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1.
Background
Abdominal aortic aneurysm (AAA) is a cardiovascular health problem. Ultrasound screening has been shown to reduce the risk of AAA-related, but not all-cause, mortality. The recent introduction of screening in several countries has meant that thousands of patients with a small AAA (<5·5cm) that does not require immediate treatment are diagnosed annually. We sought to investigate the cardiovascular profiles of patients with ectatic aortas and assess whether participation in screening reduces cardiovascular risk.Methods
We used three sets of data: from the National Health Service AAA Screening Programme (NAAASP) during the 2013–14 round that were linked with Health Episode Statistics (HES) (235?409 individuals); a subset of the Framingham Study population who had an abdominal CT scan in 2004–05 and were followed up for 10 years (1383 individuals); and data for patients with a small AAA who had been in surveillance for at least 1 year in the UK Aneurysm Growth Study (UKAGS) (384 individuals) or from a national UK audit (1538 individuals), to assess cardiovascular risk and events.Findings
In the linked NAAASP–HES cohort, cardiovascular mortality was 0·30% (95% CI 0·28–0·32) for individuals with an abdominal aortic diameter of less than 2·5 cm; 0·81% (0·51–1·11) for those between 2·5 and 2·9 cm; and 1·30% (0·90–1·71) for those less than 3·0 cm. Death from a cardiovascular event was more likely for individuals with a small AAA than for those without AAA (risk ratio 4·33, 95% CI 3·15–5·97). In the Framingham cohort, abdominal aortic diameter was independently associated with cardiovascular events (hazard ratio [HR] 1·1, 95% CI 1·02–1·18; p<0·0001). An abdominal aortic diameter of more than 2·5 cm was also associated with cardiovascular events (HR 7·6, 95% CI 5·1–11·3; p<0·0001). In the UKAGS and audit populations, patients were not more likely to take antiplatelet agents or statins after entering screening surveillance; cholesterol concentrations and blood pressure also increased.Interpretation
In these contemporary large cohorts of patients with small AAA, cardiovascular events and death were common and were the leading cause of death. The implication is that patients are not more likely to receive cardiovascular protection if they enter screening or surveillance with existing protocols. Cardiovascular risk reduction interventions should be implemented in screening programmes in the future.Funding
Academy of Medical Sciences, National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, NIHR. 相似文献2.
Aravinthan Varatharaj Maria Liljeroth Stig Cramer Charlotte Stuart Elina Zotova Angela Darekar Henrik Larsson Ian Galea 《Lancet》2017
Background
Systemic inflammation can affect disease expression in multiple sclerosis. The mechanism might involve blood–brain barrier disruption. We aimed to assess the effects of systemic inflammation on disease progression in multiple sclerosis and the role of blood–brain barrier disruption.Methods
We recruited adults with relapsing–remitting multiple sclerosis and healthy controls from the general population. Three-dimensional dynamic-contrast enhanced MRI was used to measure blood–brain barrier permeability in the normal-appearing white matter (NAWM). Urinary neopterin, a product of activated macrophages, was measured to provide a readout of systemic inflammation. All study activities were performed in University Hospital Southampton after ethics approval (REC 12/SC/0176).Findings
12 patients with mutliple sclerosis and 12 healthy controls were recruited. Blood–brain barrier permeability in NAWM, measured as the constant Ktrans, was significantly higher in patients than in controls (mean 0·024 ml/100g per min [SD·0·018] vs 0·006 [0·004], p=0·015). Systemic inflammatory activity, measured as the urinary neopterin:creatinine ratio (UNCR), was also significantly higher (3·35 [1·98] vs 1·36 [0·29], p=0·002). Across all participants, there was a weak positive correlation between Ktrans and UNCR (r=0·40, p=0·031).Interpretation
Our findings support the hypothesis that the effects of systemic inflammation on expression of multiple sclerosis disease are mediated by blood–brain barrier disruption. Targeting this disruption and systemic inflammation might provide novel avenues for disease-modifying therapy.Funding
University of Southampton, National Institute for Health Research, Multiple Sclerosis Society. 相似文献3.
