Reevaluating health metrics:Unraveling the limitations of disabilityadjusted life years as an indicator in disease burden assessment

In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and qualitative data,is grounded in preferences regarding disability status.This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application.In contrast to the quality-adjusted life years approach,derived from multi-attribute utility theory,the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights.Claiming to rely on no mathematical or economic theory,DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators,notably content validity,reliability,specificity,and sensitivity.The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative,leading to numerous publications in international literature.Despite widespread adoption,the DALY synthetic indicator has prompted significant methodological concerns since its inception,manifesting in inconsistent and non-reproducible results.Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments,a reassessment is warranted.This reconsideration is imperative for enhancing the robustness and reliability of public health decisionmaking processes.

比较YEARS评分与简化Wells联合年龄校正D-二聚体评分用于疑似肺栓塞患者的诊断价值

目的通过前瞻性研究比较YEARS评分与简化Wells联合年龄校正D-二聚体评分(sWells-Age)用于疑似肺栓塞患者的诊断价值。方法纳入2021年3月3日到2022年4月30日于宜宾市第二人民医院就诊且符合纳排标准的可疑肺栓塞病人522名,采用前瞻性观察研究,由临床医师对照YEARS评分收集患者基线信息,计算患者YEARS评分及sWells-Age评分判断其目前肺栓塞临床可能性。所有排除肺栓塞且未进行抗凝治疗的患者进行3个月随访。以CTPA检查结果作为诊断金标准,分别计算YEARS评分及sWells-Age评分敏感度、特异度、κ值等指标,绘制两者ROC曲线并计算AUC值。结果sWells-Age评分及YEARS评分灵敏度分别为85.71%、93.41%(P<0.001),特异度分别为69.23%、56.92%(P<0.001),AUC值分别为0.775(95%CI 0.688~0.816)、0.752(95%CI 0.711~0.838),与CTPA的κ值分别为0.526、0.465,均>0.410,结果一致性均属于中等,两者灵敏度比较(χ^(2)=5.143,P<0.025),差异具有统计学意义,两者特异度比较(χ^(2)=12.500,P<0.001),差异具有显著统计学意义。结论sWells-Age评分优于YEARS评分,但YEARS评分项目少,灵敏度及安全性高,可应用于早期肺栓塞患者的筛查。

Bowel preparation protocol for hospitalized patients ages 50 years or older:A randomized controlled trial

BACKGROUND The incidence and mortality rate of colorectal cancer progressively increase with age and become particularly prominent after the age of 50 years.Therefore,the population that is≥50 years in age requires long-term and regular colonoscopies.Uncomfortable bowel preparation is the main reason preventing patients from undergoing regular colonoscopies.The standard bowel preparation regimen of 4-L polyethylene glycol(PEG)is effective but poorly tolerated.AIM To investigate an effective and comfortable bowel preparation regimen for hospitalized patients≥50 years in age.METHODS Patients were randomly assigned to group 1(2-L PEG+30-mL lactulose+a lowresidue diet)or group 2(4-L PEG).Adequate bowel preparation was defined as a Boston bowel preparation scale(BBPS)score of≥6,with a score of≥2 for each segment.Non-inferiority was prespecified with a margin of 10%.Additionally,the degree of comfort was assessed based on the comfort questionnaire.RESULTS The proportion of patients with a BBPS score of≥6 in group 1 was not significantly different from that in group 2,as demonstrated by intention-to-treat(91.2%vs 91.0%,P=0.953)and per-protocol(91.8%vs 91.0%,P=0.802)analyses.Furthermore,in patients≥75 years in age,the proportion of BBPS scores of≥6 in group 1 was not significantly different from that in group 2(90.9%vs 97.0%,P=0.716).Group 1 had higher comfort scores(8.85±1.162 vs 7.59±1.735,P<0.001),longer sleep duration(6.86±1.204 h vs 5.80±1.730 h,P<0.001),and fewer awakenings(1.42±1.183 vs 2.04±1.835,P=0.026)than group 2.CONCLUSION For hospitalized patients≥50 years in age,the bowel preparation regimen comprising 2-L PEG+30-mL lactulose+a low-residue diet produced a cleanse that was as effective as the 4-L PEG regimen and even provided better comfort.

