因素综合效应值的概念及估算

提出一种因素对于多种疾病的综合效应值的概念以及估算方法 。

江苏盐城宫颈癌及癌前病变危险因素人群归因危险度研究

目的:探讨江苏盐城地区宫颈癌及癌前病变的危险因素,为有效开展预防工作提供科学依据。方法:采取病例-对照研究方法,对115例宫颈癌患者和132例对照者的一般状况、疾病认知情况、月经婚孕史、性行为史、生活方式、生殖道既往患病史、家族史等进行调查,通过单因素及多因素统计分析其危险因素,并计算人群归因危险度(PAR)。结果:被动吸烟量、生殖道既往病史、使用避孕套避孕、性生活后阴道冲洗、5年内是否参加宫颈癌筛查与宫颈癌及癌前病变发生密切相关(P<0.05),其OR值分别为2.213、3.104、0.141、0.219、5.001,调整PAR分别为52.28%、41.85%、79.18%、27.83%、44.52%,综合PAR为93.35%。结论:正确了解宫颈癌及癌前病变发生的危险因素,采取针对性的有效措施,可有效预防女性宫颈癌和癌前病变的发生。

队列研究中多因素调整人群归因危险度的估计及其应用

[目的]介绍多因素调整人群归因危险度(PARP)估计方法及其在队列研究中的应用。[方法]利用2002～2006年建立的上海市男性健康队列(SMHS),在拟合多因素Cox风险比例模型基础上,以男性肺癌为例估计其常见危险因素的PARP。文中分别介绍了PAR在未调整和调整混杂因素情况下的估计方法,以及95%可信区间的计算。数据分析通过SAS程序来实现。[结果]上海市男性健康队列共61500名对象,截止2010年12月31日,共发生肺癌507例。调整其他因素对肺癌影响后,吸烟、酗酒、慢性支气管炎史、肺癌家族史对肺癌的多因素调整人群归因危险度及其95%可信区间分别为64.31%(54.95%～72.13%)、8.46%(3.82%～12.97%)、6.43%(1.13%～11.56%)、3.43%(1.15%～5.62%),其他生活方式因素中水果摄入不足、身体消瘦分别可解释18.33%(0.93%～34.60%)和3.16%(0.42%～5.84%)的上海市区男性肺癌的发生。[结论]上海市区男性肺癌的发生很大程度上归因于吸烟、酗酒、身体消瘦、水果摄入不足等不良生活方式因素。多因素调整人群归因危险度是一个重要的流行病学指标,尤其对指导病因复杂的慢性疾病预防和控制的公共卫生实践非常重要,值得推广应用。

CRP与心血管事件

目前 ,已经确定了的冠心病危险因素有 2 4 6个 ,传统危险度因素不能完全阐明疾病的发生。近年来已经证实炎症机制在冠心病的发病和并发症中起重要作用 ,急性时相反应物—CRP在心血管事件发生的预示以及治疗后的预后判断等方面具有重要价值。本文综述了近期有关研究。

Crohn's disease and risk of fracture: does thyroid disease play a role?

AIM: To assess the role of thyroid disease as a risk for fractures in Crohn's patients.METHODS: A cross-sectional study was conducted from 1998 to 2000. The study group consisted of 210 patients with Crohn's disease. A group of 206 patients without inflammatory bowel disease served as controls. Primary outcome was thyroid disorder. Secondary outcomes included use of steroids, immunosuppressive medications, surgery and incidence of fracture.RESULTS: The prevalence of hyperthyroidism was similar in both groups. However, the prevalence of hypothyroidism was lower in Crohn's patients (3.8 % vs 8.2 %, P=0.05).Within the Crohn's group, the use of immunosuppressive agents (0 % vs11 %), steroid usage (12.5 % vs37 %), small bowel surgery (12.5 % vs 28 %) and large bowel surgery (12.5 % vs27 %) were lower in the hypothyroid subset as compared to the euthyroid subset. Seven (3.4 %) Crohn'spatients suffered fracture, all of whom were euthyroid.CONCLUSION: Thyroid disorder was not found to be associated with Crohn's disease and was not found to increase the risk for fractures. Therefore, screening for thyroid disease is not a necessary component in the management of Crohn's disease.

