Using time series analysis to forecast the health-related quality of life of post-menopausal women with non-metastatic ER+ breast cancer: A tutorial and case study

BackgroundTime series models are widely used forecasting techniques in health care for long time series and are typically built in commercial statistical packages. However, for short time series data, such as health-related quality of life (HRQoL), guidance on how to select and use appropriate time series models is lacking. This tutorial provides a step-by-step guide adopting a time series analysis framework for HRQoL forecasting.ObjectiveWe walk through a case study examining the forecasting of the effects of adjuvant endocrine therapy on the HRQoL of post-menopausal women with non-metastatic ER + breast cancer using data from the HRQoL sub-protocol of the Tamoxifen arm of the Arimidex, tamoxifen, alone or in combination (ATAC) trial.MethodsThe forecasting of HRQoL consists of four steps: 1) data extraction and accuracy check, 2) forecasting horizon definition and identification of data pattern, 3) forecasting model identification and fitting using five forecasting approaches appropriate for short time series ((i) double exponential smoothing, (ii) double moving average, (iii) fuzzy forecasting, (iv) grey forecasting, and (v) Volterra series), 4) forecasting model selection. A user-friendly visual basic for applications (VBA) Excel add-in is made available to interested users to facilitate the application of the tutorial.ResultsThe Grey method and Volterra series appeared to be good candidates to forecast the effects of adjuvant endocrine therapy on the HRQoL of post-menopausal women with non-metastatic ER + breast cancer enrolled in the ATAC trial.ConclusionIt is feasible to forecast the effects of treatments on HRQOL even when the time series is short.     

生物信息学在肝细胞癌风险预测中的应用

生物信息学是一门交叉科学,通过综合运用数学、计算机科学和生物学的各种工具,来阐明和理解大量生物数据所包含的生物学意义。随着基因组学测序技术的不断发展,产生大量的生物学数据资源,从大数据中挖掘所蕴藏的生物学意义,已成为了当前亟待解决的主要任务之一。本文主要归纳总结基于特征基因的肝癌风险预测模型,为肝癌的早期检测、预后和治疗方案的优化提供新观点。     

Using newspaper obituaries to “nowcast” daily mortality: Evidence from the Italian COVID-19 hot-spots

Real-time tracking of epidemic helps governments and health authorities make timely data-driven decisions. Official mortality data, whenever reliable and available, is usually published with a substantial delay. We report results of using newspapers obituaries to “nowcast” the mortality levels observed in Italy during the COVID-19 outbreak between February 24, 2020 and April 15, 2020. Mortality levels predicted using obituaries outperform forecasts based on past mortality according to several performance metrics, making obituaries a potentially valid alternative source of information to deal with epidemic surveillance.     

断层解剖学分析在四肢软组织肉瘤手术计划中的应用

目的 探讨断层解剖学分析在软组织肉瘤外科边界设计中的作用。方法 2012年3月至2014年12月我科收治四肢软组织肉瘤患者10例,术前行0.625 mm薄层扫描MRI和/或CTA检查。逐层详细分析断层解剖结构,确定肿瘤累及间室、反应带区域,以间室结合广泛边缘切除为原则准确设计肿瘤切除的边界,手术严格按照设计边界进行。对术后标本观察反应带和边界厚度,做两个维度最小边界测量,病理学检查明确肿瘤性质,确认切除标本边缘是否存在肿瘤细胞。结果 ①术后肿瘤实体与术前断层解剖分析大小相比差异无统计学意义（P＞0.05）。②术后测量肿瘤外正常组织厚度,手术类型达到广泛切除或治愈性切除标准,与术前计划一致。肿瘤完整切除,术后手术切缘病理检查未发现肿瘤细胞浸润。③末次随访患者功能恢复良好,未见肿瘤复发。结论 逐层断层解剖分析为软组织肉瘤提供精确数字化外科边界,合理而精确切口设计,减少出血、创伤和肿瘤污染的可能性,有利于肿瘤切除时实现治愈性切除。规范断层解剖影像学检查和逐层断层解剖分析应该成为恶性软组织肉瘤切除术前设计必要步骤。     

