Variations in clinicopathologic characteristics of thyroid cancer among racial ethnic groups: analysis of a large public city hospital and the SEER database

Background

Clinicopathologic variables influence the treatment and prognosis of patients with thyroid cancer.

Methods

A retrospective analysis of public hospital thyroid cancer database and the Surveillance, Epidemiology and End Results 17 database was conducted. Demographic, clinical, and pathologic data were compared across ethnic groups.

Results

Within the public hospital database, Hispanics versus non-Hispanic whites were younger and had more lymph node involvement (34% vs 17%, P < .001). Median tumor size was not statistically different across ethnic groups. Similar findings were demonstrated within the Surveillance, Epidemiology and End Results database. African Americans aged <45 years had the largest tumors but were least likely to have lymph node involvement. Asians had the most stage IV disease despite having no differences in tumor size, lymph node involvement, and capsular invasion.

Conclusions

There is considerable variability in the clinical presentation of thyroid cancer across ethnic groups. Such disparities persist within an equal-access health care system. These findings suggest that factors beyond socioeconomics may contribute to such differences.     

不同麻醉方式手术患者留置尿管时机选择比较分析

目的观察不同麻醉方式的手术患者留置尿管的最佳时间。方法将2011年1月至2014年1月该院收治的28例因外科手术需要留置尿管的患者,根据麻醉方式及导尿时机选择将其分为腰-硬联合麻醉前留置尿管（Ⅰ前组）、腰-硬联合麻醉10 min后留置尿管（Ⅰ后组）、全身麻醉前留置尿管（Ⅱ前组）、全身麻醉10 min后留置尿管（Ⅱ后组）共四组,各7例。收集、分析相关数据,比较四组患者插管时心率、血压、并发症等各项指标。结果不同麻醉方式麻醉10 min后留置尿管,患者插管前后心率和血压比同种床醉方式麻醉前留置尿管稳定,且患者舒适度好、并发症少,差异均有统计学意义（P〈0.05）。结论无论是腰-硬联合麻醉还是全身麻醉的手术患者,留置尿管的最佳时间均为麻醉10 min后。     

彝族地区小儿结核性脑膜炎临床特征分析

目的分析彝族地区小儿结核性脑膜炎的临床特征,探讨早期诊断的有效方法,减少误诊。方法回顾性分析2010年1月-2012年12月我院71例临床诊断结核性脑膜炎的住院患儿病例资料。结果农村彝族患病率高,占全组病例90．1％,全组病例仅4例有明确卡介苗接种史。全组患儿主要临床表现为：发热,神经系统症状颅内压增高和脑膜刺激征。胸部X线片或胸部cT异常31例（47．0％）,其中粟粒型结核6例（19．4％）。全组69例行头部CT,42例异常,阳性率为60．9％,其中33例伴随脑积水改变（46．5％）。结论发热伴颅内压增高,脑神经损害是小儿结核性脑膜炎常见的表现。彝族地区卡介疫苗接种覆盖率低,发病率高,应重视宣传及加强对基层的防疫工作。头颅CT是结核性脑膜炎早期诊断和判断预后比较有效的方法。对疑诊患者或脑脊液不典型患者应早期行头部CT及胸部X线片检查。     

