Analysis of Breast Cancer Screening Results and Influencing Factors of Breast Cancer in Guangdong Province from 2017 to 2021.

BACKGROUNDS: Breast cancer screening plays an important role in the early detection, diagnosis and treatment of breast cancer. The aim of this study was to evaluate the screening results and explore the influencing factors of breast cancer detection rate in Guangdong. METHODS: This cross-sectional study was conducted among 2,024,960 women aged 35-64 in Guangdong Province during 2017-2021. The data about breast cancer screening information were collected from the Guangdong maternal and child health information system. Descriptive statistical analysis was used to explain demographic characteristics and results of breast cancer screening. The generalized linear regression model was applied to analyze the related influencing factors of breast cancer detection rate. RESULTS: The estimated detection rate of breast cancer in Guangdong Province is 70.32/105, with an early diagnosis rate of 82.06%. After adjusting covariates, those women with older age (45-55 [OR (95% CI) 2.174 (1.872, 2.526)], 55-65 [OR (95% CI) 2.162 (1.760, 2.657)]), education for high school ([OR (95% CI) 1.491 (1.254, 1.773)]) and older age at first birth ([OR (95% CI) 1.632 (1.445, 1.844)]) were more likely to have higher detection rate of breast cancer. No history of surgery or biopsy ([OR (95% CI) 0.527 (0.387, 0.718)]), no history of breast cancer check ([OR (95% CI) 0.873 (0.774, 0.985)]) and no family history of breast cancer ([OR (95% CI) 0.255 (0.151, 0.432)]) women were more likely to screen negative for breast cancer (P < 0.05). CONCLUSION: The detection rate of breast cancer in screening showed an increasing trend year by year in Guangdong Province. Older age, education for high school and older age at first birth were risk factors for breast cancer detection rate, while no surgery or biopsy history, no family history of breast cancer and no history of breast cancer check were protective factors.

In vivo measurement of regional corneal tangent modulus.

Currently available clinical devices are unable to measure corneal biomechanics other than at the central region. Corneal stiffness (S), thickness, and radius of curvature was measured at the central cornea (primary fixation) and 3 mm from the temporal limbus (primary and nasal fixations). The corneal tangent modulus (E) of 25 healthy subjects was calculated from these data. After confirming normality, repeated measures analysis of variance (RMANOVA) revealed significant difference in S (F(2, 48) = 21.36, p < 0.001) at different corneal regions and direction of fixations. E also varied significantly at different corneal regions and direction of fixations (RMANOVA: F(2, 48) = 23.06, p < 0.001). A higher S and a lower E were observed at the temporal region compared with the corneal centre. Nasal fixation further increased S and E values compared with primary fixation. Due to the specific arrangement of corneal collagen fibrils, heterogeneity of corneal biomechanical properties is expected. In future clinical practice, localized corneal biomechanical alternation and measurement might assist corneal disease detection and post-surgery management. In addition, practitioners should be aware of the fixation effect on corneal biomechanical measurement.

High myopes have lower normalised corneal tangent moduli (less 'stiff' corneas) than low myopes.

PURPOSE: To compare corneal tangent moduli between low and high myopes. METHODS: Corneal hysteresis (CH) and corneal resistance factor (CRF) of 32 low and 32 high myopes were obtained using an Ocular Response Analyzer, followed by a corneal indentation device that measured corneal stiffness. Corneal topography, pachymetry, Goldmann applanation tonometry intraocular pressure (GAT-IOP), and corneal compensated intraocular pressure (IOPcc) were also obtained. Corneal tangent modulus was calculated on the basis of corneal stiffness, central corneal thickness and corneal radius. Comparisons between groups and associations between corneal biomechanical and ocular parameters were performed. RESULTS: Corneal tangent moduli were positively correlated with GAT-IOP (R2 = 0.078, p = 0.025), and IOPcc (R2 = 0.12, p = 0.006). Despite similarity in corneal thickness and radius, high myopes exhibited a significantly higher IOPcc (16.4 ± 2.51 mmHg) than low myopes (13.1 ± 1.96 mmHg; t(62) = -5.57, p < 0.0001). Both groups had similar corneal stiffness (0.063 ± 0.0085 and 0.063 ± 0.0079 N mm-1 for low and high myopes, respectively) and CRF (9.6 ± 1.58 and 9.5 ± 1.90 mmHg for low and high myopes, respectively). Moreover, high myopes exhibited a significantly lower CH (9.5 ± 1.51 mmHg) than low myopes (10.6 ± 1.38 mmHg; t(62) = 2.92, p = 0.005). After normalising corneal tangent moduli to the mean intraocular pressure in normal eyes (15.5 mmHg) using IOPcc, high myopes showed a significantly lower corneal tangent moduli (0.47 ± 0.087 MPa) than low myopes (0.57 ± 0.099 MPa; t(62) = 4.17, p < 0.0001). CONCLUSIONS: High myopes had lower normalised corneal tangent moduli than low myopes, which indicated that their corneas were less stiff. This is the first in vivo study comparing elastic moduli of the cornea in different refractive groups. Further studies are warranted to understand whether a less stiff cornea is a cause for or an outcome from myopia development.

