[Risk factor assessment and adverse outcome prediction of placenta accreta in pregnant women after cesarean section complicated with placenta previa: a national multicenter retrospective study].

Objective: To study the risk factors of adverse pregnancy outcomes for the diagnosis and treatment of pregnancy after cesarean section complicated with placenta previa. Methods: A national multicenter retrospective study was conducted to select a total of 747 pregnant women with the third trimester singleton pregnancy after cesarean section complicated with placenta previa from 12 tertiary hospitals in January 1st to December 31st, 2018. The risk factors of severe adverse outcomes [hysterectomy, intraoperative blood loss ≥1 000 ml, intraoperative diagnosis of placenta accreta spectrum disorders (PAS)] in pregnant women with second pregnancy complicated with placenta previa after cesarean section were investigated by logistic regression analysis. The roles of prenatal ultrasonography and magnetic resonance imaging (MRI) in the prediction of PAS and severe adverse outcomes were observed. According to whether vascular intervention was performed (uterine artery embolization or abdominal aortic balloon occlusion), the pregnant women were divided into the blocked group and the unblocked group, and the maternal and infant perinatal outcomes between the two groups were compared. Results: (1) General information: the hysterectomy rate of 747 pregnant women with second pregnancy complicated with placenta previa after cesarean section was 10.4% (78/747), the intraoperative blood loss ≥1 000 ml in 55.8% (417/747), and PAS was confirmed in 47.5% (355/747). The incidence of uterine rupture was 0.8% (6/747). (2) Analysis of risk factors for severe adverse outcomes: based on binary unconditioned logistic regression univariate and multivariate analysis, the risk factors for hysterectomy were the mode of vascular embolization and intraoperative blood loss. The probability of hysterectomy with uterine artery embolization was 5.319 times higher than that with abdominal aortic balloon occlusion (95%CI: 1.346-21.018). The risk factors of intraoperative blood loss ≥1 000 ml were the number of cesarean section delivery, ultrasonography indicated PAS and suspected PAS, intraoperative PAS and complete placenta previa. The risk factors for intraoperative PAS were uterine scar thickness, ultrasonography indicated PAS and suspected PAS, MRI indicated PAS and suspected PAS, and complete placenta previa. (3) The roles of ultrasonography and MRI in predicting PAS: the sensitivity and specificity of ultrasonography in predicting PAS were 47.5% and 88.4%; the kappa value was 0.279 (P<0.001), with fair agreement. The sensitivity and specificity of MRI to predict PAS were 79.2% and 97.8%, respectively. The kappa value was 0.702 (P<0.001), indicating a good agreement. The intraoperative blood loss and hysterectomy rate of pregnant women with PAS indicated by ultrasonography and MRI were significantly higher than those with PAS only by ultrasonography or MRI. (4) Influence of vascular occlusion on pregnancy outcome: there were no significant differences in intraoperative blood loss and incidence of intraoperative bleeding ≥1 000 ml between the blocked group and the unblocked group (all P>0.05). There was no significant difference in intraoperative blood loss between the pregnant women with abdominal aortic balloon occlusion, uterine artery embolization and those without occlusion (P=0.409). The hysterectomy rate of pregnant women with uterine artery embolization was significantly higher than those with abdominal aortic balloon occlusion [39.3% (22/56) vs 10.0% (5/50), P=0.001]. Conclusions: In the third trimester of pregnancy with placenta previa after cesarean section, MRI examination has better consistency in predicting PAS than ultrasonography examination. Ultrasonography examination combined with MRI examination could effectively predict the hysterectomy rate and intraoperative blood loss. Vascular occlusion could not reduce the amount of intraoperative blood loss. The hysterectomy rate of pregnant women with uterine artery embolization is higher than those with abdominal aortic balloon occlusion.

[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.

Distribution, combined pollution and risk assessment of antibiotics in typical marine aquaculture farms surrounding the Yellow Sea, North China.

