Optimization of Diagnosis-Related Groups for 14,246 Patients with Uterine Leiomyoma in a Single Center in Western China Using a Machine Learning Model.

Background: Uterine leiomyoma (UL) is one of the most common benign tumors in women, and its incidence is gradually increasing in China. The clinical complications of UL have a negative impact on women's health, and the cost of treatment poses a significant burden on patients. Diagnosis-related groups (DRG) are internationally recognized as advanced healthcare payment management methods that can effectively reduce costs. However, there are variations in the design and grouping rules of DRG policies across different regions. Therefore, this study aims to analyze the factors influencing the hospitalization costs of patients with UL and optimize the design of DRG grouping schemes to provide insights for the development of localized DRG grouping policies. Methods: The Mann-Whitney U-test or the Kruskal-Wallis H-test was employed for univariate analysis, and multiple stepwise linear regression analysis was utilized to identify the primary influencing factors of hospitalization costs for UL. Case combination classification was conducted using the exhaustive chi-square automatic interactive detection (E-CHAID) algorithm within a decision tree framework. Results: Age, occupation, number of hospitalizations, type of medical insurance, Transfer to other departments, length of stay (LOS), type of UL, admission condition, comorbidities and complications, type of primary procedure, other types of surgical procedures, and discharge method had a significant impact on hospitalization costs (P<0.05). Among them, the type of primary procedure, other types of surgical procedures, and LOS were the main factors influencing hospitalization costs. By incorporating the type of primary procedure, other types of surgical procedures, and LOS into the decision tree model, patients were divided into 11 DRG combinations. Conclusion: Hospitalization costs for UL are mainly related to the type of primary procedure, other types of surgical procedures, and LOS. The DRG case combinations of UL based on E-CHAID algorithm are scientific and reasonable.

Nickel Single Atom Density-Dependent CO2 Efficient Electroreduction.

The transition metal-nitrogen-carbon (M─N─C) with MNx sites has shown great potential in CO2 electroreduction (CO2RR) for producing high value-added C1 products. However, a comprehensive and profound understanding of the intrinsic relationship between the density of metal single atoms and the CO2RR performance is still lacking. Herein, a series of Ni single-atom catalysts is deliberately designed and prepared, anchored on layered N-doped graphene-like carbon (x Ni1@NG-900, where x represents the Ni loading, 900 refers to the temperature). By modulating the precursor, the density of Ni single atoms (DNi) can be finely tuned from 0.01 to 1.19 atoms nm-2. The CO2RR results demonstrate that the CO faradaic efficiency (FECO) predominantly increases from 13.4% to 96.2% as the DNi increased from 0 to 0.068 atoms nm-2. Then the FECO showed a slow increase from 96.2% to 98.2% at -0.82 V versus reversible hydrogen electrode (RHE) when DNi increased from 0.068 to 1.19 atoms nm-2. The theoretical calculations are in good agreement with experimental results, indicating a trade-off relationship between DNi and CO2RR performance. These findings reveal the crucial role of the density of Ni single atoms in determining the CO2RR performance of M─N─C catalysts.

A large sample-based case-control study of related risk factors of two types of lichenoid vulvar disease (LVD).

PURPOSE: The purpose of this study is to identify the associated factors of two types of lichenoid vulvar disease (LVD) and to compare the differences in related factors between the different pathological types of lichenoid vulvar disease (LVD). METHODS: The study conducted at the West China second Hospital of Sichuan University included a total of 1770 patients with biopsy-confirmed vulvar lichen simplex chronicus (VLSC)and vulvar lichen sclerosus(VLS), along with 1209 patients with normal vulvovagina as control. Further pathological subtype analysis was carried out on 163 cases of vulvar lichen simplex chronicus and 51 cases of vulvar lichen sclerosus. In addition, Univariate chi-square test and multivariate logistic regression were used to analyze the lichenoid vulvar disease group and vulvovaginal normal control group. RESULTS: Univariate analysis revealed that there were statistically significant differences (P < 0.05) in factors between the LVD group and the control group, except for living type, sleep habit, history of drinking, and allergic diseases. There was no significant difference in late sleep, spicy diet, and coffee intake in the factors of life and eating habits and the concomitant disease factors. Furthermore, univariate analysis showed that except for eating seafood, humid living environment, residence, caffeinated drinks, hypertension, and vaginitis, there were statistical differences in the related factors of LVSC. CONCLUSION: The incidence about lichenoid vulvar disease is influenced by various factors such as dietary habits, living environment, mental stress, concomitant diseases, hormone levels and so on, and there were no significant differences in these factors between VLS and VLSC except for income, work stress, systemic immune diseases, and menopause.

