[Epidemioloical characteristics and economic burden analysis of palmoplantar pustulosis in urban areas of China].

Objective: To analyze the epidemiological characteristics and economic burden of palmoplantar pustulosis (PPP) in China. Methods: A population-based retrospective study was conducted using the data from China's Urban Basic Medical Insurance data from January 1, 2012, to December 31, 2016. International Classification of Diseases code and diagnoses in Chinese for PPP were used to identify cases and estimate the prevalence, incidence, and cost. Subgroup analyses were performed according to age and sex, and sensitivity analyses were conducted to evaluate the robustness of the results. Age-adjusted prevalence rates were calculated based on the 2010 national census data. Results: The crude prevalence and incidence rate of PPP in 2016 were 2.730/100 000 (95%CI: 2.218/100 000-3.242/100 000) and 1.556/100 000 (95%CI: 1.154/100 000-1.958/100 000), and the prevalence rate of females (2.910/100 000) was higher than that of males (2.490/100 000, χ2=97.48, P=0.001). The incidence rate of females (1.745/100 000) was also higher than that of males (1.418/100 000, χ2=85.02, P=0.001). The age peak of incidence and prevalence of patients with PPP was in the 30-39-year age group and a small peak existed in the 0-3-year age group among people under 20 years old. From 2012 to 2016, the average number of visits was (2.44±0.04) per patient, and the total per-capita cost per year was (982.40±39.19) yuan. Conclusion: In 2016, the prevalence and incidence rate of PPP in China were higher in females than in males, and the highest age peak was in the 30-39-year age group.

Rapid and accurate identification of bacteria utilizing laser-induced breakdown spectroscopy.

Timely and accurate identification of harmful bacterial species in the environment is paramount for preventing the spread of diseases and ensuring food safety. In this study, laser-induced breakdown spectroscopy technology was utilized, combined with four machine learning methods - KNN, PCA-KNN, RF, and SVM, to conduct classification and identification research on 7 different types of bacteria, adhering to various substrate materials. The experimental results showed that despite the nearly identical elemental composition of these bacteria, differences in the intensity of elemental spectral lines provide crucial information for identification of bacteria. Under conditions of high-purity aluminum substrate, the identification rates of the four modeling methods reached 74.91%, 84.05%, 85.36%, and 96.07%, respectively. In contrast, under graphite substrate conditions, the corresponding identification rates reached 96.87%, 98.11%, 98.93%, and 100%. Graphite is found to be more suitable as a substrate material for bacterial classification, attributed to the fact that more characteristic spectral lines are excited in bacteria under graphite substrate conditions. Additionally, the emission spectral lines of graphite itself are relatively scarce, resulting in less interference with other elemental spectral lines of bacteria. Meanwhile, SVM exhibited the highest precision rate and recall rate, reaching up to 1, making it the most effective classification method in this experiment. This study provides a valuable approach for the rapid and accurate identification of bacterial species based on LIBS, as well as substrate selection, enhancing efficient microbial identification capabilities in fields related to social security and military applications.

[Construction of a schistosomiasis transmission risk assessment system in Wuhan City based on analytic hierarchy process].

OBJECTIVE: To construct a schistosomiasis transmission risk assessment system in Wuhan City and preliminary evaluate its application effect, so as to promote the rational allocation of schistosomiasis control resources and accelerate the progress towards schistosomiasis elimination. METHODS: The schistosomiasis risk assessment indicators were collected through referring schistosomiasis surveillance data of Wuhan City from 2014 to 2020, literature review and expert interviews. Indicators within each criterion and sub-criterion were screened using the Delphi method, and a hierarchical structure model was created based on analytic hierarchy process. Quantitative assignment of each indicator was conducted according to relative importance, and the weight and combination weight of each criterion were calculated in each analytic hierarchy framework to create a schistosomiasis transmission risk assessment system, which was used for the schistosomiasis transmission risk assessment in 12 national schistosomiasis surveillance sites in Wuhan City. RESULTS: A three-level schistosomiasis transmission risk assessment system was preliminarily constructed, which included a target layer, 5 criterion layers and 21 sub-criterion layers. Of all indicators in the criterion layer, transmission route had the highest weight (0.433), followed by source of Schistosoma japonicum infection (0.294); and among all indicators in the sub-criterion layer, S. japonicum infection in Oncomelania hupensis and sentinel mice had the highest combination weight (0.125), followed by prevalence of S. japonicum infection in humans (0.091) and bovines (0.053), snail control by chemical treatment (0.049), positive rate of inquiry examinations (0.048), allocation of schistosomiasis control professionals (0.045), and areas of submerged snail-infested settings (0.041). Of the 12 national schistosomiasis surveillance sites in Wuhan City, there were 5 sites with weights of > 0.8, 4 sites with weights of 0.6 to 0.8, and 3 sites with weights of < 0.6 in 2020. CONCLUSIONS: A schistosomiasis transmission risk assessment system has been constructed based on analytic hierarchy process in Wuhan City, which may provide a evidence-based basis for health resource allocation and decision-making for schistosomiasis control.