降钙素原对儿童急性阑尾炎严重程度的预测价值

目的 评价降钙素原（PCT）对儿童急性阑尾炎严重程度的预测价值.方法 收集2011年10月至2012年3月我们收治的93例诊断为急性阑尾炎的患儿临床资料,包括年龄、性别、入院时PCT及CRP、并发症（腹腔脓肿、肠梗阻）、住院时间等.根据手术所见或病理检查结果将患儿分为急性阑尾炎组和急性阑尾炎伴局限性或弥漫性腹膜炎组.结果 急性阑尾炎组53例,腹膜炎组40例.腹膜炎组出现并发症的比例高于急性阑尾炎组,住院时间较长,且PCT、CRP水平显著高于急性阑尾炎组（PCT：0.43 vs 3.37 ng/mL,P＜0.001,CRP：3.0vs13.8 mg/L,P＜0.001）.在诊断腹膜炎的敏感性、特异性、阳性预测值、阴性预测值方面,当PCT以0.93 ng/mL为阈值时,分别为85.0％、91.6％、88.3％、89.0％,而CRP以4.05 mg/L为阈值时,分别为90.0％、67.9％、67.9％、90.0％.结论 入院时PCT及CRP对儿童急性阑尾炎的严重程度具有一定的预测价值,且PCT性能略优于CRP.     

腹腔镜胆道探查手术不良转归的预测指标

目的:研究腹腔镜胆道探查患者术前疾病指标与手术不良转归的相关性。方法:收集218例腹腔镜胆道探查患者的术前资料,采用多变量分析定义三个手术不良转归:中转开放手术,术后发生并发症,术后住院时间延长。结果:患者血清胆红素水平增高与中转开放手术有关[OR=1.01(CI=1.00-1.01),P=0.01]。66.5%的患者无任何术后并发症,16%的患者有轻度ClavienⅠ级并发症,1例死亡;年龄越高,发生ClavienⅡ～Ⅴ级并发症的几率越高[OR=1.03(CI=1.01-1.05),P=0.02]。术前胆总管直径增粗[OR=1.16(CI=1.08-1.25),P<0.001]、既往上腹部手术史[OR=4.89(CI=1.10-21.74),P=0.04]及血清胆红素值增高[OR=1.04(CI=1.01-1.88),P=0.02]是术后住院时间延长的预测指标。结论:腹腔镜胆道探查手术是安全的,但高龄、黄疸、胆总管直径增粗及既往手术史可增加手术风险,此类患者应考虑其他治疗方法,以获得更好的预后。     

重症吉兰-巴雷综合征的预测因素分析

目的分析轻症与重症吉兰-巴雷综合征(Guillain-Barrésyndrome,GBS)患者临床及神经电生理检查特点,筛选出重症患者的预测因素。方法回顾性分析2006年1月至2015年11月在本院住院治疗的GBS患者101例。根据疾病高峰期Hughes评分划分为轻症组(0~2分)和重症组(3~6分)。分别统计两组患者发病年龄、性别、前驱感染史、首发症状、是否有延髓功能障碍、是否累及颅神经和自主神经、有无轴索损害等指标,分析两组之间差异,并筛选出重症患者的预测因素。结果以非感觉异常为首发症状(P0.001)、有延髓功能障碍(P0.001)、颅神经受累(P=0.025)、自主神经系统受累(P=0.018)、运动系统受累(P=0.004)以及轴索损害(P0.001)的患者容易发展为重型患者。多因素Logistic回归分析发现轴索损害(P=0.008,OR=4.632)、延髓受累(P=0.010,OR=10.420)、颅神经受累(P=0.047,OR=0.076)是发展为重型的独立危险因素。结论轴索损害、延髓受累和颅神经受累可能是GBS患者发展至重型的有意义的预测因素。     