Hui Chen Lizheng Shi Ming Xue Xiao Dong Ni Wang Jieqing Chen Weiguo Zhu Yue Cai Hua Xu Qun Meng 《Lancet》2017
Background
The prevalence of acute myocardial infarction (AMI) has increased in China within the past few decades and is now a major cause of mortality. Percutaneous coronary intervention (PCI) is an effective treatment for AMI. We aimed to investigate how geographical and hospital characteristics affect in-hospital mortality and PCI use for AMI admissions in tertiary hospitals.Methods
We extracted data from the Nationwide Hospital Discharge Database from China's National Center for Health Statistics. Adjusted odds ratios (aORs) with 95% CI from multivariable logistic regressions were reported as associations between geographical variation or hospital characteristics and in-hospital mortality or PCI use, controlling for demographics and comorbidity scores.Findings
We identified 242866 adult admissions with AMI as primary diagnosis in 2015 from 1055 tertiary hospitals. The nationwide in-hospital mortality rate of AMI was 4·7% and differed significantly by geographic regions: 6·44% in northeast China; 5·84% in west China, 4·50% in south China, 3·77% in east China, and 3·60% in north China. Compared with eastern China, a high risk of in-hospital mortality was found in northeast China (aOR 1·86; 95%CI 1·75–1·98), west China (1·74; 1·62–1·86), south China (1·32; 1·24–1·40), and north China (1·14; 1·06–1·22). Hospital characteristics associated with the highest mortality were non-teaching hospitals (1·18; 1·12–1·24) and tertiary B hospitals (1·06; 1·01–1·11). The nationwide rate of PCI use was 45·3%. Compared with eastern China, PCI use was low in northeast China (0·49; 0·47–0·50), west China (0·63; 0·62–0·65), north China (0·83; 0·81–0·85), and south China (0·88; 0·86–0·91). Other factors that contributed to lowering the rate of PCI use were non-teaching hospitals (0·84; 0·81–0·865) and tertiary B hospitals (0·55; 0·53–0·56).Interpretation
Among China's tertiary hospitals, substantial disparities of in-hospital mortality and PCI use be attributable to geographical and hospital characteristics. More efforts are needed to reduce disparities and improve access to effective health technology.Funding
National Natural Science Foundation of China Grant (81671786). The funder had no role in the conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation or approval of the Abstract. 相似文献4.
Background
Infections can trigger acute vascular events but the differential effect of specific respiratory pathogens is unknown. We aimed to quantify the association between laboratory-confirmed respiratory bacterial or viral infections and first myocardial infarction or stroke to inform intervention development and targeting.Methods
Scottish Morbidity Record data on first myocardial infarction or stroke (International Classification of Diseases, 10th revision, codes) were linked to records of Streptococcus pneumoniae, influenza, rhinovirus, parainfluenza, respiratory syncytial virus, or human metapneumovirus from the Electronic Communication of Surveillance in Scotland (National Services Scotland) dataset on individuals aged 40 years or older from Jan 1, 2004, to Dec 31, 2014. We analysed incidence ratios for myocardial infarction or stroke in the 28 days after infection compared with baseline using self-controlled case series.Findings
There were 1227 individuals with myocardial infarction (751 men [61%]) and 762 with stroke (392 men [51%]). Median age was 68 years (IQR 59–77). The relative incidence of myocardial infarction was markedly raised in the first 1–3 days after both bacterial and viral infections (incidence ratio 5·98, 95% CI 2·47–14·4 [p<0·0001] and 5·59, 1·77–17·6 [p=0·003], respectively) and persisted for about 1 week. For stroke, the respective relative incidence after respiratory infection was even higher for days 1–3 (12·3, 5·48–27·7 [p<0·0001] and 6·79, 1·67–27·50 [p=0·007]). Elevated stroke risks after both bacterial and viral infections persisted to 28 days (p<0·0001).Interpretation
Our findings suggest that respiratory bacterial and viral infections act as vascular triggers. For stroke, the incidence ratio remained elevated a month after the date of respiratory sampling but for myocardial infarction the raised incidence ratio appeared to be more transient, suggesting potentially different mechanisms. This study highlights the need to ensure adequate uptake of influenza and pneumococcal vaccines as well as appropriate treatment during infections to reduce vascular risk.Funding
Academy of Medical Sciences. 相似文献5.
