Computerized Assessment of the Tumor-stromal Ratio and Proposal of a Novel Nomogram for Predicting Survival in Invasive Breast Cancer.

Background: Various studies have verified the prognostic significance of the tumor-stromal ratio (TSR) in several types of carcinomas using manually assessed H&E stained histologic sections. This study aimed to establish a computerized method to assess the TSR in invasive breast cancer (BC) using immunohistochemistry (IHC)-stained tissue microarrays (TMAs), and integrate the TSR into a novel nomogram for predicting survival. Methods: IHC-staining of cytokeratin (CK) was performed in 7 prepared TMAs containing 240 patients with 480 invasive BC specimens. The ratio of tumor areas and stromal areas was determined by the computerized method, and categorized as stroma-low and stroma-high groups using the X-tile software. The prognostic value of the TSR at 5-year disease free survival (5-DFS) in each subgroup was analyzed. Univariate and multivariate analyses were performed and a novel nomogram for predicting survival in invasive breast cancer was established and assessed. Results: The newly developed computerized method could accurately recognize CK-labeled tumor areas and non-labeled stromal areas, and automatically calculate the TSR. Stroma-low and stroma-high accounted for 38.8% (n = 93) and 61.2% (n = 147) of the cases, according to the cut-off value of 55.5% for stroma ratio. The Kaplan-Meier analysis showed that patients in the stroma-high group had a worse 5-DFS compared to patients in the stroma-low group (P = 0.031). Multivariable analysis indicated that the T stage, N status, histological grade, ER status, HER-2 gene, and the TSR were potential risk factors of invasive BC patients, which were included into the nomogram (P < 0.10 for all). The nomogram was well calibrated to predict the probability of 5-DFS and the C-index was 0.817, which was higher than any single predictor. A dynamic nomogram was built for convenient use. The area under the curve (AUC) of the nomogram was 0.870, while that of the TNM staging system was 0.723. The Kaplan-Meier analysis showed that the nomogram had a better risk stratification for invasive BC patients than the TNM staging system. Conclusions: Based on IHC staining of CK on TMAs, this study successfully developed a computerized method for TSR assessment and established a novel nomogram for predicting survival in invasive BC patients.

Analysis of In-hospital Neonatal Death in the Tertiary Neonatal Intensive Care Unit in China: A Multicenter Retrospective Study.

BACKGROUND: Globally, the proportion of child deaths that occur in the neonatal period remains a high level of 37-41%. Differences of cause in neonate death exist in different regions as well as in different economic development countries. The specific aim of this study was to investigate the causes, characteristics, and differences of death in neonates during hospitalization in the tertiary Neonatal Intensive Care Unit (NICU) of China. METHODS: All the dead neonates admitted to 26 NICUs were included between January l, 2011, and December 31, 2011. All the data were collected retrospectively from clinical records by a designed questionnaire. Data collected from each NICU were delivered to the leading institution where the results were analyzed. RESULTS: A total of 744 newborns died during the 1-year survey, accounting for 1.2% of all the neonates admitted to 26 NICUs and 37.6% of all the deaths in children under 5 years of age in these hospitals. Preterm neonate death accounted for 59.3% of all the death. The leading causes of death in preterm and term infants were pulmonary disease and infection, respectively. In early neonate period, pulmonary diseases (56.5%) occupied the largest proportion of preterm deaths while infection (27%) and neurologic diseases (22%) were the two main causes of term deaths. In late neonate period, infection was the leading cause of both preterm and term neonate deaths. About two-thirds of neonate death occurred after medical care withdrawal. Of the cases who might survive if receiving continuing treatment, parents' concern about the long-term outcomes was the main reason of medical care withdrawal. CONCLUSIONS: Neonate death still accounts for a high proportion of all the deaths in children under 5 years of age. Our study showed the majority of neonate death occurred in preterm infants. Cause of death varied with the age of death and gestational age. Accurate and prompt evaluation of the long-term outcomes should be carried out to guide the critical decision.

Attitudes towards Advance Care Planning and Healthcare Autonomy among Community-Dwelling Older Adults in Beijing, China.

OBJECTIVES: To investigate the preferences of ACP and healthcare autonomy in community-dwelling older Chinese adults. METHODS: A community-based cross-sectional study was conducted with older adults living in the residential estate of Chaoyang District, Beijing. RESULTS: 900 residents were enrolled. 80.9% of them wanted to hear the truth regarding their own condition from the physician; 52.4% preferred to make their own healthcare decisions. Only 8.9% of them preferred to endure life-prolonging interventions when faced with irreversible conditions. 78.3% of the respondents had not heard of an ACP; only 39.4% preferred to document in an ACP. Respondents with higher education had significantly higher proportion of having heard of an ACP, as well as preferring to document in an ACP, compared to those with lower education. Those aged <70 years had higher proportion of having heard of an ACP, as well as refusing life-prolonging interventions when faced with irreversible conditions, compared to those aged ≥ 70 years. CONCLUSIONS: Although the majority of community-dwelling older Chinese adults appeared to have healthcare autonomy and refuse life-prolonging interventions in terms of end-of-life care, a low level of "Planning ahead" awareness and preference was apparent. Age and education level may be the influential factors.