A retrospective comparative cohort study of ultra-pulse CO2 lattice laser and glucocorticoids in the treatment of vulvar epithelial nonneoplastic lesions.

Background: A comparison of topical glucocorticoids with CO2 fractional laser treatment was conducted to investigate the differences in the efficacy of non-neoplastic vulvar epithelial lesion treatments in different pathological types and to provide a scientific basis for the management of these disorders. This paper was to study the difference of curative effect of different pathological types of non-tumor vulvar epithelial lesions and provide scientific basis for the treatment of these diseases. Methods: From November 2016 to July 2018, 178 cases of vulvar lichen simplex chronicus (LSC) or lichen sclerosus were confirmed with vulvar biopsy at our institute. Finally, 160 patients were enrolled in this trial. The patients were divided into 2 groups: a group treated with topical hormone and a group treated with CO2 lattice laser therapies. There were 80 cases in each group, including 40 with LSC and 40 with lichen sclerosus. Patients applied 1 gram of progesterone cream and betamethasone cream to the affected area in the morning and evening, respectively, once a day for 3 months. The efficacy was evaluated with the Patient Global Impression of Change (PGI-C) subjective symptom improvement scale and clinical efficacy evaluation scale. The formula was applied to calculate the curative effect index. Results: The PGI-C scores at 1, 3, and 6 months of treatment showed that the laser treatment group had remarkably superior outcomes to the glucocorticoid treatment group. The clinical efficacy score scale at 3- and 6-month treatments indicated a significantly greater curative effect in the laser than in the glucocorticoid treatment (P=0.006 and P=0.002 respectively). In the glucocorticoid group, the clinical effects of different pathological subtypes were significantly different following the 1- and 3-month treatments. The efficacy of treatment for LSC was better than that for lichen sclerosus. Following the 3- and 6-month treatments, the clinical effect for LSC was better than that of lichen sclerosus (3 months: 95% vs. 75%; 6 months: and 95% vs. 70%). Conclusions: Ultrapulse CO2 lattice laser was more effective than was glucocorticoid therapy in the treatment of vulvar epithelial non-tumor-like lesions.

Comparison of electrophysiology therapy and glucocorticoid therapy in the treatment of 2 subtypes of vulvar epithelial non-neoplastic lesions: a prospective cohort study.

Background: Lichen-like lesions with degeneration and pigmentation alterations can be divided into the following 2 types: (I) chronic simple lichen; and (II) sclerosing lichen. The etiology of the disease is unknown. This study sought to examine the therapeutic effects of electrophysiological smooth-muscle electrical stimulation in the treatment of lichen-like lesions of the vulva. Methods: A total of 80 outpatients, who had been confirmed to have vulvar lichen-like lesions by vulvar biopsy at our hospital from November 2016 to March 2018, were prospectively included in this study. The patients received electrophysiology or glucocorticoid therapy. After completing a treatment cycle according to the clinical treatment routine, the outpatients were monitored at 1-, 3- and 6-month intervals. Patients used an improvement scale (i.e., the patient global impression of change scale) to score their subjective perceptions and subjective symptoms. The clinical curative effect scale was used to calculate the curative effect index and grade the curative effect. Results: After 1 month of treatment, the active enhancement of simple lichen in the electrophysiological treatment group and glucocorticoid treatment group improved, while the active enhancement of simple lichen in the electrophysiological treatment group improved after 3 months of treatment. After 6 months of treatment, the subjective improvement score of the electrophysiological treatment group was better than that of lichen sclerosus. After 3 months of treatment, the effective rate of the electrophysiological therapy group was better than that of the glucocorticoid therapy group. After 6 months of treatment in the electrophysiological treatment group, the efficacy of simple lichen is also better than that of sclerotic lichen. Conclusions: Conventional hormone therapy is easier for patients to accept because of its convenience and low costs.

Association analysis of polymorphisms of candidate genes for laying traits in Yangzhou geese.