Epidemiology of Cardiovascular Mortality in Patients under 60 Years Old in a Cardiology Department in West Africa, Dakar-Senegal

Background: Our study aimed to examine cardiovascular mortality within the working-age population, exploring epidemiological, clinical, and paraclinical features, complications, and identifying etiological factors linked to mortality. Methods: We conducted a descriptive and analytical retrospective study from September 2019 to August 2022 at the General Hospital Idrissa POUYE in Dakar, we reviewed all the medical records of patients from 15 to 60 years old who died while admitted in the cardiology department. Data collected were socioeconomic status, clinical history, type of cardiovascular disaese, length of hospitalization, circumstances and timing of death. The data were analyzed with R. Studio version 2022.12.0 + 353 and Excel 2019, with a P-value Results: The study included 73 patients, indicating a specific mortality rate of 8.8% and a proportional mortality of 39%. Predominantly male (sex ratio 1.2), the average age was 44. Key cardiovascular risk factors identified were sedentarism (76.7%), hypertension (28.8%), and smoking (21.9%). The leading cause for consultation was dyspnea (72.6%). Notable findings included a majority of patients presenting with general condition deterioration (90%) and cardiovascular collapse upon admission (23.3%). Physical exam revealed signs of heart failure in 63%. Echocardiography showed left ventricular ejection fraction impairment (81%) and pulmonary hypertension (78%). Immediate causes of death were primarily cardiogenic shock (45.2%) and septic shock (37%). The analytical study indicates that the data most closely associated with mortality were age, socio-economic level, ischemic heart disease (p = 0.034), rheumatic valvulopathies, pulmonary embolism (p = 0.034), hypertension (HTA) (p = 0.009), smoking (p = 0.011), diabetes (p = 0.011), dyslipidemias, prolonged bedrest (p = 0.001), morbid obesity (p = 0.001), and COVID-19 infection (p = 0.017). Conclusion: The prevalence of ischemic heart diseases, pulmonary embolisms, and valvulopathies in premature mortality statistics underscores the need for enhanced cardiovascular prevention efforts.

Characteristics of the HIV/AIDS Epidemic among People Aged≥50 Years in China during 2018–2021

Objective This study aimed to determine the current epidemiological status of PLWHA aged≥50 years in China from 2018 to 2021.It also aimed to recommend targeted interventions for the prevention and treatment of HIV/AIDS in elderly patients.Methods Data on newly reported cases of PLWHA,aged≥50 years in China from 2018 to 2021,were collected using the CRIMS.Trend tests and spatial analyses were also conducted.Results Between 2018 and 2021,237,724 HIV/AIDS cases were reported among patients aged≥50 years in China.The main transmission route was heterosexual transmission(91.24%).Commercial heterosexual transmission(CHC)was the primary mode of transmission among males,while non-marital non-CHC([NMNCHC];60.59%)was the prevalent route in women.The proportion of patients with CHC decreased over time(Z=67.716,P<0.01),while that of patients with NMNCHC increased(Z=153.05,P<0.01).The sex ratio varied among the different modes of infection,and it peaked at 17.65 for CHC.The spatial analysis indicated spatial clustering,and the high-high clustering areas were mainly distributed in the southwestern and central-southern provinces.Conclusion In China,PLWHA,aged≥50 years,were predominantly infected through heterosexual transmission.The primary modes of infection were CHC and NMNCHC.There were variations in the sex ratio among different age groups,infected through various sexual behaviors.HIV/AIDS cases exhibited spatial clustering.Based on these results,the expansion of HIV testing,treatment,and integrated behavioral interventions in high-risk populations is recommended to enhance disease detection in key regions.

