Association between health insurance programs and rehabilitation services utilisation among people with disabilities: evidence from China.

OBJECTIVES: Rehabilitation is crucial to improve the health status of people with disabilities. Previous studies mainly analysed the impact of health insurance on utilisation of general health services; the relationship between health insurances and rehabilitation services utilisation among Chinese people with disabilities has been long neglected. This study aimed to analyse the association between health insurance programs and rehabilitation services utilisation among disabled people. STUDY DESIGN: This was a cross-sectional study. METHODS: The data used in this study were derived from 2021 National Household Income Survey of Disabled People and National Basic Database of People with Disabilities conducted by China Disabled Persons' Federation. Logistic regression model was used to analyse the relationship between health insurance and rehabilitation services utilisation, and the propensity score matching method was used to check the robustness of the results. RESULTS: (1) Disabled people insured by the Basic Medical Insurance System for Urban Employees (BMISUE) and the Basic Medical Insurance System for Urban and Rural Residents (BMISURR) were positively associated with rehabilitation service utilisation (odds ratio [OR] = 1.852, 95% confidence interval [CI]:1.268, 2.707; OR = 1.375, 95% CI: 0.962, 1.966). (2) The utilisation level of rehabilitation service among disabled people insured by BMISUE was significantly higher than those insured by BMISURR (OR = 1.355, 95% CI: 1.161, 1.581). (3) The supply of rehabilitation services at the community level was positively correlated with the utilisation by people with disabilities. CONCLUSION: Health insurance can improve the financial accessibility of using rehabilitation services, and the utilisation level will increase as the benefits level of health insurance increase.

[In vitro optical assessment of three types of non-diffractive extended depth-of-focus intraocular lenses].

Objective: To evaluate the in vitro optical performance of three types of non-diffractive extended depth-of-focus (EDoF) intraocular lenses (IOLs). Methods: Experimental study. Three Vivity IOLs, three Eyhance IOLs, and three ES60 IOLs were included. The professional optical bench OptiSpheric® IOL PRO 2 and an ISO-2 corneal model were applied. The through-focus modulation transfer function (MTF) and predicted visual acuity (logarithm of the minimum angle of resolution) of different spatial frequencies and different focuses under apertures of 3.0 mm and 4.5 mm were recorded. The aspheric monofocal (Tecnis ZCB00), diffractive EDoF (Tecnis Symfony), and trifocus (STF1) IOLs, as well as the lowest visual requirement criteria of EDoF IOLs of American Academy of Ophthalmology served as assessment controls. Results: For the 3.0-mm aperture, the peak value of the MTF was highest with ZCB00, followed by Eyhance, ES60, Vivity, Symfony, and STF1. All experimental non-diffractive EDoF IOLs had two MTF peaks, and the distance between both peaks was longest with Vivity (1.76 D), followed by ES60 (1.43 D) and Eyhance (1.36 D). Among the control IOLs, Symfony had two MTF peaks, and the peak MTF of the intermediate focus was highest. STF1 had three MTF peaks, and the peak MTF of the near focus was highest. For the 4.5-mm aperture, the ranking of the MTF peak of the six types of IOLs was the same as that for the 3.0-mm aperture. Vivity had an increased MTF peak of the distance focus, but a decreased intermediate focus MTF peak, while the MTF peaks of the distance, intermediate, and near focuses in the other IOLs decreased, compared to those for the 3.0-mm aperture. The predicted visual acuity of the distance focus of the three types of non-diffractive EDoF IOLs was all better than 0.0. The predicted visual acuity of the intermediate focus of the Vivity IOL and the ES60 IOL was 0.11 and 0.05 better than that of the Eyhance IOL, respectively. Based on the predicted visual acuity of 0.2, Vivity and ES60 had a depth of focus of at least 0.50 D exceeding ZCB00, while Eyhance had a depth of focus of 0.40 D exceeding ZCB00. Conclusions: In the experiments in vitro, the three types of non-diffractive EDoF IOLs exhibited varying degrees of intermediate to near focus optical performance while maintaining distance focus optical performance. The Eyhance IOL showed better distance focus optical performance than ES60 and Vivity IOL. The Vivity IOL and the ES60 IOL showed better depth of focus extensions than the Eyhance IOL and met the lowest visual requirement criteria of EDoF IOLs of American Academy of Ophthalmology.(This article was published ahead of print on the Online-First Publishing Platform for Excellent Scientific Researches of Chinese Medical Association Publishing House on April 29, 2024).

Paediatric meningitis in the conjugate vaccine era and a novel clinical decision model to predict bacterial aetiology.

OBJECTIVES: The aims of this study were to assess aetiology and clinical characteristics in childhood meningitis, and develop clinical decision rules to distinguish bacterial meningitis from other similar clinical syndromes. METHODS: Children aged <16 years hospitalised with suspected meningitis/encephalitis were included, and prospectively recruited at 31 UK hospitals. Meningitis was defined as identification of bacteria/viruses from cerebrospinal fluid (CSF) and/or a raised CSF white blood cell count. New clinical decision rules were developed to distinguish bacterial from viral meningitis and those of alternative aetiology. RESULTS: The cohort included 3002 children (median age 2·4 months); 1101/3002 (36·7%) had meningitis, including 180 bacterial, 423 viral and 280 with no pathogen identified. Enterovirus was the most common pathogen in those aged <6 months and 10-16 years, with Neisseria meningitidis and/or Streptococcus pneumoniae commonest at age 6 months to 9 years. The Bacterial Meningitis Score had a negative predictive value of 95·3%. We developed two clinical decision rules, that could be used either before (sensitivity 82%, specificity 71%) or after lumbar puncture (sensitivity 84%, specificity 93%), to determine risk of bacterial meningitis. CONCLUSIONS: Bacterial meningitis comprised 6% of children with suspected meningitis/encephalitis. Our clinical decision rules provide potential novel approaches to assist with identifying children with bacterial meningitis. FUNDING: This study was funded by the Meningitis Research Foundation, Pfizer and the NIHR Programme Grants for Applied Research.