Background
With the rapid pace of population ageing, tuberculosis in older people has become a public health challenge in China. However, the age-structured epidemiological transition and its impact on achieving the end tuberculosis targets by 2035 have not been understood well. We analysed the age-structured incidence and mortality of pulmonary tuberculosis reported in China to inform current and future control programmes.Methods
In this longitudinal study, we compared the trends of age-specific reported incidence and mortality of pulmonary tuberculosis from 2005 to 2015 in China. In addition to crude rates, we calculated age-adjusted rates from 2006 to 2015 by taking the population in 2005 as reference. We determined the annual crude and age-adjusted rates of reduction by fitting an exponential linear regression model, and extrapolated up to 2035 given fixed decline rates. All data were collected from national Infectious Disease Reporting System and Diseases Surveillance System.Findings
We noted overall downward trends of reported tuberculosis incidence and mortality in all age and sex groups since 2005, whereas the proportion of older people (aged 65 years and older) among reported patients with tuberculosis and deaths increased gradually. The total tuberculosis incidence and mortality were significantly higher in older people (193·0 cases per 100?000 people and 18·7 deaths per 100?000 people, respectively) than in younger groups (66·6 cases per 100?000 and 1·7 deaths per 100?000 people). The average annual decline in crude incidence was 4·2% (95% CI 3·5–4·9) and 5·1% (4·3–5·9%) in age-adjusted incidence; the annual decline in crude mortality was 9·7% (95% CI 8·4–10·9) and 12·4% (10·9–13·8) in age-adjusted mortality. Extrapolating this trend, by 2035, the crude incidence of tuberculosis was expected to reach 26·8 cases per 100?000 people and the age-adjusted incidence to reach 20·6 cases per 100?000 people, which would result in a total reduction of 57·8% and 65·0%, respectively, compared with the rates in 2015. By 2035, the crude mortality was expected to reach 0·33 deaths per 100?000 people and the age-adjusted mortality to reach 0·15 deaths per 100?000 people, which would result in a total reduction of 86·0% and 92·0%, respectively, compared with the rates in 2015.Interpretation
These findings demonstrated an age transition of tuberculosis epidemic and the effects of population ageing on slowing down tuberculosis control progress made in China. An average 6–7% reduction would be cancelled out by 2035 given current tuberculosis decline trend and demographic change. An enhanced surveillance with age-sensitive analysis of patients with tuberculosis and a targeted response are needed.Funding
None. 相似文献6.
Kenneth Chan Riyaz Patel Xiangyuan Pu Iain A Simpson Robin N Poston Salim Hayek Shu Ye Arshed Quyyumi 《Lancet》2017
Background
Genome-wide association studies have identified ADAMTS7 as a risk locus for coronary artery disease and myocardial infarction. Functional studies suggest that ADAMTS7 might promote cellular processes in atherosclerosis. We sought to examine whether carriers of a loss-of-function genetic variant exhibit favourable characteristics on plaque histology, angiographic coronary artery disease severity, and cardiovascular outcomes.Methods
The single-nucleotide polymorphism rs3825807 was used as a marker for ADAMTS7. Human coronary atherosclerotic plaques (n=50) were genotyped, and characterised with immunohistochemical analysis. Burden of angiographic coronary artery disease was assessed by angiographic severity scores in two independent population-based cohorts—the Southampton Atherosclerosis Study (SAS, n=1359) in the UK, and the prospective Emory Genebank study (Emory GB, n=2684) in the USA. Follow-up data were collected in Emory GB over a median of 7 years.Findings
Human coronary atherosclerotic plaques with the loss-of-function G allele exhibited thinner fibrous cap (p=0·017) and lower percentage area of α-actin (smooth muscle cell marker) in the intima (p=0·029). After adjustment for age and sex, the G allele was associated with less coronary artery disease in both SAS (odds ratio 0·82, 95% CI 0·67–0·99), and Emory GB (0·84, 0·74–0·95). Angiographic burden was further characterised with the Gensini Score (GS) and Sullivan Extent Score (SES). ADAMTS genotypes were associated with all of the angiographic severity scores in both SAS (GS p=0·026, SES p=0·029) and Emory GB (GS p<0·0001, SES p<0·0001). Outcome analysis showed lower incidence of revascularisation for G allele carriers (hazard ratio 0·77, 95% CI 0·60–0·98), but not all cause mortality (1·12, 0·92–1·35).Interpretation
Carriers of the ADAMTS7 loss-of-function allele G had reduced atherosclerotic plaque progression, as demonstrated by thinner cap and smooth muscle migration. In addition there was less severe angiographic coronary artery disease in the SAS and Emory GB cohorts, as well as lower incidence of revascularisation procedure, further supporting the role of this protease in promoting atherosclerosis.Funding
None. 相似文献7.