Surgical treatment of intrahepatic cholangiocarcinoma: a retrospective study of 104 cases

Objective: To explore the clinicopathological features, surgical treatment techniques, and prognostic risk factors of intrahepatic cholangiocarcinoma(ICC).Methods: A total of 104 ICC cases were collected from January 2008 to December 2013 at Tianjin Medical University Cancer Institute and Hospital and divided into the hepatic hilum lymphadenectomy(HLL, 21 cases), extended hepatic hilum lymphadenectomy(EHLL, 12 cases), and non-lymphadenectomy(NL, 71 cases) groups. The clinical data of the patients were retrospectively analyzed, and the prognostic differences were compared among different groups.Results: The 1-, 2-, and 3-year overall survival(OS) rates of all cases were 72.1%, 56.1%, and 43.7%, respectively. The median survival duration was 34 months. The 1-, 2-, and 3-year OS rates of the HLL group(42.9%, 28.6%, and 28.6%, respectively) were significantly lower than those of the NL group(78.9%, 62.5%, and 47.8%, respectively). Meanwhile, the 1-, 2-, and 3-year OS rates of the EHLL group(75.0%, 56.1%, and 33.3%, respectively) were not significantly different from those of the other two groups.Univariate analysis showed that age, gender, American Joint Committee on Cancer(AJCC) stage, differentiation, ferritin(Fer),carbohydrate antigen19-9(CA19-9) and carcinoembryonicantigen(CEA) levels, lymph node metastasis(LNM), and lymph node dissection(LND) were prognostic factors for the long-term survival of ICC. Meanwhile, multivariate analysis revealed that age,AJCC stage, differentiation, Fer levels, and LNM were independent risk factors for survival.Conclusions: ICC patients will not benefit from lymphadenectomy in the absence of LNM. However, systematic lymphadenectomy may improve ICC outcomes if the location of lymphatic metastasis is known. Age, AJCC stage, differentiation,Fer level, and LNM are independent risk factors for survival in ICC.

Changes in blood alcohol concentration and driving ability after alcohol intake

Objective: To study the relationship between the amount of consumed alcohol, blood alcohol concentration (BAC), and driving ability among a part of the population in Southwest China and to provide reference for the formulation of the legal limits for safe driving. Methods: Seventy-six randomly selected volunteer drivers each had three times of alcohol intake (100 ml each time). After each drank, BAC was measured with gas chromatograph and driving ability was evaluated. The drivers were grouped according to age, weight, alcohol tolerance and driving experience respectively and changes in BAC and driving ability were analyzed. Results: Average BAC and the percentage of drivers showing impaired driving ability in the groups increased after each intake of 100 ml alcohol. BAC in Group≤60 kg was more susceptible to alcohol than that in Group>60 kg. When each drank, alcohol had greater influence on drivers who had comparatively shorter driving experience. Conclusion: Volume of consumed alcohol, BAC and driving ability have direct associations among one another and are all under the influence of various factors including individual conditions. To set an appropriate legal BAC limit for safe driving should take an overall consideration of all factors.