Enhancing gestational diabetes mellitus risk assessment and treatment through GDMPredictor: a machine learning approach.

BACKGROUND: Gestational diabetes mellitus (GDM) is a serious health concern that affects pregnant women worldwide and can lead to adverse pregnancy outcomes. Early detection of high-risk individuals and the implementation of appropriate treatment can enhance these outcomes. METHODS: We conducted a study on a cohort of 3467 pregnant women during their pregnancy, with a total of 5649 clinical and biochemical records collected. We utilized this dataset as our training dataset to develop a web server called GDMPredictor. The GDMPredictor utilizes advanced machine learning techniques to predict the risk of GDM in pregnant women. We also personalize treatment recommendations based on essential biochemical indicators, such as A1MG, BMG, CysC, CO2, TBA, FPG, and CREA. Our assessment of GDMPredictor's effectiveness involved training it on the dataset of 3467 pregnant women and measuring its ability to predict GDM risk using an AUC and auPRC. RESULTS: GDMPredictor demonstrated an impressive level of precision by achieving an AUC score of 0.967. To tailor our treatment recommendations, we use the GDM risk level to identify higher risk candidates who require more intensive care. The GDMPredictor can accept biochemical indicators for predicting the risk of GDM at any period from 1 to 24 weeks, providing healthcare professionals with an intuitive interface to identify high-risk patients and give optimal treatment recommendations. CONCLUSIONS: The GDMPredictor presents a valuable asset for clinical practice, with the potential to change the management of GDM in pregnant women. Its high accuracy and efficiency make it a reliable tool for doctors to improve patient outcomes. Early identification of high-risk individuals and tailored treatment can improve maternal and fetal health outcomes http://www.bioinfogenetics.info/GDM/ .

Global, regional, and national trends in osteoarthritis disability-adjusted life years (DALYs) from 1990 to 2019: a comprehensive analysis of the global burden of disease study.

OBJECTIVES: This study aimed to investigate global, regional, and national trends in osteoarthritis disability-adjusted life years (DALYs) from 1990 to 2019, identify the burden of osteoarthritis in different age groups, and assess age, period, and cohort effects on osteoarthritis DALYs. STUDY DESIGN: A comprehensive analysis of the Global Burden of Disease Study 2019 data, covering 204 countries and territories. METHODS: We conducted a comprehensive analysis using data from the Global Burden of Disease Study 2019, encompassing 204 countries and territories. Age-standardized DALY rates were calculated, and the age-period-cohort model was employed to examine the age, period, and cohort effects on osteoarthritis DALYs. The annual percentage change (APC) and average annual percentage change (AAPC) were estimated to evaluate trends in DALYs. RESULTS: Globally, osteoarthritis DALYs increased by 114.48 % between 1990 and 2019, with an age-standardized DALY rate growth of 3.3 %. The largest relative growth in DALYs occurred in Middle and Low-middle Socio-Demographic Index (SDI) regions. DALYs increased significantly in almost all age-specific groups, particularly among 45-74 years old age groups. Age, period, and cohort effects analysis revealed a general increase in osteoarthritis DALYs risk over time, with some variations by SDI quintiles and sex. The steepest increase in DALYs occurred in the 30-34 years age group, and the trend attenuated with increasing age. Males showed significantly slower DALYs growth than females in age groups with non-overlapping 95 % confidence intervals. Age effects were consistently higher in females, especially in high-SDI countries. Period and cohort effects generally demonstrated a climbing risk of osteoarthritis DALYs across different SDI quintiles, with more pronounced increases in lower-SDI regions. CONCLUSIONS: Our findings highlight the substantial and increasing burden of osteoarthritis at global, regional, and national levels from 1990 to 2019, with significant variations by age, period, and cohort. These results underscore the importance of developing targeted public health strategies and interventions to address the growing impact of osteoarthritis, particularly in lower-SDI regions and among older populations.

[Analysis of disease burden of lung cancer attributable to chromium in Chinese population from 1990 to 2019].