Background
Chinese coal miners are at high risk of occupational disease becausethey work underground during most of the daylight hours and are exposed to weight-bearing activity. But data concerning bone mineral density (BMD) and risk factors of BMD is lacking. We aim to identify the factors associated with low bone BMD in coal miners.Methods
Measurements were taken at the lumbar spine and proximal femur using DXA (OSTEOCORE-2 Vision, Medilink, France). Demographic, lifestyle, physical, and occupational characteristics were collected through standardised questionnaires. Univariate, multivariate, and multiple regression were performed.Findings
We recruited 1650 coal miners aged 30–60 years from Kailuan, a city in Hebei province of China, from May to November, 2011. 51 miners (10%) older than 50 years were osteoporotic, and 191 miners (36%) had osteopenia at the lumbar spine. Four miners (1%) were osteoporotic, and 134 miners (25%) had osteopenia at the femoral neck. Pearson correlation showed that lumbar spine and femoral neck BMD correlated positively with weight (r=0·155, p<0·0001; r=0·194, p<0·0001) and body-mass index (BMI; r=0·108, p<0·0001; r=0·177, p<0·0001). Number of years of work (r=–0·134, p<0·0001) and age (r=–0·116, p<0·0001) were negatively correlated with femoral neck BMD. On multiple regression analysis, BMI was the only independent predictor of lumbar spine BMD (η2=0·005, p<0·0001), whereas both BMI (η2=0·007, p<0·0001) and years of work (η2=0·003, p<0·01) were independent predictors of femoral neck BMD.Interpretation
Age, low BMI, and long duration of work are risk factors for low BMD of coal miners in China, along with low calcium supplements intake, less time of sun exposure, smoking, and drinking history.Funding
Specific Research Project of Health Pro bono Sectors, Ministry of Health, China (201002014). 相似文献8.
Background
We have previously described outcomes in severe alcoholic hepatitis, identifying abstinence after hospital discharge as the only independent predictor of long-term survival. The outcome of patients presenting with other forms of decompensated alcohol-related liver disease is unknown. Our aim was to assess predictors of inpatient and long-term survival in patients admitted with decompensated alcohol-related cirrhosis compared with those with severe alcoholic hepatitis.Methods
A retrospective case-note review was performed for all index hospital admissions with alcoholic-related liver disease between April 1, 2005, and Dec 31, 2011. Patients with decompensated alcohol-related cirrhosis (Child-Pugh score ≥7 and bilirubin <80 mmol/L) were compared with a previously studied cohort with severe alcoholic hepatitis admitted over the same time period (discriminant function ≥32, corroborated by biopsy results where available). Predictors of inpatient survival were determined using binary logistic regression, and the Kaplan-Meier method was used to estimate long-term survival.Findings
177 patients were studied (73 decompensated alcohol-related cirrhosis, 104 severe alcoholic hepatitis). In decompensated alcohol-related cirrhosis, the independent determinants of inpatient mortality were hospital-acquired infection (odds ratio 20·2, 95% CI 3·5–118; p=0·001) and hepatic encephalopathy (9·3, 1·8–47; p=0·007). Overall median survival was similar in both groups (26 months [IQR 12·8–39·2] in decompensated alcohol-related cirrhosis vs 23 [10·6–35·4] in severe alcoholic hepatitis, p=0·872) with similar abstinence rates at last follow-up (41·1% vs 34·6%, p=0·431). In severe alcoholic hepatitis, abstinence at last follow-up was the only predictor of survival (3 year survival 75·2% in abstainers vs 33·2% in continued drinkers, p=0·012). However, in decompensated alcohol-related cirrhosis, abstinence did not predict long-term survival (median survival 36 months [IQR 22·3–49·7] in abstainers vs 38 [9·9–66·1] in continued drinkers, p=0·949).Interpretation
Inpatient mortality in decompensated alcohol-related liver disease was predicted by hospital-acquired infection and hepatic encephalopathy. Long-term survival in decompensated alcohol-related cirrhosis did not significantly improve with abstinence, which is in contrast to severe alcoholic hepatitis, and this suggests a reduced scope for disease reversibility thereby mandating earlier assessment for liver transplantation.Funding
None. 相似文献9.