Effect of a Nutrition Education Intervention on Food Safety Knowledge, Attitudes and Practices of Mothers of Children under 5 Years in the Peri-Urban Areas of Bobo-Dioulasso: Before and after Study

Background: This study assessed the effect of a nutrition education intervention. This intervention aimed to improve the knowledge, attitudes, and practices of mothers on food safety in the peri-urban areas of Bobo-Dioulasso in Burkina Faso. Methods: A total of 243 mothers of children under 5 years in the peri-urban of Bobo-Dioulasso were administered the FAO questionnaire for food safety knowledge, attitudes, and practices assessment during two cross-sectional surveys, before and after the intervention, in January and October 2017. The intervention included two components consisting of a theoretical phase (counselling and discussion) and cooking demonstrations implemented for ten months. To account for the before-and-after design of the study, the McNemar’s test was used to assess the effect of the intervention on food safety KAP of mothers of children under 5 years. Results: The mean age of mothers was 29 ± 6.2 years and 50.6% of them were between 20 and 29 years old. One for knowledge (cooking thoroughly with, p-value = 0.0001) and another for attitudes (perceived benefits of reheating leftovers before eating them, p-value = 0.0001), significantly increased after the intervention. In terms of food safety practices, all the indicators (cleaning of dirty surfaces, plates and utensils and storage of perishable foods) significantly increased (all p = 0.0001 Conclusion: This study provided some evidence of an effective nutrition education intervention for improving maternal KAP on food safety for their child’s feeding.

Review of Two Years of Surgical Activities of the General Surgery Department of the Reference Health Center of Commune I of Bamako Mali

The objectives of this work were to evaluate the surgical activities carried out in the general surgery department of the Reference Health Center of Commune I of Bamako, to describe the sociodemographic characteristics of the operated patients, to determine the main pathologies encountered and to evaluate qualitatively the result of the treatment. In order to improve performance, and the quality of care, and to identify common pathologies in the surgical department, we undertook a retrospective study on surgical activities from January 2009 to December 2010. At the end of this study, out of 474 men and 187 women (equal sex ratio 2.53);we were able to determine the frequency of surgical pathologies. Farmers, housewives and pupils/students were the most represented with 25.9% respectively;20% and 13.3%. The most frequently observed pathologies were wall hernia (44.8%), prostate adenoma (12%) and acute appendicitis (10.5%). The average length of hospitalization was 3.43 days. Infectious complications affected 25 patients (3.8% of cases) and a death rate of 0.45% (i.e. 3 patients). The average cost of care was 53,500 FCFA. Indeed, the reality of surgical practice in health centers was not the same because of the level of skills of practicing surgeons.

Simulating Responses of Rice Yield and Nitrogen Fates to Ground Cover Rice Production System under Different Types of Precipitation Years

The Ground Cover Rice Production System(GCRPS)has considerable potential for securing rice production in hilly areas.However,its impact on yields and nitrogen(N)fates remains uncertain under varying rainfall conditions.A two-year field experiment(2021–2022)was conducted in Ziyang,Sichuan Province,located in the hilly areas of Southwest China.The experiment included two cultivation methods:conventional flooding paddy(Paddy,W1)and GCRPS(W2).These methods were combined with three N management practices:N1(no-N fertilizer),N2(135 kg/hm^(2)urea as a base fertilizer in both W1 and W2),and N3(135 kg/hm^(2)urea with split application for W1 and 67.5 kg/hm^(2)urea and chicken manure separately for W2).The WHCNS(Soil Water Heat Carbon Nitrogen Simulator)model was calibrated and validated to simulate ponding water depth,soil water storage,soil mineral N content,leaf area index,aboveground dry matter,crop N uptake,and rice yield.Subsequently,this model was used to simulate the responses of rice yield and N fates to GCRPS under different types of precipitation years using meteorological data from 1980 to 2018.The results indicated that the WHCNS model performed well in simulating crop growth and N fates for both Paddy and GCRPS.Compared with Paddy,GCRPS reduced N leaching(35.1%–54.9%),ammonia volatilization(0.7%–13.6%),N runoff(71.1%–83.5%),denitrification(3.8%–6.7%),and total N loss(33.8%–56.9%)for all precipitation year types.However,GCRPS reduced crop N uptake and yield during wet years,while increasing crop N uptake and yield during dry and normal years.Fertilizer application reduced the stability and sustainability of rice yield in wet years,but increased the stability and sustainability of rice yield in dry and normal years.In conclusion,GCRPS is more suitable for normal and dry years in the study region,leading to increased rice yield and reduced N loss.