Objective: To analyze the disease burden and change trend of lung cancer attributable to chromium in Chinese population from 1990 to 2019, and to provide reference for the formulation of health policies and strategies of disease prevention and control. Methods: In October 2022, using the data and findings of the burden of disease, injury and risk factor published in the Global Burden of Disease Study 2019 (GBD 2019), the burden of lung cancer and its changes caused by occupational hexavalent chromium exposure in Chinese population from 1990 to 2019 were analyzed according to year and gender. The average age structure of the world population was used as the standard population to calculate standardized indicators, and then compared with the global population. Results: The incidence number, death number, disability adjusted life years (DALY) of lung cancer attributable to chromium in Chinese population of 2019 were 833 cases, 790 cases and 22118 person years, respectively. Compared with 1990 (257 cases, 277 cases, 8631 person years), the increase was 224.1%, 185.2%, 156.3%, higher than the global level (101.0%, 134.2%, 117.2%). The standardized morbidity, mortality and DALY rates of lung cancer attributable to chromium in Chinese population of 2019 were 0.059/100000, 0.056/100000 and 1.555/100000, which respectively increased by 169.7%, 137.4%, 113.3% in comparison with that of 1990 (0.022/100000, 0.023/100000 and 0.729/100000). The average annual percent changes were 18.8%, 15.1% and 13.5%, which were higher than the global level (5.7%, 8.4% and 7.0%). In 2019, the DALY caused by chromium-related lung cancer in the Chinese population accounted for 0.0058% (22118/382205568) of the all-cause disease burden in the Chinese population, and 51.8% (22118/42718) of the global population. In 2019, the disease burden of lung cancer attributable to chromium was higher in males than in females, the number of incidence, death and DALY were 576 cases (69.1%), 525 cases (66.5%) and 14717 person years (66.5%), respectively. Conclusion: In 2019, the proportion of disease burden caused by lung cancer attributable to chromium in the Chinese population is low, but it accounts for a high proportion of the global population burden of lung cancer attributable to chromium, and the standardized incidence, mortality and DALY rates show an increasing trend year by year from 1990 to 2019.

[A cross-sectional survey on the allocation of nursing human resources in burn centers in China].

Objective: To investigate the allocation of nursing human resources in burn centers in China. Methods: A cross-sectional survey was conducted. Using a self-designed questionnaire, a survey was carried out from January to March 2022 to investigate the January to December 2021 status of 39 burn centers in China that met the inclusion criteria based on six strategic regions and other regions, including the hospital grade and the region, the number of nurses and opening beds in the burn centers and burn intensive care units (BICUs), the age, working seniority in burn specialty, educational background, professional title, personnel employment, and turnover of nurses and training of newly recruited nurses in the burn centers. Results: This survey covered 30 provinces, municipalities, and autonomous regions in China (excluding Hong Kong Special Administrative Region, Macao Special Administrative Region, and Taiwan region of China). A total of 39 questionnaires were collected, all of which were valid. The 39 burn centers were located in 38 tertiary A hospitals and 1 tertiary B hospital, with 26 burn centers in strategic areas. The nurse/bed ratio of burn centers in the Greater Bay Area of Guangdong, Hong Kong, and Macao was the highest, while the nurse/bed ratio of burn centers in border ethnic minority area was the lowest. Except for the Chengdu-Chongqing Economic Circle, BICUs had been set up in burn centers in other regions. Among the 39 burn centers, the percentage of nurses aged 25 to 34 years was 51.21% (738/1 441), the percentage of nurses worked in burn specialty for less than 5 years was 31.16% (449/1 441), the percentage of nurses with bachelor's degree was 69.74% (1 005/1 441), and the percentage of nurses with nursing professional title was 44.14% (636/1 441), which were the highest. There were significant differences in the employment of nurses, the percentage of permanent nurses in burn centers in the collaborative development zone of Beijing-Tianjin-Hebei was 82.48% (113/137), while the percentage of permanent nurses in burn centers in important military strategic area was only 9.42% (34/361); the turnover rate of nurses was 9.03% (143/1 584), among which the turnover rate of nurses was 18.14% (80/441) in burn centers in important military strategic area. The training for newly recruited nurses in 39 burn centers was mainly based on the guidance of senior nurses and the pre-job education+specialist training. Conclusions: The burn nursing human resources in strategic areas in China are seriously insufficient and unevenly distributed, with unstable nurse team and lack of standardized specialist training. In particular, the nursing human resources in BICUs need to be equipped and supplemented urgently.

[Comprehensive assessment of mismatch repair and microsatellite instability status in molecular classification of endometrial carcinoma].