Background
Ischaemia reperfusion injury is a key cause of mortality and graft loss after liver transplantation. After tissue injury, monocytes are rapidly mobilised and recruited to injured tissue by monocyte chemoattractant protein-1 (MCP-1). Elevated MCP-1 concentrations correlate with poorer outcomes in patients after haemorrhagic stroke but have not been evaluated as a prognostic marker in clinical liver transplantation. We aimed to assess the role of inflammatory monocytes and MCP-1 in ischaemia reperfusion injuryMethods
Adult patients undergoing liver transplantation at the Royal Free Hospital, London, UK, were recruited. Liver biopsy samples were collected preimplantation and 2 h after reperfusion from five patients. Intrahepatic mononuclear cells were extracted for immediate analysis by flow cytometery. Plasma MCP-1 concentrations from 33 patients were measured preoperatively by ELISA, 2 h and 24 h after reperfusion, and correlated with graft function by measurement of day 3 aspartate aminotransferase (AST) and early allograft dysfunction (EAD) score.Findings
Flow cytometric analysis demonstrated an increase in mean classical monocytes after reperfusion compared with preimplantation (4·18% of total live cells [SD 2·61] vs 0·61 [0·38], p=0·018). In three of the five recipients we distinguished cells of donor versus recipient origin by HLA-A allele expression to demonstrate that 88% (6·24) of the classical monocytes were recipient derived in the postreperfusion biopsy sample. Median MCP-1 concentrations were significantly raised after reperfusion (385·61 pg/mL [IQR 244·75–715·20] vs 71·2 [55·61–113·99], p<0·0001) and had reduced to 740·61 (38·46–133·71) within 24 h. Patients with EAD (n=17) had significantly higher MCP-1 concentrations at 24 h than those without EAD (74·82 [66·69–219·93] vs 47·44 [29·53–77·73], p=0·037). MCP-1 concentrations at 24 h correlated with day 3 AST concentrations (p=0·002).Interpretation
Our results show that classical monocytes are rapidly recruited to the liver after ischaemia reperfusion injury, and that high MCP-1 concentrations at 24 h are associated with poorer graft function. Therefore, MCP-1 blockade presents an attractive strategy to reduce graft ischaemia reperfusion injury.Funding
None. 相似文献10.
Shao-Ming Wang Philip R Taylor Jin-Hu Fan Ruth Pfeiffer Mitchell H Gail He Liang Gwen A Murphy Sanford M Dawsey You-Lin Qiao Christian C Abnet 《Lancet》2017
Background
A beneficial effect of daily supplementation with a combination of selenium, vitamin E, and beta-carotene was observed on total and cancer mortality in a Chinese population, and this protective effect endured for 10 years post-intervention. We aimed to study the longer durability of this effect.Methods
This randomised, double-blind, placebo-controlled trial was conducted in four communes in Linxian, China, from 1986 to 1991. Active follow-up continued until 2016. 29?584 residents aged 40–69 years randomly received supplementations based on a factorial design. They received either factor A (retinol/zinc), B (riboflavin/niacin), C (vitamin C/molybdenum), or D (selenium/vitamin E/beta-carotene), or placebo daily for 5·25 years. The primary endpoints were total and cancer mortality. We used hazard ratios (HRs) and 95% CIs to identify the intervention effects of four different factors using Cox proportional hazards models. Ethics approval was obtained from the Institutional Review Board of the Cancer Hospital, Chinese Academy of Medical Sciences and the US National Cancer Institute. This trial is registered with ClinicalTrials.gov, number NCT00342654.Findings
Up to 2016, the interventions showed no effect on total mortality, overall, or by sex. The previously reported protective effect of factor D against total mortality was lost after 10 years from the end of the intervention. The protective effect of factor D for gastric cancer was attenuated (HR 0·93, 95% CI 0·85–1·01; p=0·10), but a newly apparent protective effect against oesophageal cancer was found for factor B (0·92, 0·85–1·00; p=0·04). Other associations, both protective and adverse, were observed for specific causes of death. Protective effects were found in people younger than 55 years at baseline against death from non-upper gastrointestinal cancer for factor A (0·80, 0·69–0·92; p=0·002), and against death from stroke for factor C (0·89, 0·82–0·96; p=0·002). By contrast, we found an increased risk of esophageal cancer for patients who began the intervention after age 55 years for factor C (1·16, 1·04–1·30; p=0·01) and factor D (1·20, 1·07–1·34; p=0·002).Interpretation
Short-term supplementation with vitamins and minerals is unlikely to have a meaningful effect on mortality more than a decade after the supplementation ends, even in a nutritionally deprived population.Funding
National Cancer Institute contracts (N01-SC-91030, N01-RC-47701 and HHSN261201200034C to the Cancer Hospital/Institute, Chinese Academy of Medical Sciences). 相似文献11.