[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.

Global, regional, and national time trends in myocarditis-related mortality, 1990-2019: An age-period-cohort analysis.

OBJECTIVE: The aim of this study was to analyze the tendency of myocarditis mortality in 204 countries and areas during the last three decades and its connection with age, epoch, and birth cohort. MATERIALS AND METHODS: The Global Burden of Disease 2019 Study acquired a cause-specific myocarditis mortality estimate. The net drift, as well as the influence caused by age, period, and birth cohort, were evaluated by the age-period-cohort model. Additionally, we analyzed the tendency in research intensity and international collaboration across countries using 3,983 myocarditis-related publications from four periods during 1990-2019. RESULTS: During the last three decades, 101 of 204 countries and areas experienced an increase (net drifts ≥0.0%) or stagnant declines (≥-0.5%) in the death rate. In particular, increasing death rate was generally discovered in most countries whose Socio-demographic indexes (SDIs) are high and middle-high, such as the United States [net drift=2.11% (95% CI 1.71-2.51)] and Italy [2.65% (1.24-4.08)]. Countries with a higher number of deaths were more active in this field of study, such as the United States (237 publications), China (120), and Italy (73). The United States and Italy, whose total link strengths were 209 and 135, respectively, were more active in international collaborative studies. CONCLUSIONS: Despite the global decrease in myocarditis death rate during the last three decades, negative period and cohort effects and elevated mortality were discovered in numerous countries, especially in those whose SDIs were high, and the age distribution of deaths shifted from adolescent to middle-aged and older populations. We also observed a decline in myocarditis research in some countries with increased mortality.

Assessment of hesitancy to COVID-19 vaccine in patients with rheumatic arthritis.

OBJECTIVE: The COVID-19 pandemic caused by SARS-CoV-2 in 2019 has greatly impacted global health, leading to high morbidity and mortality rates. Rheumatoid arthritis (RA) patients have faced numerous challenges during the pandemic, including concerns about infection, limited medical resources, and shortages of medication. While vaccination is a crucial strategy against COVID-19, the reasons behind vaccine hesitancy (VH) among people with RA remain largely unexplored. SUBJECTS AND METHODS: We conducted a cross-sectional, single-arm study in China from July 18 to August 18, 2021. Using a self-administered questionnaire and a convenient sampling method, we investigated vaccine attitudes and VH among RA patients. The questionnaire developed by the investigators was validated by two public health experts and one senior rheumatologist. It covered sociodemographics, disease-related variables, vaccination attitudes, and willingness, etc. We employed Chi-squared and regression analyses to identify factors associated with VH toward COVID-19 vaccination. RESULTS: A total of 184 RA patients were enrolled in the survey, with 113 (61.41%) expressing unwillingness to be vaccinated. The Chi-squared test revealed significant differences in employment status and related systemic damage (p < 0.05). Among the unvaccinated RA patients, 71.68% believed COVID-19 vaccination might impact their disease. Binary and multicollinearity logistic regression analyses showed that the acute stage of RA (p < 0.001, OR = -3.165, 95% CI: 0.035 - 0.164) and fear of disease development caused by drug discontinuation during vaccination (p < 0.001, OR = -3.591, 95% CI: 0.005 - 0.157) were the restricting factors influencing the COVID-19 vaccine inoculation rate in RA patients. CONCLUSIONS: The COVID-19 vaccination rate among RA patients in China is low due to limited knowledge, misconceptions, and insufficient promotion. Boosting confidence and understanding of the vaccine's effectiveness and safety is crucial to improve vaccination success.

