Identifying peripheral arterial disease in the elderly patients using machine-learning algorithms.

BACKGROUND: Peripheral artery disease (PAD) is a common syndrome in elderly people. Recently, artificial intelligence (AI) algorithms, in particular machine-learning algorithms, have been increasingly used in disease diagnosis. AIM: In this study, we designed an effective diagnostic model of PAD in the elderly patients using artificial intelligence. METHODS: The study was performed with 539 participants, all over 80 years in age, who underwent the measurements of Doppler ultrasonography and ankle-brachial pressure index (ABI). Blood samples were collected. ABI and two machine-learning algorithms (MLAs)-logistic regression and a random forest (RF) model-were established to diagnose PAD. The sensitivity and specificity of the models were analyzed. An additional RF model was designed based on the most significant features of the original RF model and a prospective study was conducted to demonstrate its external validity. RESULTS: Thirteen of the 28 features introduced to the MLAs differed significantly between PAD and non-PAD participants. The respective sensitivities and specificities of logistic regression, RF, and ABI were as follows: logistic regression (81.5%, 83.8%), RF (89.3%, 91.6%) and ABI (85.1%, 84.5%). In the prospective study, the newly designed RF model based on the most significant seven features exhibited an acceptable performance rate for the diagnosis of PAD with 100.0% sensitivity and 90.3% specificity. CONCLUSIONS: An RF model was a more effective method than the logistic regression and ABI for the diagnosis of PAD in an elderly cohort.

Receptive and Expressive Vocabulary Skills and Their Correlates in Mandarin-Speaking Infants with Unrepaired Cleft Lip and/or Palate.

BACKGROUND: Vocabulary skills in infants with cleft lip and/or palate (CL/P) are related to various factors. They remain underexplored among Mandarin-speaking infants with CL/P. This study identified receptive and expressive vocabulary skills among Mandarin-speaking infants with unrepaired CL/P prior to cleft palate surgery and their associated factors. METHODS: This is a cross-sectional study involving patients at the Cleft Lip and Palate Center of the Stomatological Hospital of Xi'an Jiaotong University between July 2017 and December 2018. The Putonghua Communicative Development Inventories-Short Form (PCDI-SF) was used to assess early vocabulary skills. RESULTS: A total of 134 children aged 9-16 months prior to cleft palate surgery were included in the study. The prevalences of delays in receptive and expressive vocabulary skills were 72.39% (95% CI: 64.00-79.76%) and 85.07% (95% CI: 77.89-90.64%), respectively. Multiple logistic regression identified that children aged 11-13 months (OR = 6.46, 95% CI: 1.76-23.76) and 14-16 months (OR = 24.32, 95% CI: 3.86-153.05), and those with hard/soft cleft palate and soft cleft palate (HSCP/SCP) (OR = 5.63, 95% CI: 1.02-31.01) were more likely to be delayed in receptive vocabulary skills. CONCLUSIONS: Delays in vocabulary skills were common among Mandarin-speaking CL/P infants, and age was positively associated with impaired and lagging vocabulary skills. The findings suggest the necessity and importance of early and effective identification of CL/P, and early intervention programs and effective treatment are recommended for Chinese CL/P infants.

Comparison of immersion ultrasound and low coherence reflectometry for ocular biometry in cataract patients.

AIM: To compare the results of axial length (AL) biometry in cataract eyes by three methods: immersion B-ultrasound (IB) biometry, immersion A-ultrasound (IA) biometry and optical low coherence reflectometry. METHODS: In this prospective observational study of eyes with cataract AL measurements were performed using immersion ultrasound and optical low coherence reflectometry device. The results were evaluated using Bland-Altman analyses. The differences between both methods were assessed using the paired t-test, and its correlation was evaluated by Pearson coefficient. RESULTS: Eighty eyes of 80 patients (39 men and 41 women) for cataract surgery were included in the study. The values of AL could be got from all 80 eyes by IB and IA, the difference of AL measurements between IA and IB was of no statistical significance (P=0.97); the mean difference in AL measurements was -0.031 mm (P=0.26; 95%CI, -0.09 to 0.02); linear regression showed an excellent correlation (r=0.98, P<0.0001). Forty-five of eighty eyes with results of AL measurements, which can be obtained by three methods; the difference of AL measurements was of no statistical significance (IA vs IB, P=0.18; IA vs Lenstar, P=0.51; IB vs Lenstar, P=0.07); linear regression showed an excellent correlation (IA vs IB, r=0.99; IA vs Lenstar, r=0.96; IB vs Lenstar, r=0.96); Bland-Altman analysis also showed good agreement between the two methods [IA vs IB, 95% limits of agreement (LoA), -0.36 to 0.28 mm; IA vs Lenstar, 95% LoA, -0.65 to 0.69 mm; IB vs Lenstar, 95% LoA, -0.55 to 0.68 mm]. CONCLUSION: Measurements with the optical low coherence reflectometry correlated well with IB and IA. In the eyes with serious refractive medium opacity, the measurements of AL could not be achieved or existed deviations when using optical low coherence reflectometry device. Under such circumstances, we should choose IA or IB as the optimization method to obtain measurements, in order to get much more accurate results.