This study focused on the distribution, combined pollution, potential source and risk assessment of 17 antibiotics in an aquaculture ecosystem surrounding the Yellow sea, North China. Antibiotics were detected in various matrices (seawater, sediment/biofilm, organism and feed) in different aquaculture modes (greenhouse and outdoor aquaculture) during the wet and dry seasons in coastal areas of Shandong province. The innovation points of the study were as follows: (1) To the best of our knowledge, this study was one of the few to investigate the occurrence and distribution of antibiotics in mariculture environments along the Yellow Sea coast; (2) Biofilms, a focus of the study, might act as a sink for antibiotics in the aquaculture ecosystem; and (3) The correlation of heavy metals and antibiotic concentrations was proved, which could correspondingly be used as an indicator for antibiotic concentrations in the studied area. The levels of antibiotics in water were observed to be relatively low, at the ng/L level. Trimethoprim was the most prevalent antibiotic, and was detected in all water samples. Oxytetracycline was detected at high concentrations in biofilms (up to 1478.29 ng/g). Moreover, biofilms exhibited a higher antibiotic accumulation capacity compared to sediments. Concentrations of oxytetracycline and doxycycline were high in feed, while other antibiotics were almost undetected. Tetracycline was widely detected and the concentration of enrofloxacin was highest in organisms. Correlation analysis demonstrated that environmental parameters and other coexisting contaminants (e.g. heavy metals) significantly affected antibiotic concentrations. In addition, the concentration of Zn was significantly correlated with the total antibiotic concentration and was proportional to several antibiotics in water and sediment (biofilm) samples (p < 0.01). High Mn concentrations were closely related to total and individual (e.g. sulfadiazine, sulfamethazine and enrofloxacin) antibiotic levels, which may result in the combined contamination of the environment. Antibiotics in estuaries and groundwater generally originated from aquaculture wastewater and untreated/treated domestic sewage. Most of the detected antibiotics posed no risk to the environment. Ciprofloxacin and enrofloxacin found in water may present high ecological and resistance risks, while the two antibiotics observed to accumulate in fish may pose a considerable risk to human health through diet consumption. All antibiotics detected in seafood were lower than the respective maximum residue limits. This study can act as a reference for the government for the determination of antibiotic discharge standards in aquaculture wastewater and the establishment of a standardized antibiotic monitoring and management system.

[Cost-effectiveness of lung cancer screening worldwide: a systematic review].

Objective: From the economic point of view, this study was to systematically assess the status quo on lung cancer screening in the world and to provide reference for further research and implementation of the programs, in China. Methods: PubMed, EMbase, The Cochrane Library,CNKI and Wanfang Data were searched to gather papers on studies related to economic evaluation regarding lung cancer screening worldwide, from the inception of studies to June 30(th), 2018. Basic characteristics, methods and main results were extracted. Quality of studies was assessed. Cost were converted to Chinese Yuan under the exchange rates from the World Bank. The ratio of incremental cost-effectiveness ratio (ICER) to local GDP per capita were calculated. Results: A total of 23 studies (only 1 randomized controlled trial) were included and the overall quality was accepted. 22 studies were from the developed countries. Nearly half of the studies (11 studies) took 55 years old as the starting age of the screening program. Smoking history was widely applied for the selection of criteria on target populations (18). Low-dose computed tomography (LDCT) was involved in every study used to evaluate the economic effectiveness. Annual (17) and once-life time (7) screening were more common frequencies. 22 studies reported ICERs for LDCT screening, compared to no screening, of which 17 were less than 3 times local GDP per capita, and were considered as cost-effectiveness, according to the WHO's recommendation. 15 and 7 studies reported ICERs for annual and once-life time screening, of which 12 and 7 studies were in favor the results of their cost-effectiveness, respectively. Additionally, the cost-effectiveness of once-lifetime screening was likely to be superior to the annual screening. Differences of cost-effectiveness among the subgroups, by starting age or by the smoking history, might exist. Conclusions: Based on the studies, evidence from the developed countries demonstrated that LDCT screening programs on lung cancer, implemented among populations selected by age and smoking history, generally appeared more cost-effective. Combined with the local situation of health resource, the findings could provide direction for less developed regions/countries lacking of local evidence. Low frequency of LDCT screening for lung cancer could be adopted when budget was limited. Data on starting ages, smoking history and other important components related to the strategy of screening programs, needs to be precisely evaluated under the situation of local population.

