目的在上海市闵行区高血压人群中,探究年龄和体重指数(body mass index,BMI)对癌症发生的共同作用。方法研究对象为2007—2015年进入上海市闵行区电子健康信息系统的未患癌症的212394名高血压患者。将年龄、BMI以平滑函数形式纳入广义加...目的在上海市闵行区高血压人群中,探究年龄和体重指数(body mass index,BMI)对癌症发生的共同作用。方法研究对象为2007—2015年进入上海市闵行区电子健康信息系统的未患癌症的212394名高血压患者。将年龄、BMI以平滑函数形式纳入广义加性Cox比例风险模型,用双变量响应模型构建曲面图使结果可视化,全面分析两者对癌症发生的联合效应。结果截至2018年12月31日,累计22141名高血压患者新发癌症。年龄与癌症发生风险整体呈线性趋势,而BMI与癌症发生风险整体呈“U”型,BMI在26 kg/m^(2)左右时癌症发生风险最低。不同BMI下,随着年龄增大,癌症发生风险均增加;不同年龄下,BMI与癌症发生风险的关联不同:青年人群(20~44岁)中BMI与癌症发生风险无明显关联,中老年人群(≥45岁)中BMI与癌症发生风险呈“U”型关联,BMI在26 kg/m^(2)左右时癌症发生风险最低。结论建议高血压人群控制BMI在合理范围内,特别是中老年人群,以减少癌症发生。展开更多
Aims: To determine the prevalence and clinical predictors of subclinical atherosclerosis and myocardial ischaemia in uncomplicated type 2 diabetes and assess their relationship to short-term outcome. Methods and resul...Aims: To determine the prevalence and clinical predictors of subclinical atherosclerosis and myocardial ischaemia in uncomplicated type 2 diabetes and assess their relationship to short-term outcome. Methods and results: Established risk factors and coronaryartery calcium(CAC) scores were prospectively measured in 510 asymptomatic type 2 diabetic subjects(mean age 53± 8 years,61% males) without prior cardiovascular disease. Myocardial perfusion scintigraphy(MPS) was performed in all subjects with CAC >100 Agatston units(AU)(n=127), and a random sample of the remaining patients with CAC ≤ 100 AU(n=53). Significant CAC(>10 AU) was found in 46.3% . Twenty events occurred(two coronary deaths, nine non-fatal myocardial infarctions, three acute coronary syndromes, three non-haemorrhagic strokes, and three late revascularisations) during a median follow-up of 2.2 years(25th-75th percentile=1.9-2.5 years). The age, systolic blood pressure, the duration of diabetes, United Kingdom Prospective Diabetes Study risk score, CAC score, and extent of myocardial perfusion abnormality were significant predictors of time to cardiovascular events in a univariable Cox proportional hazard model. No cardiac events or perfusion abnormalities occurred in subjects with CAC ≤ 10 AU up until 2 years of follow-up. CAC and MPS findings were synergistic for the prediction of short-term cardiovascular events. Conclusion: Subclinical atherosclerosis, measured by CAC imaging, is superior to the established cardiovascular risk factors for predicting silent myocardial ischaemia and short-term outcome. Further studies evaluating the impact of CAC imaging on clinical outcomes and its cost effectiveness are warranted.展开更多
Purpose. We evaluated the prognostic significance of tumor metabolic activity on pretreatment positron emission tomography using the glucose analog F- 18 fluorodeoxyglucose (FDG- PET) in patients with carcinoma of the...Purpose. We evaluated the prognostic significance of tumor metabolic activity on pretreatment positron emission tomography using the glucose analog F- 18 fluorodeoxyglucose (FDG- PET) in patients with carcinoma of the cervix undergoing radiotherapy with or without concurrent chemotherapy. Methods. We studied 96 consecutive patients who underwent FDG- PET prior to initiation of radiotherapy with or without concurrent chemotherapy for carcinoma of the cervix. Pretreatment FDG uptake of the primary tumor was assessed with the semiquantitative standardized uptake value (SUV) and correlated with di-sease- free and overall survival. Survival was estimated by the Kaplan- Meier