Egg production is an important economic trait in the Chinese goose industry. Due to the low heritability of annual egg production traits in geese, large-scale individual selection based on annual egg production measurements cannot be carried out. Therefore, new selection methods must be applied for large-scale early selections. To screen for effective molecular markers for early Yangzhou geese selection, the genotypes and gene frequencies of mutated loci of five candidate genes related to egg production, MAGI-1, ACSF2, ASTN2, KIAA1462, and ARHGAP21, were detected and analyzed by PCR-direct sequencing.Furthermore, correlation analysis was performed with annual egg mass and body weight at the point of lay and egg weight, and the results were as follows:Magi-1 (Record-106975)was A > G, ACSF2 (Record-106582)was A > C, ASTN2 (Record-111407)was A > T, KIAA1462 (Record-134172)was A > T, and the base of ARHGAP21 (Record-112359) was G > T. At all the five loci above, the Yangzhou geese population followed the Hardy-Weinberg equilibrium (P > 0.05). The results of the association analysis between different genotypes and production performance showed no significant differences in annual egg production, body weight at the point of lay, and egg weight, among different genotypes (P > 0.05) at the mutation loci of MAGI-1 and ASTN2. At the ACSF2 and KIAA1462, the annual egg production of AC was significantly higher than that of AA and CC (P < 0.05), the annual egg production of TT was significantly higher than that of AA (P < 0.05), and there were no significant differences in body weight at the point of lay and egg weight, among the three genotypes (P > 0.05). At ARHGAP21, the body weight at the lay point of the TT genotype was the highest, which was significantly higher than that of GG (P < 0.05); however, there was no significant difference with the heterozygous GT genotype for this trait (P > 0.05). Therefore, Genotype AC at ACSF2 and genotype TT at KIAA1462 could be used as favorable genotypes for egg production, and genotype TT at ARHGAP21 could be used as a favorable genotype for weight in Yangzhou geese.

Identification of potential associated factors for stress urinary incontinence in women: a retrospective study.

Background: This study sought to analyze the potential associated factors for female stress urinary incontinence (SUI). Methods: A total of 5,013 women were screened for pelvic floor function at the West China Second Hospital of Sichuan University from January 2015 to January 2019. Of these, 410 patients were diagnosed with SUI. A single-factor Chi-square test and multi-factor logistic regression analysis were conducted to examine the relationship between pre-pregnancy urinary incontinence, vaginal delivery, menopause, and hormone therapy, chronic cough, and smoking, and postpartum SUI. Results: The postpartum SUI rate in patients with urinary incontinence during pregnancy was 19.33%, while that of patients without urinary incontinence was only 5.44%. The rates of urinary incontinence in patients experiencing vaginal delivery or cesarean delivery were 13.62% and 4.36%, respectively. The SUI incidences in patients with or without a family genetic history of SUI were 28.46% and 7.48%, respectively. The incidence rates of SUI in smoking and non-smoking patients were 18.92% and 8.39%. The rate of SUI in patients with chronic cough (16.46%) behaved significantly differently from those with non-chronic cough (8.21%). The occurrence of SUI was highly correlated with the following factors, including pre-pregnancy urinary incontinence (OR =5.256; 95% CI: 2.061-13.409; P<0.001), urological incontinence during the pregnancy period (OR =2.965; 95% CI: 2.111-4.163; P<0.001), vaginal delivery (OR =4.028; 95% CI: 2.909-5.577; P<0.001), and genetic history (OR =4.341; 95% CI: 2.8-6.73; P<0.001). Conclusions: The occurrence of SUI is highly related to a history of urinary incontinence, the delivery mode, chronic cough, smoking, and genetic history. Further, urinary incontinence before and during pregnancy, natural delivery, and genetic history are important independent high-associated factors for SUI. Our findings show the importance of screening for the above associated factors in association with SUI.

Real-Time Detection of Body Nutrition in Sports Training Based on Cloud Computing and Somatosensory Network.

With the progress of society and the improvement of living standards, sports training has gradually become an area of increasing concern for society and individuals. To more comprehensively grasp the physical function, body shape, and physical fitness of athletes, many researchers have conducted extensive research on the real-time detection of human body nutrition. This study is mainly supported by cloud computing and somatosensory network technology, and the real-time detection of human body composition in sports training is the main research object. In the experiment, two methods of human body composition detection were tested: the BIA method and the body composition analysis method based on the electrochemical sensor of body sweat. It designed a human nutrient composition detection system based on the BIA method. The error rate of the system is relatively small, which is basically maintained at about 2%. It uses a body surface sweat electrochemical sensor to detect changes in glucose concentration during human exercise. After exercising for a period of time, the test subject's sweat glucose concentration remained around 0.5 mM.

