血液肿瘤患者化疗后肛周感染危险因素病例对照研究

目的 探讨血液肿瘤患者接受化疗后发生肛周感染的危险因素。方法 采用回顾性病例对照研究的方法,对四川省某三级甲等医院血液内科2020年12月—2021年5月收治的进行化疗的348例血液肿瘤住院患者相关资料（人口学特征、疾病特征、医疗及护理病例记录、实验室检查结果）予以回顾性分析,根据出院诊断发生肛周感染的病例作为病例组,其余病例作为对照组,统计血液肿瘤患者接受化疗后肛周感染的发生率,采用单因素分析和二元Logistic回归分析肛周感染的危险因素。结果 348例血液肿瘤化疗患者,发生肛周感染35例,感染率为10.1%;Logistic回归分析显示,年龄<60岁（OR=8.776,P=0.039）、痔疮史（OR=7.733,P<0.001）、肛周感染史（OR=14.981,P<0.001）、腹泻（OR=3.893,P=0.019）及白细胞计数<1×10⁹/L（OR=6.851,P=0.002）是血液肿瘤患者接受化疗后发生肛周感染的独立危险因素。结论 血液肿瘤患者接受化疗后肛周感染的发生率较高,年龄<60岁、痔疮史、肛周感染史、腹泻、白细胞计数<1×10⁹/L导致血液肿瘤化疗患者肛周感染率增加,在护理化疗期的血液肿瘤患者过程中,应该结合肛周感染的危险因素,采取针对性干预措施,降低肛周感染发生率。     

Hepatitis B virus infection and the risk of cancer among the Chinese population

The relationship between hepatitis B virus (HBV) and nonhepatocellular cancers remains inconclusive. This large case-control study aimed to assess the associations between HBV infection status and multiple cancers. Cases (n = 50 392) and controls (n = 11 361) were consecutively recruited from 2008 to 2016 at the First Affiliated Hospital of Nanjing Medical University. Multivariable adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression by adjusting age and gender. A meta-analysis based on published studies was also performed to verify the associations. Of these, 12.1% of cases and 5.5% of controls were hepatitis B surface antigen (HBsAg) seropositive. We observed significant associations between HBsAg seropositivity and esophagus cancer (aOR [95% CI] = 1.32 [1.13-1.54]), stomach cancer (1.46 [1.30-1.65]), hepatocellular carcinoma (HCC; 39.11 [35.08-43.59]), intrahepatic and extrahepatic bile duct carcinoma (ICC and ECC; 3.83 [2.58-5.67] and 1.72 [1.28-2.31]), pancreatic cancer (PaC; 1.37 [1.13-1.65]), non-Hodgkin lymphoma (NHL; 1.88 [1.61-2.20]) and leukemia (11.48 [4.05-32.56]). Additionally, compared to participants with HBsAg−/anti-HBs−/anti-HBc−, participants with HBsAg−/anti-HBs−/anti-HBc+, indicating past HBV-infected, had an increased risk of esophagus cancer (aOR [95% CI] = 1.46 [1.24-1.73]), stomach cancer (1.20 [1.04-1.39]), HCC (4.80 [3.95-5.84]) and leukemia (15.62 [2.05-119.17]). Then the overall meta-analysis also verified that HBsAg seropositivity was significantly associated with stomach cancer (OR [95% CI] = 1.23 [1.14-1.33]), ICC (4.05 [2.78-5.90]), ECC (1.73 [1.30-2.30]), PaC (1.26 [1.09-1.46]), NHL (1.95 [1.55-2.44]) and leukemia (1.54 [1.26-1.88]). In conclusion, both our case-control study and meta-analysis confirmed the significant association of HBsAg seropositivity with stomach cancer, ICC, ECC, PaC, NHL and leukemia. Of note, our findings also suggested that the risk of stomach cancer elevated for people whoever exposed to HBV.     

