Risk of a second malignant neoplasm among 5-year survivors of cancer in childhood and adolescence in British Columbia, Canada

BACKGROUND: We examined second malignancies, a recognized late effect of therapy among survivors of childhood and adolescent cancer, among a recent, population-based cohort of 2,322 5-year survivors diagnosed before 20 years of age in British Columbia (BC), Canada between 1970 and 1995. PROCEDURE: Survivors and second malignancies were identified from the BC Cancer Registry. Risk of second malignancy was evaluated using standardized incidence ratios (SIRs), absolute excess risk (AER), and cumulative risk. The effect of demographic, temporal, and disease-related characteristics on risk was assessed. RESULTS: Fifty-five second malignancies were observed after 26,071 person-years of follow-up. Relative rate of developing a second malignancy among survivors was 5 times higher than expected (SIR = 5.0, 95% CI, 3.8-6.5), and absolute excess risk was 1.7 deaths per 1,000 person-years. Cumulative incidence of a second malignancy was 5.1% at 25 years after diagnosis of the first cancer. SIRs and absolute excess risk of subsequent cancer was higher among females (SIR = 5.9, 95% CI, 4.5-8.3 and AER = 2.66). While relative risk of second cancer was higher for those diagnosed before 10 years of age (SIR = 10.6, 95% CI, 7.1-16.0), absolute excess risk was slightly higher for those diagnosed after 10 years of age. SIRs were significantly elevated for all follow-up periods, but absolute excess risk of a second cancer was highest among patients surviving more than 15 years. CONCLUSIONS: Increased risk of a subsequent neoplasm is evident among childhood cancer survivors diagnosed in more recent periods than has been previously reported, continues years after diagnosis, and varies according to several risk factors. Continued surveillance is essential to quantify and characterize long-term and changing risks for appropriate follow-up.     

智慧医院互联网化服务设计与应用研究

以北京大学第三医院互联网诊疗服务应用为例,介绍智慧医院互联网化服务体系与安全体系设计以及具体应用实践,阐述智慧医院互联网诊疗服务构建策略.     

A prospective study of 63 couples with a history of recurrent spontaneous abortion: contributing factors and outcome of subsequent pregnancies

To evaluate the possible causes of recurrent spontaneous abortion(RSA) and to elucidate the prognosis for subsequent pregnancies63 RSA patients were studied. Parental karyo-typing revealedchromosomal aberrations in six of the 63 couples (4.8%). Therate of increased concentrations of antibodies against cardiolipinwas comparable in the patients (10.0%) and in 30 parous controls(6.7%), as was also the occurrence of other autoantibodies (43.3and 36.7%, respectively). Hysteroscopy revealed uterine cavityabnormalities in 11 of the 55 patients studied (20.0%). Altogether,for 35 RSA women (55.4%) investigations resulted in entirelynormal findings; abnormal findings were more frequently encounteredin primary aborters (56.8%) than in secondary aborters (26.9%,P < 0.05). During the follow-up period of 24.1 ± 15.4months, 48 patients became pregnant a total of 65 times, andthe cumulative live birth rate was 62.5%. A living fetus wasseen in ultrasound examination in 46 pregnancies (70.7%), whereasa blighted ovum was diagnosed in nine pregnancies (13.8%). Anadditional nine pregnancies aborted so suddenly that no ultrasoundexamination was performed, and one ectopic pregnancy was treatedlaparoscopically. Of the initially viable pregnancies, 13 (28.3%)ended in miscarriage and two were terminated due to fetal anomalies.Normal findings in the investigations were associated with asmaller risk for abortion (40.0%) than were abnormal findings(65.5%, P < 0.05). Of the 30 babies, six (20.0%, with babiesfrom one twin pregnancy excluded) were growth-retarded, 9.7%were born before 37 weeks of gestation, and 22.8% of the mothershad impaired glucose tolerance during pregnancy. Thus pregnanciesin RSA women were accompanied by increased risk for fetal growthretardation, preterm delivery and impaired glucose toleranceand needed, therefore, to be followed carefully.     

Subsequent pregnancy affects nutritional status of previous child: a study from Bhutan

In a rural area of Bhutan, anthropometric measurements of 113 children and interviews with their mothers were carried out monthly for 32 months. The purpose of the study was to investigate the effect of a mother's subsequent pregnancy on growth in weight of her last–born child. The children whose mothers had a subsequent birth interval of 18–30 months were matched for date of birth with children whose mothers did not become pregnant. Growth of the children during the subsequent pregnancy was compared with growth during the same period of children whose mothers were not pregnant. A statistically significant reduction of 28% was found (p < 0.05), which was most pronounced in early pregnancy. A similar trend was found for change in mid–upper–arm circumference (p < 0.05). The study provides evidence of a causal relationship between a moderate subsequent pregnancy interval and a concurrent reduction in growth rate for the previous child     

Consumption of a smoothie or cereal-based breakfast: impact on thirst,hunger, appetite and subsequent dietary intake