早孕期血清NGAL表达水平及其与妊娠期糖尿病发病的关联

目的探讨早孕期血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平与妊娠期糖尿病(GDM)发病的关联。方法筛选具有妊娠期糖尿病的危险因素的产妇共198例进行前瞻性研究,结果共诊断97例GDM设为GDM组,其余101例为GDM高危组,匹配100例正常分娩的孕妇为健康对照组。于整个孕周检测血清NGAL水平,早孕期检测空腹血糖等指标,采用稳态模型评估胰岛素抵抗指数(HOMA-IR)。结果中孕期NGAL水平显著高于早孕期。GDM组早、中、晚孕期NGAL水平均显著高于GDM高危组和健康对照组。GDM组早孕期空腹血糖、空腹胰岛素HOMA-IR和血清NGAL水平均显著高于健康对照组。早孕期NGAL在发生GDM的患者和存在GDM高因素的人群相比有统计学差异,而空腹血糖、空腹胰岛素和HOMA-IR在两者之间无统计学差异。逐步回归分析发现HOMA-IR及总胆固醇是血清NGAL独立的协变量。结论早孕期对存在GDM高危因素的孕妇进行血清NGAL检测对GDM发生具有一定预测作用,NGAL与胰岛素抵抗和血脂水平存在一定关联。     

PsTg对甲状腺乳头状癌术后功能性淋巴结转移患者131I最佳治疗反应的预测价值

目的:探讨¹³¹I治疗前刺激性甲状腺球蛋白(psTg)水平对甲状腺乳头状癌(PTC)术后功能性残留淋巴结转移且无远处转移患者¹³¹I最佳治疗反应(ER)的预测价值。 方法:回顾性纳入2011年3月至2015年6月间于郑州大学附属肿瘤医院行甲状腺双侧叶全切+淋巴结清扫术后首次行¹³¹I治疗时确诊为功能性残留淋巴结转移且无远处转移的PTC患者72例[男22例、女50例,年龄14~76(46.5±14.4)岁;血清甲状腺球蛋白抗体(TgAb)水平均正常]。根据治疗反应评估体系将患者分为ER组和非ER组。采用两独立样本 t检验、 χ²检验、Mann-Whitney U检验比较2组患者的一般临床特征,再进行多因素logistic回归分析;采用ROC曲线评估psTg、转移淋巴结大小(短径)对ER的预测价值。 结果:ER组44例,非ER组28例,2组患者的性别、年龄、临床分期、术后转移淋巴结个数和位置差异均无统计学意义( t=0.82, χ²值:0.16~2.60,均 P>0.05);而美国甲状腺协会(ATA)初始风险分层( χ²=33.38)、转移淋巴结大小( U=296.50)和psTg( U=111.00)差异均有统计学意义(均 P<0.001)。多因素回归分析显示,psTg[比值比( OR)=0.047, 95% CI: 0.004~0.500, P=0.011]和转移淋巴结大小( OR=0.146, 95% CI: 0.032~0.666, P=0.013)是影响ER的独立因素,而ATA初始风险分层不是独立因素( OR=0.266, 95% CI: 0.051~1.390, P=0.116)。PsTg、转移淋巴结大小的ROC AUC分别为0.904、0.873;当psTg以20.05 μg/L为界值时,其预测ER的灵敏度和特异性分别为96.4%(27/28)和75.0%(33/44);当转移淋巴结大小以0.75 cm为界值时,其预测ER的灵敏度和特异性分别为78.6%(22/28)和81.8%(36/44)。 结论:PsTg可以较好地预测PTC术后功能性残留淋巴结转移患者¹³¹I疗效,转移淋巴结大小对疗效也有重要影响。     

Health workforce planning in Europe: Creating learning country clusters

In this article, the different dimensions and determinants of health workforce planning (HWF) are investigated to improve context-sensitivity and mutual learning among groups of countries with similar HWF characteristics. A novel approach to scoring countries according to their HFW characteristics and type of planning is introduced using data collected in 2012 by a large European Union project involving 35 European countries (the ‘Matrix Study’ [8]). HWF planning is measured in terms of three major dimensions: (1) data infrastructure to monitor the capacities and dynamics of health workforces, (2) the institutions involved in defining and implementing labour market regulations, and (3) the availability of models to estimate supply–demand gaps and to forecast imbalances. The result shows that the three dimensions of HWF planning are weakly interrelated, indicating that countries invest in HWF in different ways. Determinant analysis shows that countries with larger health labour markets, National Healthcare Service (NHS), mobility, and strong primary health care score higher on HWF planning dimensions than others. Consequently, the results suggest that clustering countries with similar conditions in terms of HWF planning is a way forward towards mutual and contextual learning.