin Hospital of Shanghai Jiaotong University School of Medicine,139 in the Peking University Cancer Hospital,128 in the Fujian Provincial Cancer Hospital,114 in the First Hospital Affiliated to Army Medical University,104 in the First Affiliated Hospital of Nanchang University,104 in the Affiliated Hospital of Qinghai University,103 in the Weifang People's Hospital,102 in the Fujian Medical University Union Hospital,99 in the First Affiliated Hospital of Air Force Medical University,97 in the Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine,60 in the Hangzhou First People's Hospital Affiliated to Zhejiang University School of Medicine,48 in the Fudan University Shanghai Cancer Center,29 in the First Affiliated Hospital of Xi'an Jiaotong University,26 in the Lishui Municipal Central Hospital,26 in the Guangdong Provincial People's Hospital,23 in the Jiangsu Province Hospital,13 in the First Affiliated Hospital of Sun Yat-Sen University,7 in the Second Hospital of Jilin University,4 in the First Affiliated Hospital of Xinjiang Medical University,2 in the Beijing Chao-Yang Hospital of Capital Medical University.Observation indicators:(1) the incidence of POPF after radical gastrectomy;(2) treatment of grade B POPF after radical gastrectomy;(3) analysis of clinicopathological data;(4) analysis of surgical data;(5) risk factors for grade B POPF after radical gastrectomy.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using ANOVA.Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test.Univariate analysis was conducted using the t test or chi-square test based on data excluding missing data of clinicopathological and surgical data.Multivariate analysis was conducted using the Logistic regression model based on factors with P＜0.20 in univariate analysis.Results There were 2 089 patients screened for eligibility,including 1 512 males,576 females and 1 without sex information,aged (62± 11)years.The body mass index (BMI) was (23±3) kg/m2.(1) The incidence of POPF after radical gastrectomy:the total incidence rate of POPF in the 2 089 patients was 20.728％(433/2 089).The incidence rates of biochemical fistula,grade B pancreatic fistula,and grade C pancreatic fistula were 19.627％(410/2 089),1.101％(23/2 089),0,respectively.(2) Treatment of grade B POPF after radical gastrectomy:2 of 23 patients with grade B POPF after radical gastrectomy had drainage tube placed for more than 21 days and received anti-infective therapy.Four of 23 patients with grade B POPF after radical gastrectomy had ascites detected by imaging examination,of which 2 received peritoneal drainage guided by ultrasound,1 received failed puncture drainage,1 received no puncture drainage,and they were given anti-infective therapy.Eleven of 23 patients with grade B POPF after radical gastrectomy had no ascites detected by imaging examinations,and they were given anti-infective therapy and inhibitors of pancreas secretion for clinical manifestation as fever or elevated white blood cells.Six patients with no typical clinical manifestations were given somatostatin to inhibite pancreas secretion and prolonged duration of abdominal drainage tube placement (with a median time of 7 days).All the 23 patients recovered well after treatment,without reoperation.(3) Analysis of clinicopathological data:for the 2 089 patients,BMI,cases with or without neoadjuvant therapy were (23±3) kg/m2,1 487,160 of patients without pancreatic fistula,(23±3)kg/m2,386,22 of patients with biochemical fistula,and (24±3)kg/m2,22,1 of patents with grade B pancreatic fistula,showing significant differences between the three groups (F=5.787,x2 =8.269,P＜0.05).(4) Analysis of surgical data:for the 2 089 patients,cases with open surgery,laparoscopic assisted surgery,totally laparoscopic surgery (surgical method),cases with D1 lymph lode dissection,D2 lymph lode dissection,and other lymph lode dissection (range of lymph lode dissection),cases with no omentectomy,partial omentectomy,and total omentectomy (range of omentectomy),cases with no usage of energy facility,usage of CUSA,LigaSure,LigaSure+CUSA as energy facility,cases with or without biological glue,the number of lymph node dissection were 737,624,292,24,1 580,51,418,834,381,63,1 530,23,16,1 431,201,33±14 of patients without pancreatic fistula,146,189,74,11,389,9,110,171,128,35,359,6,9,378,31,31± 14 of patients with biochemical fistula,and 14,5,4,0,20,3,6,13,4,2,18,1,2,22,1,37±16 of patients with grade B pancreatic fistula,showing significant differences between the three groups (x2=15.578,9.397,15.023,28.245,8.359,F=4.945,P＜ 0.05).(5) Risk factors for grade B POPF after radical gastrectomy:results of univariate analysis showed that usage of energy facility was a related factor for grade B POPF after radical gastrectomy (x2=9.914,P＜0.05).Results of multivariate analysis showed that laparoscopic assisted surgery,combined evisceration,application of LigaSure + CUSA,the number of lymph lode dissection were independent factors for for grade B POPF after radical gastrectomy (odds ratio=0.168,3.922,9.250,1.030,95％ confidence interval:0.036-0.789,1.031-14.919,1.036-82.602,1.001-1.059,P＜0.05).Conclusions The incidence of grade B POPF after radical gastrectomy is relatively low.Laparoscopic assisted surgery,combined evisceration,application of LigaSure + CUSA,and the number of lymph lode dissection are independent risk factors for grade B POPF.Trial Registration:This study was registrated at ClinicalTrial.gov in United States with the registration number of NCT03391687.