[Analysis of the incidence and burden of intraocular foreign bodies in China based on age-period-cohort model].

Objective: This study aims to analyze the incidence, disease burden, and trend of intraocular foreign bodies in China from 1990 to 2019, and to analyze the trend of changes in age, period, and cohort of Chinese men. Methods: The data related to the incidence rate and disease burden of intraocular foreign bodies in China from 1990 to 2019 were obtained from the Global Burden of Disease Database (GBD database) on the website of the Institute for Health Indicators and Evaluation (IHME) of the University of Washington, United States, and the annual percentage rate change (AAPC) of intraocular foreign bodies in China was calculated using the Joinpoint software to describe the long-term trend of their incidence rate and disease burden over time. Using Stata17 software, an age period cohort model was constructed to analyze the age, period, and cohort factors affecting intraocular foreign bodies in men. Results: In 2019, the incidence rate of intraocular foreign bodies in China was 791.20/100 000, and the DALY rate was 10.32/100 000, with an average annual decline rate of 1.70% and 1.48% respectively. In 2019, the number of cases of intraocular foreign bodies in China was 11.253 6 million, and the DALY was 1 812.29 million person years. Among them, the incidence and disease burden of intraocular foreign bodies in men were more severe than those in women, and the incidence and disease burden risk of intraocular foreign bodies in men aged 30-35 and 45-50 were the highest. The incidence and disease burden risk of intraocular foreign bodies in elderly men gradually increased. Conclusions: As a common ophthalmic disease, the incidence of intraocular foreign bodies and the DALY rate are declining, but the disease burden is increasing. With the aging of the population, the incidence of intraocular foreign bodies in the elderly will further increase in the future, which should be considered by policy makers. The findings of this study can help governments and healthcare planners formulate practical and targeted policy responses.

[Enlightening from optimizing post-authorization safety monitoring system of SARS-CoV-2 vaccines in major economies worldwide].

Ongoing global pandemic of Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has promoted the unprecedented rapid development and large-scale rolling out of different platform-based COVID-19 vaccines worldwide. How to effectively respond to the expected scale increasing adverse events after vaccination campaign of COVID-19 vaccines is a common problem faced by the world. A lot of countries and regions around the world have arranged in advance at different levels, optimizing the original vaccine safety monitoring system from the perspectives of strengthening the foundation and capabilities, promoting internal and external cooperation, upgrading methods, as well as improving transparency and public communication, which has ensured the good and efficient operation of the system and can provide reference for the construction of relevant fields in China.

Fate of Hemodialysis Patients Undergoing Transcarotid Revascularization.

INTRODUCTION: Carotid revascularization in patients with end-stage renal disease (ESRD) continues to be a controversial topic, as life expectancy is poor, thus, preventing the recouperation of cumulative stroke-risk reduction in the postoperative period. We performed this primarily descriptive analysis of the results of transcarotid revascularization (TCAR) in renal failure patients. METHODS: A retrospective review of two independent carotid revascularization databases maintained at two large health systems were performed to capture all consecutive TCAR procedures. Patients were classified as either (1) ESRD or (2) preserved renal function (PRF) and compared with standard univariate techniques, where appropriate. RESULTS: From December 2015 to April 2022, 851 consecutive TCARs were attempted at our participating facilities. Of these, 27 were performed in ESRD patients (all hemodialysis). These patients were younger and presented with a higher Charlson Comorbidity Index. The incidence of a high anatomic risk criterion as defined for the Centers for Medicare and Medicaid Services (CMS) were similar between groups, as was the incidence of a symptomatic carotid lesion. There were no differences between the groups in terms of intraoperative characteristics and the postoperative medication management were grossly similar by renal function. In the 30-day perioperative period, there were no stroke, death, or myocardial infarction in the 27 ESRD patients treated with TCAR. The mean duration of follow-up in the ESRD cohort was 15.0 months. During this time, there was no ipsilateral stroke events, one contralateral stroke, and one MI. All 27 carotid stents remained patent during this period. Six patients perished after TCAR at a mean interval of 12.2 months after TCAR. CONCLUSION: Survival is poor after carotid revascularization via the TCAR technique on intermediate follow-up. Careful patient selection is required to identify those who will survive to collect on the cumulative stroke-risk reduction afforded by carotid intervention.

