Background:Breast cancer is the most commonly diagnosed cancer and leading cause of cancer death among women worldwide but has patterns and trends which vary in different countries.This study aimed to evaluate the glo...Background:Breast cancer is the most commonly diagnosed cancer and leading cause of cancer death among women worldwide but has patterns and trends which vary in different countries.This study aimed to evaluate the global patterns of breast cancer incidence and mortality and analyze its temporal trends for breast cancer prevention and control.Methods:Breast cancer incidence and mortality data in 2020 were obtained from the GLOBOCAN online database.Continued data from the Cancer Incidence in Five Continents Time Trends,the International Agency for Research on cancer mortality and China National Central Cancer Registry were used to analyze the time trends from 2000 to 2015 through Joinpoint regression,and annual average percent changes of breast cancer incidence and mortality were calculated.Association between Human Development Index and breast cancer incidence and mortality were estimated by linear regression.Results:There were approximately 2.3 million new breast cancer cases and 685,000 breast cancer deaths worldwide in 2020.Its incidence and mortality varied among countries,with the age-standardized incidence ranging from the highest of 112.3 per 100,000 population in Belgium to the lowest of 35.8 per 100,000 population in Iran,and the age-standardized mortality from the highest of 41.0 per 100,000 population in Fiji to the lowest of 6.4 per 100,000 population in South Korea.The peak age of breast cancer in some Asian and African countries were over 10 years earlier than in European or American countries.As for the trends of breast cancer,the age-standardized incidence rates significantly increased in China and South Korea but decreased in the United States of America(USA)during 2000-2012.Meanwhile,the age-standardized mortality rates significantly increased in China and South Korea but decreased in the United Kingdom,the USA,and Australia during 2000 and 2015.Conclusions:The global burden of breast cancer is rising fast and varies greatly among countries.The incidence and mortality rates of breast cancer incre展开更多
OBJECTIVE: To assess the effectiveness and safety of Kuntai capsule and hormone replacement therapy in treatment of perimenopausal syndrome.METHODS: Articles were retrieved from the databases Cochrane Database of Syst...OBJECTIVE: To assess the effectiveness and safety of Kuntai capsule and hormone replacement therapy in treatment of perimenopausal syndrome.METHODS: Articles were retrieved from the databases Cochrane Database of Systematic Reviews,Pub Med, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database. Only randomized controlled trials were included; 15 trials involving1243 patients were identified from January 2005 to April 2015. A systemic review and Meta-analysis of publications was performed. The review was limit-ed to randomized controlled trials that compared Kuntai capsule and hormone replacement therapy to treat perimenopausal syndrome for at least 3months. The primary outcome assessed was the treatment efficacy at 3 months, including effective rate of Kupperman menopausal scores, Kupperman menopausal scores, and blood estradiol(E2) or blood follicle stimulating hormone(FSH) levels.Other outcomes assessed were safety or adverse events, such as gastrointestinal complaints, breast distending pain, or vaginal bleeding.RESULTS: Kupperman menopausal scores showed no significant difference in effective rate [odds ratio(OR): 1.05, 95% confidence intervals(CI): 0.71 to1.55] and changes in FSH level [mean difference(MD): 2.14, 95% CI:-2.36 to 6.65]. There was a significant statistical difference in Kupperman menopausal scores(MD:-1.14, 95% CI:-2.03 to-0.25)and changes in E2level(MD:-16.41, 95% CI:-18.83to-13.69). There were fewer adverse events in the Kuntai capsule group than in the hormone replacement therapy group(OR: = 0.35, 95% CI: 0.25 to0.48, P < 0.01).CONCLUSION: Compared with hormone replacement therapy, Kuntai capsule can improve perimenopausal symptoms and blood E2 levels, and reduce the incidence of adverse events.展开更多
Objective To characterize the histological and epidemiological features of male lung cancer patients in China. Methods The demographic and histological information about male lung cancer patients identified from 2000-...Objective To characterize the histological and epidemiological features of male lung cancer patients in China. Methods The demographic and histological information about male lung cancer patients identified from 2000-01-01 to 2012-12-31, was collected from the Cancer Hospital of the Chinese Academy of Medical Sciences. Relative frequencies （RF） were estimated for major histological subtypes and compared according to the years of diagnosis and birth. Results The RF of adenocarcinoma （ADC） increased from 21.96% to 43.36% and the RF of squamous cell carcinoma （SCC） decreased from 39.11% to 32.23% from 2000 to 2012 in the 15 427 male lung cancer patients included in this study （Z=17,909, P〈0.0001; Z=-6.117, P〈0.0001）. The RF of ADC increased from 28.72% in 2000-2004, 36.88% in 2005-2008 to 48.61% in 2009-2012 in patients born after 1960. The age-adjusted RF of ADC in 2007-2012 increased consistently in all the investigated areas. Conclusion The increased RF of ADC in male lung cancer patients highlights the need for further investigation of the etiologic factors of these tumors. Smoke-free policies rather than modifying tobacco products should be enforced.展开更多
Objective To estimate the prevalence of elevated blood pressure（EBP） in Chinese children and identify individual and family factors associated with EBP. Methods A nationwide cross-sectional study was conducted in 20...Objective To estimate the prevalence of elevated blood pressure（EBP） in Chinese children and identify individual and family factors associated with EBP. Methods A nationwide cross-sectional study was conducted in 2010 using stratified cluster sampling. Participants＇ blood pressure was measured, and their parents completed a questionnaire on personal and family characteristics. Prevalence and correlates of EBP were assessed. Results Among a total of 24,333 participants, 20.2% of boys and 16.3% of girls had EBP. The prevalence of EBP increased with the ascending trend of waist circumference, Waist-to-height ratio, and body mass index. The adjusted prevalence ratios（aP Rs） for obese boys and girls were 2.50 and 2.97, respectively. Fewer urban boys（16.2%） had EBP than rural boys（21.7%）. Boys with a family history of hypertension were 12% more likely to have EBP. Children whose mothers received a college education tended to have lower likelihood of EBP; with an aP R was 0.85 among boys and 0.78 among girls. Conclusion EBP is common among obese students and those who have a family history of hypertension. A negative association between mothers＇ education levels and EBP risk in children was found.展开更多
Background: Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor of vascular origin with an unknown etiology, a low incidence, and a variable natural course. We evaluated the management and prognosis of HEH ...Background: Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor of vascular origin with an unknown etiology, a low incidence, and a variable natural course. We evaluated the management and prognosis of HEH from the Surveillance, Epidemiology and End Results (SEER) program and changes in treatment modalities of HEH over 30 years. Methods: From 1973 to 2014 in the SEER database, we selected patients diagnosed with HEH. We analyzed the clinical characteristics, patterns of management, and clinical outcomes of patients with HEH. Results: We identi ed 79 patients with HEH (median age: 54.0 years;male to female ratio: 1:2.6). The initial extent of disease was local in 22 (27.8%) patients, regional metastasis in 22 (27.8%), distant metas-tasis in 31 (39.2%) and unknown in 4 (5.1%). The median size of primary tumor was 3.85 cm (interquartile range, 2.50 7.93 cm). Among 74 patients with available management data, the most common manage-ment was no treatment (29/74, 39.2%), followed by chemotherapy only (22/74, 29.7%), liver resection-based (13/74, 17.6%), and transplantation-based therapy (6/74, 8.1%). The 5-year cancer-speci c survival rate was 57.8%. Patients who underwent surgical treatment had signi cantly higher survival than those who underwent non-surgical treatment (5-year survival;88% vs. 49%, P=0.019). Multivariate analysis revealed that surgical therapy was the only independent prognostic factor for survival (hazard ratio: 0.20, P=0.040). Conclusions: Resection or liver transplantation is worth considering for treatment of patients with HEH.展开更多