Case series of COVID-19 patients from the Qinghai-Tibetan Plateau Area in China.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a serious infection caused by the new coronavirus severe acute respiratory syndrome coronavirus 2. The disease was first identified in December 2019 and has caused significant morbidity and mortality worldwide. AIM: To explore the clinical characteristics and treatments for COVID-19 in the Qinghai-Tibetan Plateau Area in China. METHODS: We retrospectively analyzed the blood cell counts (neutrophils and lymphocytes), blood gas analysis, and thoracic computed tomography changes of patients from Qinghai Province before, during, and after treatment (January 23, 2020 to February 21, 2020). In addition, we summarized and analyzed the information of critical patients. All data were analyzed using SPSS 17.0 (SPSS Inc., Chicago, IL, United States). The quantitative and count variables are represented as the mean ± SD and n (%), respectively. RESULTS: The main symptoms and signs of patients with COVID-19 were fever, dry cough, cough with phlegm, difficulty breathing, and respiratory distress with a respiration rate ≥ 30 times/min, finger oxygen saturation ≤ 93% in the resting state, and oxygenation index less than 200 but greater than 100 (after altitude correction). Eighteen patients with COVID-19, of whom three were critical, and the others were in a mild condition, were included. The main manifestations included fever, dry cough, and fatigue. Three patients developed difficulty breathing and had a fever. They were eventually cured and discharged. Adjuvant examinations showed one case with reduced white cell count (6%) (< 4 × 109/L), six with reduced count of lymphocytes (33%) (< 0.8 × 109/L), and one with abnormal blood glucose level. All 18 patients were discharged, and no death occurred. CONCLUSION: Our findings provide critical insight into assessing the clinical diagnosis and treatment for COVID-19 in the Tibetan plateau area.

Association between dynamic obesity and mortality in patients with first-ever ischemic stroke: A hospital-based prospective study.

Although obesity is an established risk factor of primary stroke, the association between obesity and post-stroke mortality remains unclear. The aim of this study was to investigate the association between dynamic obesity status and mortality in survivors of their first stroke in China.Of 775 patients with first-ever ischemic stroke included in a longitudinal study, 754 patients were included in this study and categorized into 4 categories of body mass index (BMI) (underweight, normal weight, overweight, and obese) and 2 categories of waist circumference (WC) (normal WC and abdominal obesity) according to standard Chinese criteria. The mortality information and obesity status were obtained via telephone follow-up every 3 months, beginning in 2010 through 2016. Time-dependent Cox proportional hazards models were used to estimate the unadjusted and adjusted hazard ratios (HRs) for the relationship between all-cause mortality and dynamic obesity status.Of 754 patients, 60.87% were male, and the overall mean age was 61.45 years. After adjusting for possible confounders, significant inverse associations were identified between BMI and WC and all-cause mortality. Compared with those with normal BMI or WC, those with abdominal obesity or overweight had a significantly lower risk of all-cause mortality (HR and 95% confidence intervals [CIs]: .521 [.303-.897] and 0.545 [.352-.845], respectively), whereas patients with underweight had the highest risk and those with obesity had lower risk of mortality, though it was not statistically significant (1.241 [.691-2.226] and .486 [.192-1.231], respectively).Overweight and abdominal obesity were paradoxically associated with reduced risk of mortality in patients who survived their first-ever ischemic stroke in China. Future prospective studies must look at evaluating the role of obesity in different stroke subtypes and devise appropriate weight-management strategies for optimal prognoses in secondary prevention in these survivors.

Associations between Lesion Locations and Stroke Recurrence in Survivors of First-ever Ischemic Stroke: A Prospective Cohort Study.