[68Ga-PSMA-I&T PET/CT for assessment of tumor burden in primary lesions of treatmentnaïve prostate cancer].

OBJECTIVE: To investigate the value of 68Ga-labeled prostate specific membrane antigen (PSMA) PET/CT for assessing tumor load in primary lesions for risk stratification and predicting metastasis of newly diagnosed prostate cancer (PCa). METHODS: We retrospectively analyzed the data of 36 patients (mean age 71.3 ± 8.6 years, range 56 to 89 years) with newly diagnosed PCa undergoing 68Ga-PSMA-I&T PET/CT from June 2018 to July 2019. SUVmax and SUVmean of the primary lesions were measured, and the primary PSMA tumor volume (PSMA-TV) and total lesion PSMA (TL-PSMA) were automatically measured and calculated in all the patients. The correlations of primary SUVmax, PSMA-TV, and TL-PSMA with PSA and Gleason score (GS) were analyzed, and SUVmax, PSMA-TV and TL-PSMA of the primary lesions were compared among different PCa subgroups. RESULTS: SUVmax, PSMA-TV and TL-PSMA of the primary lesions were all correlated with PSA and GS (P < 0.05). PCa subgroup analysis showed that SUVmax, PSMA-TV and TL-PSMA were all significantly higher in patients with PSA >20 ng/mL than in those with PSA ≤20 ng/mL (P < 0.001), and were higher in patients with a GS ≥8 than in those with a GS ≤7 (P < 0.001). PSMA-TV and TL-PSMA were significantly higher in patients with tumor metastasis than in those without metastasis (P < 0.001), while SUVmax did not differ significantly with tumor metastasis. SUVmax (P=0.002), PSMA-TV (P < 0.001), and TL-PSMA (P < 0.001) were all significantly higher in high-risk group than in low-to moderate-risk group. CONCLUSION: PSMA-TV and TL-PSMA of 68Ga-PSMA-I&T PET/CT have potential value in predicting risk stratification and metastasis of newly diagnosed PCa.

[Contribution of central motion conduction time to the assessment of corticospinal tract lesions and its clinical significance].

Objective: To investigate the association of central motion conduction time (CMCT) with corticospinal tract lesions and its clinical application. Methods: Patients who completed transcranial magnetic stimulation-motor evoked potentials were included from Department of Neurology, Xuanwu Hospital between June 2020 and June 2021. The differences of CMCT values between corticospinal tract sign-positive group and tendon reflex-positive group and the relevant negative groups were compared. The consistency between increased CMCT values and the positive signs of corticospinal tract damage, as well as the significance of CMCT in different neurological diseases were further evaluated. Results: A total of 271 patients were included in the study, aged 12-86 (49±16) years, with 137 males (50.55%) and 134 females (49.45%). The CMCT valuesï¼»M（Q1，Q3）］from Hoffmann's sign-positive group [9.52 (8.54, 10.99) ms vs 9.03 (8.30, 9.53) ms], Babinski's sign-positive group [19.54 (16.97, 24.43) ms vs 16.85(15.63, 18.55) ms] and tendon reflex-positive group [15.38 (9.27, 19.28) ms vs 10.49(8.79, 16.60) ms] were larger than those of relevant negative groups (all P<0.01). In the Babinski sign-positive group, 78.01%(181/232) of the patients had increased CMCT, while in the Hoffmann's sign-positive group, only 26.03%(19/73) of the patients had increased CMCT, indicating that the contribution of CMCT from the lower extremities to the assessment of corticospinal tract lesions was better than that of the upper extremities. With the increase of CMCT values in lower limbs, Babinski sign positive rate increased, the difference was statistically significant(P<0.001). In nervous system diseases, the consistency between CMCT and pathological signs was 75.65% (205/271). Conclusions: The contribution of CMCT from the lower extremities to the assessment of corticospinal tract lesions is superior to that of upper limbs. The higher increase of CMCT values are more reliable for corticospinal tract damage. CMCT has a good concordance with corticospinal tract lesions in some neurological diseases, which can be used to assist clinical diagnosis.

