Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years o...Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over- or undertreatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC.Methods: Patients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors.Results: Forty-six patients were studied. The median follow-up time after surgery was 4.6 years(range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived(4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go(TUG), Eastern Cooperative Group Performance Status(ECOG PS), Instrumental Activities of Daily Living(IADLs), Vulnerable Elders Survey(VES-13) scoring systems were significantly associated with increased long term mortality risk.Conclusion: Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients.展开更多
The interactive effects of natural and human factors on ecosystems have been well studied, and the quantitative assessment of large-scale ecological vulnerability caused by natural and human factors is now one of the ...The interactive effects of natural and human factors on ecosystems have been well studied, and the quantitative assessment of large-scale ecological vulnerability caused by natural and human factors is now one of the most active topics in the ifeld. Taking the Guangxi Xijiang River Economic Belt in southwest China （GXEB） as a case study, we assess ecological vulnerability based on the Vulnerability Scoping Diagram （VSD） model. The indices system is decomposed into three sub objects, ten elements and 25 indicators layer by layer, which included factors from both natural and human ifelds. Results indicate that zones with lower, middle-lower, middle, middle-higher and higher vulnerability account for 11.31%, 22.63%, 27.60%, 24.39%, and 14.07%, respectively. The western and eastern parts of GXEB are more vulnerable than the central part and the mountain and urban areas are of higher vulnerability than the basins and river valleys. Compared with a vulnerability assessment based on natural factors only, it is concluded that human activities indeed cause the transition from naturally stable zones to vulnerable zones. The nature-dominated vulnerable zones are different with human-dominated ones in size and distribution, the latter being smaller, more scattered and distributed in urban areas and their surroundings. About 53%of total construction land is distributed in zones with middle and middle-higher ecological vulnerability;less vulnerable zones should attract construction in the future. Relevant suggestions are proposed on how to reduce vulnerability according to inducing factors. The VSD model has a signiifcant advantage in the quantitative evaluation of ecological vulnerability, but is insufficient to distinguish nature- or human-dominated vulnerability quantitatively.展开更多
Vulnerability research is the core issue and one of the research hotspots of sustainable development science.Vulnerability and its evaluation framework provide a new perspective for rural social-ecosystem studies.This...Vulnerability research is the core issue and one of the research hotspots of sustainable development science.Vulnerability and its evaluation framework provide a new perspective for rural social-ecosystem studies.This paper introduced the‘input-output’efficiency theory and constructed the‘SEE-PSR’framework for the analysis of social-ecosystem vulnerability in the rural area in Qingpu District of Shanghai City.The DEA models,spatial autocorrelation model,multivariate logistic regression model,geographical detector and hierarchical cluster model were used to analyze the spatial differences of social-ecosystem vulnerability,and its geographical impact mechanisms and ecological restorations,in 184 administrative villages in this area.The results can be divided into three main points.(1)The results of the‘input-output’efficiency model of the EW-DEA based on entropy weight aggregation crossover was more reliable and accurate for the evaluation of rural social-ecosystem vulnerability.The vulnerability of the social-ecosystems in the administrative villages showed a trend of gradual decline from east to west,with an average value of vulnerability of 0.583,and the vulnerability of social systems had become an important factor in constraining the decrease of the vulnerability of the social-ecosystems in the region.(2)The distances from the center of Shanghai City,from Dianshan Lake,from the center of Qingpu District and from the water area were the four dominant geographical factors affecting the vulnerability of the social-ecosystem in this region.The geographical impacts exhibited the spatial differentiations of systemic structure,the substitution of typological attributes and the transformation level.(3)The geographical factors coupling the impact types of the social-ecosystem vulnerability were divided spatially into 10 types.The geographic multi-factor coupling impact types were dominant,which presented multi-cyclic spatial patterns and were dominated by the central multi-factor which was surrounded by the single factor types on both sides.According to the different types,some feasible ways of ecological restoration were proposed,which drew on the experiences of integrated territory consolidation to remediate the vulnerability of rural social-ecological systems.The results of this study can provide scientific reference for rural spatial reconstruction,regional ecological restoration and sustainable development for the regions characterized by conflict in the‘strict protection of the ecological environment and vigorous development of the economy’.展开更多
文摘Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over- or undertreatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC.Methods: Patients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors.Results: Forty-six patients were studied. The median follow-up time after surgery was 4.6 years(range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived(4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go(TUG), Eastern Cooperative Group Performance Status(ECOG PS), Instrumental Activities of Daily Living(IADLs), Vulnerable Elders Survey(VES-13) scoring systems were significantly associated with increased long term mortality risk.Conclusion: Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients.