Objective: To redefine overdiagnosis and reestimate the proportion of overdiagnosis of breast cancer caused by screening based on the Surveillance, Epidemiology, and End Results(SEER, 1973-2015) Program data.Methods: ...Objective: To redefine overdiagnosis and reestimate the proportion of overdiagnosis of breast cancer caused by screening based on the Surveillance, Epidemiology, and End Results(SEER, 1973-2015) Program data.Methods: The breast cancer diagnosed before 1977 was defined as the no-screening cohort since America had initiated breast cancer screening from 1977. The breast cancer diagnosed in 1999 was defined as the screening cohort due to no increases in both the proportion of early-stage breast cancer until 1999 and the overall survival of early-stage breast cancer diagnosed over the three years since 1999. The magnitude of overdiagnosis was calculated as the difference in the proportions of early-stage breast cancer patients with long-time(15-year) survival to all breast cancer patients between two cohorts.Results: Over 23 years before and after widespread screening in America, the proportion of early-stage breast cancer patients increased from 52.1%(16,891/32,443) to 72.7%(16,021/22,025)(P<0.001). The 15-year survival rate of early-stage breast cancer patients increased from 51.1% to 61.5%(P<0.001), while the proportions of earlystage breast cancer patients with long-time survival to all breast cancer patients increased from 26.6%(52.1%×51.1%) to 44.7%(72.7%×61.5%). Assuming no improvements in cancer screening technology and treatment technology, 18.1%(44.7%-26.6%) of breast cancer patients were overdiagnosed associated with screening. The age-specific overdiagnosis rates were 18.9%, 24.7%, 24.5%, 20.5%, and 8.3% for breast cancer patients aged 40-49, 50-59, 60-69, 70-74, and ≥75 years old, respectively.Conclusions: Overdiagnosis caused by mammographic screening is probably overestimated in current screening practices. Further trials with more sophisticated designs and analyses are needed to validate our findings in the future.展开更多
Hemorrhagic cystitis(HC)is a common complication of allogeneic hematopoietic stem cell transplantation(HSCT).The incidence is about 7%to 68%,and some patients have to suffer a long period of frequent,urgent,and painfu...Hemorrhagic cystitis(HC)is a common complication of allogeneic hematopoietic stem cell transplantation(HSCT).The incidence is about 7%to 68%,and some patients have to suffer a long period of frequent,urgent,and painful urination,which brings great pain.This study aimed to analyze risk factors of HC and its effect on patient survival.We collected the medical records of 859 patients who underwent HSCT at our hospital between August 2016 and August 2020.Patients with and without HC were matched using propensity score matching at a 1:1 ratio based on sex,age,and diagnosis,and logistic regression analyses were used to identify factors associated with HC.We used Kaplan–Meier curves to analyze the survival rates of patients in the HC and non-HC groups.We also analyzed the relationship between BK viral load and the occurrence of HC using receiver operating characteristic curve(ROC)analysis.After propensity score matching,there were 131 patients each in the HC and non-HC groups.In the HC group,89 patients(67.9%)had mild HC(stage II°)and 43(32.1%)had severe HC(stage III–IV).The median interval between stem cell transplantation and HC development was 31(3–244)days.Univariate analysis indicated that donor age,hematopoietic stem cell source,HLA,acute graft-versus-host disease,busulfan,anti-thymocyte globulin(ATG),total body irradiation,cytomegalovirus(CMV)(urine),and BK polyomavirus(BKV)(urine)were significantly associated with HC.ATG,CMV(urine),and BKV(urine)were independent risk factors for HC based on the multivariate analysis.The Kaplan–Meier survival analysis showed no significant difference between the HC and non-HC groups(P=0.14).The 1-and 2-year survival rates in the HC group were 78.4%and 69.6%,respectively,and the corresponding rates in the non-HC group were 84.4%and 80.7%,respectively.ROC analysis indicated that a urine BKV load of 1×10^(7) copies/mL was able to stratify the risk of HC.In conclusion,when the BKV load is>1×10^(7),we needtobe aware of the potential for the development of HC.展开更多
China implemented the public hospital reform in 2012. This study utilized bootstrapping data envelopment analysis（DEA） to evaluate the technical efficiency（TE） and productivity of county public hospitals in Easter...China implemented the public hospital reform in 2012. This study utilized bootstrapping data envelopment analysis（DEA） to evaluate the technical efficiency（TE） and productivity of county public hospitals in Eastern, Central, and Western China after the 2012 public hospital reform. Data from 127 county public hospitals（39, 45, and 43 in Eastern, Central, and Western China, respectively） were collected during 2012–2015. Changes of TE and productivity over time were estimated by bootstrapping DEA and bootstrapping Malmquist. The disparities in TE and productivity among public hospitals in the three regions of China were compared by Kruskal–Wallis H test and Mann–Whitney U test. The average bias-corrected TE values for the four-year period were 0.6442, 0.5785, 0.6099, and 0.6094 in Eastern, Central, and Western China, and the entire country respectively, with average non-technical efficiency, low pure technical efficiency（PTE）, and high scale efficiency found. Productivity increased by 8.12%, 0.25%, 12.11%, and 11.58% in China and its three regions during 2012–2015, and such increase in productivity resulted from progressive technological changes by 16.42%, 6.32%, 21.08%, and 21.42%, respectively. The TE and PTE of the county hospitals significantly differed among the three regions of China. Eastern and Western China showed significantly higher TE and PTE than Central China. More than 60% of county public hospitals in China and its three areas operated at decreasing return scales. There was a considerable space for TE improvement in county hospitals in China and its three regions. During 2012–2015, the hospitals experienced progressive productivity; however, the PTE changed adversely. Moreover, Central China continuously achieved a significantly lower efficiency score than Eastern and Western China. Decision makers and administrators in China should identify the causes of the observed inefficiencies and take appropriate measures to increase the efficiency of county public hospitals in the th展开更多
Fertility in China was long constrained by the One-Child policy enacted in 1978. Over time the policy was progressively relaxed,first in rural areas and then for couples who both had no siblings.A Selective Two-Child ...Fertility in China was long constrained by the One-Child policy enacted in 1978. Over time the policy was progressively relaxed,first in rural areas and then for couples who both had no siblings.A Selective Two-Child policy which started in January-June 2014allowed a second child for couples for whom one spouse was an only child. Now with the Universal Two-Child policy, as of展开更多
Transparency Ecosystemfor Research and Journals inMedicine(TERM)Working Group summarized the essential recommendations that should be considered to review and publish a high-quality guideline.These recommendations fro...Transparency Ecosystemfor Research and Journals inMedicine(TERM)Working Group summarized the essential recommendations that should be considered to review and publish a high-quality guideline.These recommendations fromeditors and reviewers included the 10 components of essential requirements:systematic review of existing relevant guidelines,guideline registration,guideline protocol,stakeholders,conflicts of interest,clinical questions,systematic reviews,recommendation consensus,guideline reporting,and external review.TERMWorking Group abbreviates them as PAGE(essential requirements for Publishing clinical prActice GuidelinEs),recommends guideline authors,editors,and peer reviewers use them for high-quality guidelines.展开更多