method. Univariate and multivariate analyses were performed with the logistic likelihood ratio test and the Cox proportional hazards model, respectively. Results. Five-year disease- free survivals in patients with maximal SUV < 10.2 and ≥ 10.2 were 71% and 52% (P = 0.0289)- respectively, while overall survivals were 72% and 69% (P = 0.4), respectively. On multivariate analysis, lymph node metastasis on FDG- PET was found to be predictive of disease- free survival (P < 0.0001). Both the SUV for FDG and FIGO Stage I disease were found to be marginally predictive of disease- free survival (P = 0.055 and P = 0.058, respectively). Conclusions. FDG uptake within primary cervical cancer, as measured by SUV, is predictive of disease- free survival in patients undergoing radiotherapy for cervical cancer. High FDG uptake may be useful in identifying patients who may require more aggressive initial therapy.展开更多
Aims: To determine whether survival after discharge following pre- hospital cardiopulmonary arrest has improved. Methods and results: The Heartstart Register was used to identify all 1659 patients discharged alive fro...Aims: To determine whether survival after discharge following pre- hospital cardiopulmonary arrest has improved. Methods and results: The Heartstart Register was used to identify all 1659 patients discharged alive from Scottish hospitals during 1991- 01 following pre- hospital arrest due to cardiac aetiology. The cohort was split into tertiles using year of arrest. A Cox proportional hazards model was used to determine risk of death relative to 1991- 93. Patients who survived cardiopulmonary arrest in 1997- 01 were less likely to die from any cause(unadjusted HR 0.60, 95% CI 0.48- 0.75, P< 0.001) or cardiac disease(unadjusted HR 0.50, 95% CI 0.38- 0.65, P< 0.001). After adjustment for case- mix, there remained significant declines in all- cause(adjusted HR 0.62, 95% CI 0.50- 0.78, P< 0.001) and cardiac death(adjusted HR 0.52, 95% CI 0.39- 0.68, P< 0.001). Clinical management had improved,with increased use of thrombolysis(47- 63% , χ 2 trend, P< 0.001), beta- blockers(28- 53% , χ 2 trend, P< 0.001), ACE- inhibitors(48- 69% , χ 2 trend, P< 0.001), and anti- thrombotics(79- 88% , χ 2 trend, P< 001). Adjustment for recorded changes in management attenuated the decline in all- cause death(adjusted HR 0.77, 95% CI 0.60- 0.98, P=0.03). Conclusion: Survival following cardiopulmonary arrest has improved after adjusting for changes in case- mix. Better clinical management has contributed to this improvement.展开更多
The impact of selective estrogen receptor modulators on cardiovascular disease outcomes in postmenopausal women remains unclear. This analysis assessed the effect of raloxifene on the incidence of cardiovascular adver...The impact of selective estrogen receptor modulators on cardiovascular disease outcomes in postmenopausal women remains unclear. This analysis assessed the effect of raloxifene on the incidence of cardiovascular adverse events in postmenopausal women followed for ≤ 8 years as participants in a 4- year osteoporosis treatment trial and a subsequent 4- year follow- up trial. The Continuing Outcomes Relevant to Evista(CORE) trial, designed to determine the effect of raloxifene on the incidence of invasive breast cancer, was a 4- year follow- up study to the 4- year Multiple Outcomes of Raloxifene Evaluation(MORE)- osteoporosis