Objective: To explore the concordance and causes of different mismatch repair (MMR) and microsatellite instability (MSI) detection results in endometrial carcinoma (EC) molecular typing. Methods: A total of 214 EC patients diagnosed from January 2021 to April 2023 were selected at the Department of Pathology, Peking University Third Hospital. The immunohistochemistry (IHC) results of MMR protein were reviewed. Tumor specific somatic mutations, MMR germline mutations, microsatellite scores and tumor mutation burden (TMB) were detected by next-generation sequencing (NGS) with multi-gene panel. Methylation-specific PCR was used to detect the methylation status of MLH1 gene promoter in cases with deficient MLH1 protein expression. In cases with discrepant results between MMR-IHC and MSI-NGS, the MSI status was detected again by PCR (MSI-PCR), and the molecular typing was determined by combining the results of TMB and MLH1 gene promoter methylation. Results: (1) In this study, there were 22 cases of POLE gene mutation subtype, 55 cases of mismatch repair deficient (MMR-d) subtype, 29 cases of p53 abnormal subtype, and 108 cases of no specific molecular profile (NSMP). The median age at diagnosis of MMR-d subtype (54 years old) and the proportion of aggressive histological types (40.0%, 22/55) were higher than those of NSMP subtype [50 years old and 12.0% (13/108) respectively; all P<0.05]. (2) Among 214 patients, MMR-IHC test showed that 153 patients were mismatch repair proficient (MMR-p), 49 patients were MMR-d, and 12 patients were difficult to evaluate directly. MSI-NGS showed that 164 patients were microsatellite stable (MSS; equal to MMR-p), 48 patients were high microsatellite instability (MSI-H; equal to MMR-d), and 2 patients had no MSI-NGS results because the effective sequencing depth did not meet the quality control. The overall concordance between MMR-IHC and MSI-NGS was 94.3% (200/212). All the 12 discrepant cases were MMR-d or subclonal loss of MMR protein by IHC, but MSS by NGS. Among them, 10 cases were loss or subclonal loss of MLH1 and (or) PMS2 protein. Three discrepant cases were classified as POLE gene mutation subtype. In the remaining 9 cases, 5 cases and 3 cases were confirmed as MSI-H and low microsatellite instability (MSI-L) respectively by MSI-PCR, 6 cases were detected as MLH1 gene promoter methylation and 7 cases demonstrated high TMB (>10 mutations/Mb). These 9 cases were classified as MMR-d EC. (3) Lynch syndrome was diagnosed in 27.3% (15/55) of all 55 MMR-d EC cases, and the TMB of EC with MSH2 and (or) MSH6 protein loss or associated with Lynch syndrome [(71.0±26.2) and (71.5±20.1) mutations/Mb respectively] were significantly higher than those of EC with MLH1 and (or) PMS2 loss or sporadic MMR-d EC [(38.2±19.1) and (41.9±24.3) mutations/Mb respectively, all P<0.01]. The top 10 most frequently mutated genes in MMR-d EC were PTEN (85.5%, 47/55), ARID1A (80.0%, 44/55), PIK3CA (69.1%, 38/55), KMT2B (60.0%, 33/55), CTCF (45.5%, 25/55), RNF43 (40.0%, 22/55), KRAS (36.4%, 20/55), CREBBP (34.5%, 19/55), LRP1B (32.7%, 18/55) and BRCA2 (32.7%, 18/55). Concurrent PTEN, ARID1A and PIK3CA gene mutations were found in 50.9% (28/55) of MMR-d EC patients. Conclusions: The concordance of MMR-IHC and MSI-NGS in EC is relatively high.The discordance in a few MMR-d EC are mostly found in cases with MLH1 and (or) PMS2 protein loss or MMR protein subclonal staining caused by MLH1 gene promoter hypermethylation. In order to provide accurate molecular typing for EC patients, MLH1 gene methylation, MSI-PCR, MMR gene germline mutation and TMB should be combined to comprehensively evaluate MMR and MSI status.

[Value of C-peptide-based insulin resistance index for evaluating correlation between insulin resistance and serum uric acid level in individuals undergoing health examination].

OBJECTIVE: To investigate the value of C-peptide-based insulin resistance index in evaluating the correlation between insulin resistance and serum uric acid (Ua) level in subjects undergoing health examination. METHODS: The data of 46 017 subjects undergoing health examination were retrospectively collected from the Second Medical Center of PLA General Hospital from January, 2017 to December, 2021. The subjects were divided into Ua≤420 µmol/L group and Ua>420 µmol/L group for comparison of HOMA insulin resistance index (HOMA2-IR) and HOMA insulin resistance-C peptide (HOMA2 IR-CP). The correlations of HOMA2-IR and HOMA2 IR-CP with Ua level were analyzed using Pearson correlation analysis and linear regression analysis. Hierarchical interaction analysis was conducted to assess the differences in the association between insulin resistance index and Ua level in different subgroups. The ROC curve was used to evaluate the predictive ability of insulin resistance index for an increased Ua level. RESULTS: The levels of HOMA2-IR and HOMA2 IR-CP were significantly lower in Ua≤420 µmol/L group than in Ua>420 µmol/L group. Univariate Pearson correlation analysis showed a weak correlation of HOMA2-IR with Ua (r=0.262, P<0.001) and moderate correlation of HOMA2 IR-CP with Ua (r=0.409, P<0.001). Multivariate linear regression analysis, after adjustment for confounding factors, demonstrated that HOMA2-IR (R2=0.445, P<0.001) and HOMA2 IR-CP (R2=0.461, P<0.001) were both factors affecting Ua level. Hierarchical interaction analysis showed that the association of insulin resistance index with Ua level varied significantly with gender, age, and glucose metabolism (P<0.001). ROC curve showed that the areas under the curve predicted an increased Ua level by HOMA2-IR and HOMA2 IR-CP were 0.662 and 0.722, respectively. CONCLUSIONS: HOMA2 IR-CP is a more accurate indicator for assessing the correlation between insulin resistance and Ua level.

[Comparison of the predictive value of Padua and the IMPEDE assessment scores for venous thromboembolism in patients with newly diagnosed multiple myeloma: A single institution experience].

Objective: To compare the predictive efficacy of the two thrombosis risk assessment scores (Padua and IMPEDE scores) in venous thromboembolism (VTE) within 6 months in patients with newly diagnosed multiple myeloma (NDMM) in China. Methods: This study reviewed the clinical data of 421 patients with NDMM hospitalized in Beijing Jishuitan Hospital from April 2014 to February 2022. The sensitivity, specificity, accuracy, and Youden index of the two scores were calculated to quantify the thrombus risk assessment of VTE by the Padua and IMPEDE scores. The receiver operating characteristics curves of the two evaluation scores were drawn. Results: The incidence of VTE was 14.73%. The sensitivity, specificity, accuracy, and Youden index of the Padua score were 100%, 0%, 14.7%, and 0% and that of the IMPEDE score was 79%, 44%, 49.2%, and 23%, respectively. The areas under the curve of Padua and IMPEDE risk assessment scores were 0.591 and 0.722, respectively. Conclusion: IMPEDE score is suitable for predicting VTE within 6 months in patients with NDMM.