Glioblastoma （GBM） is the most common and most aggressive primary brain tumor in adults. The existence of a small population of stem-like tumor cells that efficiently propagate tumors and resist cytotoxic therapy is...Glioblastoma （GBM） is the most common and most aggressive primary brain tumor in adults. The existence of a small population of stem-like tumor cells that efficiently propagate tumors and resist cytotoxic therapy is one proposed mechanism leading to the resilient behavior of tumor cells and poor prognosis. In this study, we performed an in-depth analysis of the DNA methylation landscape in GBM- derived cancer stem ceils （GSCs）. Parallel comparisons of primary tumors and GSC lines derived from these tumors with normal controls （a neural stem cell （NSC） line and normal brain tissue） identified groups of hyper- and hypomethylated genes that display a trend of either increasing or decreasing methylation levels in the order of controls, primary GBMs, and their counterpart GSC lines, respectively. Interestingly, concurrent promoter hypermethylation and gene body hypomethylation were observed in a subset of genes including MGMT, AJAP1 and PTPRN2. These unique DNA methylation signatures were also found in primary GBM-derived xenograft tumors indicating that they are not tissue culture-related epigenetic changes. Integration of GSC-specific epigenetic signatures with gene expression analysis further identified candidate tumor suppressor genes that are frequently down-regulated in GBMs such as SPINT2, NEFM and PENK. Forced re-expression of SPINT2 reduced glioma cell proliferative capacity, anchorage independent growth, cell motility, and tumor sphere formation in vitro. The results from this study demonstrate that GSCs possess unique epigenetic signatures that may play important roles in the pathogenesis of GBM.展开更多
Adverse birth outcomes are a leading cause of mortality in children in China, but the environmental influences of these conditions remain largely unexplained in this population. We aimed to evaluate the levels of poly...Adverse birth outcomes are a leading cause of mortality in children in China, but the environmental influences of these conditions remain largely unexplained in this population. We aimed to evaluate the levels of polycyclic aromatic hydrocarbons (PAHs) in Chinese pregnant women and their newborns, and to examine the association between levels of PAHs and infant birth weight. We conducted a cross-sectional study including 81 pairs of mothers and newborns from four hospitals in four different cities in China. High Performance Liquid Chromatography was used to measure the concentration of nine PAHs in maternal and cord blood and multiple linear regression analyses were used to evaluate the associations of these PAHs with infant birth weight. Anthracene (ANT) had the highest average concentration and detection rate (geometric mean = 69.54 ng/g and 76.5%, respectively) in maternal serum samples, while fluoranthene (FLT) had the highest concentration and detection rate (geometric mean = 68.4 ng/g and 50.6%, respectively) in the cord blood. Most of the measured PAHs in maternal serum and three PAHs in cord blood were inversely but non-significantly associated with birth weight. The strongest associations were observed for higher concentrations of benzo (a) pyrene (BaP) in maternal serum (230.7 g decrease for levels > median vs. < LOD;p = 0.151) and for ANT in cord blood (153.1 g decrease for levels < median vs. < LOD;p = 0.208). Ant and FLT were the predominant PAHs in the maternal and cord blood serum. Serum concentrations of several measured PAHs were associated with a decreased birth weight, although not significantly, suggesting that further studies with larger sample sizes are needed to validate our findings.展开更多
Analysis of carcinogenicity data generally involves a trend test across all dose groups and a pairwise comparison of the high dose group with the control. The most commonly used test for a positive trend is the Cochra...Analysis of carcinogenicity data generally involves a trend test across all dose groups and a pairwise comparison of the high dose group with the control. The most commonly used test for a positive trend is the Cochran-Armitage test. This test is asymptotically normal. For the pairwise comparison of the high dose group with the control group, we propose two modifications: the first modification is to apply the test on the data from high dose and control groups after dropping the data from the low and the medium dose groups;the second modification is to adjust the test conditional on data from all dose groups. We compare the power performance of these two modifications for the pairwise comparisons.展开更多
BACKGROUND Retrograde single balloon enteroscopy(SBE)is a minimally invasive procedure which is less frequently performed compared with antegrade SBE.There are few studies on the retrograde through-the-scope enterosco...BACKGROUND Retrograde single balloon enteroscopy(SBE)is a minimally invasive procedure which is less frequently performed compared with antegrade SBE.There are few studies on the retrograde through-the-scope enteroscopy(TTSE),a novel technique for evaluation of the small bowel.AIM To compare the clinical utility and safety of retrograde TTSE with retrograde SBE.METHODS Clinical data and complications of retrograde TTSE(2014-2018)and retrograde SBE(2011-2018)performed in a community hospital were reviewed and presented as mean±SD or frequency(%)and compared using proper statistical tests.Technical success was defined as insertion of the enteroscope>20 cm beyond ileocecal valve.RESULTS Data obtained from 54 retrograde SBE in 49 patients and 27 retrograde TTSE in 26 patients were studied.The most common indication for retrograde enteroscopy was iron deficiency anemia(41 patients)followed by gastrointestinal bleeding(37 patients),and chronic diarrhea(7 patients).The duration of retrograde SBE procedure(91.9±34.2 min)was significantly longer compared with retrograde TTSE(70.5±30.7 min)(P=0.04).Technical success was comparable in TTSE[23/27(85.2%)]and SBE[41/54(75.9%)(P=0.33)].The mean depth of insertion beyond the ileocecal valve in retrograde SBE(92.5±70.0 cm)tended to be longer compared with retrograde TTSE(64.6±49.0 cm)(P=0.08).No complication was observed in this study.CONCLUSION Both retrograde TTSE and retrograde SBE are feasible and safe.Retrograde TTSE takes a shorter time and has a comparable technical success with SBE.TTSE has a lower capacity of small bowel insertion.展开更多
Transparency Ecosystem for Research and Journals in Medicine(TERM)working group summarized the essential recommendations that should be considered to review and publish a high-quality guideline.These recommendations f...Transparency Ecosystem for Research and Journals in Medicine(TERM)working group summarized the essential recommendations that should be considered to review and publish a high-quality guideline.These recommendations from editors and reviewers included 10 components of essential requirements:systematic review of existing relevant guidelines,guideline registration,guideline protocol,stakeholders,conflicts of interest,clinical questions,systematic reviews,recommendation consensus,guideline reporting and external review.TERM working group abbreviates them as PAGE(essential requirements for Publishing clinical prActice GuidelinEs),and recommends guideline authors,editors,and peer reviewers to use them for high-quality guidelines.展开更多