Socioeconomic and Environmental Determinants to Preterm Birth in Tibetan Women: An Analysis Based on the Hierarchically Conceptual Frame.

BACKGROUND: Preterm birth is a common cause of death in newborns and may result from many determinants, but evidence for the socioeconomic and environmental determinants of preterm birth in Tibetan women of childbearing age is limited. The aim of this study was to understand the current status of preterm birth in native Tibetan women and investigate the socioeconomic and environmental determinants. METHODS: Data were drawn from a cohort study which was conducted from August 2006 to August 2012 in rural Lhasa, Tibet, China. A total of 1419 Tibetan pregnant women were followed from 20 weeks' gestation until delivery; the loss to follow-up rate was 4.69%. The incidence of preterm birth was estimated to show the status of preterm births in Tibet. Logistic regression models for longitudinal data were established, and odds ratios (ORs) together with 95% confidence intervals (CIs) were used to evaluate the association between the occurrence of preterm birth and 16 selected potential determinants based on the hierarchical conceptual frame. RESULTS: The incidence of preterm birth was 4.58% (95% CI = 3.55-5.80%). After adjusting for health-related variables of the mothers and newborns, socioeconomic and environmental determinants associated with preterm birth included season (spring: OR = 0.28, 95% CI = 0.09-0.84; autumn: OR = 0.21, 95% CI = 0.06-0.69; and winter: OR = 0.31, 95% CI = 0.12-0.82) and calendar year of delivery (2010: OR = 5.03, 95% CI = 1.24-20.35; 2009: OR = 6.62, 95% CI = 1.75-25.10; and 2007-2008: OR = 5.93, 95% CI = 1.47-23.90). CONCLUSIONS: The incidence of preterm birth among native Tibetan women was low and there was a decreasing trend in recent years; however, it is still essential to strengthen seasonal maternal care, extend the spacing between pregnancies, and reinforce adequate maternal nutrition.

The impact of economic factors on treatment results for tumor inpatients in the under-developed Western region of China.

OBJECTIVE: To discuss the influences of economic factors on the treatment outcomes of cancer patients and the relaxation effects of medical insurance policies on the influences of economic factors. METHOD: The concentration index (CI) and horizontal inequality (HI) of treatment outcomes of cancer patients were calculated and the role of the economy, disease, and other factors to HI was analyzed by describing the influence of treatment expense on the treatment outcomes of different cancer patients. RESULTS: The study showed that the equity of the death rate and the effective rate of six types of cancer patients was good. The HI of the cure rate was 0.225, indicating a strong, pro-rich inequity of the cancer inpatient cure rate, while the contribution of the economic factors to HI was 0.158. The uncured rate in the low-cost group represented the rate of patients who discontinued the treatment; the HI was -0.324, indicating a strong, pro-poor inequity. The relaxation effect on the HI of the cured rate by medical insurance was 14.9%, while the effect on the HI of the uncured rate was 18.7%. CONCLUSION: At present, medical insurance has demonstrated relaxation effects on the fairness of treatment outcomes to some extent. The main reason for this inequity comes from the payment of the items at present. To relieve such inequity to a greater extent, the payment system should be changed and diagnosis-related groups should be implemented.

Application of traditional indexes and adverse events in the ophthalmologic perioperative medical quality evaluation during 2010-2012.