treatment trial. Of the 7,705 participants originally enrolled in MORE, 4,011 were enrolled in CORE and thus participated in both trials(MORE- CORE participants). The incidence of serious cardiovascular(i.e., coronary and cerebrovascular) adverse events during 8 years, confirmed by external adjudication in the 2 trials, was compared between treatment groups using Cox proportional hazards models. The 8- year incidence of serious cardiovascular adverse events did not differ significantly between the raloxifene(5.5% ) and placebo(4.7% ) groups(hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.86 to 1.56). Similar results were obtained when coronary(HR 1.22, 95% CI 0.82 to 1.83) or cerebrovascular(HR 1.19, 95% CI 0.78 to 1.84) events were analyzed separately, and when cardiovascular events were analyzed in the 459 MORE- CORE participants who were at increased risk of cardiovascular events by previously established criteria(HR 1.03, 95% CI 0.58 to 1.82). In conclusion, we found no evidence of a beneficial or harmful effect of raloxifene on the incidence of cardiovascular events overall, or coronary or cerebrovascular events, in postmenopausal osteoporotic women at relatively low risk of cardiovascular events.展开更多
文摘目的在上海市闵行区高血压人群中,探究年龄和体重指数(body mass index,BMI)对癌症发生的共同作用。方法研究对象为2007—2015年进入上海市闵行区电子健康信息系统的未患癌症的212394名高血压患者。将年龄、BMI以平滑函数形式纳入广义加性Cox比例风险模型,用双变量响应模型构建曲面图使结果可视化,全面分析两者对癌症发生的联合效应。结果截至2018年12月31日,累计22141名高血压患者新发癌症。年龄与癌症发生风险整体呈线性趋势,而BMI与癌症发生风险整体呈“U”型,BMI在26 kg/m^(2)左右时癌症发生风险最低。不同BMI下,随着年龄增大,癌症发生风险均增加;不同年龄下,BMI与癌症发生风险的关联不同:青年人群(20~44岁)中BMI与癌症发生风险无明显关联,中老年人群(≥45岁)中BMI与癌症发生风险呈“U”型关联,BMI在26 kg/m^(2)左右时癌症发生风险最低。结论建议高血压人群控制BMI在合理范围内,特别是中老年人群,以减少癌症发生。
文摘Aims: To determine the prevalence and clinical predictors of subclinical atherosclerosis and myocardial ischaemia in uncomplicated type 2 diabetes and assess their relationship to short-term outcome. Methods and results: Established risk factors and coronaryartery calcium(CAC) scores were prospectively measured in 510 asymptomatic type 2 diabetic subjects(mean age 53± 8 years,61% males) without prior cardiovascular disease. Myocardial perfusion scintigraphy(MPS) was performed in all subjects with CAC >100 Agatston units(AU)(n=127), and a random sample of the remaining patients with CAC ≤ 100 AU(n=53). Significant CAC(>10 AU) was found in 46.3% . Twenty events occurred(two coronary deaths, nine non-fatal myocardial infarctions, three acute coronary syndromes, three non-haemorrhagic strokes, and three late revascularisations) during a median follow-up of 2.2 years(25th-75th percentile=1.9-2.5 years). The age, systolic blood pressure, the duration of diabetes, United Kingdom Prospective Diabetes Study risk score, CAC score, and extent of myocardial perfusion abnormality were significant predictors of time to cardiovascular events in a univariable Cox proportional hazard model. No cardiac events or perfusion abnormalities occurred in subjects with CAC ≤ 10 AU up until 2 years of follow-up. CAC and MPS findings were synergistic for the prediction of short-term cardiovascular events. Conclusion: Subclinical atherosclerosis, measured by CAC imaging, is superior to the established cardiovascular risk factors for predicting silent myocardial ischaemia and short-term outcome. Further studies evaluating the impact of CAC imaging on clinical outcomes and its cost effectiveness are warranted.