[Assessing the efficiency of schistosomiasis control programs in Jiangsu Province from 2005 to 2015 using data envelopment analysis (Malmquist index method)].

OBJECTIVE: To assess the total factor productivity (TFP) of schistosomiasis control programs in Jiangsu Province, so as to provide insights into sustainable schistosomiasis control. METHODS: The data envelopment analysis-Malmquist index method was employed to analyze the human resources and financial investments in schistosomiasis control programs from health sectors in each schistosomiasis-endemic city of Jiangsu Province from 2005 to 2015, and assess the outputs of each schistosomiasis control project. RESULTS: The overall productive efficiency of schistosomiasis control programs in Jiangsu Province showed an increasing tendency, and the mean fluctuation of annual TFP was 2.3%. The comprehensive technical efficiency, including pure efficiency and scale efficiency, appeared a steady increase with minor fluctuations, and the mean fluctuation of annual comprehensive technical efficiency was 3.8%. The growth rate of technical progress fluctuated greatly from 2005 to 2011, and showed a steady increase from 2012 to 2015, which became a major contributor to the growth of TFP. A higher growth rate of TFP was seen in Huai ' an and Changzhou cities, which showed a greater comprehensive technical efficiency, and a large fluctuation was observed in the growth rate of technical progress in Yancheng, Nanjing, Huai ' an and Yangzhou cities. CONCLUSIONS: There is a continuous improvement in the technical level of schistosomiasis control programs in Jiangsu Province, and technical application and supervision and management capacity also show a steady increase. In addition, the application of new techniques and new strategies contributes greatly to TFP growth. In the future, the investment into new techniques and new strategies should be increased to ensure the sustainable schistosomiasis control in Jiangsu Province.

Assessment of the minimal available phosphorus needs of laying hens: Implications for phosphorus management strategies.

The oversupply of dietary phosphorus (P) leads to increased feed costs and discharge of excessive P to the environment, thus directly impacting the sustainability of egg production practices. The present study was conducted to better define the minimal available P needs of laying hens. Fifty-six Lohmann white laying hens were individually caged and fed one of 7 diets with graded levels of available P (0.15, 0.20, 0.25, 0.30, 0.35, 0.40, or 0.45%) for 12 weeks. Records were maintained for body weight, feed intake, and egg production during the experimental period. Blood and egg samples were collected and digestibility studies conducted at wk 6 and 12 of the experiment. At the end of the experiment, tibia characteristics and expression of the P transporters in the small intestine and kidney were determined. Lowering dietary available P from 0.45 to 0.15% generally reduced plasma P concentrations (P < 0.01), but hen productive performance, plasma calcium, parathyroid hormone and other constituents, tibia bone mineral density and content, tibia ash percentage, and mRNA abundance of the small intestine, and kidney type II sodium/phosphate cotransporter were not different among treatments. Specific gravity and eggshell thickness tended to increase with reducing dietary P (P < 0.05). Total P intake, excretion, and retention net amount decreased (P < 0.01) with reducing dietary P, but its retention rate (of intake) remained unchanged. Furthermore, changing dietary P did not affect calcium retention rate and net deposition of total P and calcium in eggs. These data indicate that reducing dietary available P up to 0.15% is adequate to maintain health and performance of layers. As such, this minimal available P estimate should serve as a benchmark for the assessment of P contents of commercial laying hen rations, with the goal of enhancing the sustainability of egg production.

Assessment of the minimal available phosphorus needs of pullets during the pre-laying period.