[Analysis on influencing factors of HBV intrauterine transmission based on integration of decision tree model and logistic regression model].

Objective: To investigate the influencing factors of HBV intrauterine transmission and their interaction effects by integrating logistic regression model and Chi-squared automatic interaction detector (CHAID) decision tree model. Methods: A total of 689 pairs of HBsAg-positive mothers and their neonates in the obstetrics department of the Third People's Hospital of Taiyuan from 2007 to 2013 were enrolled, and the basic information of mothers and their neonates were obtained by questionnaire survey and medical record review, such as the general demographic characteristics, gestational week and delivery mode. HBV DNA and HBV serological markers of the mothers and newborns were detected by fluorescence quantitative PCR and electrochemiluminescence immunoassay respectively. The CHAID decision tree model and unconditional logistic regression analysis were used to explore the factors influencing HBV intrauterine transmission in neonates of HBsAg-positive mothers. Results: Among the 689 neonates, the incidence of HBV intrauterine transmission was 11.47% (79/689). After adjusted for confounding factors, the first and second logistic multivariate analysis showed that cesarean delivery was a protective factor for HBV intrauterine transmission (OR=0.25, 95%CI: 0.14-0.43; OR=0.27, 95%CI: 0.15-0.46); both models indicated that maternal HBeAg positivity and HBV DNA load ≥2×105 IU/ml before delivery were risk factors of HBV intrauterine transmission (OR=3.89, 95%CI: 2.32-6.51; OR=3.48, 95%CI: 2.12-5.71), respectively. The CHAID decision tree model screened three significant factors influencing HBV intrauterine transmission, the most significant one was maternal HBeAg status, followed by delivery mode and maternal HBV DNA load. There were interactions between maternal HBeAg status and delivery modes, as well as delivery mode and maternal HBV DNA load before delivery. The rate of HBV intrauterine transmission in newborns of HBeAg-positive mothers by vaginal delivery increased from 19.08% to 29.37%; among HBeAg-positive mothers with HBV DNA ≥2×105 IU/ml, the rate of HBV intrauterine transmission increased to 33.33% in the newborns by vaginal delivery. Conclusions: Maternal HBeAg positivity,maternal HBV DNA ≥2×105 IU/ml and vaginal delivery could be risk factors for HBV intrauterine transmission in newborns. Interaction effects were found between maternal HBeAg positivity and vaginal delivery, as well as vaginal delivery and high maternal HBV DNA load. Logistic regression model and the CHAID decision tree model can be used in conjunction to identify the high-risk populations and develop preventive strategies accurately.

[Assessment of lymphocytic function in vitro stimulated by specific tumor polypeptide combined with dendritic cells].