AIM: To evaluate the medical quality of ophthalmologic perioperative period during 2010-2012 in our hospital. METHODS: The relevant data of perioperative period were collected in our hospital during 2010-2012, and the medical quality of perioperative period was evaluated by using the traditional evaluation indexes and adverse events. Whereby, the traditional indicators include vision changes, improving of intraocular pressure, diagnostic accordance rate before and after operation, cure improvement rate, successful rescue rate, and incidence of surgical complications, etc. Adverse events are associated with ophthalmologic perioperative events including pressure sores, postoperative wound infection, drug adverse events, and equipment related adverse events. RESULTS: There were 1483, 1662 and 1931 ophthalmic operations in our hospital in the year 2010, 2011 and 2012, respectively. From traditional index analysis, the proportions of vision improvement for each year were 96.43%, 96.76% and 97.32%, respectively; the rates of intraocular pressure improvement were 87.50%, 85.72% and 90.17%, respectively (P <0.05); the diagnostic accordance rates before and after operation were 99.86%, 99.94% and 99.90%, respectively; cure improvement rates were 99.73%, 99.93% and 99.84%, respectively; the successful rescue rates were 82.98%, 81.46% and 76.66%, respectively; the complications incidence rates were 18.44%, 17.52% and 17.97%, respectively. The negative factor analysis results showed that: among all the patients of ophthalmic surgeries in our hospital during 2010 and 2012, only one case of postoperative wound infection was found in 2011, and also only one case of tumbling in 2010. The adverse drug events for each year were 1 case (0.07%), 2 cases (0.12%), and 4 cases (0.21%), respectively; the medical device adverse events for each year were 3 cases (0.20%), 5 cases (0.30%), and 6 cases (0.31%), respectively. Noticeably, only one case with postoperative infection of endophthalmitis was found in 2011. Moreover, no pulmonary infection or pulmonary embolism occurred during the three years. The perioperative adverse event rates for each year were 0.34% (5/1483), 0.48% (8/1662) and 0.52% (10/1931), respectively. Though incidence was rising during the three years period, no statistical significance was observed (P>0.05). It is the same case with drugs and medical devices adverse events (P >0.05). CONCLUSION: Traditional indicators reflect an excellent operation of the perioperative ophthalmologic quality, whereas adverse events analysis indicates some underlying problems. Compared with the traditional indexes for medical quality evaluation, the index of adverse events is more reasonable and easier to make an objective evaluation for medical quality of ophthalmologic perioperation, facilitating further refine analysis. Reasonable application of the adverse events indicators helps hospital to make the detailed quality control measures.

Methylenetetrahydrofolate reductase gene polymorphisms and skin cancer risk: a meta-analysis.

We sought to determine whether the methylenetetrahydrofolate reductase (MTHFR) A1298C and C677T polymorphisms are associated with increased skin cancer risk. We performed literature searches of the PubMed, BIOSIS Previews, and Web of Science databases to identify eligible articles published through September 15, 2013. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed-effects or random-effects models. Publication bias and subgroup analyses were also performed. Eight articles, which consisted of 10,066 subjects (2,672 patients and 7,394 controls), were included in the meta-analysis. Homozygous MTHFR 1298C individuals were 1.29 times more likely to develop skin cancer (95% CI, 1.04-1.61) compared with A1298C allele (AA or AC) carriers. There was an increased risk for C allele homozygotes compared with the 1,298 AA+AC carriers (OR, 1.45; 95% CI, 1.08-1.96) when restricted to basal cell carcinomas (BCC). The 1298C homozygote carriers increased the odds of BCC by 1.47 times (95% CI, 1.07-2.01) compared with those who were 1298A homozygote carriers. ORs for all genetic models yielded a null association. The data obtained from this meta-analysis suggest that the MTHFR 1298C allele is associated with increased skin cancer risk, particularly BCC; however, no association was observed between the MTHFR C677T polymorphism and skin cancer.

Impact of a clinical pathway on hospital costs, length of stay and early outcomes after hepatectomy for hepatocellular carcinoma.

BACKGROUND: A clinical pathway (CP) can standardize and improve perioperative care for a number of interventions. In hepatic surgery, however, pertinent evidence is very limited. This study was conducted to implement a CP for hepatocellular carcinoma (HCC) patients undergoing hepatectomy, and to evaluate its effects on hospital costs, length of hospital stay (LOHS) and early clinical outcomes. MATERIALS AND METHODS: Medical records for HCC patients undergoing hepatectomy were retrospectively reviewed before implementation of a CP (the non-CP group) from March 2012 to August 2012. This information was compared with the data collected prospectively from patients after implementation of the CP (the CP group) between September 2012 and April 2013. Hospital costs, LOHS and early clinical outcomes were evaluated and compared between groups. RESULTS: There were no significant differences in terms of patient clinical characteristics between the two groups. For clinical outcome measures, no significant differences were found in postoperative complications, mortality and readmission rate. The hospital costs were significantly reduced from 24,844 RMB in the non-CP group to 19,761 RMB in the CP group (p<0.01). In addition, patients of the CP group also had shorter LOHS compared with the non-CP group (8.3 versus 12.3 days, p<0.001). CONCLUSIONS: The CP proved to be an effective approach to minimize hospital costs and LOHS with hepatectomy for HCC without compromising patient care.

