上海市癌症流行现况和防治实践

了解上海市普陀区户籍居民主要恶性肿瘤所致过早死亡情况,为降低早死概率,实现早死概率控制目标提供参考。

收集2004—2016年上海市普陀区户籍居民恶性肿瘤发病、死亡资料,通过编制寿命表计算恶性肿瘤粗发病率、标化发病率、粗死亡率、标化死亡率、早死概率等指标,并采用年度变化百分比（APC）和平均年度变化百分比（AAPC）反映发病率、死亡率、早死概率的变化趋势。

2004—2016年上海市普陀区户籍居民恶性肿瘤粗发病率从383.51/10万上升至573.94/10万（APC=3.52%,P<0.01）,标化发病率从223.20/10万变化至241.38/10万（AAPC=0.67%,P=0.11）。粗死亡率从229.99/10万变化至269.94/10万（APC=1.64%,P<0.01）,标化死亡率从122.48/10万变化至87.49/10万（APC=-2.04%,P<0.01）。早死概率从7.14%变化至5.53%（AAPC=-2.29%,P<0.01）,其中男性从8.73%变化至7.10%（AAPC=-1.74%,P=0.01）,女性从5.54%变化至3.88%（AAPC=-2.88%,P=0.08）。早死概率顺位前10位肿瘤中,男、女性首位主要为气管、支气管和肺癌,男性肝癌（APC=-3.83%,P=0.01）、女性胃癌（APC=-4.17%,P<0.01）早死概率呈下降趋势,其余肿瘤变化趋势不明显（P>0.05）。男性鼻咽癌、女性宫颈癌死亡率列前10位以外,早死概率位列前10位。

恶性肿瘤所致早死概率总体呈下降趋势,但女性、居前10位的主要恶性肿瘤早死概率未下降,早死概率控制压力仍然较大。应从可防、可筛的主要致早死的肿瘤入手,使早死概率下降。

     

慢性阻塞性肺疾病急性加重期糖皮质激素序贯治疗的策略

目的比较慢性阻塞性肺疾病急性加重期（AECOPD）糖皮质激素序贯治疗两种策略的疗效。方法120例AECOPD患者随机分为两组,小于7天组或7天以上组,均在常规应用抗生素,平喘止咳化痰的基础上,静脉给予地塞米松5～10mg治疗。前者于3～5d后序贯口服强的松治疗后吸入糖皮质激素（3—5d）,而后出院,院外继续应用吸入激素＋长效p2受体兴奋剂治疗。后者则序贯时间为地塞米松用7天后,余同前。对比分析各项疗效指标以及平均住院天数。结果小于7天组的患者的平均住院天数较7天以上组明显减少,其余观察指标无统计学差异。结论使用地塞米松小于7天的序贯治疗可以起到一定的疗效,并减少平均住院天数。     

The Effects of γ-rays on Fecundity and Mutagenesis in Oregon-R Males of Drosophila

Summary

Oregon-R males were tested in day-by-day sperm samples for dominant visible and hemizygous sex-linked mutations, fecundity (number of offspring produced), and crossing-over after exposure to cobalt-60 γ in the 100 r to 10 kr range. Tests totalled 42 184 X-chromosomes and 210 111 flies. Mutations were most frequent after irradiation during meiosis and spermiogenesis in low doses. Only sperm and gonial cells subsequently produced adult flies after exposure to 5 kr and 10 kr. After 500 r fecundity was reduced chiefly in cells in late mitosis, and in earlier and later stages with increasing doses. Reduced fecundity may not be due to the kind of mutation detected here, but both effects may combine to influence the frequency of mutations recovered, particularly from irradiated meiotic and spermiogenic cells. Males receiving 500 r might contribute more mutations to a population's gene pool than competing males after a substantially higher dose.     

Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Ecological Study in the Basque Country,Spain (2000–2011)

Chronic obstructive pulmonary disease (COPD) is a prevalent condition in adults aged ≥40 years characterized by progressive airflow limitation associated with chronic inflammatory response to noxious particles in the airways and lungs. Smoking, genetics, air pollution, nutrition and other factors may influence COPD development. Most hospitalizations and deaths for COPD are caused by its acute exacerbations, which greatly affect the health and quality of life of COPD patients and pose a high burden on health services. The aims of this project were to identify trends, geographic patterns and risk factors for COPD exacerbations, as revealed by hospitalizations and deaths, in the Basque Country, Spain, over a period of 12 years (2000–2011). Hospitalization and mortality rates for COPD were 262 and 18 per 100,000 population, respectively, with clusters around the biggest cities. Hospital mortality was 7.4%. Most hospitalized patients were male (77.4%) and accounted for 72.1% of hospital mortality. Hospitalizations decreased during the study period, except for 50–64 year-old women, peaking significantly. Using a multivariate modeling approach it was shown that hospitalizations were positively correlated with increased atmospheric concentrations of NO₂, CO, PM₁₀, and SO₂, and increased influenza incidence, but were negatively associated with increased temperatures and atmospheric O₃ concentration. COPD exacerbations decreased in the Basque Country during 2000–2011, but not among 50–64-year-old women, reflecting the high smoking prevalence among Spanish women during the 1970–1990s. The main metropolitan areas were those with the highest risk for COPD exacerbations, calling attention to the role of heavy car traffic. Influenza virus, cold temperatures, and increased atmospheric NO₂, CO, PM₁₀, and SO₂ (but decreased O₃) concentrations were identified as potential contributors to the burden of COPD exacerbations in the community. These findings are important for both the understanding of the disease process and in providing potential targets for COPD-reducing initiatives and new avenues for research.     

