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Objective To investigate the effects of socioeconomic factors on the prognosis of multiple myeloma (MM) patients and construct a prediction model for evaluating myeloma-specific survival (MSS) rates. Methods A total of 32625 patients diagnosed with MM between January 2007 and December 2016 were included through the SEER database. Cox regression model was used to analyze the predictive indicators of MSS. The results of the multivariate subgroup analysis were presented as forest plots. The significant factors identified in the multivariate Cox analysis were used to construct a nomogram. The predictive performance of the nomogram was assessed using the AUC and calibration plots. A nomogram score-based risk stratification system was constructed using a restricted cubic spline. Results Patients were divided into five groups according to their socioeconomic status (SES). Groups with higher SES had relatively higher proportions of those part of the White, insured, married, and urban populations. Age, gender, race, marital status, insurance status, and SES were independent prognostic factors of MSS (all P < 0.001). The linear trend of increased MSS risk with decreasing SES was most pronounced among the White, married, insured, and urban patients (all P < 0.001). The nomogram exhibited good discrimination and accuracy in both training and validation sets, showing AUC values of 0.701, 0.709, and 0.722 for predicting 3-, 5-, and 8-year MSS, respectively. A risk stratification model was established based on the nomogram total points and the HR, which then divided patients into three different risk levels with substantial survival disparities (all P < 0.001). Conclusion Socioeconomic factors, such as marital status, insurance status, and SES, have a significant impact on the survival outcomes of MM patients. The nomogram and the risk stratification model based on these factors can accurately and reliably predict MSS.
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Objective To investigate the current knowledge and execution status of venous thromboembolism (VTE) prevention and management among critical care practitioners in cancer hospitals in China. Methods A self-designed electronic questionnaire was used to survey the registered medical members from the Critical Care Medicine Society of China Anti-Cancer Association (CACA), 409 practitioners participated in the survey with validated questionnaires. The respondents were divided into physician group (n = 142) and nurse group (n = 267) according to the occupation. The practitioners' basic knowledge situation of VTE prevention, the daily practice of VTE prophylaxis, and the prevention of anti-coagulation situation in patients undergoing tumor surgery and non-surgery treatment were analyzed. Results Respondents from 24 Departments of Critical Care Medicine of Cancer Hospitals in 17 provinces and 4 municipalities across China participated in the survey, accounting for 29.0% of the total registered members of the Critical Care Medicine Society of CACA. ① Practitioners' current basic knowledge and attitude of VTE prevention:45.8% (11/24) of the hospitals involved in the survey had established VTE quality control system; 66.5% (272/409) of the respondents very concerned about VTE; the proportion of respondents very concerned about VTE [83.8% (119/142) vs. 57.3% (153/267)] and proportion of respondents who thought that VTE had a significant effect on prognosis [84.5% (120/142) vs. 74.9% (200/267)] in physician group were significantly higher than those in nurse group (both P < 0.05); a similar proportion of the respondents in physician and nurse groups suggested energetic prevention of VTE should be carried out [70.4% (100/142) vs. 69.3% (185/267), P > 0.05]. ② Daily practice of VTE prevention: compared with American College of Chest Physicians (ACCP) and National Comprehensive Cancer Network (NCCN) guidelines, the proportion of the respondents who were familiar with the VTE guidelines from the Chinese society of clinical oncology (CSCO) was significantly higher [61.4% (251/409) vs. 38.9% (159/409), 38.1% (156/409)]; 99.0% (405/409) of the respondents believed guidelines were necessary for the VTE prevention and management of critically ill cancer patients, meanwhile 60.6% (248/409) suggested the implementation of the current guidelines needed to be adjusted according to the clinical practical situation; 85.1% (348/409) of the respondents performed regular VTE risk assessment in clinical practice; 81.9% (335/409) implemented VTE prevention strategy based on difference in risk stratification results; 66.7% (273/409) of the respondents selected