AIM： To investigate the prevalence and risk factors of gastroesophageal reflux disease （GERD） symptoms in Qashqai migrating nomads with a different life style in Fars province, southern Iran. METHODS： In summer 20...AIM： To investigate the prevalence and risk factors of gastroesophageal reflux disease （GERD） symptoms in Qashqai migrating nomads with a different life style in Fars province, southern Iran. METHODS： In summer 2006, 748 Qashqai migrating nomads aged 25 years or more were enrolled using a multiple-stage stratified cluster random sampling method. A questionnaire consisting of demographic characteristics, lifestyle and GERD symptoms （heartburn, regurgitation, chest pain, dysphagia, hoarseness and cough） as completed for each subject. RESULTS： The questionnaire was completed in 717 subjects. The prevalence rate of GERD, defined as reflux occurring at least one time per week in the preceding year, was 33% （237 subjects）. The prevalence was higher in older individuals （36.0% vs 28.9%, P 〈 0.05） and in those with other gastrointestinal complaints （51.0% vs 27.8%, P 〈 0.001）, but not different in obese and non-obese subjects. It was also higher in those consuming fruits and vegetables more than once a week （36.2% vs 17.3%, P 〈 0.001）. GERD had a positive correlation with smoking （42.1% vs 27.8%, P 〈 0.001）, but a negative relation with non-alcoholic beverages. The association between GERD and non-steroidal antiinflammatory drugs （NSAIDs） consumption was also significant （40.2% vs 25.4%, P 〈 0.001）. CONCLUSION： The prevalence of GERD （33%） is very high in Qashqai migrating nomads which may be due to a lower socioeconomic and educational level of these people and difference in the life style. Older age, frequent consumption of fruits and vegetables, smoking and NSAIDs are risk factors for GERD in this population.展开更多
Purpose:The median time from the event leading to the spinal cord injury(SCI)to the time of decompressive surgery is estimated to be 6.9 days in Iran,which is much longer than the proposed ideal time(less than 24 h)in...Purpose:The median time from the event leading to the spinal cord injury(SCI)to the time of decompressive surgery is estimated to be 6.9 days in Iran,which is much longer than the proposed ideal time(less than 24 h)in published guidelines.The current qualitative study aimed to determine the reasons for the observed decompression surgery delay in Iran from the perspective of neurosurgeons.Methods:This qualitative study is designed to perform content analysis on the gathered data from face-to-face semi-structured interviews with 12 Iranian neurosurgeons.Results:The findings of the current study suggest that patient-related factors constitute more than half of the codes extracted from the interviews.Overall,the type of injury,presence of polytrauma,and surgeons’’wrong attitude are the main factors causing delayed spinal cord decompression in Iranian patients from the perspective of neurosurgeons.Other notable factors include delay in transferring patients to the trauma center,delay in availability of necessary equipment,and scarce medical personnel.Conclusion:In the perspective of neurosurgeons,the type of injury,presence of polytrauma,and surgeons’’wrong attitude are the leading reasons for delayed decompressive surgery of individuals with SCI in Iran.展开更多
Background:Malnutrition and malaria are both significant causes of morbidity and mortality in African children.However,the extent of their spatial comorbidity remains unexplored and an understanding of their spatial c...Background:Malnutrition and malaria are both significant causes of morbidity and mortality in African children.However,the extent of their spatial comorbidity remains unexplored and an understanding of their spatial correlation structure would inform improvement of integrated interventions.We aimed to determine the spatial correlation between both wasting and low mid upper arm circumference(MUAC)and falciparum malaria among Somalian children aged 6-59 months.Methods:Data were from 49227 children living in 888 villages between 2007 to 2010.We developed a Bayesian geostatistical shared component model in order to determine the common spatial distributions of wasting and falciparum malaria;and low-MUAC and falciparum malaria at 1×1 km spatial resolution.Results:The empirical correlations with malaria were 0.16 and 0.23 for wasting and low-MUAC respectively.Shared spatial residual effects were statistically significant for both wasting and low-MUAC.The posterior spatial relative risk was highest for low-MUAC and malaria(range:0.19 to 5.40)and relatively lower between wasting and malaria(range:0.11 to 3.55).Hotspots for both wasting and low-MUAC with malaria occurred in the South Central region in Somalia.Conclusions:The findings demonstrate a relationship between nutritional status and falciparum malaria parasitaemia,and support the use of the relatively simpler MUAC measurement in surveys.Shared spatial distribution and distinct hotspots present opportunities for targeted seasonal chemoprophylaxis and other forms of malaria prevention integrated within nutrition programmes.展开更多
Objective:To investigate what extent lead-time bias is likely to affect endoscopic screening effectiveness for esophageal cancer in the high-risk area in China.Methods:A screening model based on the epidemiological ca...Objective:To investigate what extent lead-time bias is likely to affect endoscopic screening effectiveness for esophageal cancer in the high-risk area in China.Methods:A screening model based on the epidemiological cancer registry data,yielding a population-level incidence and mortality rates,was carried out to simulate study participants in the high-risk area in China,and investigate the effect of lead-time bias on endoscopic screening with control for length bias.Results:Of 100,000 participants,6,150(6.15%)were diagnosed with esophageal squamous dysplasia during the 20-year follow-up period.The estimated lead time ranged from 1.67 to 5.78 years,with a median time of 4.62 years[interquartile range(IQR):4.07-5.11 years]in the high-risk area in China.Lead-time bias exaggerated screening effectiveness severely,causing more than a 10%overestimation in 5-year cause-specific survival rate and around a 43%reduction in cause-specific hazard ratio.The magnitude of lead-time bias on endoscopic screening for esophageal cancer varied depending on the screening strategies,in which an inverted U-shaped and U-shaped effects were observed in the 5-year cause-specific survival rate and cause-specific hazard ratio respectively concerning a range of ages for primary screening.Conclusions:Lead-time bias,usually causing an overestimation of screening effectiveness,is an elementary and fundamental issue in cancer screening.Quantification and correction of lead-time bias are essential when evaluating the effectiveness of endoscopic screening in the high-risk area in China.展开更多
Objective:Prevention and early detection of colorectal cancer(CRC)can increase the chances of successful treatment and reduce burden.Various data mining technologies have been utilized to strengthen the early detectio...Objective:Prevention and early detection of colorectal cancer(CRC)can increase the chances of successful treatment and reduce burden.Various data mining technologies have been utilized to strengthen the early detection of CRC in primary care.Evidence synthesis on the model’s effectiveness is scant.This systematic review synthesizes studies that examine the effect of data mining on improving risk prediction of CRC.Methods:The PRISMA framework guided the conduct of this study.We obtained papers via Pub Med,Cochrane Library,EMBASE and Google Scholar.Quality appraisal was performed using Downs and Black’s quality checklist.To evaluate the performance of included models,the values of specificity and sensitivity were comparted,the values of area under the curve(AUC)were plotted,and the median of overall AUC of included studies was computed.Results:A total of 316 studies were reviewed for full text.Seven articles were included.Included studies implement techniques including artificial neural networks,Bayesian networks and decision trees.Six articles reported the overall model accuracy.Overall,the median AUC is 0.8243[interquartile range(IQR):0.8050-0.8886].In the two articles that reported comparison results with traditional models,the data mining method performed better than the traditional models,with the best AUC improvement of 10.7%.Conclusions:The adoption of data mining technologies for CRC detection is at an early stage.Limited numbers of included articles and heterogeneity of those studies implied that more rigorous research is expected to further investigate the techniques’effects.展开更多
基金The National Key Research and Development Program of ChinaThe Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences+1 种基金This work was supported by grants from the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(CIFMS,grant No.2018-I2M-3-003)the National Key Research and Development Program of China(grant No.2018YFC1315305).