Viral Genotypes and Associated Risk Factors of Hepatocellular Carcinoma in India

Objective This study aims to investigate the etiological relationship among hepatitis B virus （HBV）, hepatitis C virus （HCV）, and alcohol as risk factors in a cohort of hepatocellular carcinoma （HCC） patients from India. The clinical and biochemical profiles and tumor characteristics in the HCC cases were also evaluated. Methods A total of 357 consecutive cases of HCC fulfilling the diagnostic criteria from the Barcelona-2000 EASL conference were included in the study. The blood samples were evaluated for serological evidence of HBV and HCV infection, viral load, and genotypes using serological tests, reverse transcription-polymerase chain reaction, and restriction fragment length polymorphism. Results The male/female ratio for the HCC cases was 5.87：1. Majority of the HCC patients （33.9%） were 50 to 59 years of age, with a mean age of 4±13.23 years. More than half the cases （60.8%） had underlying cirrhosis at presentation. Among the HCC patients, 68.9% were HBV related, 21.3% were HCV related, 18.8%, were alcoholic, and 18.2% were of cryptogenic origin. The presence of any marker positive for HBV increased the risk for developing HCC by almost 27 times [OR： 27.33; （12.87-60.0）]. An increased risk of 10.6 times was observed for HCC development for cases positive for ally HCV marker [OR： 10.55; （3.13-42.73）]. Heavy alcohol consumption along with HCV RNA positivity in cirrhotic patients was found to be a risk for developing HCC by 3 folds ]OR： 3.17; （0.37-70.71）]. Conclusions Patients of chronic HBV infection followed by chronic HCV infection were at higher risk of developing HCC in India. Chronic alcohol consumption was found to be a risk factor in cirrhotic cases only when it was associated with HCV RNA positivity. Most of the patients had a large tumor size （〉5 cm） with multiple liver nodules, indicating an advanced stage of the disease thus making curative therapies difficult.

Association between serum homocysteine and arterial stiffness：role of anti-hypertensive drugs

To the Editor I read the article of Zhang, et al. with great interest. They investigated the association of homocysteine with arterial stiffness in Chinese community-based elderly persons. The carotid-femoral pulse wave velocity （PWV） was significantly higher in the high homocyteine group than in the normal one, however, there was no differences in carotid-radial PWV between the high homocyteine group and the normal one. Homocysteine levels were strongly associated with the carotidfemoral PWV even after adjustment for classical risk factors of cardiovascular disease. I congratulate the authors for this important study. However, I want to make minor criticism for this study from the methodological aspect.

Fire risk evaluation research on fully mechanized coalface based on the uncertainty measure theory

A relatively perfect coalmine fire risk-evaluating and order-arranging model that includes sixteen influential factors was established according to the statistical information of the fully mechanized coalface ground on the uncertainty measure theory. Then the single-index measure function of sixteen influential factors and the calculation method of computing the index weight ground on entropy theory were respectively established. The value assignment of sixteen influential factors was carried out by the qualitative analysis and observational data, respectively, in succession. The sequence of fire danger class of four experimental coalfaces could be obtained by the computational aids of Matlab according to the confidence level criterion. Some conclusions that the fire danger class of the No.l, No.2 and No.3 coalface belongs to high criticality can be obtained. But the fire danger class of the No.4 coalface belongs to higher criticality. The fire danger class of the No.4 coalface is more than that of the No.2 coalface. The fire danger class of the No.2 coalface is more than that of the No.1 coalface. Finally, the fire danger class of the No.1 coalface is more than that of the No.3 coalface.

Clinical course of sub-centimeter-sized nodules detected during surveillance for hepatocellular carcinoma

AIM: To evaluate the outcome of sub-centimeter-sized nodules (SCSNs) detected during surveillance for hepatocellular carcinoma (HCC) in patients at risk. METHODS: We retrospectively analyzed a total of 142 patients with liver cirrhosis or chronic hepatitis B or C without a prior history of HCC in whom a SCSN was detected during HCC surveillance. We calculated the rate of HCC development from SCSNs in the study population and analyzed the differences in the baseline clinical characteristics and imaging features between the patients with SCSNs that eventually developed into HCC and patients with SCSNs that did not develop into HCC.RESULTS: During 667 person-years of follow-up, HCC developed in 33 patients. The calculated HCC development rate was 4.9% per year. The cumulative one-, two-, three- and five-year HCC development rates were 5.6%, 10.6%, 14.1% and 20.4%, respectively. Upon baseline comparison, the HCC group was older (54.4 ± 8.3 years vs 48.9 ± 9.4 years; P = 0.003) and had lower albumin levels (3.56 ± 0.58 g/dL vs 3.84 ± 0.55 g/dL; P = 0.012) and higher baseline alpha-fetoprotein (AFP) levels (8.5 ng/mL vs 5.4 ng/mL; P = 0.035) compared to the non-HCC group. Nodule pattern and initial radiologic diagnosis also differed between the two groups. Multivariate analysis revealed that age [P = 0.012, odds ratio (OR) =1.075, 95% confidence interval (CI) =1.016-1.137], sex (P = 0.009, OR = 3.969, 95% CI: 1.403-11.226), and baseline AFP level (P = 0.024, OR = 1.039, 95% CI: 1.005-1.073) were independent risk factors for developing HCC. CONCLUSION: The overall risk of HCC development in patients with SCSNs is similar to that in liver cirrhosis patients. Patients with these risk factors need to be closely monitored during follow-up.