The use of preventable hospitalization for monitoring the performance of local health authorities in long-term care

ObjectiveThe objective of the study was to examine whether there are differences in the performance of long-term care programs between local health authorities, using preventable hospitalization as an indicator.MethodsA retrospective cohort study compared the rate of preventable hospitalization for local health authorities in Tuscany (Italy) between January 2012 and September 2016. Several administrative datasets for the patients in long-term care programs were linked at the individual (patient) level. Elderly disabled patients 65 years of age and older in long-term care programs in Tuscany from both types of programs: nursing homes (n = 4 196) and home care (n = 15 659) were included in the study.ResultsThe rate of preventable hospitalization differed considerably between local health authorities. Three out twelve local health authorities had a significantly lower and one had a significantly higher preventable hospitalization rate than the regional average.ConclusionThere was a large variation in the rate of preventable hospitalization among the local health authorities. Applying preventable hospitalization as an indicator for quality, with implications for periodical audit can be used for monitoring the performance of a long-term care program.     

Long-term outcomes of rigid ring versus De Vega annuloplasty for functional tricuspid regurgitation: A propensity score-matching analysis

ObjectiveThis study was conducted to compare the outcomes of rigid ring versus De Vega annuloplasty for the treatment of functional tricuspid regurgitation (TR).MethodsFrom 2003 to 2017, De Vega annuloplasty (group D) was used in 231 patients, and rigid ring annuloplasty (group R) was used in 204 patients for the treatment of functional TR during left-sided valve surgery. A propensity score-matching analysis was used to pair group D (n = 109) with group R (n = 109). The primary outcomes were long-term overall survival and cardiac death, and the secondary outcomes were tricuspid valve-related events and TR recurrence (TR moderate or severe). The follow-up data were complete in 99.6% (447 out of 449) of the patients with a follow-up duration of 102 months.ResultsThere were no differences in the overall survival and cardiac death between the propensity score-matched groups (P = .793 and P = .175, respectively) up to 14 years after surgery. Tricuspid valve-related events, including cardiac death, permanent pacemaker implantation, thromboembolism, bleeding and tricuspid valve reoperation were also similar between the 2 matched groups during the follow-up (P > .999). However, cumulative incidence of TR recurrence was significantly higher in group R than in group D (P = .007). Multivariate analysis indicated the annuloplasty method (De Vega) and preoperative TR grade as risk factors for late TR recurrence.ConclusionsIn functional TR, annuloplasty methods did not influence long-term overall survival, cardiac mortality, and tricuspid valve-related events. However, rigid ring annuloplasty showed less late TR recurrence. Rigid ring annuloplasty can be considered for the treatment of functional TR in terms of its better durability.     

Development of a clinical prediction model for an international normalised ratio ≥ 4·5 in hospitalised patients using vitamin K antagonists

Vitamin K antagonists (VKAs) used for the prevention and treatment of thromboembolic disease, increase the risk of bleeding complications. We developed and validated a model to predict the risk of an international normalised ratio (INR) ≥ 4·5 during a hospital stay. Adult patients admitted to a tertiary hospital and treated with VKAs between 2006 and 2010 were analysed. Bleeding risk was operationalised as an INR value ≥4·5. Multivariable logistic regression analysis was used to assess the association between potential predictors and an INR ≥ 4·5 and validated in an independent cohort of patients from the same hospital between 2011 and 2014. We identified 8996 admissions of patients treated with VKAs, of which 1507 (17%) involved an INR ≥ 4·5. The final model included the following predictors: gender, age, concomitant medication and several biochemical parameters. Temporal validation showed a c statistic of 0·71. We developed and validated a clinical prediction model for an INR ≥ 4·5 in VKA‐treated patients admitted to our hospital. The model includes factors that are collected during routine care and are extractable from electronic patient records, enabling easy use of this model to predict an increased bleeding risk in clinical practice.