Factors Associated with Mortality in Children Aged 1 Month to 15 Years Hospitalized in the Pediatric Ward of the Kalaban-Coro Reference Health Center: Cross-Sectional Study

Introduction: Infant and child mortality is a worldwide concern, but developing countries such as Mali are more affected. The aim of this study was to investigate morbidity and factors associated with mortality in children aged 1 month to 15 years. Methodology: This was a cross-sectional study which took place from January 1 to December 31, 2020 covering children aged 1 month to 15 years hospitalized at the Kalaban-Coro CSRéf. Data were entered into Excel and analyzed using SPSS version 20 software. Results: Five hundred children aged 1 months to 15 years were included. The age range 1 to 5 years (53.6%) and male sex (58.2%) were the most represented. Malaria (72.2%), acute respiratory infections (6.2%) and diarrhea/dehydration (3%) were the main morbidities. Mortality was estimated at 10.6%, and the two main causes of death were malaria (56.6%) and acute respiratory infections (7.54%). Univariate analysis revealed a statistically significant association between the dependent variable (death) and age (p Conclusion: This study confirms the high rate of infant and child morbidity and mortality in our health facilities. Strengthening human resources and intensifying behavior-change communication can help reverse the trend.

Quality-adjusted life years and surgical waiting list:Systematic review of the literature

BACKGROUND The quality-adjusted life year(QALY)is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and procedures.Surgical waiting lists(SWLs)represent a pressing problem in public healthcare.The QALY measure has rarely been used in the context of surgery.It would be interesting to know how many QALYs are lost by patients on SWLs.AIM To investigate the relationship between QALYs and SWLs in a systematic review of the scientific literature.METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.An unlimited search was carried out in PubMed,updated on January 19,2024.Data on the following variables were investigated and analyzed:Specialty,country of study,procedure under study,scale used to measure QALYs,the use of a theoretical or real-life model,objectives of the study and items measured,the economic value assigned to the QALY in the country in question,and the results and conclusions published.RESULTS Forty-eight articles were selected for the study.No data were found regarding QALYs lost on SWLs.The specialties in which QALYs were studied the most in relation to the waiting list were urology and general surgery,with 15 articles each.The country in which the most studies of QALYs were carried out was the United States(n=21),followed by the United Kingdom(n=9)and Canada(n=7).The most studied procedure was organ transplantation(n=39),including 15 kidney,14 liver,5 heart,4 lung,and 1 intestinal.Arthroplasty(n=4),cataract surgery(n=2),bariatric surgery(n=1),mosaicplasty(n=1),and septoplasty(n=1)completed the surgical interventions included.Thirty-nine of the models used were theoretical(the most frequently applied being the Markov model,n=34),and nine were real-life.The survey used to measure quality of life in 11 articles was the European Quality of Life-5 dimensions,but in 32 articles the survey was not specified.The willingness-to-pay per QALY gained ranged from$100000 in the United States to€20000 in Spain.CONCLUSION The relationship between QALYs and SWLs has only rarely been studied in the literature.The rate of QALYs lost on SWLs has not been determined.Future research is warranted to address this issue.