Unilateral and Multiple Cavitation Sounds During Lumbosacral Spinal Manipulation

ObjectiveThe purpose of this study was to determine from which side of the spine the popping sound (PS) emanates during side-lying, rotatory high-velocity low-amplitude (HVLA) thrust manipulation directed to the L5-S1 articulation using a time-frequency analysis. Secondary aims were to calculate the average number of PSs, the duration of lumbar thrust manipulation, and the duration of a single PS.MethodsThirty-four asymptomatic participants received 2 lumbar HVLA thrust manipulations targeting the right and left L5-S1 articulations. Two high sampling rate accelerometers were secured bilaterally 25 mm lateral to the midline of the L5-S1 interspace. For each manipulation, 2 audio signals were extracted and singularly processed via spectrogram calculation to obtain the release of energy over time on each side of the lumbosacral junction.ResultsDuring 60 HVLA thrust manipulations, it was measured a total of 320 PSs. Of those PSs, 176 occurred ipsilateral and 144 occurred contralateral to the targeted L5-S1 articulation; that is, the PS was no more likely to occur on the upside than the downside facet after right or left rotatory L5-S1 HVLA thrust manipulation. Moreover, PSs occurring on both sides at the same time were detected very rarely (ie, 2% of cases) with the lumbar HVLA thrust manipulations. The mean number of audible PSs per lumbosacral HVLA thrust manipulation was 5.27 (range 2-9). The mean duration of a single manipulation was 139.13 milliseconds (95% confidence interval: 5.61-493.79), and the mean duration of a single PS was 2.69 milliseconds (95% confidence interval: 0.95-4.59).ConclusionBased on our findings, spinal manipulative therapy practitioners should expect multiple PSs that most often occur on the upside or the downside facet articulations when performing HVLA thrust manipulation to the lumbosacral junction (ie, L5-S1). However, whether the multiple PSs found in this study emanated from the same joint or adjacent ipsilateral or contralateral facet joints remains unknown. A single model may not necessarily be able to explain all of the audible sounds during HVLA thrust manipulation.     

广西白裤瑶族人群高血压患病率调查

目的 了解广西白裤瑶族人群高血压的患病情况及其影响因素. 方法 采用分层随机整群抽样方法对1170名≥15岁白裤瑶族人群的血压、身高、体重、体质指数、腰围、血脂及载脂蛋白进行测定,并将其结果与1173名当地的汉族人群作比较. 结果 广西白裤瑶族人群标准化高血压患病率明显低于当地的汉族人群(11.53%比16.79%,P＜0.01);白裤瑶族人群平均收缩压、舒张压和脉压水平也明显低于汉族人群[分别为(115.7±16.3)mm Hg比(120.0±16.3)mm Hg(1 mm Hg=0.133 kPa),P＜0.01;(74.1±9.4)mm Hg比(75.9±10.4)mm Hg,P＜0.01和(41.6±12.0)mmHg比(44.2±11.2)mm Hg,P＜0.01].白裤瑶族人群高血压患病与性别、年龄、体力活动、体质指数、腰围、总能量、总脂肪和钠盐摄人量呈正相关,与教育水平呈负相关,而汉族人群高血压患病与性别、年龄、体力活动、喝酒、体质指数、腰围、总能量、总脂肪和钠盐摄入量呈正相关,与教育水平呈负相关.白裤瑶族和汉族人群高血压的知晓率为11.81%比21.76%(P＜0.05),治疗率为5.51%比12.95%(P＜0.05),控制率为2.36%比8.29%(P＜0.05). 结论 广西白裤瑶族人群高血压患病率显著低于汉族人群,可能与其特殊的饮食习惯、低盐摄入、生活方式以及遗传因素等有关.     

Two novel SNPs in the promoter region of PKR gene in hepatitis C patients and their impact on disease outcome and response to treatment

Background and study aims

The double-stranded RNA dependent protein kinase (PKR) plays a vital role in the immune system. During HCV infection, PKR has antiviral effect by inhibition of protein synthesis of the HCV. The functional single nucleotide polymorphisms (SNPs) in PKR promoter region might have a relation to HCV disease outcome and response to treatment. The objective of the present work was threefold. First, it proposed an optimized protocol for PCR amplification of PKR promoter. Second, it screened the promoter region of PKR gene in HCV Egyptian patients to detect the possible SNPs’ function. Third, to study the association between the detected SNPs and the response to treatment.