OBJECTIVE: To assess the activation function of specific tumor polypeptide for dendritic cell vaccine on lymphocytes proliferation, production of cytokines and killing activity in vitro by using dendritic cells as antigen presenting vector. METHODS: Peripheral blood dendritic cells (DC) and cytokine-induced killer (CIK) were isolated and cultured by adherent culture method; CCK-8 method was used to assess the proliferation function of lymphocytes and the killing function of lymphocytes to tumor cells; enzyme-linked immunospot assay method was used to evaluate the secretion function of cytokines. The experiment was divided into tumor polypeptide group (peptide with DC-CIK), DC-CIK group and CIK group. RESULTS: With presence of interleukin-2 (IL-2) in the culture system, the lymphocyte proliferation of the three groups was obvious. The absorbance at 450 nm of tumor polypeptide group was significantly higher than that of CIK group at the time points day 4 and day 6 (day 4: Z=-3.79, P < 0.001; day 6: Z =-2.95, P < 0.01). The absorbance at 450 nm of group tumor polypeptide was significantly higher than that of DC-CIK group on day 4 (Z=-2.02, P < 0.05). Without IL-2 in the culture system, lymphocytes proliferated slowly in all the three groups, and there was no significant difference in 450 nm absorbance at each time point. The levels of IL-4 (Z=-2.61, P < 0.01), granulocyte-macrophage colony-stimulation factor (GM-CSF, Z=-3.85, P < 0.001), interferon- γ (IFN- γ, Z=-3.56, P < 0.001) and tumor necrosis factor-α (TNF-ɑ, Z=-3.40, P < 0.001) of tumor polypeptide group were higher than those of CIK group. There was no significant difference in the production of cytokines except IL-4 (Z=-2.15, P < 0.05) when tumor polypeptide group was compared with DC-CIK group. The production of IFN-γ (Z=-2.44, P < 0.05), TNF-ɑ (Z=-2.26, P < 0.05) and GM-CSF (Z=-3.73, P < 0.001) in DC-CIK group were higher than those of CIK group. Although there was no significant difference in killing activity between tumor polypeptide group, DC-CIK group and CIK group at hour 18 and hour 24, and the killing activity of tumor polypeptide group was higher than that of the other two groups. CONCLUSION: Tumor peptide combined with dendritic cells can improve the proliferation activity of CIK cells in vitro, and increase the secretion of several cytokines.

[Roles of detection, surveillance and early warning on outbreaks or epidemics of infectious diseases].

Infectious diseases are still one of the leading causes of morbidity and death globally, affecting public health and life, social and economic development, and even national security. Early detection focuses on detecting the abnormal information of infectious disease outbreaks or epidemics in a timely and sensitive way to conduct field investigation and verification. It is also a precursor to effective surveillance and early warning system. The effective surveillance and early warning system can fully and accurately understand the real conditions, driving forces, and transmission chain of the occurrence of a specific infectious disease outbreak and epidemic and put forward scientific and effective prevention and control strategies and measures. Due to the measurement of the resources support and the particular data collection value, it is not easy to obtain epidemiological, etiological, and other data information in a timely, complete and accurate manner. This paper summarized the theory and technology on early detection, effective surveillance, and early warning information on infectious diseases. It also integrated and utilized the multi-source data, including effective infectious disease surveillance and the country's early warning system, to better understand the outbreak epidemic, causes, risks, processes, and driving forces. Thus, it is possible to set up a sensitive, specific staging measurement innovative technical system to monitor, early warning, and timely respond to acute infectious diseases through multidisciplinary cooperation in China. It provides the basis for strengthening the surveillance and early warning of new emerging and major infectious diseases and public health emergencies, avoiding the spread of inadequate response to infectious disease, and preventing the resources waste of over-response.

[The effect of episiotomy on pelvic floor muscle function within six months after first childbirth through electromyography and questionnaires assessment].

Objective: To compare the impact of mediolateral episiotomy on pelvic floor muscle (PFM) function through surface electromyography (sEMG) and quality of life questionnaire assessment. Methods: From January 2018 to June 2019, 1 250 eligible primiparous women were enrolled in Beijing Hospital and the First People's Hospital of Yunnan Province. Participants were divided into episiotomy group (n=676)and non-episiotomy group (n=574). Both groups underwent clinical pelvic examination, sEMG assessment, and quality of life (QOL) questionnaire assessment at two fixed time points: 6-8 weeks, 6 months after vaginal delivery. Follow-up of sEMG amplitudes and their correlation with QOL questionnaire scores were evaluated. Results: Among the women delivered with episiotomy, the peak amplitude of phasic contraction (PPC) was (17.7±5.3) µV at 6-8 weeks after childbirth and (29.6±8.7) µV at 6 months after childbirth. The mean amplitude of tonic contraction (MTC) was (14.8±7.4) µV and (22.2±8.9) µV, respectively. In the non-episiotomy group, PPC was (20.0±7.9) µV and (35.4±10.7) µV at 6-8 weeks and 6 months, and MTC was (17.8±9.0) µV and (27.5±8.9) µV, respectively. Compared with EMG amplitudes at 6-8 weeks, both PPC and MTC significantly improved at 6 months in both groups (all P<0.01). Moreover, episiotomy was related with significantly lower PPC and MTC at both fixed checkups. Besides, both IIQ-7 and PFIQ-7 questionnaire scores improved at 6 months compared with those at 6-8 weeks in both groups (all P<0.001). There was consistently significant difference in QOL scores between episiotomy and non-episiotomy group at two checkups (all P<0.05). A negative correlation was observed between PFM contractile amplitudes and QOL scores at both time points after childbirth (all P<0.05), and the correlation weakened with time. Conclusion: Episiotomy has a negative impact on the postpartum PFM contractile function within 6 months after childbirth. The negative correlation between the sEMG and QOL scores indicates that sEMG is a candidate assessment for PFM function follow-up after childbirth.

