[Effects of early debridement and conservative eschar removal followed by wound coverage with acellular dermal matrix in the treatment of children with deep burns].

Objective: To explore the effects of early debridement and conservative eschar removal followed by wound coverage with acellular dermal matrix (ADM), i.e., early surgery, in the treatment of children with deep burns. Methods: This study was a retrospective cohort study. From January 2017 to December 2022, 278 deep burned hospitalized children aged 1-7 years who met the inclusion criteria were admitted to Central Hospital Affiliated to Shandong First Medical University. According to the differences in treatment processes, 134 children who underwent early surgery+routine dressing change were enrolled in eschar removal+dressing change group (77 males and 57 females, aged 1 (1, 2) years), and 144 children who underwent only routine dressing change were enrolled in dressing change alone group (90 males and 54 females, aged 1 (1, 2) years). Fifty-one children without full-thickness burns in eschar removal+dressing change group were enrolled in eschar removal+dressing change group 1 (26 males and 25 females, aged 1 (1, 2) years), and 57 cases of the 83 children with full-thickness burns who did not undergo autologous skin grafting at the same time of early surgery (namely early skin grafting) in eschar removal+dressing change group were included in eschar removal+dressing change group 2 (37 males and 20 females, aged 1 (1, 2) years). Seventy-six children without full-thickness burns in dressing change alone group were included in dressing change alone group 1 (51 males and 25 females, aged 1 (1, 3) years), and 68 children with full-thickness burns in dressing change alone group were included in dressing change alone group 2 (39 males and 29 females, aged 1 (1, 2) years). For deep partial-thickness burn wounds and small full-thickness burn wounds in eschar removal+dressing change group, the eschar removal was performed on the basis of retaining a thin layer of denatured dermis so as to preserve the healthy tissue of the wound base, and ADM was applied to all wounds externally after eschar removal. For larger full-thickness burn wounds in this group, especially those located in the functional part of joints, eschar removal to the plane layer of viable tissue and early autologous skin grafting was needed. When the superficial wounds of children healed or tended to heal, the residual wounds were evaluated, and elective autologous skin grafting was performed if it was difficult to heal within 14 days. The healing time, intervention healing time, times of operation/dressing change, and times of intervention operation/dressing change in children with deep partial-thickness burn wounds of children in eschar removal+dressing change group, dressing change alone group, eschar removal+dressing change group 1, and dressing change alone group 1 were recorded. At the last follow-up (follow-up period was set to 7-12 months), the modified Vancouver scar scale (mVSS) scores of the most severe area of scar hyperplasia of healed deep partial-thickness burn wounds of 54 children in eschar removal+dressing change group and 48 children in dressing change alone group were recorded. The healing time and times of operation/dressing change of all burn wounds of children in eschar removal+dressing change group and dressing change alone group, and the healing time and times of operation/dressing change of full-thickness burn wounds of children in eschar removal+dressing change group 2 and dressing change alone group 2 were recorded. The incidences of wound infection, sepsis, fever, and fever after 5 days of burns in children of eschar removal+dressing change group and dressing change alone group during wound healing. Results: Compared with those in dressing change alone group, the healing time and intervention healing time were significantly shortened, and the times of operation/dressing change and times of intervention operation/dressing change were significantly reduced in children with deep partial-thickness burn wounds in eschar removal+dressing change group (with Z values of -11.00, -11.33, -12.64, and -11.65, respectively, P<0.05). Compared with those in dressing change alone group 1, the healing time and intervention healing time were significantly shortened, and the times of operation/dressing change and times of intervention operation/dressing change were significantly reduced in children with deep partial-thickness burn wounds in eschar removal+dressing change group 1 (with Z values of 6.57, 6.46, 8.04, and 6.57, respectively, P<0.05). At the last follow-up, the mVSS score of the most severe scar hyperplasia area of healed deep partial-thickness burn wounds of 54 children in eschar removal+dressing change group was 4.00 (3.00,5.00), which was significantly lower than 6.50 (5.00,7.00) of 48 children in dressing change alone group (Z =-4.67, P<0.05).Compared with those in dressing change alone group, the healing time was significantly shortened, and times of operation/dressing change was significantly reduced in all burn wounds in eschar removal+dressing change group (with Z values of -5.20 and -6.34, respectively, P<0.05). Compared with those in dressing change alone group 2, the healing time was significantly shortened, and times of operation/dressing change was significantly reduced in full-thickness burn wounds in eschar removal+dressing change group 2 (with Z values of -5.22 and -5.73, respectively, P<0.05). During wound healing, the probabilities of fever and fever after 5 days of burns in children of eschar removal+dressing change group were significantly lower than those in dressing change alone group (with χ2 values of 4.13 and 3.91, respectively, P<0.05); only 1 child in dressing change alone group developed sepsis, and there was no statistically significant difference in the wound infection rate of children in the two groups (P>0.05). Conclusions: For children with deep burns, early surgery, and early skin grafting or elective autologous skin grafting as needed, have better short-term and long-term effects than those without early surgery.