Fanfan Chan Niannian Chen Jianrong He Jinhua Lu Fanghua Liu Weidong Li Wanqing Xiao Songying Shen Mingyang Yuan Kar Keung Cheng Huimin Xia Ben Willem Mol Xiu Qiu 《Lancet》2017
Background
Gestational hypertension and pre-eclampsia are major causes of perinatal mortality. Prediction of gestational hypertension and pre-eclampsia is of great interest because it enables early intervention, thus improving prognosis. Most existing prediction models consist of biomarkers, which might be unavailable in low-resourced countries. We aimed to establish a prediction model of gestational hypertension and pre-eclampsia using data at early pregnancy.Methods
We studied women with singleton delivery from Born in Guangzhou Cohort Study (BIGCS), China. Predictors included maternal age, educational level, income level, prepregnancy weight, height, passive smoking, and blood pressure collected at the first antenatal-care visit (around 16 weeks' gestation). Information on diagnosis of gestational hypertension or pre-eclampsia was extracted from medical records using international classification of disease code (ICD-10). We used logistic regression to develop prediction models. Discrimination and calibration were assessed with receiver operation characteristics (ROC) and calibration plot, respectively.Findings
Between Feb 1, 2012, and Jan 1, 2016, we recruited 12?915 women, of which 326 (2·52%) women were diagnosed with gestational hypertension and 82 (0·66%) had pre-eclampsia. The prediction model for gestational hypertension with maternal characteristics alone had an area under the ROC-curve of 0·67 (95% CI 0·62–0·72). Maternal mean arterial pressure (MAP) had an area under the curve (AUC) of 0·74 (95% CI 0·70–0·79), whereas the AUC of the model with MAP and maternal characteristic combined was 0·76 (0·72–0·81), which was slightly better than for MAP alone (p=0·03). Results for prediction of pre-eclampsia were very similar to those of gestational hypertension. Calibration plots showed that the prediction model with MAP had good fit.Interpretation
Our findings show that MAP has acceptable predictive ability of gestational hypertension and pre-eclampsia and can be used to triage further care. Our relatively large sample size ensured stronger statistical power. Model validation need to be performed in a separate population.Funding
National Natural Science Foundation of China (81673181), Guangzhou Science and Technology Bureau, Guangzhou, China (2011Y2-00025, 201508030037) 相似文献12.
Background
Hepatitis B-related liver cirrhosis and hepatocellular carcinoma is a serious problem in China. Radiofrequency ablation had been considered a good option because it is minimally invasive. The aim of this study was to compare the perioperative outcomes of laparoscopic liver resection (LLR) with percutaneous radiofrequency ablation (RFA) for patients with hepatocellular carcinoma patients.Methods
A retrospective analysis of a prospective database for liver tumours identified patients with liver cirrhosis who underwent LLR and RFA of hepatocellular carcinoma in the University of Hong Kong, Queen Mary Hospital, Hong Kong between March 18, 2002, and Nov 23, 2015. The complications and-long term outcome after the operations were compared.Findings
We identified 217 patients who underwent laparoscopic treatment of hepatocellular carcinoma with liver cirrhosis in the University of Hong Kong, Queen Mary Hospital, between 2000 and 2015. 112 patients had undergone percutaneous RFA, and 105 patients who had undergone LLR with similar were selected for comparison. The patient baseline parameters, including age, sex, comorbidity, tumour size, number, and stage of hepatocellular carcinoma, did not differ between patients in the LLR and RFA groups. The median number of tumours was one tumour per patient in both treatment groups (range 1–3; p=0·517). Patients in the RFA group and LLR group had similar duration of hospital stay (2 days vs 4 days, p<0·0001), morbidity (4·5% vs 9·5%, p=0·142), and mortality (0% vs 0%). Intrahepatic recurrence was 70·5% in the RFA group versus 28·6% in the LLR group (p<0·0001). RFA was associated with the lowest overall survival (90·8 months in the RFA group vs >146·4 months in the LLR group, p=0·00019) and lowest disease-free survival (16·9 months vs 74·9 month; p<0·0001).Interpretation
LLR and RFA are well tolerated in patients with liver cirrhosis. A better survival outcome has been observed in the LLR group. We suggest LLR be considered as an option in selected patients who are deemed poor candidates for open hepatectomy.Funding
None. 相似文献13.