[Cost-effectiveness of primary prophylaxis with PEG-rhG-CSF in early-stage breast cancer patients receiving chemotherapy in China].

Objective: To evaluate the cost effectiveness of primary prophylaxis (PP) with pegylated recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF), PP with recombinant human granulocyte colony stimulating factor (rhG-CSF) and no prophylaxis in women with early-stage breast cancer in China. Methods: Two phase Markov models were constructed for a hypothetical cohort of patients aged 45 with stage Ⅱ breast cancer. The first phase modelled costs and outcomes of 4 cycles docetaxel combined with cyclophosphamide [TC×4, febrile neutropenia (FN) risk>20%] chemotherapy, which assumptions based on literature reviews, including FN rates [base-case (deterministic sensitivity analysis range), 0.29 (0.24-0.35)] and related events [FN case-fatality, 3.4 (2.7-4.1)]. Second phase modelled the long term survival which was link with the relative dose intensity (RDI) [mortality hazard ratio (HR) of RDI < 85% vs ≥85%, 1.45 (1.00-2.32)]. Clinical effectiveness, therapeutic costs, and economic utilities were estimated from peer-reviewed publications and expert opinions in case of unavailability of published evidences. Results: Compared to rhG-CSF PP and no prophylaxis, the cost of PEG-rhG-CSF PP increased to 5 208.19 RMB and 5 222.73 RMB, respectively. The quality-adjusted life-years (QALYs) enhanced to 0.066 and 0.297, respectively. Accordingly, the incremental cost effectiveness ratios (ICERs) are 79 146.3 RMB and 17 558.77 RMB per QALY, which were both below the willingness to pay (WTP) threshold of three times GDP per capita (18, 000 RMB) recommended by the WHO. Sensitivity analysis suggested that the more clinically effective the primary prophylaxis with PEG-rhG-CSF is, the more cost-effective primary prophylaxis with PEG-rhG-CSF will be. And the lower the mortality HR of RDI<85% vs ≥85% is, the more cost-effective primary prophylaxis with PEG-rhG-CSF will be. Conclusion: Although the cost of PP PEG-rhG-CSF is higher, considering the additional benefits, the administrating of PP PEG-rhG-CSF is likely to be a cost-effective alternative to PP rhG-CSF and no prophylaxis in patients with early stage breast cancer whose FN risks are more than 20% in China.

[Predictive ability of risk assessment tool regarding HIV infection for men who have sex with men].