文摘Purpose. We evaluated the prognostic significance of tumor metabolic activity on pretreatment positron emission tomography using the glucose analog F- 18 fluorodeoxyglucose (FDG- PET) in patients with carcinoma of the cervix undergoing radiotherapy with or without concurrent chemotherapy. Methods. We studied 96 consecutive patients who underwent FDG- PET prior to initiation of radiotherapy with or without concurrent chemotherapy for carcinoma of the cervix. Pretreatment FDG uptake of the primary tumor was assessed with the semiquantitative standardized uptake value (SUV) and correlated with di-sease- free and overall survival. Survival was estimated by the Kaplan- Meier method. Univariate and multivariate analyses were performed with the logistic likelihood ratio test and the Cox proportional hazards model, respectively. Results. Five-year disease- free survivals in patients with maximal SUV < 10.2 and ≥ 10.2 were 71% and 52% (P = 0.0289)- respectively, while overall survivals were 72% and 69% (P = 0.4), respectively. On multivariate analysis, lymph node metastasis on FDG- PET was found to be predictive of disease- free survival (P < 0.0001). Both the SUV for FDG and FIGO Stage I disease were found to be marginally predictive of disease- free survival (P = 0.055 and P = 0.058, respectively). Conclusions. FDG uptake within primary cervical cancer, as measured by SUV, is predictive of disease- free survival in patients undergoing radiotherapy for cervical cancer. High FDG uptake may be useful in identifying patients who may require more aggressive initial therapy.
文摘Aims: To determine whether survival after discharge following pre- hospital cardiopulmonary arrest has improved. Methods and results: The Heartstart Register was used to identify all 1659 patients discharged alive from Scottish hospitals during 1991- 01 following pre- hospital arrest due to cardiac aetiology. The cohort was split into tertiles using year of arrest. A Cox proportional hazards model was used to determine risk of death relative to 1991- 93. Patients who survived cardiopulmonary arrest in 1997- 01 were less likely to die from any cause(unadjusted HR 0.60, 95% CI 0.48- 0.75, P< 0.001) or cardiac disease(unadjusted HR 0.50, 95% CI 0.38- 0.65, P< 0.001). After adjustment for case- mix, there remained significant declines in all- cause(adjusted HR 0.62, 95% CI 0.50- 0.78, P< 0.001) and cardiac death(adjusted HR 0.52, 95% CI 0.39- 0.68, P< 0.001). Clinical management had improved,with increased use of thrombolysis(47- 63% , χ 2 trend, P< 0.001), beta- blockers(28- 53% , χ 2 trend, P< 0.001), ACE- inhibitors(48- 69% , χ 2 trend, P< 0.001), and anti- thrombotics(79- 88% , χ 2 trend, P< 001). Adjustment for recorded changes in management attenuated the decline in all- cause death(adjusted HR 0.77, 95% CI 0.60- 0.98, P=0.03). Conclusion: Survival following cardiopulmonary arrest has improved after adjusting for changes in case- mix. Better clinical management has contributed to this improvement.
文摘The impact of selective estrogen receptor modulators on cardiovascular disease outcomes in postmenopausal women remains unclear. This analysis assessed the effect of raloxifene on the incidence of cardiovascular adverse events in postmenopausal women followed for ≤ 8 years as participants in a 4- year osteoporosis treatment trial and a subsequent 4- year follow- up trial. The Continuing Outcomes Relevant to Evista(CORE) trial, designed to determine the effect of raloxifene on the incidence of invasive breast cancer, was a 4- year follow- up study to the 4- year Multiple Outcomes of Raloxifene Evaluation(MORE)- osteoporosis treatment trial. Of the 7,705 participants originally enrolled in MORE, 4,011 were enrolled in CORE and thus participated in both trials(MORE- CORE participants). The incidence of serious cardiovascular(i.e., coronary and cerebrovascular) adverse events during 8 years, confirmed by external adjudication in the 2 trials, was compared between treatment groups using Cox proportional hazards models. The 8- year incidence of serious cardiovascular adverse events did not differ significantly between the raloxifene(5.5% ) and placebo(4.7% ) groups(hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.86 to 1.56). Similar results were obtained when coronary(HR 1.22, 95% CI 0.82 to 1.83) or cerebrovascular(HR 1.19, 95% CI 0.78 to 1.84) events were analyzed separately, and when cardiovascular events were analyzed in the 459 MORE- CORE participants who were at increased risk of cardiovascular events by previously established criteria(HR 1.03, 95% CI 0.58 to 1.82). In conclusion, we found no evidence of a beneficial or harmful effect of raloxifene on the incidence of cardiovascular events overall, or coronary or cerebrovascular events, in postmenopausal osteoporotic women at relatively low risk of cardiovascular events.