Dietary phosphorus (P) oversupply is costly to the poultry industry and represents a point source of excessive P discharge to the environment via manure application to soils. The current study was conducted to investigate the effects of dietary available P (AP) level on growth performance, plasma biochemistry, bone characteristics, and P flow in order to assess minimal AP needs of pullets during the pre-lay period. A total of 192 Lohmann pullet chicks were randomly allocated to one of 4 treatments with 8 replicate cages of 6 birds per cage. The pullets of Low (L; the lowest AP regimen) were fed diets in a sequence of 0.200, 0.175, and 0.150% AP for the age period of 0 to 4 wk, 4 to 8 wk, and 8 to 16 wk, respectively. The AP level was increased by an increment of 0.1% in each phase in Low-Medium (LM), Medium-High (MH) and High (H), thus making H (control) consisting of 0.500, 0.475, and 0.450% AP. Overall, there were no main effects of treatment on body weight gain (BWG), feed intake (FI) and feed conversion ratio (FCR). However, compared with the H treatment, BWG or FI of the L treatment was lower during the first 8 wk post-hatch, but became comparable or higher over the last 8 wk (P < 0.05); FCR of L birds was greater over wk 0 to 4 but became smaller over wk 8 to 16 (P < 0.05). Plasma P was lower in L than H treatments at wk 8 but turned comparable at wk 16 (P < 0.001). Bone characteristics were not different for pullets fed various AP regimens. Total P intake and excretion were reduced with lowering dietary AP (P < 0.001), but its retention percent was not affected. The results indicated that the lowest AP regimen (0.200-0.175-0.150%) in the current study was adequate to support healthy growth and development of pre-lay pullets, while reducing P excretion in manure.

Meta-analysis comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis.

BACKGROUND: Previous studies comparing early laparoscopic cholecystectomy (ELC) with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis were incomplete. A meta-analysis was undertaken to compare the cost-effectiveness, quality of life, safety and effectiveness of ELC versus DLC. METHODS: PubMed, Embase, the Cochrane Library and Web of Science were searched for randomized clinical trials (RCTs) that compared ELC (performed within 7 days of symptom onset) with DLC (undertaken at least 1 week after symptoms had subsided) for acute cholecystitis. RESULTS: Sixteen studies reporting on 15 RCTs comprising 1625 patients were included. Compared with DLC, ELC was associated with lower hospital costs, fewer work days lost (mean difference (MD) -11·07 (95 per cent c.i. -16·21 to -5·94) days; P < 0·001), higher patient satisfaction and quality of life, lower risk of wound infection (relative risk 0·65, 95 per cent c.i. 0·47 to 0·91; P = 0·01) and shorter hospital stay (MD -3·38 (-4·23 to -2·52) days; P < 0·001), but a longer duration of operation (MD 11·12 (4·57 to 17·67) min; P < 0·001). There were no significant differences between the two groups in mortality, bile duct injury, bile leakage, conversion to open cholecystectomy or overall complications. CONCLUSION: For patients with acute cholecystitis, ELC appears as safe and effective as DLC. ELC might be associated with lower hospital costs, fewer work days lost, and greater patient satisfaction.

Clinical application and prognostic assessment of serum Tumor Associated Material (TAM) from esophageal cancer patients.

OBJECTIVE: To explore the correlation between serum levels of Tumor Associated Materials (TAM) and clinicopathological parameters and prognosis in patients with esophageal cancer (EC). PATIENTS AND METHODS: The levels of TAM were determined by chemical colorimetry in 100 EC patients and 100 healthy controls. RESULTS: Serum TAM levels were significantly higher in patients with esophageal carcinoma than in the control group (p < 0.001). High levels of TAM were associated with tumor size (p = 0.004), tumor depth (p < 0.001), stage (p < 0.001), lymph node metastases (p < 0.001), tumor differentiation (p = 0.001), tumor respectability (p = 0.002) and disease progression (p < 0.001). The poor prognostic outcomes were correlated with an elevated level of TAM (p = 0.001). Kaplan-Meier analysis showed patients with increased levels of TAM after operation had an lower overall survival (p < 0.001) and disease-free survival (p < 0.001). In addition, multivariate Cox proportional hazard analyses revealed that TAM may be an independent factor affecting the overall survival and disease-free survival (p < 0.001). CONCLUSIONS: The detection of TAM could be used to screen for tumor and assess unfavorable prognosis in patients with EC.