[Comparison of aspirin treatment strategies for primary prevention of cardiovascular diseases: A decision-analytic Markov modelling study].

OBJECTIVE: To compare the expected population impact of benefit and risk of aspirin treatment strategies for the primary prevention of cardiovascular diseases recommended by different guidelines in the Chinese Electronic Health Records Research in Yinzhou (CHERRY) study. METHODS: A decision-analytic Markov model was used to simulate and compare different strategies of aspirin treatment, including: Strategy ①: Aspirin treatment for Chinese adults aged 40-69 years with a high 10-year cardiovascular risk, recommended by the 2020 Chinese Guideline on the Primary Prevention of Cardiovascular Diseases; Strategy ②: Aspirin treatment for Chinese adults aged 40-59 years with a high 10-year cardiovascular risk, recommended by the 2022 United States Preventive Services Task Force Recommendation Statement on Aspirin Use to Prevent Cardiovascular Disease; Strategy ③: Aspirin treatment for Chinese adults aged 40-69 years with a high 10-year cardiovascular risk and blood pressure well-controlled (< 150/90 mmHg), recommended by the 2019 Guideline on the Assessment and Management of Cardio-vascular Risk in China. The high 10-year cardiovascular risk was defined as the 10-year predicted risk over 10% based on the 2019 World Health Organization non-laboratory model. The Markov model simulated different strategies for ten years (cycles) with parameters mainly from the CHERRY study or published literature. Quality-adjusted life year (QALY) and the number needed to treat (NNT) for each ischemic event (including myocardial infarction and ischemic stroke) were calculated to assess the effectiveness of the different strategies. The number needed to harm (NNH) for each bleeding event (including hemorrhagic stroke and gastrointestinal bleeding) was calculated to assess the safety. The NNT for each net benefit (i.e., the difference of the number of ischemic events could be prevented and the number of bleeding events would be added) was also calculated. One-way sensitivity analysis on the uncertainty of the incidence rate of cardiovascular diseases and probabilistic sensitivity analysis on the uncertainty of hazard ratios of interventions were conducted. RESULTS: A total of 212 153 Chinese adults, were included in this study. The number of people who were recommended for aspirin treatment Strategies ①-③ was 34 235, 2 813, and 25 111, respectively. The Strategy ③ could gain the most QALY of 403 [95% uncertainty interval (UI): 222-511] years. Compared with Strategy ①, Strategy ③ had similar efficiency but better safety, with the extra NNT of 4 (95%UI: 3-4) and NNH of 39 (95%UI: 19-132). The NNT per net benefit was 131 (95%UI: 102-239) for Strategy ①, 256 (95%UI: 181-737) for Strategy ②, and 132 (95%UI: 104-232) for Strategy ③, making Strategy ③ the most favorable option with a better QALY and safety, along with similar efficiency in terms of net benefit. The results were consistent in the sensitivity analyses. CONCLUSION: The aspirin treatment strategies recommended by the updated guidelines on the primary prevention of cardiovascular diseases showed a net benefit for high-risk Chinese adults from developed areas. However, to balance effectiveness and safety, aspirin is suggested to be used for primary prevention of cardiovascular diseases with consideration for blood pressure control, resulting in better intervention efficiency.

[HIV self-testing and related factors in men who have sex with men in Shijiazhuang].

Objective: To understand HIV self-testing and related factors in men who have sex with men (MSM) in Shijiazhuang. Methods: From August to September 2020, convenient sampling was used to recruit MSM in Shijiazhuang. Online questionnaires were used to collect information about their demographic characteristics, sexual behaviors and HIV self-testing. logistic regression model was used to analyze the related factors associated with HIV self-testing. Results: In the 304 MSM respondents, 52.3% (159/304) had HIV self-testing in the past 6 months, and 95.0% (151/159) used fingertip blood HIV detection reagent. Self-purchase was the main way to obtain HIV testing reagents (45.9%, 73/159), followed by supply from MSM social organization (44.7%, 71/159). The reasons for having HIV self-testing were non-specific testing time (67.9%, 108/159) and privacy protection (62.9%,100/159), the reasons for having no HIV self-testing included inability of using (32.4%, 47/145), being unaware of HIV self-testing reagent (24.1%, 35/145), and worry about inaccurate self-testing results (19.3%, 28/145). Multivariate logistic regression analysis showed that being 18-29 years old (aOR=2.68, 95%CI: 1.20-5.94), obtaining free HIV self-testing kits in recent 6 months (aOR=8.61, 95%CI: 4.09-18.11) and making friends through Internet and social software (aOR=2.68, 95%CI: 1.48-4.88) were positive factors for having HIV self-testing. Conclusion: HIV self-testing is a more flexible and convenient way to detect HIV in MSM, and the promotion of HIV self-testing in MSM should be strengthened to further increase the HIV detection rate in this population.