Are BRICS Countries Winning the War on HIV/AIDS？ Magnitude and Risk Factors

The aim of this study was to analyse the responses to HIV/AIDS in BRICS （Brazil, Russia, India, China and South Africa） countries to determine if they are winning the war on this pandemic. The authors used a comparative case study approach and multiple data sources on HIV prevalence, incidence, mortality, and risk factors of HIV. BRICS has 42% of the world＇s population, a total of 11.1 million people living with HIV （PLHIV） and an average HIV prevalence of 2.8%. Overall, there were 11.1 million PLHIV, 739,909 new infections, and 592,786 deaths in BRICS countries in 2012. The magnitude of HIV in BRICS countries was Brazil （.5%）, Russia （1.1%）, India （.3%）, China （.1%）, and South Africa （12.2%）. New infections declined by 30% or more and overall prevalence and deaths also declined in Brazil, India, China, and South Africa. The epidemic has stabilized in Brazil at .6%. Russia has one of the world＇s fastest-growing H1V epidemics, India has the largest burden of HIV in Asia and South Africa has the largest number of PLHIV. During a 10 year period, Russia had a 47% increase in new HIV infections. This suggests that Russia may be losing the battle against HIV at this stage. On the other hand, India and South Africa seem to have turned the corner with declines in HIV infections of 43% and 38% respectively.

Intimate Partner Violence in Papua New Guinea

The aim of the study was to determine the prevalence, associated risk factors, consequences and preventive measures oflPV （intimate partner violence） within the selected population in Goroka, Papua New Guinea. Questions derived from the prevalidated scales were used to measure the IPV. Questionnaires were distributed to both men and women aged from 18 to 60. The participants were staff and students of University of Goroka, staff of the Goroka Secondary school and North Goroka Primary school, Teachers in-charges of the elementary schools in the Eastern Highlands Province and the villagers from Asaroufa and Kotuni villages. Of the 95 respondents, 78.95% were victims of IPV. Among the victims 37.33% were males and 62.67% females. The physical, sexual and psychological abuses were experienced by both men and women. The significant risk factors found to be associated with violence were young age, low education, low socioeconomic status, marital conflicts, history of abuse during childhood, and male patriarchal values. The interpersonal relationship tends to be an important factor for prevailing violence free environment within the intimate partners. Intimate partner violence is prevalent in PNG. The strongest independent predictors were the excessive drinking of alcohol and marital conflict. Preventive measures such as compulsory and free technical education for all children less than 14 years old and life skills training and violence awareness campaign for both men and women must be provided to reduce the intimate partner violence.

应用白细胞过滤器发生红细胞输血反应多个州的分析

2000年，美国红十字协会（ARC）收到多个行政区病人接受了少白细胞（LR）红细胞单位后发生了罕见的原因不明输血反应的报告。作者评估分析接受LR—RBC输血病人输血反应的潜在危险度因素。一病案调查确定为2000年1月1日开始背痛到5月25日期间，任何接受LR—RBC输注后发生背部疼痛的病人。对照组为医疗保健机构输过血的病人，配对比例为1：3。用配套的案例对照研究，回顾血液采集过程使用的设备和产品处理过程质量控制试验记录确定产品反应特殊危险因素。用血液采集和处理地区的红细胞发放资料确定反应发生率。在5个州的13个医疗中心发现29次反应，案例对照研究包含18例病案病例和78名对照。