文摘Background:Breast cancer is the most commonly diagnosed cancer and leading cause of cancer death among women worldwide but has patterns and trends which vary in different countries.This study aimed to evaluate the global patterns of breast cancer incidence and mortality and analyze its temporal trends for breast cancer prevention and control.Methods:Breast cancer incidence and mortality data in 2020 were obtained from the GLOBOCAN online database.Continued data from the Cancer Incidence in Five Continents Time Trends,the International Agency for Research on cancer mortality and China National Central Cancer Registry were used to analyze the time trends from 2000 to 2015 through Joinpoint regression,and annual average percent changes of breast cancer incidence and mortality were calculated.Association between Human Development Index and breast cancer incidence and mortality were estimated by linear regression.Results:There were approximately 2.3 million new breast cancer cases and 685,000 breast cancer deaths worldwide in 2020.Its incidence and mortality varied among countries,with the age-standardized incidence ranging from the highest of 112.3 per 100,000 population in Belgium to the lowest of 35.8 per 100,000 population in Iran,and the age-standardized mortality from the highest of 41.0 per 100,000 population in Fiji to the lowest of 6.4 per 100,000 population in South Korea.The peak age of breast cancer in some Asian and African countries were over 10 years earlier than in European or American countries.As for the trends of breast cancer,the age-standardized incidence rates significantly increased in China and South Korea but decreased in the United States of America(USA)during 2000-2012.Meanwhile,the age-standardized mortality rates significantly increased in China and South Korea but decreased in the United Kingdom,the USA,and Australia during 2000 and 2015.Conclusions:The global burden of breast cancer is rising fast and varies greatly among countries.The incidence and mortality rates of breast cancer incre
文摘OBJECTIVE: To assess the effectiveness and safety of Kuntai capsule and hormone replacement therapy in treatment of perimenopausal syndrome.METHODS: Articles were retrieved from the databases Cochrane Database of Systematic Reviews,Pub Med, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database. Only randomized controlled trials were included; 15 trials involving1243 patients were identified from January 2005 to April 2015. A systemic review and Meta-analysis of publications was performed. The review was limit-ed to randomized controlled trials that compared Kuntai capsule and hormone replacement therapy to treat perimenopausal syndrome for at least 3months. The primary outcome assessed was the treatment efficacy at 3 months, including effective rate of Kupperman menopausal scores, Kupperman menopausal scores, and blood estradiol(E2) or blood follicle stimulating hormone(FSH) levels.Other outcomes assessed were safety or adverse events, such as gastrointestinal complaints, breast distending pain, or vaginal bleeding.RESULTS: Kupperman menopausal scores showed no significant difference in effective rate [odds ratio(OR): 1.05, 95% confidence intervals(CI): 0.71 to1.55] and changes in FSH level [mean difference(MD): 2.14, 95% CI:-2.36 to 6.65]. There was a significant statistical difference in Kupperman menopausal scores(MD:-1.14, 95% CI:-2.03 to-0.25)and changes in E2level(MD:-16.41, 95% CI:-18.83to-13.69). There were fewer adverse events in the Kuntai capsule group than in the hormone replacement therapy group(OR: = 0.35, 95% CI: 0.25 to0.48, P < 0.01).CONCLUSION: Compared with hormone replacement therapy, Kuntai capsule can improve perimenopausal symptoms and blood E2 levels, and reduce the incidence of adverse events.
基金supported by NIH Project‘Epidemiology and Intervention Research for Tobacco Control in China’(R01 RFA-TW-06-006)Beijing Run-for-Hope Fund(YF2010-48)
文摘Objective To characterize the histological and epidemiological features of male lung cancer patients in China. Methods The demographic and histological information about male lung cancer patients identified from 2000-01-01 to 2012-12-31, was collected from the Cancer Hospital of the Chinese Academy of Medical Sciences. Relative frequencies （RF） were estimated for major histological subtypes and compared according to the years of diagnosis and birth. Results The RF of adenocarcinoma （ADC） increased from 21.96% to 43.36% and the RF of squamous cell carcinoma （SCC） decreased from 39.11% to 32.23% from 2000 to 2012 in the 15 427 male lung cancer patients included in this study （Z=17,909, P〈0.0001; Z=-6.117, P〈0.0001）. The RF of ADC increased from 28.72% in 2000-2004, 36.88% in 2005-2008 to 48.61% in 2009-2012 in patients born after 1960. The age-adjusted RF of ADC in 2007-2012 increased consistently in all the investigated areas. Conclusion The increased RF of ADC in male lung cancer patients highlights the need for further investigation of the etiologic factors of these tumors. Smoke-free policies rather than modifying tobacco products should be enforced.
基金supported by the Young Scholar Scientific Research Foundation of the Chinese Center for Disease Control and Prevention(grant#China CDC 2010A205)
文摘Objective To estimate the prevalence of elevated blood pressure（EBP） in Chinese children and identify individual and family factors associated with EBP. Methods A nationwide cross-sectional study was conducted in 2010 using stratified cluster sampling. Participants＇ blood pressure was measured, and their parents completed a questionnaire on personal and family characteristics. Prevalence and correlates of EBP were assessed. Results Among a total of 24,333 participants, 20.2% of boys and 16.3% of girls had EBP. The prevalence of EBP increased with the ascending trend of waist circumference, Waist-to-height ratio, and body mass index. The adjusted prevalence ratios（aP Rs） for obese boys and girls were 2.50 and 2.97, respectively. Fewer urban boys（16.2%） had EBP than rural boys（21.7%）. Boys with a family history of hypertension were 12% more likely to have EBP. Children whose mothers received a college education tended to have lower likelihood of EBP; with an aP R was 0.85 among boys and 0.78 among girls. Conclusion EBP is common among obese students and those who have a family history of hypertension. A negative association between mothers＇ education levels and EBP risk in children was found.