The relationship between air quality improvement and the onset of type 2 diabetes mellitus: a prospective cohort study / 公共卫生与预防医学

Objective To explore the effect of decreased air pollutants concentrations on the incidence of Type 2 Diabetes Mellitus (T2DM). Methods A prospective cohort was designed in Tianjin where the air quality gradually improved from 2014 to 2018. A total of 5 077 community residents (18-90 years old) were recruited as the baseline population from 2013 to 2014. From 2014 to 2018 follow-up was carried out year by year to observe the new incidence of T2DM in the cohort. The HR and 95%CI (95% confidence interval) were calculated with the multiple Cox proportional hazard regression model to evaluate the effect of the decrease in the concentrations of SO2, NO2, and particulate matters with diameters 10, PM2.5) on the incidence of T2DM. Results The cohort was followed up year by year from 2014 to 2018, with a cumulative follow-up of 25 385 person-years over the 5 years. At the same time, the air quality of Tianjin was significantly improved. Statistical analysis results after covariate adjustment revealed that the risk of T2DM in the population decreased by 0.172, 0.124, and 0.210 times, for a decrease of 10 μg/m3 in the annual average concentrations of SO2, PM10, and PM2.5 each, respectively (SO2：HR=0.828，95%CI=0.757-0.907；PM10：HR=0.876，95%CI=0.816-0.941；PM2.5：HR=0.790，95%CI=0.694-0.899). Conclusion The implementation of environmental protection measures to improve air pollution could reduce the risk of T2DM in the population and control the increasing prevalence.

A Prospective Cohort Study of Medication Beliefs and their Impact on Medication Adherence in Aboriginal and Nonaboriginal Patient

@#Introduction: Most research has primarily focused on the influence of patients' beliefs on medication adherence in non-aboriginal populations. This study compared medication beliefs among aboriginal and non-aboriginal patients with hypertension and/or diabetes mellitus, predictors of medication beliefs, and their impact on medication adherence. Methods: A prospective cohort study was conducted using the Beliefs about Medicines Questionnaire-Specific on a randomly selected sample of 38 patients for each group. Medication adherence was measured by pill counts and prescription refill history. Results: Over half of the aboriginal and non-aboriginal patients believed that the medications are necessary for their health. In particular, aboriginal patients had higher necessity score (mean 21.32, SD 2.90) than non-aboriginal patients (mean 19.45, SD 3.68, p<0.05). More aboriginal patients worried about the longterm effects of their medications (78.9%) and drug dependence (81.6%). In aboriginal group, greater disease knowledge was associated with higher necessity scores [F(1,36)=12.67, p<0.05, R2=0.26] and positive necessity-concerns differential (NCD) [F(1,36)=6.092, p<0.05, R2=0.145]. In non-aboriginal group, older patients were associated with higher necessity scores [F(1,36)=5.855, p<0.05, R2=0.140] while females were associated with greater concerns scores [F(1,36)=6.170, p<0.05, R2=0.146] and negative NCD, which had also been observed in the employed patients [F(2,35)=7.314, p<0.05, R2=0.295]. Medication non-adherence was more prevalent among aboriginal patients (73.7%) and was predominantly associated with higher concerns in both groups. Conclusion: Despite strong medication necessity beliefs, levels of concerns were substantial in both groups and were associated with medication non-adherence. More patient-centred approaches should be designed to address patients' concerns and improve treatment outcomes.