Diurnal Variation of Corneal Tangent Modulus in Normal Chinese.

PURPOSE: The aim of this study was to investigate the diurnal variation of corneal tangent modulus, measured using a novel corneal indentation device, in healthy Chinese subjects. METHODS: The central corneal thickness (CCT), mean central corneal radius (meanK), intraocular pressure (IOP), and corneal stiffness of 25 young adults aged 21 to 25 years (23.0 ± 1.0 yrs) were measured at 3-hour intervals from 09:00 to 21:00 in the course of 1 day. Corneal tangent modulus was calculated on the basis of corneal stiffness, CCT, and meanK. Repeated-measures analyses of variance were performed to compare the diurnal changes in ocular parameters over time. RESULTS: Significant diurnal variations were observed in CCT and IOP (P < 0.001 and P = 0.025, respectively). Both parameters showed a decreasing trend throughout the day. MeanK and corneal stiffness did not show any significant diurnal changes (P = 0.251 and P = 0.516, respectively). Mean corneal tangent modulus across all measurements was 0.047 ± 0.085 MPa, and its diurnal rhythm ranged from 0.469 to 0.485 MPa. The variation was nonsignificant (P = 0.526). CONCLUSIONS: The elastic properties of the cornea in healthy Chinese subjects were stable during wake time. The present study shows that the corneal indentation device obtains stable corneal biomechanics similar to other clinical devices. Future studies investigating the differences in corneal biomechanics among patients with various ocular conditions are warranted.

Soft wearable contact lens sensor for continuous intraocular pressure monitoring.

Intraocular pressure (IOP) is a primary indicator of glaucoma, but measurements from a single visit to the clinic miss the peak IOP that may occur at night during sleep. A soft chipless contact lens sensor that allows the IOP to be monitored throughout the day and at night is developed in this study. A resonance circuit composed of a thin film capacitor coupled with a sensing coil that can sense corneal curvature deformation is designed, fabricated and embedded into a soft contact lens. The resonance frequency of the sensor is designed to vary with the lens curvature as it changes with the IOP. The frequency responses and the ability of the sensor to track IOP cycles were tested using a silicone rubber model eye. The results showed that the sensor has excellent linearity with a frequency response of ∼8 kHz/mmHg, and the sensor can accurately track fluctuating IOP. These results showed that the chipless contact lens sensor can potentially be used to monitor IOP to improve diagnosis accuracy and treatment of glaucoma.

Effect of Xinjikang on left ventricular hypertrophy remodeling in hypertensive rats.

OBJECTIVE: To investigate the effects of Xinjikang on the left ventricular hypertrophy remodeling and myocardial activity in hypertension. METHODS: Sixty Wistar rats were randomly divided into four groups. The pressure-loaded left ventricular hypertrophy model was established with abdominal aorta ligation method. Rats in A and B groups were intragastrically administered with physiological saline, while C and D groups were administered with Xinjikang and metoprolol, respectively. The changes in blood pressure, E/A ratio, myocardial pathological morphology, myocardial lipoperoxides and superoxide dismustase activity in four groups were observed and compared before and after treatment. RESULTS: There were statistically significant differences in E/A ratio between C group after treatment and model group (P<0.05), while no difference was observed between A and D groups (P>0.05); after treatment the myocardial lipoperoxides and superoxide dismustase contents in C and D groups were improved significantly compared with model group (P<0.05). CONCLUSIONS: Xinjikang can improve myocardial injury, restore myocardial parenchyma and myocardial interstitial remodeling functions in hypertensive rats with the left ventricular hypertrophy.