Elevated maternal serum-free β-human chorionic gonadotropin (β-hCG) and reduced risk of spontaneous preterm delivery*

Objective: To evaluate the relationship between first and second trimester maternal serum-free β-hCG and the risk of spontaneous preterm delivery (PTD).

Study design: This was a case-control study of women evaluated and delivered at our institution from 2011 to 2015. Spontaneous PTD was defined as delivery before 37 weeks due to spontaneous preterm labor or premature rupture of membranes. Patient with multifetal gestation and those with medically indicated term or PTD were excluded.

Results: Of 877 women meeting the inclusion criteria, 173 delivered preterm and 704 delivered at term, and 8.1% had high free β-hCG in one or both trimesters. High maternal first and/or second trimester free β-hCG (≥95th percentile) was associated with lower rates of PTD. Thirty-two women with high free β-hCG in both first and second trimesters delivered at term. Gestational age at delivery and birth weights were lower in women who did not have high free β-hCG in any trimester. Low free β-hCG (≤5th percentile) in either trimester was not associated with an increased or decreased likelihood of PTD. Logistic regression demonstrated an independent association of high free β-hCG (≥95th percentile) with a reduced likelihood of PTD. Stratified analysis revealed a stronger impact of this association in women with no prior history of PTD.

Conclusions: High free β-hCG, in the absence of risk factors for medically indicated PTD, is associated with a reduced likelihood of spontaneous PTD and may represent a marker indicating lower risk.     

Risk factors for Cutibacterium acnes spinal implant-associated infection: a case–case–control study

ObjectivesThe aim was to determine the characteristics of patients who developed Cutibacterium acnes spinal implant-associated infection (SIAI) and the associated risk factors.MethodsWe conducted two parallel case–control studies comparing 59 patients with SIAI caused by C. acnes (cases 1) and 93 patients with SIAI caused by other microorganisms (cases 2) diagnosed during 2010–2015 with 302 controls who underwent spinal instrumentation without subsequent infection.ResultsLate-onset infections (median time to diagnosis, 843 days versus 23 days; p < 0.001) were more common in cases 1 than in cases 2. However, 20/59 (34%) of cases 1 occurred within the first 3 months after the index surgery. In addition, cases 1 were less likely to have fever (27%, 16/59 versus 58%, 54/93; p 0.001) or wound inflammation (39%, 23/59 versus 72%, 67/93; p < 0.001). Moreover, 24/59 (40%) of cases 1 presented with polymicrobial infections, and staphylococcal pathogens accounted for 22/24 (92%) of the co-infections. By comparing and contrasting the two multivariate risk models (cases 1 versus controls and cases 2 versus controls), the following factors associated with C. acnes SIAI development were identified: age <54 years (adjusted odds ratio (aOR) 2.43, 95% confidence interval (CI) 1.09–5.58, p 0.03), a body mass index <22 kg/m² (aOR 2.47, 95% CI 1.17–5.29, p 0.02), and thoracic instrumentation (aOR 16.1, 95% CI 7.57–37.0, p < 0.001).ConclusionsFuture therapeutic and prophylactic studies on C. acnes SIAI should focus on young, thin patients who undergo spinal instrumentation procedures involving the thoracic spine.     

A nested case-control study on radiation dose-response for cardiac events in breast cancer patients in Germany