Several studies have indicated that stroke survivors with multiple lesions or with larger lesion volumes have a higher risk of stroke recurrence. However, the relationship between lesion locations and stroke recurrence is unclear. We conducted a prospective cohort study of first-ever ischemic stroke survivors who were consecutively enrolled from January 2010 to December 2015. Stroke recurrence was assessed every 3 months after post-discharge via telephone interviews by trained interviewers. Lesion locations were obtained from hospital-based MRI or CT scans and classified using two classification systems that were based on cerebral hemisphere or vascular territory and brain anatomical structures. Flexible parametric survival models using the proportional hazards scale (PH model) were used to analyze the time-to-event data. Among 633 survivors, 63.51% (n=402) had anterior circulation ischemia (ACI), and more than half of all ACIs occurred in the subcortex. After a median follow-up of 2.5 years, 117 (18.48%) survivors developed a recurrent stroke. The results of the multivariate PH model showed that survivors with non-brain lesions were at higher risk of recurrence than those with right-side lesions (HR, 2.79; 95%CI, 1.53, 5.08; P=0.001). There was no increase in risk among survivors with left-side lesions (HR, 0.97; 95%CI, 0.53, 1.75; P=0.914) or both-side lesions (HR, 1.24; 95%CI, 0.75, 2.07; P=0.401) compared to those with right-side lesions. Additionally, there were no associations between stroke recurrence and lesion locations that were classified based on vascular territory and brain anatomical structures. It was concluded that first-ever ischemic stroke survivors with non-brain lesion had higher recurrence risk than those with right-side lesion, although no significant associations were found when the lesion locations were classified by vascular territory and brain anatomical structures.

Association between obesity status and successful aging among older people in China: evidence from CHARLS.

BACKGROUND: The paper aimed to examine the association between obesity status and successful aging among elderly adults in China and further find gender differences in the effect of components of successful aging on obesity status. METHODS: The data came from the follow-up survey(2015) of China Health and Retirement Longitudinal Study (CHARLS) and 4019 dwellers age 60 and over are included. Obesity status were defined by the body mass index (BMI) according to Chinese criteria. Successful aging was defined following Rowe and Kahn's multidimensional model. Multivariable logistic regression was used to estimate the relationship between obesity status and successful aging. RESULTS: The rate of successful aging in men and women was 18.87 and 9.48% respectively. For BMI, the proportion of population with underweight, overweight and obesity in men was 10.29, 23.04 and 29.63% respectively and that in women was 1.40, 11.69 and 9.47%. Men with obesity (OR = 1.587 95% CI 1.087 ~ 2.316) has an positive relationship with successful aging than normal weight men; Women with underweight (OR = 0.197 95% CI 0.058 ~ 0.824) has an negative relationship with successful aging than normal weight women; Meanwhile, no matter men and women, the relationship between obesity status and successful aging were not significant among oldest adults(≥75 years). CONCLUSION: Obesity status was significantly association with successful aging in young older adults (60-74 years), and the components of successful aging differently were related with the obesity status of male and female.

Cefoperazone-sulbactam and risk of coagulation disorders or bleeding: a retrospective cohort study.

Objectives: Limited evidence has suggested that cefoperazone-sulbactam causes coagulation disorders and bleeding.Methods: The authors conducted a retrospective study to compare patients receiving cefoperazone-sulbactam versus those treated with cefoperazone-tazobactam or ceftazidime. Propensity-score matching was used to explore whether treatment with cefoperazone-sulbactam increased the risk of prothrombin time (PT) prolongation, coagulation disorders, and bleeding, or decreased platelets (PLT).Results: The cohort included 23,242 patients. Among patients receiving cefoperazone-sulbactam, the risk of PT prolongation, coagulation disorders, decreased PLT, and bleeding was 5.3%, 9.2%, 15.7%, and 4.2%, respectively. Propensity-score matching analyses suggested that cefoperazone-sulbactam increased the risk of PT prolongation (aOR 2.26, 95% CI 1.61-3.18), coagulation disorders (aOR 1.81, 95% CI 1.43-2.30), and decreased PLT (aOR 1.46, 95% CI 1.25-1.72), but not increase bleeding (aOR 1.05, 95% CI 0.79-1.40) compared with ceftazidime. Patients receiving cefoperazone-sulbactam had higher risk of PT prolongation (aOR 1.53, 95% CI 1.11-2.10), coagulation disorders (aOR 1.53, 95% CI 1.21-1.95), but not decreased PLT (aOR 0.93, 95% CI 0.81-1.07) or bleeding (aOR 1.11, 95% CI 0.87-1.42), compared with those receiving cefoperazone-tazobactam.Conclusion: Cefoperazone-sulbactam may be associated with a higher risk of PT prolongation and coagulation disorders compared with cefoperazone-tazobactam and ceftazidime.