Hypoxia inducible factor stabilization as a novel strategy to treat anemia.

Anemia, one of the most common blood disorders, globally affecting ~1.62 billion people, occurs when the level of healthy red blood cells (RBCs) or/and hemoglobin in the body becomes too low. It can cause a variety of complications to human body, some of which are potentially very serious and carry significant risk factors, thus representing a big burden for social and economic development. Current therapeutic methods are efficient in controlling this disease but associated with many problematic issues. One way to circumvent these issues is by targeting HIF-PH (Hypoxia inducible factor prolyl hydroxylases) pathway. HIF is an oxygen-sensitive transcription factor that enables aerobic organisms to adapt to hypoxia through the transcriptional activation of up to 200 genes, many of which are critical to cell survival. Experimental and clinical studies have demonstrated that stabilization of HIF can up-regulate erythropoietin (EPO) expression and in turn increase count of RBCs potentially without causing drug resistance and cardiovascular diseases commonly seen with other therapies, rendering HIF stabilization a promising way to treat anemia. In this review, we highlight the biology of HIF-PH pathway, as well as the recent advances of HIF stabilizers of a natural or synthetic origin and concerns regarding drug development in this field.

Chemical and topological short-range orders in the ternary Ni-Zr-Al metallic glasses studied by Monte Carlo simulations.

Based on the recently constructed Ni-Zr-Al n-body potential, Monte Carlo simulations are performed to study the glass formation and associated structural evolutions in the system. The micro-chemical inhomogeneity (MCI) parameter and Honeycutt and Anderson (HA) pair analysis are employed to investigate both the chemical short-range orders and topological short-range orders for the ternary Ni-Zr-Al metallic glasses. Results reveal that remarkable chemical short-range orders (CSROs) exist in the ternary Ni-Zr-Al metallic glasses and are strongly influenced by the chemical interactions among the constituent elements. Moreover, topological short-range orders are clearly formed in the ternary Ni-Zr-Al metallic glasses, with the most remarkable characteristic being the icosahedral local packing. Similarly to CSRO, the extent of icosahedral short-range orders formed in the Ni-Zr-Al system varies distinctly with the chemical composition. In addition, simulation results reveal that chemical short-range orders and topological short-range orders turn out to be influenced by different factors. Unlike CSRO, both chemical interactions and geometrical constraints play important roles in forming the topological short-range orders.

INR targets and site-level anticoagulation control: results from the Veterans AffaiRs Study to Improve Anticoagulation (VARIA).

BACKGROUND: Not all clinicians target the same International Normalized Ratio (INR) for patients with a guideline-recommended target range of 2-3. A patient's mean INR value suggests the INR that was actually targeted. We hypothesized that sites would vary by mean INR, and that sites of care with mean values nearest to 2.5 would achieve better anticoagulation control, as measured by per cent time in therapeutic range (TTR). OBJECTIVES: To examine variations among sites in mean INR and the relationship with anticoagulation control in an integrated system of care. PATIENTS/METHODS: We studied 103,897 patients receiving oral anticoagulation with an expected INR target between 2 and 3 at 100 Veterans Health Administration (VA) sites from 1 October 2006 to 30 September 2008. Key site-level variables were: proportion near 2.5 (that is, percentage of patients with mean INR between 2.3 and 2.7) and mean risk-adjusted TTR. RESULTS: Site mean INR ranged from 2.22 to 2.89; proportion near 2.5, from 30 to 64%. Sites' proportions of patients near 2.5, below 2.3 and above 2.7 were consistent from year to year. A 10 percentage point increase in the proportion near 2.5 predicted a 3.8 percentage point increase in risk-adjusted TTR (P < 0.001). CONCLUSIONS: Proportion of patients with mean INR near 2.5 is a site-level 'signature' of care and an implicit measure of targeted INR. This proportion varies by site and is strongly associated with site-level TTR. Our study suggests that sites wishing to improve TTR, and thereby improve patient outcomes, should avoid the explicit or implicit pursuit of non-standard INR targets.