[Hazard evaluation modeling of particulate matters emitted by coal-fired boilers and case analysis].

In order to evaluate the hazard of PM2.5 emitted by various boilers, in this paper, segmentation of particulate matters with sizes of below 2. 5 microm was performed based on their formation mechanisms and hazard level to human beings and environment. Meanwhile, taking into account the mass concentration, number concentration, enrichment factor of Hg, and content of Hg element in different coal ashes, a comprehensive model aimed at evaluating hazard of PM2.5 emitted by coal-fired boilers was established in this paper. Finally, through utilizing filed experimental data of previous literatures, a case analysis of the evaluation model was conducted, and the concept of hazard reduction coefficient was proposed, which can be used to evaluate the performance of dust removers.

[Cost-benefit analysis on the strategy of social health insurance regarding vaccination against influenza in Xi'an city].

OBJECTIVE: To assess the economic implications of an annual vaccination strategy against influenza among people who were on a social-health program. METHODS: A retrospective cohort study was conducted. 1900 persons who had received the influenza vaccine were served as vaccine group, while 1049 persons who did not receive the vaccine were served as controls. Cluster random sampling method was used. Both of these two groups came from Donfang Company in which there were 12,109 employers in total and all of them joined the social health insurance program. The survey was carried out when the influenza vaccine was given one year ago. RESULTS: The rates of vaccine group and control group for respiratory system diseases and cardiovascular diseases who were hospitalized, were 0.51%, 2.47% and 1.64%, 5.62% which showed 68.90% and 56.05% decrease, when compared with the control group. The crude inpatient rate among vaccinees and control group after receiving the vaccination for three and four month were 0.62%, 0.80% and 0.28%, 1.00% respectively. The inpatient rate of oldest-age group decreased by 53.59%, compared with control group. The cost-benefit ratio generated by the use of influenza vaccine in reducing the hospitalization rate was 6.48:1 for Social Health Insurants in Xi'an city. CONCLUSION: The Strategy to vaccinate the social-health-insured residents on influenza in Xi'an city had gained better economic benefits in reducing the hospitalization rate of respiratory system diseases and cardiovascular diseases for mild and old-aged persons.

[Experimental study a new device of scleral flap stent on filtration surgery in normal sheep].

OBJECTIVE: To test the effectiveness and safety of a filtering drainage device, a scleral flap stent (SFS) made of poly methyl methacrylate (PMMA) in trabeculectomy (or filtering drainage-plasty) in sheep. METHODS: 32 of normal sheep were used. Trabeculectomy was performed in both eyes and the filtering drainage device, a SFS was randomly implanted under the scleral flap in one eye. After the surgery, the intraocular pressure (IOP) was measured by Schiotz tonometer; The filtering blebs and its histopathology was examined by a slit lamp, an ultrasound biomicroscope (UBM), and electronmicroscopy. RESULTS: The IOP in eyes with trabeculectomy plus SFS was statistically significant (P < 0.001) lower than that in eyes with trabeculectomy along at one month (11.38 +/- 1.20) mm Hg vs (14.05 +/- 0.93) mm Hg and at three months (11.95 +/- 1.18) mm Hg vs (15.2 +/- 1.09 mm Hg). Compared to the pre-operation, no difference in IOP was found at one month in eyes with trabeculectomy along (16.04 +/- 1.02) mm Hg vs (14.05 +/- 0.93) mm Hg. The filtering bleb was lasted more than 3 months in eyes with trabeculectomy plus SFS while existed only one month in eyes with trabeculectomy along by both slit lamp and UBM examination. The fibroblastic proliferation of filtering pathway and scar formation was found at one months post-operation in eyes with trabeculectomy along, however, the fibroblastic proliferation and the scar formation were found at three months and at six months after surgery in eyes with trabeculectomy plus SFS, respectively, by a light and electronmicroscopy examination. Tissue compliance was good and no elimination occurred. No toxic or adverse effects were observed in the following year post-operatively. CONCLUSION: SFS is a safe and effective newly designed filtering drainage device in lowering IOP when performed together with trabeculectomy.