Study on the construction of nomogram prediction model for prognostic assessment of heart failure patients based on serological markers and echocardiography.

OBJECTIVE: We aimed to construct a nomogram prediction model for prognostic assessment of patients with heart failure (HF) based on serological markers and echocardiography. PATIENTS AND METHODS: A total of 200 HF patients admitted to the Second Affiliated Hospital of Nanchang University from January 2018 to January 2020 were selected as the research objects. According to the New York Heart Association (NYHA) cardiac function classification, they were divided into 3 groups, including 65 cases of grade II, 97 cases of grade III, and 38 cases of grade IV. Three groups of echocardiographic parameters were compared [including left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-systolic volume (LVESV)], differences in serum markers brain natriuretic peptide (BNP), soluble growth-stimulating expression gene 2 (sST2) and the Modified Early Warning Score (MEWS). The patients were divided into two groups according to their clinical outcomes during the follow-up period, including 52 cases in the death group and 148 cases in the survival group. The clinical data of the two groups were compared, and multi-factor logistic regression analysis was performed to screen out the independent risk factors affecting the patient's death. A nomogram model of the patient's mortality risk was constructed based on the independent risk factors. Receiver operating characteristic (ROC) curves and calibration curves were used to evaluate the discrimination and accuracy of the nomogram model. RESULTS: As the cardiac function class of elderly chronic heart failure (CHF) patients increases, LVEDD, LVESD, sST2, and MEWS increase and LVEF decreases (p<0.05). Multifactor analysis results showed that LVEF, LVEDD, sST2, and MEWS were independent factors affecting the clinical outcome of patients. The AUCs predicted using LVEF, LVEDD, sST2, and MEWS alone were 0.738, 0.775, 0.717, 0.831, and 0.768, respectively. There is a certain degree of discrimination, and the model has extremely high accuracy. CONCLUSIONS: MEWS, LVEDD, and sST2 increase as the NYHA cardiac function grade of HF patients increases and LVEF decreases, which can reflect the severity of the disease to a certain extent. Additionally, the nomogram model established based on this has a high predictive value for the long-term prognosis of patients and can formulate effective intervention measures for quantitative values.

[Value of serum matrix metalloproteinase 3 in the assessment of early rheumatoid arthritis].

OBJECTIVE: To investigate the expression level of serum matrix metalloproteinase 3 (MMP3) in early rheumatoid arthritis (ERA) patients with normal C-reaction protein (CRP) or erythrocyte sedimentation rate (ESR), and the significance in disease assessment. METHODS: In the study, 133 cases of early RA patients, 25 osteoarthritis (OA) patients and 60 healthy controls in Peking University People's Hospital from 2011 to 2015 were included. The RA patients were further divided into 4 groups according to levels of CRP and ESR: 88 patients with increased CRP and increased ESR, 15 patients with normal CRP and normal ESR, 17 patients with normal CRP but increased ESR, and 13 patients with increased CRP but normal ESR. All the clinical information of the patients was collected, and the serum MMP3 levels of both patients and healthy controls were detected by enzyme-linked immune sorbent assay (ELISA). RESULTS: The serum MMP3 level of RA patients with normal CRP and/or normal ESR [(72.89±6.34) µg/L] was obviously higher than that of OA patients [(42.87±4.14) µg/L] (P=0.002) and healthy controls [(31.62±2.88) µg/L] (P<0.001). The serum MMP3 levels of the patients with normal CRP and normal ESR [(47.04±9.64) µg/L] were higher than those of the healthy controls, and there was statistical significance between the two groups (P<0.05). The serum MMP3 levels of the patients with increased CRP but normal ESR [(94.18±9.11) µg/L] and the patients with normal CRP but increased ESR [(79.42±10.60) µg/L] were both higher than those of the OA patients and healthy controls, and there was obvious statistical difference (P<0.05). In the early RA patients with normal CRP and/or normal ESR, the serum MMP3 level was positively correlated with the CRP level (r=0.336, P=0.024). The positive rate of MMP3 in the patients with normal CRP and/or normal ESR was 44.44%, higher than the positive rate of CRP (28.89%) and the positive rate of ESR (37.78%). In these early RA patients, the positive rate was 52.94% in the patients with normal CRP but increased ESR and 53.85% in the patients with increased CRP but normal ESR. CONCLUSION: The detection of the serum MMP3 level was significant in the assessment of early RA patients within 2-year duration who had normal CRP or ESR value.