Multi-factorial analytical study on real-time three-dimensional echocardiographic cardiac image display quality.

Although real-time three-dimensional echocardiography (RT-3DE) can display stereoscopic images, its acquisition and image display quality are affected by many factors. So, the study aimed to evaluate the importance of factors affecting the efficiency of RT-3DE image display quality, and establish an optimized method for RT-3DE examination and image processing in children. Based on the specific cardiac acoustic characteristics in children, 83 healthy children were studied and divided into five groups. Three aspects of seven factors were selected for RT-3DE examination and analysis of orthogonal test design method, including acquisition windows, gain, compress, post process, smoothing, frequency fusion and 3D Vision. The principal effective analysis of orthogonal test design method and its table L(18)3(7) were used. The efficiency rate of three-dimensional image display quality was used as the inspection index for orthogonal test design method. From our findings, according to the average deviation orders of seven factors, the maximal average deviation was the factor of gain. The aspects with maximal average deviation of each factor were at via-subcostal and via-apical acoustic windows, 90 of gain, 60 of compress, E of post process, five of smoothing, F3 of frequency fusion and A to B of 3D Vision, respectively. Namely, the optimized method for RT-3DE examination and image displaying could be achieved by setting the factors. Multi-factorial analytical study on RT-3DE cardiac image display quality could be helpful to promote clinical application of RT-3DE, and be conducive to design a multi-parameter presetting of ultrasound system to optimize RT-3DE examination.

Echocardiographic assessment of juxtaposition of the right atrial appendage in children with congenital heart disease.

The objective of this study was to analyze the echocardiographic characteristics of juxtaposition of the atrial appendages and to determine its prevalence in children with congenital heart disease. From June 1998 to December 2008, 10,880 children underwent selective angiocardiography, magnetic resonance imaging (MRI), and echocardiography for evaluation of congenital heart disease. Juxtaposition of the atrial appendages was diagnosed based on the results of angiocardiography and MRI; the echocardiographic characteristics of this anomaly were analyzed retrospectively. There were 33 patients diagnosed with juxtaposition of the right atrial appendage (JRAA); no patient was diagnosed with juxtaposition of the left atrial appendage. The prevalence of JRAA in children with congenital heart disease was 0.30%. JRAA and abnormal spatial orientation of the atrial septum were visualized by Doppler echocardiography in 28 cases. In the remaining five cases, three cases with suspected JRAA could not be determined by echocardiography and the diagnosis was missed in two cases. The most common associated anomalies were conotruncal malformations (16 cases with double outlet of the right ventricle, 9 cases with pulmonary atresia, 6 cases with transposition of the great arteries, 1 case with tetralogy of Fallot) and tricuspid malformations (6 cases with tricuspid straddling, 3 cases with tricuspid atresia, 2 cases with tricuspid valve stenosis). Based on the characteristic alteration of the plane of the atrial septum and visualization of the malpositioned right atrial appendage, JRAA can be accurately diagnosed by Doppler echocardiography.

Echocardiographic assessment of conjoined twins with congenital heart disease in Shanghai.

BACKGROUND: The aim of this study is to improve the diagnosis of congenital heart disease in conjoined twins using echocardiography. METHODS: Six sets of conjoined twins at Shanghai Children's Medical Center and Xin-Hua Hospital from 1980 to 2006 were assessed retrospectively. Cardiac anomalies of varying degrees of severity were first evaluated using 2D echocardiography. Tissue Doppler imaging (TDI) was then performed if fused ventricles were suspected. Peak systolic velocities, peak systolic strain rates, and peak systolic strains at the fused myocardium were quantitatively measured using strain rate imaging (SRI). If the M-mode echocardiographic image was poor or difficult to measure, the myocardial performance index (MPI) of the left ventricle was calculated. RESULTS: Intracardiac anomalies were diagnosed correctly using echocardiography and confirmed by surgical findings. Cardiac functional assessment using MPI demonstrated heart failure in three out of the eight individuals. Subtle conjunction of the ventricles, however, were more difficult to visualize and two sets of conjoined twins with fused hearts could not be clearly demonstrated by echocardiography. In one case of suspected ventricular wall conjunction, TDI showed separate ventricular myocardia which was confirmed at surgery. CONCLUSIONS: Intracardiac anomalies and ventricular function can be readily demonstrated by echocardiography, but subtle conjunction of the ventricles may be more difficult to visualize. TDI may be required if there is uncertainty about the degree of cardiac fusion.