Association between non-alcoholic fatty liver disease and arterial stiffness in the non-obese, non-hypertensive, and non-diabetic young and middle-aged Chinese population

Background and objective： Non-alcoholic fatty liver disease（NAFLD） is associated with arterial stiffness in the general population. Age, obesity, hypertension, and diabetics are risk factors for arterial stiffness. In this study, we aimed to investigate the association between NAFLD and arterial stiffness as measured by brachial-ankle pulse wave velocity（baPWV） in the non-obese, non-hypertensive, and non-diabetic young and middle-aged Chinese population. Methods： A cross-sectional study with 1296 non-obese, non-hypertensive, and non-diabetic young and middle-aged（20–65 years） subjects undergoing routine medical check-ups in the International Health Care Center of the Second Affiliated Hospital of School of Medicine of Zhejiang University was carried out. Fatty liver was diagnosed by ultrasonography, and baPWV was measured using an automatic waveform analyzer. The subjects were classified into two groups according to the presence of NAFLD, and divided into a further two groups according to their baPWV. Results： The overall incidence of NAFLD was 19.0%, and NAFLD patients had a significantly higher level of baPWV than the controls（（1321±158） cm/s vs.（1244±154） cm/s; P〈0.001）. The incidence of NAFLD was clearly higher in the increased baPWV group than in the normal baPWV group（29.3% vs. 16.9%; P〈0.001）, and the incidence increased in line with the increase of baPWV quartiles in the normal range as well as with the severity of arterial stiffness（both P for trend 〈0.001）. Multiple linear logistic regression analysis showed that the presence of NAFLD was positively and independently associated with baPWV. Conclusions： Our results suggest that the presence of NAFLD is associated with arterial stiffness as measured by baPWV in the non-obese, non-hypertensive, and non-diabetic young and middle-aged Chinese population.

Analysis on the risk factors of second fracture in osteoporosis-related fractures

Objective： To explore the clinical characteristics and risk factors of refracture in patients suffering from osteoporosis-related fractures as well as effective interventions. Methods： From January 2006 to January 2008, both out-patients and in-patients in our hospital who were over 50 years old and suffered from osteoporosis-related fractures were selected for this research. They were divided into fracture group and refracture group. The refracture rate was followed up for 2 years, during which 11 patients developed refracture, thus were included in the refracture group. Therefore, 273 patients, 225 first-fracture cases, aged （67.7± 8.5） years, and 48 refracture cases, aged （72.7±9.5） years, were included in this study. General data including age and sex, fracture types, femoral neck bone mineral density （BMD） T-scores tested by dual-energy X-rays absorptiometry （DEXA）, Charlson index, time-frame between two fractures as well as mobility skill assessment were collected and analyzed by single-factor and multivariate statistical methods. Results： Females accounted for 70.2% of the fracture group and 77.1% of the refracture group. The most common refracture type was vertebral fracture for the first time and femoral neck fracture for the second time during the followup. The second fracture happened 3.7 years after the first one on average. The refracture rate was 2.12% within one year, and 4.66% within two years. Risk factors for a second fracture in osteoporotic fracture patients included age （〉75 years, HR=1.23, 95%CI 1.18-1.29; 〉85 years, HR=1.68, 95% CI 1.60-1.76）, female sex （HR=1.36, 95%CI 1.32-1.40）, prior vertebral fractures （HR= 1.62, 95%CI 1.01-2.07）, prior hip fractures （HR=1.27, 95%CI 0.89-2.42）, BMD T-score〈-3.5 （HR-1.38, 95%CI 1.17-1.72） and weakened motor skills （HR=1.27, 95%CI 1.09-1.40）. Conclusions： The risks of second fracture among patients with initial brittle fracture are substantial. There is adequate time between the first and second fractures for interventions to reduce the risks of refracture, especially for the old women with a vertebral or hip fracture. Medication, motor functional rehabilitation and fall-down prevention training are helpful.