Preventing chronic diseases by promoting healthy diet and lifestyle: public policy implications for China.

Fuelled by rapid urbanization and changes in dietary and lifestyle choices, chronic diseases have emerged as a critical public health issue in China. The Healthy China 2020 programme recently announced by the Chinese government has set an overarching goal of promoting public health and making health care accessible and affordable for all Chinese citizens by year 2020. One of important components of the programme is to reduce chronic diseases by promoting healthy eating and active lifestyles. Chronic diseases not only affect health and quality of life, but also have economical and social consequences. With a limited infrastructure for chronic disease care, China is ill-equipped to deal with the escalating chronic disease epidemic, which threatens to reverse the gains of economic development in recent decades. Population-based intervention studies conducted in China and elsewhere have demonstrated the efficacy and effectiveness of several preventive strategies to reduce risk of chronic diseases in high-risk individuals and the general population. However, translating these findings into practice requires changes in health systems and public policies. To achieve the goals set by the Healthy China 2020 programme, prevention of chronic diseases should be elevated to a national public policy priority.

Survival outcome and cost-effectiveness with docetaxel and paclitaxel in patients with metastatic breast cancer: a population-based evaluation.

BACKGROUND: A randomized controlled trial showed longer overall survival (OS) with docetaxel compared with paclitaxel in metastatic breast cancer patients with prior exposure to anthracycline. We report a similar comparison using population-based data. METHODS: Data on patients treated with single-agent paclitaxel or docetaxel were retrospectively reviewed. OS was compared using a two-tailed log-rank test and expressed as Kaplan-Meier plots. A cost-effectiveness analysis was carried out using cost/patient and OS. RESULTS: Four hundred and thirty-five patients met eligibility criteria. Prognostic factors were balanced between docetaxel and paclitaxel groups. Median OS was significantly longer for docetaxel versus paclitaxel [10.9 versus 8.3 months; hazard ratio 0.76; 95% confidence interval (CI), 0.62-0.92; P = 0.006]. The median number of cycles administered were four (docetaxel) and three (paclitaxel). The incremental cost-effectiveness ratio was $2434/per month of median survival gained. In the sensitivity analysis, the results were robust except that paclitaxel dominated when the low end of the 95% CI of survival for docetaxel was compared with the high end for paclitaxel. CONCLUSION: This population-based study corroborated the randomized trial's conclusion that for patients with metastatic breast cancer, docetaxel provided superior survival compared with paclitaxel. Each additional month of survival had an incremental cost of $2434.

Neurological and electroneuromyographic assessment of the adverse effects of acrylamide on occupationally exposed workers.

Seventy-one acrylamide workers and fifty-one unexposed referents were studied. Weak legs and numb hands and feet, preceded by skin peeling from the hands, were the early symptoms of the acrylamide workers; their early signs were impairment of vibration sensation in their toes and loss of ankle reflexes. Three cases had cerebellar involvement followed by polyneuropathy due to heavy exposure. Electroneuromyographic changes, including a decrease in the sensory action potential amplitude, neurogenic abnormalities in electromyography, and prolongation of the ankle tendon reflex latency, are of greater importance in the early detection of acrylamide neurotoxicity since they can precede the neuropathic symptoms and signs. The diagnostic criteria for occupational acrylamide intoxication of this study revealed three severe poisonings, six moderate poisonings, and 43 mild poisonings. The total prevalence of acrylamide poisoning was 73.2%. The prevention of dermal exposure to acrylamide should be emphasized.

