Analysis of the risk factors associated with incomplete endoscopic submucosal resection of rectal neuroendocrine neoplasm / 中国实用内科杂志

OBJECTIVE: To analyze the risk factors for incomplete endoscopic submucosal resection of rectal neuroendocrine neoplasms(r-NENs) and offer clinical experience after incomplete endoscopic submucosal resection. METHODS: From February 2012 to February2018, 62 cases of rectal carcinoid tumors resected by endoscopic submucosal dissection(ESD) were enrolled, and the factors associated with incomplete endoscopic resection were retrospectively analyzed by univariate and multivariate analysis. RESULTS: Univariate analysis demonstrated that depth of infiltration(P<0.05) and central depression of the surface mucosa(P<0.05) were risk factors for incomplete resection of ESD in rectal neuroendocrine neoplasms. Multivariate analysis revealed that central depression of the surface mucosa(P= 0.031) and infiltration of the lesion into the submucosa(P= 0.014) were independent risk factors for incomplete resection of rectal neuroendocrine neoplasms. CONCLUSION: Depth of infiltration into submucosa and the central depression of surface are associated with incomplete resection of rectal neuroendocrine neoplasm. After an incomplete ESD resection of rectal neuroendocrine neoplasm, without evidence of lympho-vascular invasion, a periodic follow-up examination may be considered.

Cognitive impairment and its influencing factors in the elderly / 预防医学

Objective To study the cognitive impairment and its influencing factors in people aged 60 years old or above. Methods From April to June in 2015, A total of 1 576 people aged 60 years or above in Yiwu were selected by the cluster random sampling method. The cognitive function of the respondents was evaluated by Zhejiang Major Public Health Monitoring? Program Questionnaire and Mini-Mental State Examination (MMSE) . Multivariate logistic regression model was used to analyze the influencing factors for cognitive impairment in the elderly. Results A total of 1 569 people were effectively investigated, of which 121 (7.71%) were diagnosed with cognitive impairment. The results of multivariate logistic regression analysis showed that advanced age (OR70～=1.792, 95%CI: 1.135-2.830; OR80～=4.060, 95%CI: 2.487-6.628), female (OR=1.739, 95%CI:1.135-2.664) , poor domestic economic condition (OR=2.339, 95% CI: 1.239-4.415) were the risk factors for cognitive impairment, while living with more than 4 people (OR=0.462, 95%CI: 0.246-0.867) and physical exercise (OR=0.592, 95%CI: 0.356-0.983) were the protective factors for cognitive impairment. Conclusion The prevalence of cognitive impairment was 7.71% in the elderly in Yiwu. Age, gender, family economic condition, housing condition and physical exercise were associated with cognitive impairment.

Clinical treatment of erectile dysfunction in type 2 diabeticpatients in the high-altitude area / 中华男科学杂志

Objective@#To investigate the safety and efficacy of pancreatic kininogenase combined with sildenafil in the treatment of erectile dysfunction(ED) in type 2 diabetes mellitus (DM) patients in the high-altitude area.@*METHODS@#This study included 93 ED patients with type 2 DM, all residents of the Xining area 1500 meters above sea level. We randomly divided them into an experimental group (n = 48) and a control group (n = 45), the former treated with pancreatic kininogenase(120 u, tid) and sildenafil (25 mg, qd at bedtime), while the latter with sildenafil only (25 mg, qd at bedtime).After 4 and 8 weeks of medication, we obtained the penile hemodynamic parameters,IIEF-5 scores, and sexual intercourse satisfaction(SIS) scores and compared them between the two groups of patients.@*RESULTS@#There were no statistically significant differences in age or DM course between the two groups of patients (P >0.05).Compared with the baseline, both the experimental and control groups showed remarkably improvement inthe IIEF-5 score (8.81 ± 2.06 vs 11.54 ± 7.72 and 8.29 ± 1.91 vs 9.37± 1.65, P 0.05). Even more remarkable improvement was observed at 8 weeks in the experimental and control groups in the IIEF-5 score (19.29± 1.85 and 15.43± 1.74)(P <0.05), SIS score (11.73 ± 2.57 and 6.55± 2.71) (P <0.05), and penile hemodynamic parameters(P <0.05), all with significant differences between the two groups (P <0.05).@*CONCLUSIONS@#Pancreatic kininogenase combined with sildenafil has a better clinical effect than sildenafil alone on ED in type 2 DM patientsin the high-altitude area.