[Assessment of the diagnostic value and prognosis of different detection markers in endocervical adenocarcinoma].

Objective: To study the diagnostic value of different detection markers in histological categories of endocervical adenocarcinoma (ECA), and their assessment of patient prognosis. Methods: A retrospective study of 54 patients with ECA in the Cancer Hospital, Chinese Academy of Medical Sciences from 2005-2010 were performed. The cases of ECA were classified into two categories, namely human papillomavirus-associated adenocarcinoma (HPVA) and non-human papillomavirus-associated adenocarcinoma (NHPVA), based on the 2018 international endocervical adenocarcinoma criteria and classification (IECC). To detect HR-HPV DNA and HR-HPV E6/E7 mRNA in all patients, we used whole tissue section PCR (WTS-PCR) and HPV E6/E7 mRNA in situ hybridization (ISH) techniques, respectively. Additionally, we performed Laser microdissection PCR (LCM-PCR) on 15 randomly selected HR-HPV DNA-positive cases to confirm the accuracy of the above two assays in identifying ECA lesions. Receiver operating characteristic (ROC) curves were used to analyze the efficacy of markers to identify HPVA and NHPVA. Univariate and multifactorial Cox proportional risk model regression analyses were performed for factors influencing ECA patients' prognoses. Results: Of the 54 patients with ECA, 30 were HPVA and 24 were NHPVA. A total of 96.7% (29/30) of HPVA patients were positive for HR-HPV DNA and 63.3% (19/30) for HR-HPV E6/E7 mRNA, and 33.3% (8/24) of NHPVA patients were positive for HR-HPV DNA and HR-HPV E6/E7 mRNA was not detected (0/24), and the differences were statistically significant (P<0.001). LCM-PCR showed that five patients were positive for HR-HPV DNA in the area of glandular epithelial lesions and others were negative, which was in good agreement with the E6/E7 mRNA ISH assay (Kappa=0.842, P=0.001). Analysis of the ROC results showed that the AUC of HR-HPV DNA, HR-HPV E6/E7 mRNA, and p16 to identify HPVA and NHPVA were 0.817, 0.817, and 0.692, respectively, with sensitivities of 96.7%, 63.3%, and 80.0% and specificities of 66.7%, 100.0%, and 58.3%, respectively. HR-HPV DNA identified HPVA and NHPVA with higher AUC than p16 (P=0.044). The difference in survival rates between HR-HPV DNA (WTS-PCR assay) positive and negative patients was not statistically significant (P=0.156), while the difference in survival rates between HR-HPV E6/E7 mRNA positive and negative patients, and p16 positive and negative patients were statistically significant (both P<0.05). Multifactorial Cox regression analysis showed that International Federation of Obstetrics and Gynecology (FIGO) staging (HR=19.875, 95% CI: 1.526-258.833) and parametrial involvement (HR=14.032, 95% CI: 1.281-153.761) were independent factors influencing the prognosis of patients with ECA. Conclusions: HR-HPV E6/E7 mRNA is more reflective of HPV infection in ECA tissue. The efficacy of HR-HPV E6/E7 mRNA and HR-HPV DNA (WTS-PCR assay) in identifying HPVA and NHPVA is similar, with higher sensitivity of HR-HPV DNA and higher specificity of HR-HPV E6/E7 mRNA. HR-HPV DNA is more effective than p16 in identifying HPVA and NHPVA. HPV E6/E7 mRNA and p16 positive ECA patients have better survival rates than negative.

An objective, quantitative, dynamic assessment of facial movement symmetry changes after orthognathic surgery.

The aim of this study was to generate a quantitative dynamic assessment of facial movement symmetry changes after orthognathic surgery. Twenty-five patients diagnosed with skeletal class III malocclusion with facial asymmetry who underwent bimaxillary surgery were recruited. The patients were asked to perform a maximum smile that was recorded using a three-dimensional facial motion capture system preoperatively (T0), 6 months postoperatively (T1), and 12 months postoperatively (T2). Eleven facial landmarks were selected to analyse the cumulative distance and average speed during smiling. The absolute differences for the paired landmarks between the sides were analysed to reflect the symmetry changes. The results showed that the asymmetry index of the cheilions at T2 was significantly lower than that at T0 (P = 0.004), as was the index of the mid-lateral lower lips (P = 0.006). The mean difference in cheilions was 2.13 ±â€¯1.41 mm at T0, 1.33 ±â€¯1.09 mm at T1, and 1.00 ±â€¯0.98 mm at T2. The facial total mobility at T1 was significantly lower than that at T0 (P < 0.001), while the total mobility at T2 was significantly higher than that at T1 (P = 0.012). The orthognathic surgical correction of facial asymmetry was able to improve the associated asymmetry of facial movements.

[Analysis on the allocation equality in occupational health technology service resource in Gansu Province].