Socio-economic development of Dongguan County promoted by family planning.

PIP: Because of its geographical position and its population of over 1.19 million, Dongguan County in Guangdong Province, China occupies an important position in the family planning program of the whole province, and country. In the 1st 10 days of July 1985, the Family Planning Commission of Guangdong Province conducted a survey of Dongguan County. The results show 6 remarkable changes: 1) both rural and urban people are more and more likely to practice family planning on their own accord. (The total fertility rate dropped from 5.9 in the early years of the People's Republic to 2.05 in 1982); 2) women, released from heavy household chores, have become a vital new force for the development of industrial production (The gross industrial output value of the town industry increased by 87.57% from 1987 to 1984.); 3) the living standard of both rural and urban people improved along with more flourishing industrial and agricultural production; 4) educational work and population quality have improved; 5) moral culture has progressed (Family planning is commonly practiced.); and 6) social development has occurred, such as purification of tap water, and the building of cultural, sport, and recreational facilities. The County Family Planning commission achieved its successes by political mobilization policies, scientific birth control, and good services. Their main approaches include 1) associating political mobilization with the local reality; 2) popularizing knowledge of birth control science and life science through special schools, training courses, lectures, and research; 3) rewarding 1-child families with material benefits; and 4) improving living conditions of widowed and childless old people to alleviate worries of sonless households.^ieng

[Family planning promotes social and economic development of Dongguan County].

PIP: Examination of the effects of family planning indicates 6 major social and economic changes which it has brought about in Dongguan County, China. Peoples' views on family planning have changed: they no longer believe the old notion that "more children guarantee a better life" and have done away with the convention of early marriage and early childbearing. The number of children per household has dropped from an average of 5.9 in the early 1950s to its present average of 2.05. The situation of women has undergone important changes. In the past, women bore many children and few worked outside the household. Today, in the city of Guancheng, 7000 of the 10,000 workers in city-owned factories are women. A 3rd effect of population control is increased production output and a better standard of living. Since 1979 when economic reform began, 90% of the presents built new homes and 70% of the households bought high standard consumer goods. A 4th improvement has been found in the development of education: 99.7% of school-age children attend elementary schools and the rate of graduating students is 98.2%; 92% of preschool children are involved in preschool programs; and 67,000 young women attend various kinds of vocational schools. A more civilized life style and more harmonious family lives have found as a 5th result of family planning measures. Finally, there have also been improvements in welfare and public sanitation facilities. For example, more than 200 water plants have been built in the county and 41% of the population drinks water which meets sanitation standards. It is concluded that the beneficial results of population control reported in this study should be of interest to all those involved in the field of family planning.^ieng

A survey of the family planning work done in Dongguan County.

PIP: The total fertility rate of women of childbearing age of Dongguan County in China has been decreasing gradually from 5.9 during the period following the liberation in 1949 to 2.05 in 1982. In order to encourage young couples to implement the policy of family planning consciously, the people's government of Dongguan county decided in July 1980 that all cadres and employees in county towns who received 1-child certificates would be exempted from house rent of 45 square meters from the time they get their certificates and would be allocated a living space of a 2-children family until their children reached age 16. It also stipulated that every couple could enjoy 1 month's holiday every year for 3 years and during the holiday, their salary, bonus and rate of attendance would not be affected. Because women bear less children today, they are relieved from heavy household chores and become the main working force in collective production. As a result, the development of town-run enterprises was stimulated and the total industrial output value of these enterprises increased. The average monthly salary of each female worker is about 100 yuan. In 1984, the average income per capita of the country rose to 649.2 yuan. The implementation of family planning work has eased the tension in the education field. Previously, because of the large number of school-age children in rural areas, teachers had to teach 2 classes. In the past 4 years, great emphasis was laid on intellectual investment. During this period, 2351 schools were built and several fundraising projects were implemented. Since 1981, more than 200 new running water projects were built, and new public services have been developed, including old age homes.^ieng