A study on Bayesian classification model for common respiratory infectious diseases / 预防医学

Objective To provide diagnostic clue for the investigation and laboratory examination in outbreak of common respiratory infectious diseases using a computer -aided classification model.Methods The variables were extracted from medical literature,case data of infectious diseases,reports of outbreaks such as symptoms and signs,abnormal lab test results,epidemiologic features,the incidence rates of the infectious diseases.Then a classification model was constructed using Naive Bayesian classifier and SAS 9.1 .3 Data from eight historical outbreaks of respiratory infectious diseases were used to test the model.Results Among eight outbreaks,the discriminate probability of diagnosing a disease correctly by ranking it first on the output lists of the model was 53.85%.The sensitivity was 53.85%,and specificity was 1 00.00%, and +LR was from 5.73 to ∞.The discriminant probability of diagnosing a disease correctly by ranking it within the three most probable diseases on these lists was 98.34%.The sensitivity was 98.34% and the specificity was 82.1 4%,and +LR was from 1 .26 to ∞.Conclusion A Bayesian classification model could be applied to classification and discriminant of common respiratory infectious diseases,and could improve the ability for early diagnosis of the outbreak caused by respiratory infectious diseases.

Semi-quantitative risk assessment on local transmission of Dengue fever caused by introduced cases / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To assess the risk of local transmission of Dengue caused by introduced cases with semi-quantitative method in 2015 in Zhejiang Province.</p><p><b>METHODS</b>Risk indexes of local transmission of Dengue caused by introduced cases were reviewed. The weights of indexes were computed by analytic hierarchy process and further used to generate absolute risk values by multiplying indexes. Moreover, comprehensive indexes were computed to describe relative risk by combining analytic hierarchy process and TOPSIS methods.</p><p><b>RESULTS</b>Four primary indexes and 19 secondary indexes were identified for risk assessment of local transmission of Dengue. The indexes with maximum and minimum weight were the number of immigration from countries with Dengue patients (weight value: 0.0678) and density of population (weight value: 0.0371) respectively. All CR values, statistics for measuring consistency of score matrix, were less than 0.1 (minimum: 0.000, maximum: 0.0922, average: 0.0251). The absolute risk of Zhejiang Province was within the range of 0.397-0.504 (the full score was 1.0). The risk orders of 11 municipalities sorted by relative comprehensive indexes and absolute risk values methods were similar. The three highest municipalities were Hangzhou, Wenzhou and Ningbo and the ranges of absolute risk value were 0.387-0.494, 0.404-0.511 and 0.392-0.499 respectively.</p><p><b>CONCLUSION</b>The results provides scientific basis for preventing and controlling Dengue in Zhejiang Province. The indexes and weights may be used to assess risk of Dengue in future. In addition, the semi-quantitative method constructed in this study would be a significant reference for risk assessment of public health in emergencies.</p>

Construction of early warning model of influenza-like illness in Zhejiang Province based on support vector machine / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To construct a forecasting model of influenza-like illness in Zhejiang Province.</p><p><b>METHODS</b>The number of influenza-like cases and related pathogens among outpatients and emergency patients were obtained from 11 sentinel hospitals in Zhejiang Province during 2012 to 2013 (total 104 weeks), and corresponding meteorological factors were also collected. The epidemiological characteristics of influenza during the period were then analyzed. Linear correlation and rank correlation analyses were conducted to explore the association between influenza-like illness and related factors. Optimal parameters were selected by cross validation. Support vector machine was used to construct the forecasting model of influenza-like illness in Zhejiang Province and verified by the historical data.</p><p><b>RESULTS</b>Correlation analysis indicated that 8 factors were associated with influenza-like illness occurred in one week. The results of cross validation showed that the optimal parameters were C=3, ε=0.009 and γ=0.4. The results of influenza-like illness forecasting model after verification revealed that support vector machine had the accuracy of 50.0% for prediction with the same level, while it reached 96.7% for prediction within the range of one level higher or lower.</p><p><b>CONCLUSION</b>Support vector machine is suitable for early warning of influenza-like illness.</p>

An investigation on job satisfaction and turnover intention among staff in primary health institutions in Jingning county,Zhejiang province / 预防医学