Objective: To investigate and analyze the allocation equality of occupational health technology service resource of Gansu disease control and prevention institutions, providing reference basis for optimizing the allocation of occupational health technology service resources. Methods: Combined with the survey data in September 2021, Gansu Province was divided into five economic regions by geographical location and economic characteristics. Taking the service number of enterprises and workers as the analysis dimensions, the allocation level of occupational health technology service resources in different regions was compared. The allocation equality was analyzed through Lorentz curve, Gini coefficient and Theil index. Results: There were 301 occupational health technicians and 1914 sampling and testing equipments of Gansu Provincial disease control and prevention institutions in 2021. All of the technicians and equipments were used for serving 1952 enterprises and 465800 workers. The curvature of Lorentz curves and Gini coefficient which measured by the service number of enterprises and workers were: occupational health technicians>radioactive factor sampling and testing equipment >physical factor sampling and testing equipment >chemical factor sampling and testing equipment, and chemical factor sampling and testing equipment>physical factor sampling and testing equipment >radioactive factor sampling and testing equipment >occupational health technicians, respectively. Theil index of occupational health technology service resources suggested that differences in regions were the main unfair reason effected the allocation of occupational health technicians and radioactive factor sampling and testing equipment, while the differences between regions were the main unfair reason effected the allocation of chemical and physical factor sampling and testing equipment. Conclusion: The allocation equality in occupational health technology service resources of Gansu Provincial disease control and prevention institutions was not enough, and the differences in regions and between regions should be considered. This study suggests that it is necessary to introduce more occupational health technicians. The allocation of occupational health technology service resources should match with the number of local enterprises and the types of potential hazard factors of enterprises as far as possible.

[Medical costs of brucellosis patients in Datong of Shanxi province, 2017-2019].

Objective: To explore the medical costs and influencing factors of patients diagnosed with Brucellosis in Datong of Shanxi province. Methods: Information on demographics, medical visits, and costs of patients diagnosed with Brucellosis between January 1, 2017, and December 31, 2019, were collected. Health care utilization and medical costs were analyzed from different genders, age groups, underlying diseases, clinical stages, and comorbidities. Results: A total of 2 289 patients (1 715 outpatient and 574 inpatient cases) were included in the analysis. 72.0% (1 649/2 289) were male, with an average age of (49.6±15.5) years; age between 45-59 years was the dominant group (36.2%,829/2 289). The mean age of inpatients (51.4±16.0) was higher than that of outpatients (49.0±15.2)(Z=-4.01, P<0.001). The average number of outpatient visits per outpatient was (1.6±1.5) times. The duration of hospitalization was (14.6±9.9) and (20.8±11.4) days for patients with central nervous system complications and (16.6±9.5) days for vascular system complications. Of the inpatients, 51.0% (293/574) had underlying diseases, and 30.3% (174/574) had endocrine and metabolic diseases. 54.0% (310/574) of inpatients were diagnosed with acute Brucellosis, and 46.0% (264/574) were diagnosed with chronic Brucellosis. A total of 64.3% (369/574) of inpatients had complications, 30.3% (174/574) of digestive system complications, followed by skeletal system complications (29.1%, 167/574). Among outpatients, age significantly affected medical costs (P<0.001). For inpatients, age and complications and treatment effect were influential factors (P<0.05). Patients with the combined skeletal system and central nervous system complications had significantly higher medical costs (P<0.001). Conclusions: The medical costs for outpatient cases of Brucellosis were moderate. However, the economic burden was higher for inpatients, especially those with skeletal and neurological complications. Early detection, diagnosis, and treatment of cases were essential to avoid chronic Brucellosis and its complications and reduce medical costs.

[Preventive strategy of economy class syndrome].

Economy class syndrome (ECS) refers to a series of symptoms, such as lower limb swelling, chest pain, dyspnea, and sudden death, that occur during or after a long-distance flight. Its essence is venous thromboembolism. ECS, as a preventable syndrome, is one of the causes of sudden death in long-distance travelers. Medical assistance to the African region is a very important diplomatic matter of China. It often takes medical workers more than 10 hours of long-distance flight to reach the recipient country. Therefore, it is essential to improve the understanding of ECS and corresponding prevention strategies among the long-distance traveling people including medical workers assisting Africa, which could guarantee their health and ensure the smooth implementation of the work of assisting Africa.

[Association between high-density lipoprotein cholesterol level and cardiovascular disease and all-cause mortality in the elderly population].

Objective: To investigate the relationship between high density lipoprotein cholesterol (HDL-C) and cardiovascular disease (CVD) and all-cause mortality in the elderly population. Methods: A total of 14 355 elderly persons aged ≥65 years, who participated in the annual physical examination in Kailuan Group in 2006 were included in this prospective cohort study. According to HDL-C level, the participants were divided into 4 groups: low-level group (HDL-C<1.30 mmol/L), intermediate-level group (1.30 mmol/L ≤HDL-C≤1.54 mmol/L), medium-high-level group (1.55 mmol/L ≤HDL-C≤1.80 mmol/L), high-level group (HDL-C≥1.81 mmol/L). Baseline data such as age, sex and blood lipid levels were collected and compared. Inpatient medical records and death information were obtained through the social security system, and CVD and all-cause mortality were analyzed. After adjusting for confounding factors, the medium-high-level group was used as the reference group. Cox proportional risk regression model was used to evaluate the impact of HDL-C on CVD and all-cause mortality events. The linear or nonlinear relationship between HDL-C level and CVD and all-cause mortality events was evaluated by restricted cubic spline regression model. Death competitive risk analysis was conducted, and sensitivity analysis was performed after excluding subjects with CVD or all-cause mortality within 1 year of follow-up and female participants. Results: The average age of this cohort was (71.5±5.5) years and follow-up time was (10.9±3.3) years. Compared with medium-high-level group, Cox proportional risk regression analysis showed that the HR (95%CI) of CVD and all-cause mortality in low-level group were 1.21 (1.06-1.38) (P<0.05) and 1.02 (0.95-1.11) (P>0.05), respectively; the HR (95%CI) of CVD events in high-level group was 1.17 (1.03-1.33) (P<0.05), and there was a marginal significant association with all-cause mortality, the HR (95%CI) was 1.07 (1.00-1.16) (0.050.1). Conclusions: In the elderly population, the risk of CVD is lowest when the HDL-C level is 1.55-1.80 mmol/L, either high or low HDL-C is a risk factor for CVD. High HDL-C tends to be related to increased risk of all-cause mortality and low HDL-C is not related to increased risk of all-cause mortality.