Comparison of the diagnostic value of 3-deoxy-3-18F-fluorothymidine and 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the assessment of regional lymph node in thoracic esophageal squamous cell carcinoma: a pilot study.

We used pathological examination as golden standard to determine whether 3-deoxy-3-(18)F-fluorothymidine positron emission tomography/computed tomography (FLT PET/CT) can detect regional lymph node metastasis in untreated thoracic esophageal squamous cell carcinoma and additionally performed (18)F-fluorodeoxyglucose (FDG) PET/CT for direct comparison with that of FLT. Twenty-two patients with thoracic esophageal squamous cell carcinoma underwent dual-tracer PET/CT examinations before surgery. The results of reviewing CT images and side-by-side FDG PET and FLT PET images for the diagnosis of locoregional lymph node metastasis were compared prospectively in relation to pathologic findings. All patients underwent esophagectomy and lymphadenectomy. Pathologic examination confirmed nodes positive for metastasis in 16 patients and 47 of 424 excised nodes. The uptake of FDG (median SUVmax, 5.4; range, 2.4-10.6) in locoregional lymph nodes metastases was significantly higher than that of FLT (median SUVmax, 2.8; range, 1.3-4.6). There were 14 false-positive nodes in FDG PET/CT and only 3 in FLT PET/CT; 8 false-negative nodes in FDG PET/CT, while there were 12 false negative nodes in FLT PET/CT. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FLT PET/CT were 74.47%, 99.20%, 96.46%, 92.11%, and 96.89%, respectively, whereas those of FDG PET/CT were 82.98%, 96.29%, 94.81%, 82.98%, and 96.29%, respectively. P-values were 0.450, 0.014, 0.313, 0.050, and 0.555, respectively. FLT uptake in regional lymph nodes of esophageal carcinoma is significantly lower compared with FDG uptake. FLT PET/CT has fewer false-positive findings and higher specificity compared with FDG PET/CT.

Mouse BAC ends quality assessment and sequence analyses.

A large-scale BAC end-sequencing project at The Institute for Genomic Research (TIGR) has generated one of the most extensive sets of sequence markers for the mouse genome to date. With a sequencing success rate of >80%, an average read length of 485 bp, and ABI3700 capillary sequencers, we have generated 449,234 nonredundant mouse BAC end sequences (mBESs) with 218 Mb total from 257,318 clones from libraries RPCI-23 and RPCI-24, representing 15x clone coverage, 7% sequence coverage, and a marker every 7 kb across the genome. A total of 191,916 BACs have sequences from both ends providing 12x genome coverage. The average Q20 length is 406 bp and 84% of the bases have phred quality scores > or = 20. RPCI-24 mBESs have more Q20 bases and longer reads on average than RPCI-23 sequences. ABI3700 sequencers and the sample tracking system ensure that > 95% of mBESs are associated with the right clone identifiers. We have found that a significant fraction of mBESs contains L1 repeats and approximately 48% of the clones have both ends with > or = 100 bp contiguous unique Q20 bases. About 3% mBESs match ESTs and > 70% of matches were conserved between the mouse and the human or the rat. Approximately 0.1% mBESs contain STSs. About 0.2% mBESs match human finished sequences and > 70% of these sequences have EST hits. The analyses indicate that our high-quality mouse BAC end sequences will be a valuable resource to the community.

A comparison of renal-related adverse drug reactions between rofecoxib and celecoxib, based on the World Health Organization/Uppsala Monitoring Centre safety database.