Objective To learn the present situation and influencing factors of job satisfaction and turnover intention among staff in primary health institutions in Jingning county,Zhejiang province. Methods Questionnaire investigation was conducted targeted to primary health workers in Jingning County. One hundred and ninety nine questionnaires were included in the analysis. One - way ANOVA and multivariable logistic regression were applied to analyze relative indicators. Results The mean score of general job satisfaction among primary health workers was 76. 39 ± 7. 28 in Jingning County. The two items with the lowest two scores of job satisfaction were compensation(2. 81 ± 0. 97)and advancement(3. 38 ± 0. 86),and the highest two were co - worker(4. 23 ± 0. 49)and moral value(4. 15 ± 0. 58). The percentage of turnover intention was 6. 75% in permanent workers and 36. 11% in temporary contract workers. Multivariable logistic regression showed that compensation was the main influencing factor associated with turnover intention(OR = 0. 33,95% CI:0. 19 -0. 58). Conclusion The primary health workers Jingning County are basically satisfied with their job,and low income and difficult promotion are the main problems at the moment. Increasing financial input,reforming income distribution mechanism and improving promotion channels are necessary to develop human resource in primary health institutions and to insure successful implementation of health care reform.

An analysis on the influencing factors of pregnant women's choice of abortion methods by the combination of decision tree and logistic regression model / 预防医学

Objective To understand the influencing factors of pregnant women's choice of abortion methods by exhaustive CHAID decision tree and logistic regression model,and to evaluate the two statistical methods.Methods Pregnant women who underwent artificial abortion in 2011 were selected from 30 medical institutions of 10 cities in Zhejiang province.And a questionnaire survey was conducted.The influencing factors of pregnant women's choice of abortion methods were analyzed by exhaustive CHAID decision tree and logistic regression model,and the two methods were compared.Results Exhaustive CHAID tree analysis showed that the choice of artificial abortion methods were associated with preferences,gestational age, induced abortion history,marital status,fertility condition and abortion cognitive such as slight pain in drug abortion,the time limitation of drug abortion,greater possibility of curettage after induced abortion.Preferences and gestational age were the two major influencing factors.The model was stable and well fitting with the risk estimation 0.119 and prediction error 11.90%.And the logistic regression analysis showed the similar results expect induced abortion history and marital status. Age,education level and decision source were also the influencing factors in the logistic regression model.Conclusion The combination of decision tree and logistic regression analysis can analysis the influencing factors of pregnant women's choice of abortion methods,and information from the two methods should be combined to improve the efficiency of analysis.

Meta-analysis on efficacy and safety of Shenmai injection in treatment of coronary heart disease / 中国中药杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of Shenmai injection in the treatment of coronary heart disease (CHD).</p><p><b>METHOD</b>CNKI (1979 to December 2011), VIP (1989 to December 2011), and Wanfang Data (1987 to December 2011) were retrieved for literatures concerning randomized controlled trials of Shenmai injection in the treatment of coronary heart disease. Their quality was assessed by the Jadad scale. Review Manager 5.0 and Stata 12 software were adopted for data analysis.</p><p><b>RESULT</b>Altogether 18 randomized clinical trials were included in the Meta-analysis. According to the findings, compared with routine therapy alone, the combination of Shenmai injection and routine therapy increased the overall effective rate by clinical symptoms by 22% [RD = 0.22, 95% CI (0.17, 0.26), P<0.000 01], with the relative risk ratio of [RR = 1.31, 95% CI (1.20, 1.43), P<0.000 1] and the efficacy by electrocardiogram by 25% [RD = 0.25, 95% CI (0.19, 0.31), P<0.000 01], with the relative risk ratio of [RR = 1.46, 95% CI (1.32, 1.62), P<0.000 1]. It also improved New York heart association classification (NYHA) by 33% [RD = 0.33, 95% CI (0.16, 0.49), P<0.000 01], with the relative risk ratio of [RR = 1.79, 95% CI (1.28, 2.51), P = 0.000 6] and left ventricular ejection fraction [WMD 7.55, 95% CI (2.28, 12.83)]. Additionally, studies reported that Shenmai injection could increase left ventricular stroke volume, decrease left ventricular end systolic diameter, improved hemodynamic indexes, reduced NT-pro-BNP, DMA, cytokines, TNF-alpha, IL-6 and serum enzyme, mitigated infarction-related revascularization IRA indexes and shortened the symptom improvement time and electrocardiogram recovery time. Three studies had reported adverse events, mainly dizziness, palpitation, mild abdominal distension, nausea, metal excitement and flushed face, with no serious adverse effect.</p><p><b>CONCLUSION</b>Clinical evidences prove that Shenmai injection has certain effect in treating CHD and remains to be improved in the overall effective rate. The essay, despite of some shortcomings, provides certain reference for clinical application. It is suggested holding more multicenter randomized controlled trials with rational design, strict implementation, large sample size and sufficient following-up time to further verify its efficacy and safety.</p>