Objective: To analyze the predictive ability of HIV infection risk assessment tool for men who have sex with men (MSM). Sentinel surveillance data of MSM in Taizhou prefecture of Zhejiang province was used. Methods: MSM involved in AIDS sentinel surveillance program in Taizhou from 2013 to 2017 were included in the study and items listed in the HIV infection risk assessment tool for MSM was revised. Related data on questions and options involved in sentinel surveillance was collected and individual risk scores were calculated. We determined the predictive ability of this tool by comprehensive analyzing the HIV infection status and individual risk scores. Results: A total of 1 944 MSM were included in the study, with an average age of (35.04±13.28)years old. Most of them were recruited from the venues (55.7%) and 48.2% were never married. Among these MSM, HIV infection rate was 12.6%(245/1 944) with the median of risk score as 23.99, versus 20.36 from the HIV negative ones. Significant differences appeared on the risk scores between the target populations that with different HIV status (Mann-Whitney test, P=0.007). According to the principle of decision tree, MSM were divided into two groups according to risk scores: ≤18.66 and >18.66. It appeared that the risk scores were in parallel with the rates of HIV infection (χ(2)=13.102, P<0.001). Results from the multivariate analysis showed that MSM with higher risk score were more likely to be infected with HIV (>18.66 vs. ≤18.66: aOR=1.72, 95%CI: 1.27-2.32, P<0.001). Area under the ROC curve (AUC) for HIV infection was 0.553 (95%CI: 0.516-0.590, P=0.007). At the point of risk score 19.01, Youden's index appeared the maximum, with sensitivity as 0.69 and specificity as 0.43, of this tool. Conclusions: The HIV infection risk assessment tool for MSM developed based on Delphi method can predict the risk of HIV infection in MSM to some extent. MSM with higher risk score seemed likely to be infected with HIV. Items of this tool need to be adjusted for the verification of the tool through cohort studies in the near future.

Estimating neighbourhood-level prevalence of adult obesity by socio-economic, behavioural and built environment factors in New York City.

OBJECTIVES: Some studies reveal that socio-economic status, behavioural factors, accessibility to supermarket or food store, are associated with the prevalence of obesity and overweight. In this study, we aimed to examine to what extent socio-economic, behavioural and built environment characteristics can contribute to spatial disparities in adult obesity. STUDY DESIGN: The spatial analysis was undertaken to understand the association of spatial disparities in adult obesity and spatial disparities in socio-economic, behavioural and built environment characteristics. METHODS: A spatial regression model which can remove the impact of auto-correlation in the residuals of conventionally regression models was applied to modelling local-scale rate of adult obesity (N = 59). RESULTS: Owing to the presence of residual spatial auto-correlation in the non-spatial regression model estimated, a spatial regression model was set up successfully to model local-scale rate of adult obesity across New York City (R2 = 0.8353, N = 59). Compared with socio-economic and built environment factors, behavioural factors make statistically significant contributions to spatial disparities in the prevalence of adult obesity (POAO). Particularly, two behavioural factors ('sugary drinks consumption' and 'fruits and vegetable consumption') can explain more than 70% of the variance of POAO (adjusted R2 = 0.7323, N = 59). Surprisingly, physical activity prevalence (percent of physically active adults) makes no statistically significant contributions. CONCLUSIONS: The results further suggest that the reduction of adult obesity prevalence could benefit more from decreasing intake of sugary drinks than increasing physical activity. The local government and policy are advised to prioritise decreasing exposure of residents to sugary drinks through restricting advertising or increasing taxes rather than increasing neighbourhoods' walkability through urban planning.

[Prevalence investigation of solitary plasmacytoma in China: A calculation based on national urban medical insurance in 2016].

Objective: The aim of this study is to analyze the distribution features of patients with solitary plasmacytoma and calculate the prevalence of solitary plasmacytoma in China in the year 2016. Methods: This study was based on China's urban employees' basic medical insurance and the urban residences' basic medical insurance from 21 provinces from January 1, 2016 to December 31, 2016. Patients with solitary plasmacytoma were identified by disease names and codes. Subgroup analyses were carried out by sex, region, and age. Furthermore, sensitivity analyses were performed to test the robustness of the results. Age-adjusted prevalence was calculated based on the 2010 Chinese census data, the 2013 Revised European Standard Population, the 2010 US population, and the 2011 Australian population. Results: In 2016, the prevalence of solitary plasmacytoma in China was 1.18 per 100 000 population (95%CI, 1.06-1.31) , with 1.26 per 100 000 population (95% CI, 1.10-1.43) and 1.10 per 100 000 population (95% CI, 0.93-1.29) for males and females, respectively. The age-adjusted prevalence based on the 2010 Chinese census data was 0.85 per 100 000 population (95% CI, 0.82-0.88) . Conclusion: This study estimated the prevalence of solitary plasmacytoma in China on the basis of the national urban medical insurance, which can provide clues for the enactment of solitary plasmacytoma-related medical policies and basic studies about solitary plasmacytoma.