Comparison of the flexible parametric survival model and Cox model in estimating Markov transition probabilities using real-world data.

BACKGROUND AND OBJECTIVE: Markov micro-simulation models are being increasingly used in health economic evaluations. An important feature of the Markov micro-simulation model is its ability to consider transition probabilities of heterogeneous subgroups with different risk profiles. A survival analysis is generally performed to accurately estimate the transition probabilities associated with the risk profiles. This study aimed to apply a flexible parametric survival model (FPSM) to estimate individual transition probabilities. MATERIALS AND METHODS: The data were obtained from a cohort study investigating ischemic stroke outcomes in Western China. In total, 585 subjects were included in the analysis. To explore the goodness of fit of the FPSM, we compared the estimated hazard ratios and baseline cumulative hazards, both of which are necessary to the calculate individual transition probabilities, and the Markov micro-simulation models constructed using the FPSM and Cox model to determine the validity of the two Markov micro-simulation models and cost-effectiveness results. RESULTS: The flexible parametric proportional hazards model produced hazard ratio and baseline cumulative hazard estimates that were similar to those obtained using the Cox proportional hazards model. The simulated cumulative incidence of recurrent ischemic stroke and 5-years cost-effectiveness of Incremental cost-effectiveness Ratios (ICERs) were also similar using the two approaches. A discrepancy in the results was evident between the 5-years cost-effectiveness and the 10-years cost-effectiveness of ICERs, which were approximately 0.9 million (China Yuan) and 0.5 million (China Yuan), respectively. CONCLUSIONS: The flexible parametric survival model represents a good approach for estimating individual transition probabilities for a Markov micro-simulation model.

Obesity and the onset of depressive symptoms among middle-aged and older adults in China: evidence from the CHARLS.

BACKGROUND: The association between obesity and depression has been documented in previous systematic studies but remains controversial. Many prospective studies have focused on children and youth, and several studies have examined this relationship among older populations. This study of the changes in obesity status aimed to examine the association between depression and obesity among middle-aged and elderly adults in China. METHODS: The data originated from the follow-up survey (2011 and 2013-2015) of the China Health and Retirement Longitudinal Study (CHARLS) and included 3337 residents aged at least 45 years who completed a physical examination and were evaluated with the Center for Epidemiological Studies Depression Scale (CES-D-10), which assessed depressive symptoms. Obesity status was defined by body mass index (BMI) and waist circumference (WC) according to Chinese criteria. A time-dependent Cox proportional hazards model was used to estimate the relationship between obesity status and depressive symptoms. RESULTS: The rate of depression in men and women was 26.67 and 38.37%, respectively. Based on BMI, the proportion of the population that was overweight and obese was 28.07 and 9.26%, respectively, in males and 35.03 and 16.84%, respectively, in females. Males with obesity were less likely to suffer from depressive symptoms than males with a normal weight (ORHR = 0.506, 95% CI = 0.347~ 0.736). Based on WC, the proportion of abdominal obesity was 49.35% in males and 73.65% in females. Males with abdominal obesity were less likely to suffer from depressive symptoms than males without abdominal obesity (ORHR = 0.775, 95% CI = 0.644~ 0.933). CONCLUSION: Obesity is more likely to be associated with the onset of depression in males than in females. However, regardless of underweight or overweight status, the relationship between weight and depressive symptoms is negatively associated among females and males. In conclusion, both BMI and WC can be used as tools for examining the association between obesity and depression.

Clinical implication and viral mutation in basal core promoter/pre-core of hepatitis B virus C/D recombinant.