BACKGROUND: Two isoforms of cyclooxygenase (COX) have been identified, both of them inhibited by traditional nonsteroidal anti-inflammatory drugs (NSAIDs). Inhibition of COX-2 has been associated with the therapeutic effects of NSAIDs, whereas inhibition of COX-1 is believed to be the cause of the adverse gastrointestinal effects associated with NSAID therapy. When administered at therapeutic doses, new COX-2-specific inhibitors inhibit only the COX-2 isoform. OBJECTIVE: This study sought to compare renal safety signals between the COX-2-specific inhibitors rofecoxib and celecoxib, based on spontaneous reports of adverse drug reactions (ADRs) in the World Health Organization/Uppsala Monitoring Centre (WHO/UMC) safety database through the end of the second quarter 2000. METHODS: Disproportionality in the association between a particular drug and renal-related ADR was evaluated using a bayesian confidence propagation neural network method in which a statistical parameter, the information component (IC) value, was calculated for each drug-ADR combination. In this method, an IC value significantly greater than 0 implies that the association of a drug-ADR pair is stronger than background; the higher the IC value, the more the combination stands out from the background. The ratio of actual to expected numbers of ADRs was also used to assess disproportionality. RESULTS: As with traditional NSAIDs, both COX-2-specific inhibitors were associated with renal-related ADRs. However, the adverse renal impact of rofecoxib was significantly greater than that of celecoxib. IC values were significantly different for the following comparisons: water retention (1.97 rofecoxib vs 1.18 celecoxib; P < 0.01); abnormal renal function (2.38 vs 0.70; P < 0.01); renal failure (2.22 vs 1.09; P < 0.01); cardiac failure (2.39 vs 0.48; P < 0.01); and hypertension (2.15 vs 1.33; P < 0.01). In an additional analysis, celecoxib was shown to have a similar renal safety profile to that of diclofenac and ibuprofen. CONCLUSIONS: Based on spontaneous ADR reports in the WHO/UMC safety database at the end of the second quarter 2000, this analysis indicates that rofecoxib has significantly greater renal toxicity than celecoxib or traditional NSAIDs. This negative renal impact may have the potential to increase the risk for serious cardiac and/or cerebrovascular events.

Treatment of unruptured cerebral aneurysms in California.

BACKGROUND AND PURPOSE: The impact of endovascular therapy on treatment outcomes of unruptured cerebral aneurysms has not been studied in a defined geographic area. METHODS: All primary diagnoses of unruptured aneurysms were retrieved from a statewide database of hospital discharges in California from January 1990 through December 1998. Admissions for initial treatment and all follow-up care were combined to reflect the entire course of therapy. An adverse outcome was defined as an in-hospital death or discharge to nursing home or rehabilitation hospital at any point during the treatment course. Multivariable analyses were performed with generalized estimating equations with adjustment for age, sex, ethnicity, source of admission, year of treatment, hospital volume, and clustering of observations at institutions. RESULTS: A total of 2069 patients were treated for unruptured aneurysms. Adverse outcomes were more frequent in the 1699 patients treated with surgery (25%) than in those treated with endovascular therapy (10%; P:<0.001). The difference persisted after multivariable adjustment (surgery versus endovascular therapy: odds ratio for adverse outcomes, 3.1; 95% CI, 2.5 to 4.0; P:<0.001). Adverse outcomes declined from 1991 to 1998 in patients treated with endovascular therapy (P:<0.005) but not for surgery. In-hospital deaths occurred in 3.5% of surgical cases and 0.5% of endovascular cases (P:=0.003), and the difference remained significant after adjustment (odds ratio, 6.3; 95% CI, 3.5 to 11.4; P:<0.001). Total length of stay and hospital charges were greater in surgical cases (both P:<0.001). Results were similar in a confirmatory analysis focusing on treatment differences between institutions. Institutional treatment volume was also associated with outcome but did not account for the differences between surgery and endovascular therapy. CONCLUSIONS: In California, endovascular therapy of unruptured aneurysms is associated with less risk of adverse outcomes and in-hospital death, lower hospital charges, and shorter hospital stays compared with surgery. Differences between therapies became more distinct through the years. Uncontrolled differences in prognosis of patients receiving endovascular therapy and surgery cannot be ruled out in this study of discharge abstracts.

[Different sampling method affects the voice assessment results for the patient with vocal polyp].

OBJECTIVE: In order to definitude the influence caused by the different sampling in voice assessment. METHOD: We comparing the results acquired by total section and subsection sampling. RESULT: The results acquired by subsection tended to normal more than those acquired by total section. CONCLUSION: Subsection sampling voice assessment might conceal the degree of the disease state of patients.