14.
Yu-Lan Zhao Han-Huan Luo Xin-Tian Zhang Zashi Bianba Lin Li Qian Wang Lei Guo Dian Wang Yong-Ge Ze Shan Zheng 《Lancet》2017
Background
The rural and urban integration health-care system is a new and improved health-care system in Tibet, China. The aim of this study was to investigate whether these improvements might alter the clinical–pathologic characteristics of Tibetan female with breast cancer in Tibet.Methods
This was a single-centre cross-sectional study at Tibet Autonomous Region People's Hospital. We included Tibetan adult women who had been treated for breast cancer in this hospital between Jan 1, 1973, and Dec 31, 2015. The inclusion criteria were: (1) Tibetan adult woman living in Tibet; (2) histopathology or cytopathology, or both, confirming primary breast cancer; and (3) all the treatments were finished in this hospital. The Ethics Committee of TAR People's Hospital passed this project (ID Num: ME-TBHP-15-1). Patient consent was not required according to the routine. χ2 test and logistic regression were applied, using age group and census register as the two covariates.Findings
We included 273 patients with breast cancer in the final analysis. 14 patients were in the free health-care system, 183 patients had medical insurance combined with a rural cooperative health-care system, and 76 were in a rural and urban integration health-care system. We found a decrease in tumour size (>2 cm vs 2cm; odds ratio 0·117; 95% CI 0·036–0·383) and a decrease in the proportion patients who had invasion (0·460; 0·265–0·797) among women in the rural and urban integration health–care system. The proportion of patients in early stage cancer (5·737; 1·117–29·468) and advanced stage cancer (3·917; 1·406–10·914) increased in the rural and urban integration health–care system.Interpretation
This was the first report about Tibetan women with breast cancer in Tibet. Except for advanced stage breast cancer, the clinical–pathological characteristics of Tibetan women with breast cancer improved during different health-care systems. The overall management in patients with breast cancer in advanced stage might be one of the emphases in the rural and urban integration health-care system. Information and selection bias might be the limitations of this study.Funding
Natural Science Foundation of Tibet Autonomous Region (2015ZR-13-61). 相似文献15.
Background
Premarital sex has become more acceptable in China nowadays. The Chinese Family Planning (FP) programme mainly focuses on married couples, and young unmarried women have little access to information or advice about contraception. Abortion is commonly used to end unintended pregnancies in China. This study aimed to determine risk factors related to repeat abortions in Chinese adolescents.Methods
This cross-sectional study was one component of an EU-funded project and was conducted between March 20, and Oct 5, 2013 in China. We collected data using a questionnaire filled by abortion service providers for all women seeking abortions within 12 weeks of pregnancy during a period of 2 months in selected hospitals. A total of 297 hospitals were randomly selected across 30 provinces using a stratified cluster sampling design according to the level and type of hospital. In this study, only the adolescents (younger than the minimum legal married age of 20 years for women, unintendedly pregnant) were included for analysis. All participants signed a written informed consent of which they received a copy. Ethics approvals were obtained from both ethics committees of the National Research Institution for Family Planning (NRIFP), China, and of the Ghent University, Belgium.Findings
Of the 2370 adolescents (median age 19 years, range 13–19), 927 (39%) were undergoing repeat abortions, 206 (9%) for a third time or more. The primary reason for their unintended pregnancies was non-use of contraception (1609, 68%), followed by ineffective contraception (761, 32%). After adjusting for potential confounding factors, the adolescents who had an increased risk of repeat abortions were those who had children (OR 2·63, 95% CI 1·82–3·78), those who resided in a middle-developed region (1·79, 1·30–2·48), those who resided in a relatively poor region (2·37, 1·77–3·17), and those who had used contraception during the 6 months preceding the survey (1·34, 1·08–1·65 for condom use). Adolescents who were students had a lower risk of repeat abortions than did those who were not students (0·69, 0·54–0·88).Interpretation
Repeat abortions among adolescents are highly prevalent in China. Adolescents should be offered equal access to FP in China to that of married women to reduce unintended pregnancies and repeat abortions. Correct and consistent contraception practice among adolescents should be promoted.Funding
The European Commission under the Seventh Framework Programme (FP7): INtegrating Post-Abortion Family Planning Services into China's existing abortion services in hospital setting (INPAC), 282490. 相似文献16.