云南省普洱市边民艾滋病相关知识及行为调查分析

目的 了解普洱市边民艾滋病基本知识的知晓率和安全套的使用情况,为制定相关的防治措施提供依据.方法 采取整群抽样的方法,在普洱市江城、孟连、澜沧和西盟4个边境县每个县随机抽取1～2个边境乡镇,每个乡镇随机抽取1～2个村民小组.调查人员分为协调组、调查组、实验组和质控组,入户对15 ～60岁的边民进行人口学基本特征、艾滋病相关知识和行为学调查,并采集3 ～5 mL静脉血进行HIV检测,调查结束后用Epi Data 3.0建数据库,用SPSS 15.0进行相关的统计分析.结果 共调查3250名边民,大多为已婚农民,文化素质偏低;艾滋病相关知识知晓率和接受艾滋病相关干预服务情况边4县间差异有统计学意义,艾滋病相关知识知晓率：青年人（66.67％）显著高于中老年人（45.35％）,汉族（58.81％）显著高于少数民族（47.71％）;发生性行为时安全套的使用率均较低,非固定性伴（23.47％）显著高于固定性伴（12.58％）;HIV检出率0.21％.结论 针对边民艾滋病防治工作中存在的薄弱环节,应加强对边境乡镇村民的艾滋病相关知识宣传干预、监测检测和提高免费安全套的可及性.     

浙江省成年居民血压水平区域聚集性和危险因素的多水平模型分析

目的应用多水平模型分析浙江省成年居民血压水平的区域聚集性和危险因素。方法采用多阶段整群随机方法抽取浙江省60个街道／乡镇共17 437名成年人作为研究对象,使用2水平模型分别分析SBP和DBP。结果男性SBP为(125,14±17.90)mmHg、DBP(80.02±10.07)mmHg,女性SBP为(123.36±20.20)mmHg DBP(77.42 4-10.09)mmHg;城市人群SBP为(126.294-19.46)mmHg、DBP(79.64±10.20)mmHg,农村人群SBP为(122.82±18.86)mmHg、DBP(7799±10.08)mmHg,差异均有统计学意义(P<0.001);SBP和DBP与年龄的Pearson相关系数分别为0.44和0.21(P<0.001);在SBP和DBP的变异中,环境因素分别占5.24%和4.96%;个体水平的年龄、性别、高血压家族史、服用降压药、体育锻炼、吸烟、饮酒、BMl、WC、FPG、TG和TC对SBP和DBP均有影响(P<0.05),家庭经济收入对SBP有影响(Jp<0.05),文化程度、限盐摄人、职业强度只寸DBP有影响(P<0.05);FPG和TC水平与SBP之间的数量关系以及TC水平与DB之间的数量关系在街道／乡镇间存在变化(P<0.05)。结论浙江省成年居民血压分布具有地区聚集件,高血压的预防既需要考虑年龄、BMI、FPG、TG和TC等个体因素,还应考虑地区因素以及不同地区人群对危险因素的敏感性,从而制定针对不同区域的预防策略。     

Does closure of children's medical home impact their immunization coverage?

ObjectivesLittle is known about the impact closing a health care facility has on immunization coverage of children utilizing that facility as a medical home. The authors assessed the impact of closing a Medicaid managed care facility in Philadelphia on immunization coverage of children, primarily low income children from racial/ethnic minority groups, utilizing that facility for routine immunizations.Study designObservational longitudinal cohort case study.MethodsEligible children were born 03/01/05–06/30/07, present in Philadelphia's immunization information system (IIS), and were active clients of the facility before it closed in September 2007. IIS-recorded immunization coverage at ages 5, 7, 13, 16 and 19 months through January 2009 was compared between clinic children age-eligible to receive specific vaccines before clinic closing (preclosure cohorts) and children not age-eligible to receive those vaccines prior to closing (postclosure cohorts).ResultsOf 630 eligible children, 99 (16%) had no additional IIS-recorded immunizations. Third dose DTaP vaccine coverage at age seven months among preclosure cohorts was 54.4% vs. 40.3% among postclosure cohorts [risk ratio 1.31 (1.15,1.49)]. Fourth dose DTaP coverage at 19 months was 65.9% vs. 57.7% [risk ratio 1.24 (1.08,1.42)]. MMR coverage at 16 months was 79.5% vs. 69.9% [risk ratio 1.47 (1.22, 1.76)]. Coverage for the 431331 vaccination series at 19 months was 63.8% vs. 53.8% [risk ratio 1.28 (1.12,1.88)].ConclusionsImmunization coverage declined at key age milestones for active clients of a Medicaid managed care that closed as compared with preclosure cohorts of clients from the same facility. When a primary health care facility closes, efforts should be made to ensure that children who had received vaccinations at that facility quickly establish a new medical home.