Morphological changes of silver and bighead carp in the Yangtze River over the past 50 years

Multivariate analysis was adopted to analyze 30 morphometrical characteristics of 121 one-year-old juvenile silver carp （Hypophthalmichthys molitrix） and bighead carp （Aristichthys nobilis） bred during the 1950s （＂the former population＂） and 2008 （＂the current population＂） and collected from the middle reach of the Yangtze River. The average discriminant accuracies of the former and current silver and bighead carp population were 94.2% and 98.0%, respectively. Discriminant analysis also revealed that significant differences in morphology occurred between the former and current populations of both carp in overall characteristics. One-way analysis of variance indicated that between former and current populations, silver carp showed highly significant differences （P0.01） in twelve of their characteristics and significant differences （P0.05） in eight of their characteristics, while bighead carp showed highly significant differences （P0.01） in eight of their characteristics and significant differences （P0.05） in eight of their characteristics. Six head morphology variables of the current silver and bighead carp were significantly or highly significantly larger than the former populations; fourteen characteristics of silver carp and ten characteristics of bighead carp of the current populations, mainly reflecting truck and tail morphology, were significantly or very significantly smaller than the former populations. Our results indicate that silver and bighead carp have developed a larger head and smaller truck and tail during the last 50 years. Due to such morphological changes, it seems apparent that the heads of these fish species need to be considered in regards to human diets, particularly in relation to economic and nutritious value.

17~45岁肥胖门诊患者的6分钟步行试验距离参考方程研究

背景 目前6分钟步行试验(6MWT)已经被广泛用于评估肥胖人群的运动能力,并为制订干预措施提供了参考依据。国外已有研究提出了其他人群的6MWT距离参考方程,但中国17~45岁且BMI≥30 kg/m^(2)肥胖受试者的6MWT距离参考方程研究较少。目的 为17~45岁门诊肥胖受试者制订6MWT距离参考方程,并评估其影响因素。方法 根据美国胸科学会指南,前瞻性选取2022年6月—2023年9月于江苏省苏北人民医院内分泌科肥胖门诊部就诊的143名年龄17~45岁且BMI≥30 kg/m^(2)的成年人(71名男性和72名女性),进行人体测量和6MWT。采用逐步多元回归模型建立6MWT距离参考方程,将新建立的6MWT距离参考方程与现有的预测方程进行比较。结果 143名受试者的平均6MWT距离为(506.1±49.8)m,其中男性平均6MWT距离为(515.7±50.1)m,大于女性的平均6MWT距离(496.6±47.9)m(P<0.05)。在年龄段17~23岁、24~30岁、31~37岁以及38~45岁中,男性与女性6MWT距离比较,差异均有统计学意义(P<0.05)。男性受试者的体质量、BMI、最大心率(HR_(max))、心率差(ΔHR)、腰围、舒张压差(ΔDBP)、Borg量表评分差(ΔBorg)与6MWT距离相关(P<0.05),女性受试者的体质量、BMI、腰围与6MWT距离相关(P<0.05)。以步进的方法将潜在的影响因素纳入多元线性回归方程中,最终建立6MWT距离参考公式:男性y=494.463+1.414×ΔHR-3.903×BMI+0.874×HR_(max),R^(2)=0.429,女性y=670.448+0.299×ΔHR-4.342×BMI-0.195×HR_(max),R^(2)=0.312。结论 17~45岁门诊肥胖受试者中,男性的平均6MWT距离长于女性,且在不同年龄段均有显著差异。男性的体质量、BMI、HR_(max)、ΔHR、腰围、ΔDBP、ΔBorg与6MWT距离相关,女性的体质量、BMI、腰围、ΔSBP与6MWT距离相关。通过多元线性回归分析,为男性和女性分别建立了预测6MWT距离的参考方程,这些公式可能为评估个体的体能水平提供有价值的参考。