Background
Non-optimal blood lipid profiles are a major modifiable risk factor for cardiovascular diseases. We aimed to understand trends in blood lipid profiles for 12 middle-income and high-income countries in four continents.Methods
We pooled studies that had measured blood lipids in representative samples of the general population. For this analysis, we used data for individuals aged 30–59 years only. Studies were from Australia, Belgium, China, Czech Republic, Finland, Germany, Italy, Japan, Norway, South Korea, the UK, and the USA. Using weighted linear regression, we estimated trends in mean total cholesterol, HDL cholesterol, non-HDL cholesterol, and mean total-to-HDL cholesterol ratio by country, sex, and age-group from 1973 to 2013.Findings
We pooled 267 studies, with 2·3 million participants. Over four decades, mean total and non-HDL cholesterol levels decreased in high-income western countries from high levels, whereas they increased from low levels in China and Japan. Over the same period, changes in mean HDL cholesterol and mean total-to-HDL cholesterol ratio were more heterogeneous. Mean HDL cholesterol increased substantially in Belgium, Japan, and the UK; the increase of more than 0·1 mmol/L per decade in Japanese women led to a decrease in mean total-to-HDL cholesterol ratio despite increases in mean total cholesterol. By contrast, mean HDL cholesterol declined by about 0·05–0·1 mmol/L per decade in Germany and Norway, with stagnation or possible increases in mean total-to-HDL cholesterol ratio despite declines in both mean total and non-HDL cholesterol.Interpretation
Over the past 40 years, blood lipid profiles have changed in important ways. There has been convergence in mean total and non-HDL cholesterol in high-income western and East Asian countries, whereas mean HDL cholesterol and total-to-HDL cholesterol ratio show heterogeneous trends. This study underscores the importance of analysing entire lipid profiles.Funding
Wellcome Trust. 相似文献17.
18.
Background
Coronary artery bypass graft (CABG) surgery is one of the major surgeries requiring long-term stay in hospital. This generally leads to the detrimental effects of bed-rest, including dependency in self-care, transfer, and locomotion. Our aim was to compare the effect of high-frequency and low-frequency exercise therapy in patients who had undergone CABG.Methods
Patients who had undergone CABG were recruited from PSG Medical College and Hospital, Coimbatore, India, between Jan 1 and March 31, 2006. Functional Independence Measure (FIM) and modified Borg Rating of Perceived Exertion (RPE) were used to assess functional outcome. In a quasi-experimental design, patients received either high-frequency exercise therapy (exercise three times a day for 10 days, group 1), or low-frequency exercise therapy (once a day for 10 days, group 2). Data were analysed with paired t tests.Findings
30 patients were recruited (15 in each group). Mean FIM was 75 (SD 1·77) in group 1 and 64 (1·65) in group 2. There was a significant difference between the pretest and post-test FIM values in group 1 patients (49·07 [2·43] vs 124·07 [1·75], p<0·0001) but not in group 2 patients. The RPE in group 1 and group 2 was 6·3 (0·62) and 4·2 (0·7), respectively.Interpretation
Patients given high-frequency exercise thearpy had a significant improvement in their physical activity, but low-frequency exercise did not lead to significantly improved changes. In conclusion, the high-frequency exercise therapy improves the functional ability of patients with CABG.Funding
None. 相似文献19.
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Hong-Da Chen Ni Li Jian-Song Ren Yue-Ming Zhang Shuang-Mei Zou Zhao-Xu Zheng Ju-Fang Shi Kai Zhang Jie He Min Dai 《Lancet》2017