BACKGROUND AND AIM: Hepatitis B virus (HBV) C/D recombinant is predominant in Tibet in Western China. Although the geographical and ethnic distributions of the C/D recombinant have been described, the clinical implication and the characteristics of viral mutation in the basal core promoter (BCP)/pre-core (PC) region remain unclear. METHODS: A total of 174 chronic HBV carriers, including 115 with chronic hepatitis B, 45 with liver cirrhosis, and 14 with hepatocellular carcinoma, were enrolled. Using next-generation sequencing, the S and BCP/PC genes were determined and analyzed. RESULTS: Genotypes B, C2, D, and C/D recombinant were detected in 1.1% (2/174), 19.5% (34/174), 0.6% (1/174) and 78.7% (137/174) of the patients, respectively. The clinical parameters and viral mutation frequency in the BCP/PC region were compared between C2- and C/D recombinant-infected patients. The distribution of C2 and C/D did not differ by disease status or liver function. Significantly higher levels of HBV DNA (6.7 ± 1.6 vs. 5.9 ± 1.5, p = 0.014), HBeAg (263.5 vs. 20.0, p = 0.013) and A1762T/G1764A double-mutations (81.0 vs. 61.8%, p = 0.018), but a lower frequency of G1896A stop mutation (33.6 vs. 76.5%, p < 0.001) was observed in patients with the C/D recombinant than in patients with genotype C2. The clonal frequencies of A1762T, G1764A, G1896A and A1846T were lower in patients with C/D than C2. CONCLUSION: The C/D recombinant has different mutation pattern in the BCP/PC region compared with genotype C2. The lower clonal frequencies of BCP/PC mutations may explain the higher levels of HBV DNA and HBeAg in C/D-infected patients.

Exercise and quality of life after first-ever ischaemic stroke: a two-year follow-up study.

BACKGROUND: Quality of life (QoL) post-stroke is an important health outcome. Physical deconditioning and physical inactivity are highly prevalent in stroke survivors. This study aimed to assess the long-term trends in QoL and to explore the effect of exercise on the QoL of ischaemic stroke patients. METHODS: Data for this prospective study were collected at baseline using face-to-face interviews, and telephone follow-ups were completed every three months from 2010 through 2014. QoL was evaluated with the 12-item Short-Form Health Survey (SF-12). The relationship between changes in exercise and QoL changes was analysed with a multi-level model. RESULTS: Exercise and QoL generally increased during the study period. After adjusting for covariates, the SF-12 Physical Component Summary (PCS) scores increased by 0.60 on average for each unit increase in exercise frequency and by 0.52 for each hour increase in weekly exercise time. For weekly exercise times ≤ 22.73 h, the PCS scores continued to increase with increasing exercise time. The Mental Component Summary scores increased by 0.51 on average for each unit increase in exercise frequency and by 0.35 for each hour increase in weekly exercise time. Furthermore, the standard deviations of exercise frequency and exercise time were inversely associated with changes in the PCS score. CONCLUSIONS: Exercise is an important modifiable behaviour. Long-term regular mild exercise should be recommended to improve QoL among stroke survivors.

[Application of Competing Risks Model in Predicting Smoking Relapse Following Ischemic Stroke].

OBJECTIVE: To determine factors associated with smoking relapse in men who survived from their first stroke. METHODS: Data were collected through face to face interviews with stroke patients in the hospital, and then repeated every three months via telephone over the period from 2010 to 2014. Kaplan-Meier method and competing risk model were adopted to estimate and predict smoking relapse rates. RESULTS: The Kaplan-Meier method estimated a higher relapse rate than the competing risk model. The four-year relapse rate was 43.1% after adjustment of competing risk. Exposure to environmental tobacco smoking outside of home and workplace (such as bars and restaurants) (P=0.01), single (P<0.01), and prior history of smoking at least 20 cigarettes per day (P=0.02) were significant predictors of smoking relapse. CONCLUSION: When competing risks exist, competing risks model should be used in data analyses. Smoking interventions should give priorities to those without a spouse and those with a heavy smoking history. Smoking ban in public settings can reduce smoking relapse in stroke patients.

[Sample Size Calculation using SAS for Phaseâ ¡in Two-stage Clinical Trials of Anti-tumor Drugs].

OBJECTIVE: To compare Gehan two-stage design and Simon two-stage design in sample size calculations for phase Ⅱ clinical trials of anti-tumor drugs. METHODS: We explained the sample size calculation methods with a single-stage design, Gehan two-stage design, and Simon optimal two-stage and minimax two-stage designs in line with the principle of exact binomial probability. By setting up different parameters in SAS macro program, the advantages and disadvantages of these designs were compared. RESULTS: The minimax two-stage design does not increase the maximum sample size compared with the single-stage design. Compared with the Gehan two-stage design, the Simon two-stage design has the advantage of being able to determine an early termination of trials when no or low anti-tumor activities are evident. CONCLUSION: Simon two-stage design is better than single-stage design and Gehan two-stage design. The minimax design is more popular than the optimal design.