基于APSIM模型的不同降水年型下春小麦水氮管理模式优化研究

为优化不同降水年型下春小麦高产稳产和高效利用水氮资源的管理决策方案,利用2009-2012年内蒙古自治区额尔古纳市上库力农场试验站与拉布大林农场试验站春小麦(内麦19)的试验观测资料,确定APSIM-wheat模型中小麦生长发育关键参数;基于校准后的APSIM-wheat模型模拟分析1967-2017年雨养条件下春小麦生长发育过程,并依据降水量划分了3种降水年型(干旱、平水和湿润年型),根据土壤水分亏缺指数(soil water deficit on photosynthesis,SWD_(ef))确定最优水分管理时期;设计8个灌溉量梯度(15、30、45、60、90、120、150和180 mm)和13个施N量梯度(30、45、60、75、90、105、120、150、180、210、240、270和300 kg·hm^(-2))情景模式,结合水氮管理决策的遴选关键指标[水分利用效率(water use efficiency,WUE)、氮肥利用效率(nitrogen use efficiency,NUE)和产量],探究不同气候年型下最优春小麦水氮管理模式。结果表明:(1)校准后的APSIM-wheat模型春小麦发育期模块(出苗期、抽穗期和成熟期)模拟值与观测值的均方根误差(root mean square error,RMSE)在1.17~3.64 d范围内,归一化均方根误差(normalized root mean square error,NRMSE)在0.82%~1.90%范围内;产量模块模拟值与观测值的RMSE为371.50 kg·hm^(-2),NRMSE为8.54%,说明APSIM-wheat模型可以较好地反映不同降水年型下小麦的动态生长发育过程。(2)雨养条件下春小麦分蘖期—拔节期、拔节期—抽穗期和抽穗期—开花期的SWD_(ef)较低,且在生育期内仅灌溉一次的前提下,拔节期灌溉可以减轻干旱胁迫并显著提高产量。(3)干旱、平水和湿润年型春小麦拔节期最优水氮管理模式分别为灌溉量60 mm和施氮量105 kg·hm^(-2)、灌溉量60 mm和施氮量120 kg·hm^(-2)、灌溉量30 mm和施氮量150 kg·hm^(-2),其产量分别为4810.96±551.43、5378.06±768.86和6421.33±454.09 kg·hm^(-2)。

Burden of mental disorders and risk factors in the Western Pacific region from 1990 to 2021

BACKGROUND The burden of mental disorders(MD)in the Western Pacific Region(WPR)re-mains a critical public health concern,with substantial variations across demogra-phics and countries.AIM To analyze the burden of MD in the WPR from 1990 to 2021,along with associated risk factors,to reveal changing trends and emerging challenges.METHODS We used data from the Global Burden of Disease 2021,analyzing prevalence,incidence,and disability-adjusted life years(DALYs)of MD from 1990 to 2021.Statistical methods included age-standardisation and uncertainty analysis to address variations in population structure and data completeness.RESULTS Between 1990 and 2021,the prevalence of MD rose from 174.40 million cases[95%uncertainty interval(UI):160.17-189.84]to 234.90 million cases(95%UI:219.04-252.50),with corresponding DALYs increasing from 22.8 million(95%UI:17.22-28.79)to 32.07 million(95%UI:24.50-40.68).During this period,the burden of MD shifted towards older age groups.Depressive and anxiety disorders were predominant,with females showing higher DALYs for depressive and anxiety disorders,and males more affected by conduct disorders,attention-deficit hyperactivity disorder,and autism spectrum disorders.Australia,New Zealand,and Malaysia reported the highest burdens,whereas Vietnam,China,and Brunei Darussalam reported the lowest.Additionally,childhood sexual abuse and bullying,and intimate partner violence emerged as significant risk factors.CONCLUSION This study highlights the significant burden of MD in the WPR,with variations by age,gender,and nation.The coronavirus disease 2019 pandemic has exacerbated the situation,emphasizing the need for a coordinated response.