基金supported by the Bio&Medical Tech-nology Development Program of the National Research Foun-dation(NRF)funded by the Korean government(MSIT)(NRF-2018M3A9E8023861)by a grant from the Korean Health R&D Project.Ministry of Health Welfare,Korea(HI18C0531)
文摘Background: Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor of vascular origin with an unknown etiology, a low incidence, and a variable natural course. We evaluated the management and prognosis of HEH from the Surveillance, Epidemiology and End Results (SEER) program and changes in treatment modalities of HEH over 30 years. Methods: From 1973 to 2014 in the SEER database, we selected patients diagnosed with HEH. We analyzed the clinical characteristics, patterns of management, and clinical outcomes of patients with HEH. Results: We identi ed 79 patients with HEH (median age: 54.0 years;male to female ratio: 1:2.6). The initial extent of disease was local in 22 (27.8%) patients, regional metastasis in 22 (27.8%), distant metas-tasis in 31 (39.2%) and unknown in 4 (5.1%). The median size of primary tumor was 3.85 cm (interquartile range, 2.50 7.93 cm). Among 74 patients with available management data, the most common manage-ment was no treatment (29/74, 39.2%), followed by chemotherapy only (22/74, 29.7%), liver resection-based (13/74, 17.6%), and transplantation-based therapy (6/74, 8.1%). The 5-year cancer-speci c survival rate was 57.8%. Patients who underwent surgical treatment had signi cantly higher survival than those who underwent non-surgical treatment (5-year survival;88% vs. 49%, P=0.019). Multivariate analysis revealed that surgical therapy was the only independent prognostic factor for survival (hazard ratio: 0.20, P=0.040). Conclusions: Resection or liver transplantation is worth considering for treatment of patients with HEH.
基金supported by the Natural Science Foundation of Tianjin (No. 18JCQNJC80300)Chinese National Key Research and Development Project (No. 2018YFC1315600)+1 种基金National Natural Science Foundation of China (No. 81502476)the Beijing Young Talent Program (No. 2016000021469G189).
文摘Objective: To redefine overdiagnosis and reestimate the proportion of overdiagnosis of breast cancer caused by screening based on the Surveillance, Epidemiology, and End Results(SEER, 1973-2015) Program data.Methods: The breast cancer diagnosed before 1977 was defined as the no-screening cohort since America had initiated breast cancer screening from 1977. The breast cancer diagnosed in 1999 was defined as the screening cohort due to no increases in both the proportion of early-stage breast cancer until 1999 and the overall survival of early-stage breast cancer diagnosed over the three years since 1999. The magnitude of overdiagnosis was calculated as the difference in the proportions of early-stage breast cancer patients with long-time(15-year) survival to all breast cancer patients between two cohorts.Results: Over 23 years before and after widespread screening in America, the proportion of early-stage breast cancer patients increased from 52.1%(16,891/32,443) to 72.7%(16,021/22,025)(P<0.001). The 15-year survival rate of early-stage breast cancer patients increased from 51.1% to 61.5%(P<0.001), while the proportions of earlystage breast cancer patients with long-time survival to all breast cancer patients increased from 26.6%(52.1%×51.1%) to 44.7%(72.7%×61.5%). Assuming no improvements in cancer screening technology and treatment technology, 18.1%(44.7%-26.6%) of breast cancer patients were overdiagnosed associated with screening. The age-specific overdiagnosis rates were 18.9%, 24.7%, 24.5%, 20.5%, and 8.3% for breast cancer patients aged 40-49, 50-59, 60-69, 70-74, and ≥75 years old, respectively.Conclusions: Overdiagnosis caused by mammographic screening is probably overestimated in current screening practices. Further trials with more sophisticated designs and analyses are needed to validate our findings in the future.
基金the National Natural Science Foundation of China(81670171 and 82070192)Key Project of Tianjin Natural Science Foundation(20JCZDJC00410)thrombocytopenia funding from the Yeehong Business School of Shenyang Pharmaceutical University(Sansheng TCP Young Research Funding,No.57).
文摘Hemorrhagic cystitis(HC)is a common complication of allogeneic hematopoietic stem cell transplantation(HSCT).The incidence is about 7%to 68%,and some patients have to suffer a long period of frequent,urgent,and painful urination,which brings great pain.This study aimed to analyze risk factors of HC and its effect on patient survival.We collected the medical records of 859 patients who underwent HSCT at our hospital between August 2016 and August 2020.Patients with and without HC were matched using propensity score matching at a 1:1 ratio based on sex,age,and diagnosis,and logistic regression analyses were used to identify factors associated with HC.We used Kaplan–Meier curves to analyze the survival rates of patients in the HC and non-HC groups.We also analyzed the relationship between BK viral load and the occurrence of HC using receiver operating characteristic curve(ROC)analysis.After propensity score matching,there were 131 patients each in the HC and non-HC groups.In the HC group,89 patients(67.9%)had mild HC(stage II°)and 43(32.1%)had severe HC(stage III–IV).The median interval between stem cell transplantation and HC development was 31(3–244)days.Univariate analysis indicated that donor age,hematopoietic stem cell source,HLA,acute graft-versus-host disease,busulfan,anti-thymocyte globulin(ATG),total body irradiation,cytomegalovirus(CMV)(urine),and BK polyomavirus(BKV)(urine)were significantly associated with HC.ATG,CMV(urine),and BKV(urine)were independent risk factors for HC based on the multivariate analysis.The Kaplan–Meier survival analysis showed no significant difference between the HC and non-HC groups(P=0.14).The 1-and 2-year survival rates in the HC group were 78.4%and 69.6%,respectively,and the corresponding rates in the non-HC group were 84.4%and 80.7%,respectively.ROC analysis indicated that a urine BKV load of 1×10^(7) copies/mL was able to stratify the risk of HC.In conclusion,when the BKV load is>1×10^(7),we needtobe aware of the potential for the development of HC.
基金supported by the National Natural Science Foundation of China(No.71473099)
文摘China implemented the public hospital reform in 2012. This study utilized bootstrapping data envelopment analysis（DEA） to evaluate the technical efficiency（TE） and productivity of county public hospitals in Eastern, Central, and Western China after the 2012 public hospital reform. Data from 127 county public hospitals（39, 45, and 43 in Eastern, Central, and Western China, respectively） were collected during 2012–2015. Changes of TE and productivity over time were estimated by bootstrapping DEA and bootstrapping Malmquist. The disparities in TE and productivity among public hospitals in the three regions of China were compared by Kruskal–Wallis H test and Mann–Whitney U test. The average bias-corrected TE values for the four-year period were 0.6442, 0.5785, 0.6099, and 0.6094 in Eastern, Central, and Western China, and the entire country respectively, with average non-technical efficiency, low pure technical efficiency（PTE）, and high scale efficiency found. Productivity increased by 8.12%, 0.25%, 12.11%, and 11.58% in China and its three regions during 2012–2015, and such increase in productivity resulted from progressive technological changes by 16.42%, 6.32%, 21.08%, and 21.42%, respectively. The TE and PTE of the county hospitals significantly differed among the three regions of China. Eastern and Western China showed significantly higher TE and PTE than Central China. More than 60% of county public hospitals in China and its three areas operated at decreasing return scales. There was a considerable space for TE improvement in county hospitals in China and its three regions. During 2012–2015, the hospitals experienced progressive productivity; however, the PTE changed adversely. Moreover, Central China continuously achieved a significantly lower efficiency score than Eastern and Western China. Decision makers and administrators in China should identify the causes of the observed inefficiencies and take appropriate measures to increase the efficiency of county public hospitals in the th
基金supported by the National Health and Family Planning Commission of Chinathe National Key Research & Development Program of China (2016YFC1000401 and 2016YFC1000406-1)the National Natural Science Foun-dation of China (81571517)
文摘Fertility in China was long constrained by the One-Child policy enacted in 1978. Over time the policy was progressively relaxed,first in rural areas and then for couples who both had no siblings.A Selective Two-Child policy which started in January-June 2014allowed a second child for couples for whom one spouse was an only child. Now with the Universal Two-Child policy, as of
基金supported by the Foundation of Chinese Medical Association Publishing House.