基金National Natural Science Foundation of China(41201110)Young Talents Foundation of Nanjing Institute of Geography and Limnology of CAS(NIGLAS2011QD03)
文摘The interactive effects of natural and human factors on ecosystems have been well studied, and the quantitative assessment of large-scale ecological vulnerability caused by natural and human factors is now one of the most active topics in the ifeld. Taking the Guangxi Xijiang River Economic Belt in southwest China （GXEB） as a case study, we assess ecological vulnerability based on the Vulnerability Scoping Diagram （VSD） model. The indices system is decomposed into three sub objects, ten elements and 25 indicators layer by layer, which included factors from both natural and human ifelds. Results indicate that zones with lower, middle-lower, middle, middle-higher and higher vulnerability account for 11.31%, 22.63%, 27.60%, 24.39%, and 14.07%, respectively. The western and eastern parts of GXEB are more vulnerable than the central part and the mountain and urban areas are of higher vulnerability than the basins and river valleys. Compared with a vulnerability assessment based on natural factors only, it is concluded that human activities indeed cause the transition from naturally stable zones to vulnerable zones. The nature-dominated vulnerable zones are different with human-dominated ones in size and distribution, the latter being smaller, more scattered and distributed in urban areas and their surroundings. About 53%of total construction land is distributed in zones with middle and middle-higher ecological vulnerability;less vulnerable zones should attract construction in the future. Relevant suggestions are proposed on how to reduce vulnerability according to inducing factors. The VSD model has a signiifcant advantage in the quantitative evaluation of ecological vulnerability, but is insufficient to distinguish nature- or human-dominated vulnerability quantitatively.
基金The National Natural Science Foundation of China(41471455)The Social Science Foundation of Hunan Province(20JD011)+2 种基金The Social Science Review Foundation of Hunan Province(XSP17YBZC021,XSP18ZDI035)The Humanities and Social Science Research Project of Hunan Education Department(19A086)The Key Laboratory of Key Technologies of Digital Urban-Rural Spatial Planning of Hunan Province(2018TP1042)。
文摘Vulnerability research is the core issue and one of the research hotspots of sustainable development science.Vulnerability and its evaluation framework provide a new perspective for rural social-ecosystem studies.This paper introduced the‘input-output’efficiency theory and constructed the‘SEE-PSR’framework for the analysis of social-ecosystem vulnerability in the rural area in Qingpu District of Shanghai City.The DEA models,spatial autocorrelation model,multivariate logistic regression model,geographical detector and hierarchical cluster model were used to analyze the spatial differences of social-ecosystem vulnerability,and its geographical impact mechanisms and ecological restorations,in 184 administrative villages in this area.The results can be divided into three main points.(1)The results of the‘input-output’efficiency model of the EW-DEA based on entropy weight aggregation crossover was more reliable and accurate for the evaluation of rural social-ecosystem vulnerability.The vulnerability of the social-ecosystems in the administrative villages showed a trend of gradual decline from east to west,with an average value of vulnerability of 0.583,and the vulnerability of social systems had become an important factor in constraining the decrease of the vulnerability of the social-ecosystems in the region.(2)The distances from the center of Shanghai City,from Dianshan Lake,from the center of Qingpu District and from the water area were the four dominant geographical factors affecting the vulnerability of the social-ecosystem in this region.The geographical impacts exhibited the spatial differentiations of systemic structure,the substitution of typological attributes and the transformation level.(3)The geographical factors coupling the impact types of the social-ecosystem vulnerability were divided spatially into 10 types.The geographic multi-factor coupling impact types were dominant,which presented multi-cyclic spatial patterns and were dominated by the central multi-factor which was surrounded by the single factor types on both sides.According to the different types,some feasible ways of ecological restoration were proposed,which drew on the experiences of integrated territory consolidation to remediate the vulnerability of rural social-ecological systems.The results of this study can provide scientific reference for rural spatial reconstruction,regional ecological restoration and sustainable development for the regions characterized by conflict in the‘strict protection of the ecological environment and vigorous development of the economy’.