[Effectiveness of statin treatment strategies for primary prevention of cardiovascular diseases in a community-based Chinese population: A decision-analytic Markov model].

OBJECTIVE: To evaluate the effectiveness of statin treatment strategies based on risk assessment for the primary prevention of cardiovascular diseases by the Western guidelines in a community-based Chinese population from economically developed areas using data from the Chinese electronic health records research in Yinzhou (CHERRY) study. METHODS: A Markov model was used to evaluate the effectiveness of the following statin treatment strategies, including: (1) usual care without cardiovascular risk assessment(Strategy 0); (2) using the World Health Organization (WHO) non-laboratory-based risk charts with statin treatment for high-risk group (risk ≥ 20%) (Strategy 1); (3) using the WHO laboratory-based risk charts with statin treatment for high-risk group (risk ≥ 20%) (Strategy 2); and (4) using the Prediction for Atherosclerotic cardiovascular disease Risk in China (China-PAR) model with statin treatment for high-risk group (risk ≥ 10%, Strategy 3). According to the guidelines, adults in the medium-risk group received lifestyle intervention, and adults in the high-risk group received life-style intervention and statin treatment under these strategies. The Markov model simulated different strategies for ten years (cycles) using parameters from the CHERRY study, published data, meta-analyses and systematic reviews for Chinese. The number of cardiovascular events or deaths, as well as the number need to treat (NNT) with statin per cardiovascular event or death prevented, were calculated to compare the effectiveness of different strategies. One-way sensitivity analysis on the uncertainty of incidence rate of cardiovascular diseases, and probabilistic sensitivity analysis on the uncertainty of hazard ratios of interventions were conducted. RESULTS: Totally 225 811 Chinese adults aged 40-79 years without cardiovascular diseases at baseline were enrolled. In contrast to the usual care without risk assessment-based statin treatment strategy, Strategy 1 using the WHO non-laboratory-based risk charts could prevent 3 482 [95% uncertainty interval (UI): 2 110-4 661] cardiovascular events, Strategy 2 using the WHO laboratory-based risk charts could prevent 3 685 (95%UI: 2 255-4 912) events, and Strategy 3 using the China-PAR model could prevent 3 895 (95%UI: 2 396-5 181) events. NNTs with statin per cardiovascular event prevented were 22 (95%UI: 14-54), 21 (95%UI: 14-52), and 27 (95%UI: 17-67), respectively. Strategy 3 could prevent more cardiovascular events, while Strategies 1 and 2 required fewer numbers need to treat with statin per cardiovascular event prevented. The results were consistent in the sensitivity analyses. CONCLUSION: The statin treatment strategies based on risk assessment for the primary prevention of cardiovascular diseases recommended by the Western guidelines could achieve substantive health benefits in adults from developed areas of China. Using the China-PAR model for cardiovascular risk assessment could prevent more cardiovascular diseases while using the WHO risk charts seems more efficient.

CT-based radiomics for the preoperative prediction of the muscle-invasive status of bladder cancer and comparison to radiologists' assessment.

AIM: To develop a radiomics model to predict the muscle-invasive status of bladder cancer (BC) in contrast-enhanced computed tomography (CECT) images, compared with radiologists' interpretations. MATERIALS AND METHODS: One hundred and eighty-eight CECT images with histopathologically confirmed BC were retrieved retrospectively from November 2018 to December 2019 and were divided randomly into the training (n=120) and test dataset (n=68). The BC were annotated manually and validated on the venous phase by a general radiologist and an experienced radiologist, respectively. The radiomics analysis included radiomics feature extraction and model development. The same images were also evaluated by two radiologists. The diagnostic performance of radiomics was evaluated using receiver operating characteristic (ROC) curve analysis and the area under the ROC curve (AUC), sensitivity, and specificity were calculated. The predictive performance of radiomics was then compared to visual assessments of the two radiologists. RESULTS: The radiomics model reached an AUC (95% confidence interval [CI]) of 0.979 (0.935-0.996) and 0.894 (0.796-0.956) in the training and test dataset, respectively. The radiomics model outperformed the visual assessment of radiologist A and B both in the training (0.865 [0.791-0.921], 0.894 [0.824-0.943]) and test dataset (0.766 [0.647-0.860], 0.826 [0.715-0.907]). Pairwise comparisons showed that the specificities of the radiomics model were higher than the radiologists (85.3-96.7% versus 47.1-58.3%, all p<0.05), but the sensitivities were comparable between the radiomics and the radiologists (79.4-90% versus 91.2-96.7%; all p>0.05). CONCLUSIONS: A radiomics model was developed that outperformed the radiologists' visual assessment in predicting the muscle-invasive status of BC in the venous phase of CT images.