文摘Transparency Ecosystemfor Research and Journals inMedicine(TERM)Working Group summarized the essential recommendations that should be considered to review and publish a high-quality guideline.These recommendations fromeditors and reviewers included the 10 components of essential requirements:systematic review of existing relevant guidelines,guideline registration,guideline protocol,stakeholders,conflicts of interest,clinical questions,systematic reviews,recommendation consensus,guideline reporting,and external review.TERMWorking Group abbreviates them as PAGE(essential requirements for Publishing clinical prActice GuidelinEs),recommends guideline authors,editors,and peer reviewers use them for high-quality guidelines.
基金supported in part by the National Institute of Health(Grant Nos.CA134304 and DA025779 to H.S., NS073611 and NS076759 to J.L.)
文摘Glioblastoma （GBM） is the most common and most aggressive primary brain tumor in adults. The existence of a small population of stem-like tumor cells that efficiently propagate tumors and resist cytotoxic therapy is one proposed mechanism leading to the resilient behavior of tumor cells and poor prognosis. In this study, we performed an in-depth analysis of the DNA methylation landscape in GBM- derived cancer stem ceils （GSCs）. Parallel comparisons of primary tumors and GSC lines derived from these tumors with normal controls （a neural stem cell （NSC） line and normal brain tissue） identified groups of hyper- and hypomethylated genes that display a trend of either increasing or decreasing methylation levels in the order of controls, primary GBMs, and their counterpart GSC lines, respectively. Interestingly, concurrent promoter hypermethylation and gene body hypomethylation were observed in a subset of genes including MGMT, AJAP1 and PTPRN2. These unique DNA methylation signatures were also found in primary GBM-derived xenograft tumors indicating that they are not tissue culture-related epigenetic changes. Integration of GSC-specific epigenetic signatures with gene expression analysis further identified candidate tumor suppressor genes that are frequently down-regulated in GBMs such as SPINT2, NEFM and PENK. Forced re-expression of SPINT2 reduced glioma cell proliferative capacity, anchorage independent growth, cell motility, and tumor sphere formation in vitro. The results from this study demonstrate that GSCs possess unique epigenetic signatures that may play important roles in the pathogenesis of GBM.
文摘Adverse birth outcomes are a leading cause of mortality in children in China, but the environmental influences of these conditions remain largely unexplained in this population. We aimed to evaluate the levels of polycyclic aromatic hydrocarbons (PAHs) in Chinese pregnant women and their newborns, and to examine the association between levels of PAHs and infant birth weight. We conducted a cross-sectional study including 81 pairs of mothers and newborns from four hospitals in four different cities in China. High Performance Liquid Chromatography was used to measure the concentration of nine PAHs in maternal and cord blood and multiple linear regression analyses were used to evaluate the associations of these PAHs with infant birth weight. Anthracene (ANT) had the highest average concentration and detection rate (geometric mean = 69.54 ng/g and 76.5%, respectively) in maternal serum samples, while fluoranthene (FLT) had the highest concentration and detection rate (geometric mean = 68.4 ng/g and 50.6%, respectively) in the cord blood. Most of the measured PAHs in maternal serum and three PAHs in cord blood were inversely but non-significantly associated with birth weight. The strongest associations were observed for higher concentrations of benzo (a) pyrene (BaP) in maternal serum (230.7 g decrease for levels > median vs. < LOD;p = 0.151) and for ANT in cord blood (153.1 g decrease for levels < median vs. < LOD;p = 0.208). Ant and FLT were the predominant PAHs in the maternal and cord blood serum. Serum concentrations of several measured PAHs were associated with a decreased birth weight, although not significantly, suggesting that further studies with larger sample sizes are needed to validate our findings.
文摘Analysis of carcinogenicity data generally involves a trend test across all dose groups and a pairwise comparison of the high dose group with the control. The most commonly used test for a positive trend is the Cochran-Armitage test. This test is asymptotically normal. For the pairwise comparison of the high dose group with the control group, we propose two modifications: the first modification is to apply the test on the data from high dose and control groups after dropping the data from the low and the medium dose groups;the second modification is to adjust the test conditional on data from all dose groups. We compare the power performance of these two modifications for the pairwise comparisons.
基金The study was approved by the Texas Tech University Health Sciences Center Institutional Review Board(Approval Number.E14078).
文摘BACKGROUND Retrograde single balloon enteroscopy(SBE)is a minimally invasive procedure which is less frequently performed compared with antegrade SBE.There are few studies on the retrograde through-the-scope enteroscopy(TTSE),a novel technique for evaluation of the small bowel.AIM To compare the clinical utility and safety of retrograde TTSE with retrograde SBE.METHODS Clinical data and complications of retrograde TTSE(2014-2018)and retrograde SBE(2011-2018)performed in a community hospital were reviewed and presented as mean±SD or frequency(%)and compared using proper statistical tests.Technical success was defined as insertion of the enteroscope>20 cm beyond ileocecal valve.RESULTS Data obtained from 54 retrograde SBE in 49 patients and 27 retrograde TTSE in 26 patients were studied.The most common indication for retrograde enteroscopy was iron deficiency anemia(41 patients)followed by gastrointestinal bleeding(37 patients),and chronic diarrhea(7 patients).The duration of retrograde SBE procedure(91.9±34.2 min)was significantly longer compared with retrograde TTSE(70.5±30.7 min)(P=0.04).Technical success was comparable in TTSE[23/27(85.2%)]and SBE[41/54(75.9%)(P=0.33)].The mean depth of insertion beyond the ileocecal valve in retrograde SBE(92.5±70.0 cm)tended to be longer compared with retrograde TTSE(64.6±49.0 cm)(P=0.08).No complication was observed in this study.CONCLUSION Both retrograde TTSE and retrograde SBE are feasible and safe.Retrograde TTSE takes a shorter time and has a comparable technical success with SBE.TTSE has a lower capacity of small bowel insertion.
基金supported by the Foundation of Chinese Medical Association Publishing House.
文摘Transparency Ecosystem for Research and Journals in Medicine(TERM)working group summarized the essential recommendations that should be considered to review and publish a high-quality guideline.These recommendations from editors and reviewers included 10 components of essential requirements:systematic review of existing relevant guidelines,guideline registration,guideline protocol,stakeholders,conflicts of interest,clinical questions,systematic reviews,recommendation consensus,guideline reporting and external review.TERM working group abbreviates them as PAGE(essential requirements for Publishing clinical prActice GuidelinEs),and recommends guideline authors,editors,and peer reviewers to use them for high-quality guidelines.