BackgroundPrevious studies with the majority of breast cancer (BC) patients treated up to 2000 provided evidence that radiation dose to the heart from radiotherapy (RT) was linearly associated with increasing risk for long-term cardiac disease. RT techniques changed substantially over time. This study aimed to investigate the dose-dependent cardiac risk in German BC patients treated with more contemporary RT.MethodsIn a cohort of 11,982 BC patients diagnosed in 1998–2008, we identified 494 women treated with 3D-conformal RT who subsequently developed a cardiac event. Within a nested case-control approach, these cases were matched to 988 controls. Controls were patients without a cardiac event after RT until the index date of the corresponding case. Separate multivariable conditional logistic regression models were used to assess the association of radiation to the complete heart and to the left anterior heart wall (LAHW) with cardiac events.ResultsMean dose to the heart for cases with left-sided BC was 4.27 Gy and 1.64 Gy for cases with right-sided BC. For controls, corresponding values were 4.31 Gy and 1.66 Gy, respectively. The odds ratio (OR) per 1 Gy increase in dose to the complete heart was 0.99 (95% confidence interval (CI): 0.94–1.05, P = .72). The OR per 1 Gy increase in LAHW dose was 1.00 (95% CI: 0.98–1.01, P = .68).ConclusionsContrary to previous studies, our study provided no evidence that radiation dose to the heart from 3D-conformal RT for BC patients treated between 1998 and 2008 was associated with risk of cardiac events.     

Risk of leukaemia and residential exposure to air pollution in an industrial area in Northern Italy: a case-control study

Leukaemia risk in adult populations exposed to environmental air pollution is poorly investigated. We have carried out a population-based case-control study in an area that included a fossil fuel power plant, a coke oven and two big chemical industries. Information on residential history and several risk factors for leukaemia was obtained from 164 cases, diagnosed between 2002 and 2005, and 279 controls. A higher risk for subjects residing in polluted areas was observed, but statistical significance was not reached (adjusted OR = 1.11 and 1.56 for subjects living in moderately and in heavily polluted zones, respectively, p = 0.190). Results suggest a possible aetiological role of residential air pollution from industrial sites on the risk of developing leukaemia in adult populations. However, the proportion of eligible subjects excluded from the study and the lack of any measure of air pollution prevent definitive conclusions from being drawn.     

某河流沿岸原发性肝癌危险因素的病例对照研究

目的了解该河沿岸地区原发性肝癌(PHC)的主要危险因素,为降低该地区PHC发病率提供理论依据.方法采用直接询问法,以沿河地区65例PHC患者为病例组,以远离河岸的与病例组年龄相差在5岁以内、不同姓氏、生活习惯、种植情况和生活水平等方面基本相近的居民为对照组.结果经单因素分析得出可能的危险因素有:家庭年人均收入、个人肝病史、PHC家族史、蔬菜摄入量情况、常吃盐渍食品、饮用渗水井(土井)、饮水类型、饮酒年数、负性生活事件和性格类型,经Logistic回归分析得出只有饮用渗水井(土井)、个人肝病史、饮酒和PHC家族史为有意义的预防措施. 结论该河沿岸居民的PHC的主要危险因素有:个人肝病史、饮酒和PHC家族史,距离该河越近的饮用水水质越差,这可能是离河岸近的浅层地下水易受污染所致.预防和控制奎濉河沿岸PHC最根本、最有效的措施是治理污染和打深水井.     

母乳喂养与儿童孤独症关系的Meta分析

目的 分析母乳喂养与儿童孤独症的关系,为孤独症防治提供理论依据。方法 运用Revman 5.3软件,对发表于2006-2017年有关母乳喂养与儿童孤独症关系的病例对照研究进行Meta分析,根据异质性检验结果选择固定效应模型或随机效应模型,计算OR值及95%CI,评估发表偏倚,进行敏感性分析,并对母乳喂养时间按照>1月、>3月、>6月、>12月进行亚组分析。结果 最终选出11篇文献13项研究,累计病例2 323例,对照2 839例。合并效应量结果显示,母乳喂养与孤独症关系的OR值及95%CI为0.49(0.35~0.68) (P＜0.05);亚组分析结果显示,母乳喂养>3月的合并OR值及95%CI为0.66(0.49~0.91)(P＜0.05),母乳喂养>6月的合并OR值及95%CI为0.40 (0.32~0.49)(P＜0.05)。结论 母乳喂养可能是儿童孤独症的保护因素,应提倡母乳喂养至6个月以上。