Current status of neonatal acute respiratory disorders: a one-year prospective survey from a Chinese neonatal network.

BACKGROUND: We conducted a prospective, multicenter investigation of incidence, management and outcome of neonatal acute respiratory disorders (NARD), and evaluated related perinatal risk factors and efficacy of respiratory therapies in neonatal intensive care units (NICUs) in a Chinese neonatal network. METHODS: Data were prospectively collected in 2004 - 2005 from infants with NARD defined as presence of respiratory distress and oxygen requirement during the first 3 days of life. RESULTS: A total of 2677 NARD was classified (20.5% of NICU admissions). There were 711 (5.44%) with respiratory distress syndrome (RDS), 589 (4.51%) pulmonary infection, 409 (3.13%) meconium aspiration syndrome, 658 (5.03%) aspiration of amniotic fluid and 239 (1.83%) transient tachypnoea. Meconium aspiration syndrome had the highest rate with fetal distress, transient tachypnoea from cesarean section, and RDS with maternal disorders. Assisted mechanical ventilation was applied in 53.4% of NARD, and in above five disorders with 84.7%, 52.3%, 39.8%, 24.5%, and 53.6%, respectively. Corresponding mortality in these disorders was 31.4%, 13.6%, 17.8%, 4.1% and 5.0%, respectively. Surfactant was provided to 33.9% of RDS. In all RDS infants, the survival rate was 78.8% if receiving surfactant, and 63.4% if not (P < 0.001). CONCLUSIONS: This study provided NICU admission-based incidence and mortality of NARD, reflecting efficiency of advanced respiratory therapies, which should be a reference for current development of respiratory support in NICU at provincial and sub-provincial levels, justifying efforts in upgrading standard of care in emerging regions through a collaborative manner.

[Effect of population size of performance test on short-term selection result of sire line].

The effects of the population size,boar to sow ratio,and the number of pigs tested per litter on the selection response and its coefficient of variation, inbreeding coefficient of sire line selection were studied. Pig populations of 100 to 500 sows were simulated with Monte Carlo method,and the ratios of boar to sow were 1:10 and 1:20. The number of pigs tested per litter were 2 and 4 composed equally of boars and gilts. The traits selected were average daily gain after weaning (ADG) and backfat thickness (BF) at 100 kg live weight. Breeding pigs were selected according to multiple-trait BLUP,and economic weight of BF was set as 2.5 times of that of ADG. After five generation selection, the results showed that the more the number of sows of the breeding population, the higher the cumulative selection response at 5th generation, and the slower the coefficient of inbreeding increment per generation, the smaller the coefficient of variation of the cumulative selection response at 5th generation. Increasing the number of pigs tested per litter and/or the boar to sow ratio increased the cumulative selection response at 5th generation, inbreeding coefficient increment per generation, and the coefficient of variation of the cumulative selection response at 5th generation. The cumulative selection response got higher and the increment of inbreeding coefficient slowed down significantly when the number of sows in the breeding population increased from 100 to 300,and the ratio of boar to sow and the number of pigs tested per litter were fixed. When the sow number of breeding population was increased from 300 to 400 above,the cumulative selection response only increased slightly,and the coefficient of inbreeding continued to decrease but at a diminished rate. In conclusion, for the short-term selection of sire line, it is recommended that the breeding population should be composed of 400 or above sows, 4 pigs tested per litter,and the ratio of boar to sow should be maintained at 1:20.

[Founding and genetic analysis of Landrace x Lantang pig resource population for QTL mapping].

With F2 design, 16 Chinese Lantang sows crossbred with eight highly improved Landrace boars to establish a resource population including 40 F1 sows, eight F1 boars, and 232 F2 pigs. Genetic analysis of the resource population showed that the 32 performance traits displayed some degree of variation, and coefficients of variation of the majority of economic traits exceeded 10%. The variance component analysis revealed that the ratios of additive genetic variance to phenotypic variance of the majority of economic traits were high. Of the 22 microsatellite DNA markers, only 12 microsatellite DNA markers are polymorphisic in this populations. The average heterozygosity of these markers and PIC were 0.53 and 0.46 respectively. The results showed that these markers can provide enough information for QTL mapping. In conclusion,the F2 pigs were sufficiently segregated, and were capable of serving as a resource population for QTL mapping.