Doppler myocardial performance index in assessment of ventricular function in children with single ventricles.

BACKGROUND: Quantitative assessment of ventricular function in children with single ventricles is both difficult and subjective because of asymmetric ventricular geometry. The Doppler myocardial performance index (MPI) allows the assessment regardless of ventricular shape. This study was designed to evaluate the feasibility of MPI in assessing ventricular function in children with single ventricles before and after total cavopulmonary connection (TCPC). METHODS: Subjects consisted of 161 pediatric patients with single ventricles and 80 normal children without heart disease. The maximum positive rate of ventricular pressure change (Max dp/dt) was obtained in 58 patients by cardiac catheterization. Sixty-eight children with single ventricles received TCPC. MPI was calculated from Doppler tracings of ventricular inflow and outflow, then MPI of single ventricles before and after surgery and normal heart were compared. RESULTS: Normal MPI value was 0.30+/-0.08 in the left ventricle and 0.26+/-0.08 in the right ventricle. Compared to normal children, MPI was significantly higher in 161 children with single ventricles (0.54+/-0.11, P<0.001). MPI correlated inversely with Max (dp/dt) (r=-0.77, P<0.01), and was positively related to age (r=0.54, P<0.01) in patients with single ventricles. MPI did not differ significantly before and after surgery in 68 patients with single ventricles (0.55+/-0.21 vs 0.51+/-0.20, P>0.05). However, MPI in 48 patients of <6 years old decreased significantly (0.55+/-0.21 vs 0.48+/-0.18, P<0.05), suggesting improved ventricular function. CONCLUSIONS: Compared to normal children, ventricular function is impaired in patients with single ventricles and may worsen with age. MPI provides an accurate method for assessing ventricular function in children with single ventricles before and after TCPC.

Value of real-time 3-dimensional echocardiography sectional diagnosis in complex congenital heart disease evaluated by receiver operating characteristic analysis.

OBJECTIVE: We sought to evaluate the value of real-time 3-dimensional (3D) echocardiography (RT-3DE) in the pathologic morphology of complex congenital heart disease (CHD) using receiver operating characteristic (ROC) analysis. METHODS: Thirty patients with complex CHD were examined by 2-dimensional echocardiography (2DE) and RT-3DE. Their diagnoses of pathologic morphology were made by 3 echocardiographers blinded to clinical data. Their value was evaluated by ROC analysis using a 5-point categorical scale in major cardiovascular structures and spatial relationships among complex CHD. RESULTS: Compared with surgical findings, there were 75.6% of the definitely correct in RT-3DE and 64.4% in 2DE. ROC curve for RT-3DE was located left-superior to that for 2DE, and the area under ROC curve for RT-3DE (A = 0.96) was higher than that for 2DE (A = 0.90). There was significant difference between them by the method of Z test (Z = 2.64, P = .0083). CONCLUSIONS: With the spatial 3D display of cardiovascular structural malformations, RT-3DE, coupled with conventional Doppler 2DE, may add information on complex CHD.

Methodological study on real-time three-dimensional echo-cardiography and its application in the diagnosis of complex congenital heart disease.