适变与应变:“十五五”时期人口发展规划的新格局、新挑战及其实践路径

“十五五”时期是中国基本实现社会主义现代化承上启下的关键时期,同时也是人口发展深度转型的重要节点。“十五五”人口发展规划的制定必须准确识别人口规模、结构、素质、分布等要素呈现的趋势性变化,及时把握当前人口发展的潜在机遇和堵点难点,根据人口发展新格局适时调整应变思路,不断推进人口自身均衡发展,以及人口与经济社会、资源环境的协调发展。从长远来看,人口发展规划的制定还需要纵向锚定人口高质量发展的战略目标,形成应对未来人口发展新变化的超前预案。

Wells评分、Geneva评分和YEARS法对疑似肺栓塞住院患者诊断价值的对比研究

目的探讨Wells评分、Geneva评分和YEARS法对疑似肺栓塞(PE)住院患者的诊断价值。方法回顾性分析2017年1月至2020年6月因胸痛、呼吸困难和咯血于湖南省人民医院住院治疗的946例疑似PE患者。记录所有入组患者病史、临床表现和辅助检查结果等指标。入组患者均接受Wells评分、Geneva评分和YEARS法评估。以CT肺血管造影(CTPA)为标准,分析3种评分诊断PE的灵敏度、特异度、准确度和Youden指数,同时将3组评分结果与CTPA结果进行一致性分析,并绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),评估3种评分系统诊断PE价值。结果 946例患者中CTPA确诊为PE患者257例(27.2%)。Wells评分、 Geneva评分、YEARS法诊断PE灵敏度分别为88.72%、75.88%、93.00%,特异度分别为35.37%、59.36%、25.11%,准确度分别为50.11%、63.85%、43.55%,Youden指数分别为0.24、0.35、0.18。Wells评分、Geneva评分、YEARS法与CTPA的Kappa值分别为0.16、0.28、0.11。3种评分准确度两两比较差异均有显著统计学意义(P<0.01)。Wells评分、Geneva评分、YEARS法诊断PE的AUC分别为0.622±0.019、0.676±0.019、0.591±0.020,其中Geneva评分AUC最大,与Wells评分、YEARS法差异均有统计学意义(P<0.0167),Wells评分与YEARS法差异无统计学意义(P>0.0167)。结论 3种评分对疑似PE住院患者均有一定的诊断价值,Geneva评分整体诊断价值最高,Wells评分和YEARS法诊断均不理想。

Wells评分和YEARS法对肺栓塞诊断价值的比较

目的:探讨深静脉血栓可能性评分(Wells评分)和简便诊断处理可疑肺栓塞(YEARS法)对肺栓塞患者的诊断价值,应用受试者工作特征(ROC)曲线对比Wells评分和YEARS法诊断肺栓塞的曲线下面积(AUC),以期发现更适用于临床的肺栓塞评分方法。方法:选取因疑似肺栓塞的住院患者139例,其中临床确诊肺栓塞患者48例,收集所有入选患者的病史、临床表现和辅助检查等结果,所有入选研究对象均进行Wells评分和YEARS法评估,将肺动脉血管造影(CTPA)作为诊断的金标准,应用SPSS 22.0统计软件分析2组患者Wells评分和YEARS法诊断肺栓塞的灵敏度、特异度、误诊率、漏诊率和准确度,并对Wells评分、YEARS法和CTPA的结果进行一致性分析,进一步绘制Wells评分和YEARS算法诊断肺栓塞的ROC曲线,计算并比较AUC。结果:与YEARS法比较,Wells评分对肺栓塞诊断的特异度和准确度明显升高(P<0.05),误诊率明显降低(P=0.037),而灵敏度和漏诊率差异无统计学意义(P>0.05)。Wells评分与CTPA的Kappa值为0.45,一致性强度为中度;YEARS法与CTPA的Kappa值为0.22,一致性强度尚可;Wells评分与YEARS法的Kappa值为0.11,一致性较差。Wells评分方法诊断肺栓塞的AUC为0.753±0.044 (P<0.01),YEARS法诊断肺栓塞的AUC为0.585±0.049 (P=0.101)。结论:Wells评分在肺栓塞诊断评估方面总体上优于YEARS法。