基金Supported by Office of Vice Chancellor for Research, Shiraz University of Medical Sciences, Shiraz, Iran
文摘AIM： To investigate the prevalence and risk factors of gastroesophageal reflux disease （GERD） symptoms in Qashqai migrating nomads with a different life style in Fars province, southern Iran. METHODS： In summer 2006, 748 Qashqai migrating nomads aged 25 years or more were enrolled using a multiple-stage stratified cluster random sampling method. A questionnaire consisting of demographic characteristics, lifestyle and GERD symptoms （heartburn, regurgitation, chest pain, dysphagia, hoarseness and cough） as completed for each subject. RESULTS： The questionnaire was completed in 717 subjects. The prevalence rate of GERD, defined as reflux occurring at least one time per week in the preceding year, was 33% （237 subjects）. The prevalence was higher in older individuals （36.0% vs 28.9%, P 〈 0.05） and in those with other gastrointestinal complaints （51.0% vs 27.8%, P 〈 0.001）, but not different in obese and non-obese subjects. It was also higher in those consuming fruits and vegetables more than once a week （36.2% vs 17.3%, P 〈 0.001）. GERD had a positive correlation with smoking （42.1% vs 27.8%, P 〈 0.001）, but a negative relation with non-alcoholic beverages. The association between GERD and non-steroidal antiinflammatory drugs （NSAIDs） consumption was also significant （40.2% vs 25.4%, P 〈 0.001）. CONCLUSION： The prevalence of GERD （33%） is very high in Qashqai migrating nomads which may be due to a lower socioeconomic and educational level of these people and difference in the life style. Older age, frequent consumption of fruits and vegetables, smoking and NSAIDs are risk factors for GERD in this population.
基金funded by Sina Trauma and Surgery Research Center,Tehran University of Medical Sciences(grant number 98-01-38-41413)。
文摘Purpose:The median time from the event leading to the spinal cord injury(SCI)to the time of decompressive surgery is estimated to be 6.9 days in Iran,which is much longer than the proposed ideal time(less than 24 h)in published guidelines.The current qualitative study aimed to determine the reasons for the observed decompression surgery delay in Iran from the perspective of neurosurgeons.Methods:This qualitative study is designed to perform content analysis on the gathered data from face-to-face semi-structured interviews with 12 Iranian neurosurgeons.Results:The findings of the current study suggest that patient-related factors constitute more than half of the codes extracted from the interviews.Overall,the type of injury,presence of polytrauma,and surgeons’’wrong attitude are the main factors causing delayed spinal cord decompression in Iranian patients from the perspective of neurosurgeons.Other notable factors include delay in transferring patients to the trauma center,delay in availability of necessary equipment,and scarce medical personnel.Conclusion:In the perspective of neurosurgeons,the type of injury,presence of polytrauma,and surgeons’’wrong attitude are the leading reasons for delayed decompressive surgery of individuals with SCI in Iran.
基金AMN was supported by a Wellcome Trust grant(No.:095127)that also supported DKK.DKK was also supported by a Sustaining Health award from the Wellcome Trust(No.:103926)RWS is supported as a Wellcome Trust Principal Fellow(No.:10360)JAB is supported by the Bill&Melinda Gates Foundation(No.:OPP1131320).
文摘Background:Malnutrition and malaria are both significant causes of morbidity and mortality in African children.However,the extent of their spatial comorbidity remains unexplored and an understanding of their spatial correlation structure would inform improvement of integrated interventions.We aimed to determine the spatial correlation between both wasting and low mid upper arm circumference(MUAC)and falciparum malaria among Somalian children aged 6-59 months.Methods:Data were from 49227 children living in 888 villages between 2007 to 2010.We developed a Bayesian geostatistical shared component model in order to determine the common spatial distributions of wasting and falciparum malaria;and low-MUAC and falciparum malaria at 1×1 km spatial resolution.Results:The empirical correlations with malaria were 0.16 and 0.23 for wasting and low-MUAC respectively.Shared spatial residual effects were statistically significant for both wasting and low-MUAC.The posterior spatial relative risk was highest for low-MUAC and malaria(range:0.19 to 5.40)and relatively lower between wasting and malaria(range:0.11 to 3.55).Hotspots for both wasting and low-MUAC with malaria occurred in the South Central region in Somalia.Conclusions:The findings demonstrate a relationship between nutritional status and falciparum malaria parasitaemia,and support the use of the relatively simpler MUAC measurement in surveys.Shared spatial distribution and distinct hotspots present opportunities for targeted seasonal chemoprophylaxis and other forms of malaria prevention integrated within nutrition programmes.
文摘Objective:To investigate what extent lead-time bias is likely to affect endoscopic screening effectiveness for esophageal cancer in the high-risk area in China.Methods:A screening model based on the epidemiological cancer registry data,yielding a population-level incidence and mortality rates,was carried out to simulate study participants in the high-risk area in China,and investigate the effect of lead-time bias on endoscopic screening with control for length bias.Results:Of 100,000 participants,6,150(6.15%)were diagnosed with esophageal squamous dysplasia during the 20-year follow-up period.The estimated lead time ranged from 1.67 to 5.78 years,with a median time of 4.62 years[interquartile range(IQR):4.07-5.11 years]in the high-risk area in China.Lead-time bias exaggerated screening effectiveness severely,causing more than a 10%overestimation in 5-year cause-specific survival rate and around a 43%reduction in cause-specific hazard ratio.The magnitude of lead-time bias on endoscopic screening for esophageal cancer varied depending on the screening strategies,in which an inverted U-shaped and U-shaped effects were observed in the 5-year cause-specific survival rate and cause-specific hazard ratio respectively concerning a range of ages for primary screening.Conclusions:Lead-time bias,usually causing an overestimation of screening effectiveness,is an elementary and fundamental issue in cancer screening.Quantification and correction of lead-time bias are essential when evaluating the effectiveness of endoscopic screening in the high-risk area in China.
基金supported by the National Natural Science Foundation of China(No.71804183)。
文摘Objective:Prevention and early detection of colorectal cancer(CRC)can increase the chances of successful treatment and reduce burden.Various data mining technologies have been utilized to strengthen the early detection of CRC in primary care.Evidence synthesis on the model’s effectiveness is scant.This systematic review synthesizes studies that examine the effect of data mining on improving risk prediction of CRC.Methods:The PRISMA framework guided the conduct of this study.We obtained papers via Pub Med,Cochrane Library,EMBASE and Google Scholar.Quality appraisal was performed using Downs and Black’s quality checklist.To evaluate the performance of included models,the values of specificity and sensitivity were comparted,the values of area under the curve(AUC)were plotted,and the median of overall AUC of included studies was computed.Results:A total of 316 studies were reviewed for full text.Seven articles were included.Included studies implement techniques including artificial neural networks,Bayesian networks and decision trees.Six articles reported the overall model accuracy.Overall,the median AUC is 0.8243[interquartile range(IQR):0.8050-0.8886].In the two articles that reported comparison results with traditional models,the data mining method performed better than the traditional models,with the best AUC improvement of 10.7%.Conclusions:The adoption of data mining technologies for CRC detection is at an early stage.Limited numbers of included articles and heterogeneity of those studies implied that more rigorous research is expected to further investigate the techniques’effects.