BACKGROUND: Real-time three-dimensional echocardiography (RT-3DE) has made revolutionized improvements of cardiac imaging during the past few years. However, there is no standard examination method for RT-3DE so far. This study aimed to establish the diagnostic method of RT-3DE and evaluate its application in the diagnosis of complex congenital heart diseases (CHD). METHODS: Fifty patients with complex CHD were examined by RT-3DE with modes of Live 3DE and Full Volume. A series of novel volumetric views combined with Van Praagh sequential segmental approach were introduced to reveal the pathological morphology of the hearts, which were compared with the findings of two-dimensional echocardiography (2DE), angiography and cardiac surgery. RESULTS: In 50 patients, 190 image acquisitions of Full Volume were performed at several acoustic windows including subcostal, apical and parasternal regions. Among them, 94.2% (179/190) of image acquisitions were successful. Most sectional volumetric views could be clearly displayed in 92.6% of the successful image acquisitions. However, sectional volumetric views could not be clearly displayed in 7.4%, which was mainly due to poor perspective conditions of examination location, improper instrument multi-parameter setting and insufficient information of whole heart captured in Full Volume acquisitions. As compared with surgical findings and angiography, RT-3DE made correction to the diagnoses in 2 cases including 1 with corrected transposition of the great arteries and the other with single atrium and mitral cleft. The diagnoses initially made by 2DE for these 2 patients were double outlet right ventricle with transposition of the great arteries and complete atrio-ventricular septal defect. CONCLUSIONS: RT-3DE can clearly display the pathological morphology of complex CHD by a series of novel volumetric views combined with sequential segmental approach through providing more spatial informative cardiovascular structures, which provides a practical method for RT-3DE diagnosis.

[Pathological diagnosis of conotruncal defects by transthoracic three-dimensional echocardiography].

OBJECTIVE: Recently, it has been demonstrated in several studies that three-dimensional echocardiography (3DE) with any cut view interpretation of the cardiac morphological structures and its dynamic three-dimensional display can conform to the need of accurate anatomical diagnosis of complex congenital heart diseases including conotruncal defects (CTD). 3DE can not only provide functional and morphological information of CTD to decide on surgical repair but also simulate the intra operative visualization of complex anatomical cardiac structures to improve the understanding of the anatomy of CTD, but there have been scarce studies to assess systematically the potential noninvasive diagnostic value of transthoracic 3DE for CTD in children. Thus, this study attempted to evaluate the diagnostic value of transthoracic 3DE for the pathological diagnosis of CTD in children. METHODS: HP Sonos 5500 echocardiographic system interfaced with Tomtec 3DE imaging system (echo-view 4.2 software) was used to diagnose 210 patients (132 male, 78 female, aged 0-15 years, mean 3.2 +/- 3.2 years) with CTD in Shanghai Children's Medical Center from May 2000 to November 2003, including 62 patients with double outlet right ventricle, 48 patients with transposition of great arteries, 48 patients with tetralogy of Fallot, 38 patients with pulmonary atresia with interventricular septal defect and 14 patients with persistent truncus arteriosus. Diagnostic method consisting of ten designed 3DE sectional views and Van Praagh's sequential segmental approach in congenital heart diseases was used in this study. And the results were compared with those diagnosed by two-dimensional echocardiography (2DE) and angiocardiography. Surgical findings were considered as the "gold standard". RESULTS: There were 526 image acquisitions of transthoracic 3DE in the 210 patients with CTD including 200 through subcostal window, 254 through parasternal window and 72 through apical window, among which 477 image acquisitions (93.2%) could demonstrate good spatial cardiovascular structures. Meanwhile, six 3DE sectional views of the diagnostic method of the ten designed 3DE sectional views were identified for the diagnosis of CTD as follows: en-face view of atrial and ventricular septa from left ventricle (L1a); en-face view of atrial and ventricular septa from right ventricle (L2a); four-chamber view of whole-heart oblique frontal plane (Ha and Hb); en-face view of atrial-ventricular valve from atria (S1a) and en-face view of atrial-ventricular valve from ventricles (S2a). The 3DE sectional diagnosis showed that 3DE could provide more information of inner cardiac structure than 2DE, such as ventricular configuration identification, atrial-ventricular and ventricular-arterial continuity, location and shape of ventricular septal defect (VSD), and appreciation of the defects related with aorta and pulmonary arteries, etc. In 147 cases of surgical repair, both 3DE and 2DE were in accordance with the surgical findings, but 3DE had new findings in 18 (12.2%) cases and corrected the diagnoses in 10 (6.8%) cases as compared with 2DE. CONCLUSION: The 3DE sectional diagnostic method could make a successfully sectional diagnosis of pathological morphology in CTD by demonstrating more spatial information of inner cardiac structure than 2DE and angiocardiography.