可疑肺栓塞诊断新策略--YEARS评分

肺栓塞是一种误诊率、漏诊率极高的常见肺血管病,早期识别、早期诊治对改善患者预后至关重要。肺动脉造影是确诊肺栓塞的“金标准”,因其昂贵、有创、有辐射暴露风险,在临床已经逐渐被CT肺血管造影取代。但可疑肺栓塞的患者如果未经有效评估,可能导致过度检查及不必要的医疗资源浪费,也增加了患者辐射暴露的风险。为了有效筛查可疑肺栓塞,目前有多种评分模型对可疑肺栓塞进行评估,但传统评分法相对较复杂,不易在临床工作广泛推广使用。YEARS评分是近年来针对可疑肺栓塞进行评估的新型评分模型,其是一种简单、快速的评估肺栓塞可能性的工具,可以安全有效排除可疑肺栓塞患者,该评分标准更为简便,易于记忆和临床推广。但因目前其临床应用研究有限,有待进一步在临床验证该评分的诊断价值。本文就YEARS评分的临床研究做一综述,以期为肺栓塞的诊断提供新思路、新方法。

从“上海岁月”到延安时期:中共党建策略的演变及其长远影响——一项历史政治学的考察

中共从成立初期的“上海岁月”至延安时期党建策略的演变对党的建设及中国革命的长远发展影响深远。在共产国际支持下,中共上海时期的党建工作确立了党的基本组织原则和运作模式,完成了从研究团体向初生政党的转变。这一时期党的基本框架、路径和规则得到确立,包括党的组织原则、内部治理结构、党员标准以及党的日常运作,等等。在延安时期,中共通过“整风运动”等措施,进一步完善了党建策略,实现了思想统一和组织整合,为应对复杂的政治环境和战争挑战提供了坚实保障。特别是延安时期党建的特点和成就,包括思想建设、组织结构优化、领导层的示范作用、军队党建实践等方面,表明中共党建策略的演变并非一蹴而就,而是与当时面对的政治环境变化以及中国革命的进程密切相关。

Forest change of China in recent 300 years

Based on historical documents, modern survey and statistics, as well as the result of predecessor studies, the trend and main process of forest dynamics are recognized. The forest area and forest coverage rates for each province of China from 1700 to 1949 are estimated backward by every 50 years. Linking the result with modern National Forest Inventory data, the spatial-temporal dynamics of Chinese forest in recent 300 years （AD 1700-1998） is quantitatively analyzed. The study shows that in recent 300 years, the forest area in current territory of China has declined by 0.95×10^8 hm^2 （or 9.2% of the coverage rate） in total, with a trend of decrease and recovery. Before the 1960s, there was a trend of accelerated descending. The forest area was reduced by 1.66×10^8 hm^2 （or 17% of the coverage rate） in 260 years. While after the 1960s, there has been a rapid increase. The forest area increased by 0.7×10^8 hm^2 （or 8% of the coverage rate） in 40 years. The study also shows that there is a significant spatial difference in the dynamics of forest. The amplitudes of increasing and decreasing in western China are both smaller than the ones in eastern China. During the rapid declining period from 1700 to 1949, the most serious decrease appeared in the Northeast, the Southwest and the Southeast, where the coverage rate in most provinces dropped over 20%. In Heilongjiang Province, the coverage rate dropped by 50%. In Jilin Province, it dropped by 36%. In Sichuan Province and Chongqing Municipality, it dropped by 42%. In Yunnan Province, it dropped by 35%. During the recovery period 1949-1998, the western provinces, municipality and autonomous regions, including Ningxia, Gansu, Inner Mongolia, Sichuan-Chongqing, Yunnan, Tibet, Xinjiang and Qinghai, etc, the increase rates are all below 5%, while the eastern provinces, municipality and autonomous regions （except Heilongjiang, Hubei, Jiangsu-Shanghai） have achieved an increase over 5%, among which the Guangdong-Hainan, Guangxi, Anhui, Beijing-Tianjin-Hebei, Shandong, Henan, Zhejiang, and Fujian have an increase over 10%.