Abstract

Smoothies are a popular breakfast option. However, liquids may evoke weaker satiation than nutritionally comparable semi-solid and solid foods. This study examined consumption of cereal and milk (CM) or a nutritionally comparable fruit smoothie (FS) for breakfast on subsequent dietary behaviours, in a controlled laboratory setting. Twenty-five participants (age 25?±?6?y) completed three trials, receiving either CM or FS for breakfast. Afterwards, participants remained isolated for 4?h with ad libitum access to foods/beverages. A repeat trial (CM or FS) allowed exploration of normal variability. Post-breakfast energy intake (EI) (CM = 1465(2436) vs. FS = 1787(3190) kJ, Median (IQR), p?=?0.099), time to intake of next food/fluid (meal latency) (CM = 146(97) vs. FS = 180(100) min, p?=?0.127), and subjective hunger, desire to eat, fullness and thirst ratings were similar between conditions (p’s?>?0.05). The mean coefficient of variation for EI and meal latency were 41% and 21%, respectively. Consumption of a FS does not negatively impact acute EI and meal latency.     

Fifty years of paediatric malignant bone tumours in the West Midlands,UK, 1957–2006: incidence,treatment and outcome

Parkes SE, Parke S, Manghan DC, Grimer RJ, Davies P, Morland BJ. Fifty years of paediatric malignant bone tumours in the West Midlands, UK, 1957–2006: incidence, treatment and outcome. Paediatric and Perinatal Epidemiology 2010. Malignant bone tumours in the paediatric age group (0–14 years) are uncommon; various aetiological theories exist and few reports of incidence, age and sex distributions have been published. We examined the incidence of childhood malignant bone tumours in one large single region of the UK over an extended period of 50 years. The West Midlands specialist regional children's tumour registry holds data on all malignancies and benign brain tumours in children under 15 years in the West Midlands region, which has a population of around 1 million children. Demographic and clinical data have been abstracted and diagnoses reviewed by a panel of expert pathologists. During the period 1957–2006, 259 cases of malignant paediatric bone tumours were diagnosed. There were 153 osteosarcomas, 78 Ewing sarcomas and 28 other primary bone tumours. The overall age standardised rate was 4.66, with no increase over time, although there was a significant increase in the incidence of Ewing sarcomas in the period 1965–92. Sixty‐eight per cent of tumours were in patients over 10 years, whereas the incidence in patients under 10 years showed a non‐significant increase. Survival rates increased dramatically post‐chemotherapy introduction, with Ewing sarcoma demonstrating better survival overall. This is a large study giving an overview of malignant bone tumours in the childhood population of a single region over an extended period, showing results consistent with national reports. It also examines late effects, which were mostly mobility/orthopaedic, although almost one‐fifth of patients had cardiac problems and five went on to develop second malignancies.     

电力系统扩展黑启动方案动态综合评估

大停电后恢复初期阶段的扩展黑启动策略为恢复控制提供了新的思路，不同方案的恢复效果评估是扩展黑启动决策的重要问题。本文提出一种扩展黑启动方案的动态综合评估方法。首先建立了动态综合评估的决策制定框架，构建了评估指标体系。然后采用主客观相结合的组合赋权法得到不同时段指标的综合权重，利用线性加权模型对每一时段内指标集结分别实施静态评估。再次通过基于时间度的非线性熵值规划法求解各时段的最优时间权重，以时序加权平均算子和时序几何平均算子组成的混合算子模型对所有时段的评价值再次集结，从而得到方案的最终评估结果。新英格兰39节点系统方案的算例分析结果验证了所提方法的有效性。     

北京社区绝经后女性骨折类型、部位和发生年龄关系的分析

目的 了解北京社区绝经后女性骨折发生情况,探讨骨质疏松性骨折二级预防策略。方法 选取2016年3月至2017年11月就诊于北京市朝阳区太阳宫社区卫生服务中心和香河园社区卫生服务中心的绝经后女性,共2 866人。填写自行设计的骨质疏松症危险因素调查问卷,了解受访者骨折发生的类型(暴力性或非暴力性)、部位和发生年龄。分析女性一生中不同年龄段骨折发生的特点。结果 受访的绝经后女性平均年龄（62.39±6.94）岁,受访的2 866人中有635人（19.61 %）在受访时至少已有一次骨折史,其中有73人（2.54 %）发生了两次或两次以上骨折。58.64 %的暴力性骨折发生在绝经前,80 %的脆性骨折发生在绝经后,这两种类型骨折发生的年龄具有显著统计学差异。在所有的典型部位脆性骨折当中,前臂远端骨折占比最大,为50.43 %,发生的平均年龄为（56.0±11.76）岁;髋部骨折发生占比8.33 %,平均发生年龄为（59.8±12.69）岁。结论 女性绝经后发生的骨折主要是脆性骨折,其中前臂远端脆性骨折较髋部脆性骨折至少早3年发生。加强对已发生前臂远端脆性骨折的绝经后女性的管理,对预防再发骨质疏松性骨折（尤其是髋部骨折）的效益较大。