Caprini score recommended by the guidelines for VTE risk assessment. ③ VTE prophylaxis for critically ill cancer patients: for postoperative cancer patients, 78.5% (321/409) of the respondents implemented both mechanical prophylaxis and anticoagulants for prevention of VTE, 66.3% (271/409) respondents discontinued the mechanical prophylaxis and 54.0% (221/409) discontinued prophylactic anticoagulation once the patients were ambulatory; for patients with critical cancer illness under medical treatment, only 9.5% (39/409) of the respondents routinely implemented prophylactic anticoagulation, while the majority of respondents 82.4% (337/409) implemented prophylactic anticoagulation based on a comprehensive risk assessment for bleeding; 61.1% (250/409) discontinued mechanical prophylaxis and 42.3% (173/409) discontinued prophylactic anticoagulation once the patients were ambulatory. Conclusions The results of this nation-wide survey reveal the current knowledge and practice status of the VTE prevention and management among critical care practitioners in China, indicating that VTE prophylactic anti-coagulation practice for critically ill cancer patients is still suboptimal. The present guidelines are not directing to the VTE preventive works for such patients, resulting in that the VTE preventive strategy remains largely based on experiences of medical workers rather than scientific evidence from clinical trials. Establishing and improving expert consensus or guidelines for critical cancer patients are beneficial and of great importance to elevate the level of standardizing prevention and management of VTE in China.
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BACKGROUND:Procolagen type 1 N-terminal propeptide (P1NP) and β-colagen special sequence(β-CrossLaps) are two bone metabolic markers that are closely related to osteoporosis. Combined detection of bone metabolic markers and bone mineral density is of clinical significance for the diagnosis of osteoporosis. Bone metabolic markers are ideal indicators to predict fractures, which can compensate for the lack of bone density test. OBJECTIVE:To introduce the application of bone metabolic markers in the monitoring of drug efficacy on the treatment of osteoporosis as wel as in the prediction of fracture risks in recent 20 years and to explore the clinical values of P1NP and β-CrossLaps to assess the therapeutic efficacy on osteoporosis and risks for osteoporotic fractures. METHODS:A computer-based search of CNKI and SCI databases were performed for relevant articles published from 2000 to 2014 using the keywords of “serum bone metabolic markers; osteoporosis; bone mineral density” in Chinese and English, respectively. Finaly, 44 articles meeting the inclusive criteria were reviewed. RESULTS AND CONCLUSION:This paper analyzes the source and detection mechanisms of P1NPand β-CrossLaps and then compares their advantages in the therapeutic effect assessment of osteoporosis. Serum bone metabolic markers cannot only reflect the dynamic changes of bone metabolism, but also have earlier changes than the bone mineral density. Both P1NPand β-CrossLaps are very important for assessing the early diagnosis of osteoporosis as wel as anti-osteoporosis drug efficacy.
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Objective To evaluate the ultrasound guidance method in central venous catheterization (CVC) via the axillary vein.Methods Totally 1369 CVC patients in our center from November 2010 to October 2012 were enrolled in this study.They were randomly divided into two groups based on their different procedures:ultrasound group (n =687):the central veins were assessed using ultrasound,and catheters were placed via axillary vein with ultrasound guidance ; and control group (n =682):CVC was performed using the anatomical landmark method.The operation time,one-attempt success rate,complications,and malposition rate were compared between these two groups.Results The ultrasound group had significantly shorter operation duration than the control group [(7.8± 2.2) min vs (8.4 ± 1.7) min,P =0.000],higher one-attempt success rate [(96.0％ (659/687) vs 81.7％ (557/682),P =0.000],and lower complications and malposition rate [0.6％ (4/687) vs3.7％ (25/682),P=0.000; 0.6％ (4/687) vs2.1％ (14/682),P=0.017,respectively].Conclusions Compared with the conventional landmark method via subclavical vein,ultrasound-guided CVC via axillary vein method can effectively increase success rate,decrease operation duration,attempts of puncture,and complication rate,and avoid catheter malposition.Therefore,the ultrasound method can improve the safety and accuracy of the CVC procedure and deserves wider clinical application.