[Application effects of nitrous oxide and oxygen mixed inhalation technology on analgesia and sedation during debridement and dressing change in children with moderate or severe burns].

Objective: To investigate the application effects of nitrous oxide and oxygen mixed inhalation technology on analgesia and sedation during debridement and dressing change in children with moderate or severe burns. Methods: A retrospective non-randomized contemporary controlled study was conducted. From December 2019 to November 2021, 140 burn children with moderate or severe burns, aged 1 to 3 years, who met the inclusion criteria were admitted to Central Hospital Affiliated to Shandong First Medical University. During debridement and dressing change 3 to 14 days after injury, 42 children, including 23 males and 19 females, who received nurse-centered pain management mode and analgesia and sedation with nitrous oxide and oxygen mixed inhalation technology were included in nitrous oxide group (the dressing change process using the above-mentioned technology for the first time was selected for the follow-up study). Another 42 children, including 24 males and 18 females, were included in non-nitrous oxide group from 98 children who did not apply analgesia or sedation treatment during dressing change with stratified random sampling (one dressing change process was randomly selected for the follow-up study). The face, legs, activity, cry, and consolability scale and Ramsay sedation scale were used to evaluate the pain intensity and degree of sedation, respectively, at 30 minutes before dressing change (hereinafter referred to as before dressing change), immediately after debridement, and at 30 minutes after finishing dressing change (hereinafter referred to as after dressing change). After dressing change, the self-made satisfaction scale was used to evaluate the satisfaction degree of dressing change surgeons and guardians of children for analgesic effects during dressing change. The duration of dressing change and the healing time of deep partial-thickness burn wounds were recorded. The heart rate and percutaneous arterial oxygen saturation (SpO2) before, during, and after dressing change and the occurrence of adverse events such as nausea and vomiting during dressing change were recorded. Data were statistically analyzed with Mann-Whitney U test, chi-square test, analysis of variance for repeated measurement, independent sample t test, and Bonferroni correction. Results: There were no significant differences in the score of pain intensity and score of sedation degree between children in two groups before and after dressing change (P>0.05). Immediately after debridement, the score of pain intensity of children in nitrous oxide group was 2.5±0.7, which was significantly lower than 7.6±1.0 in non-nitrous oxide group (t=-26.69, P<0.05); the score of sedation degree of children in nitrous oxide group was 1.83±0.38, which was significantly higher than 1.21±0.42 in non-nitrous oxide group (t=7.15, P<0.05). After dressing change, the satisfaction degree scores of dressing change surgeons and guardians of children for analgesic effects during dressing change of children in nitrous oxide group were significantly higher than those in non-nitrous oxide group (with t values of 10.53 and 2.24, respectively, P<0.05). The dressing change duration of children in nitrous oxide group was significantly shorter than that in non-nitrous oxide group (t=-5.33, P<0.05). The healing time of deep partial-thickness burn wounds in children between the two groups had no significant difference (P>0.05). The heart rate of children in nitrous oxide group was significantly lower than that in non-nitrous oxide group during dressing change (t=-12.40, P<0.05), while the SpO2 was significantly higher than that in non-nitrous oxide group (t=5.98, P<0.05). During dressing change, 2 children had nausea and 1 child had euphoria in nitrous oxide group, while heart rate of all children in non-nitrous oxide group continued to be higher than the normal range. Conclusions: In the process of debridement and dressing change in children with moderate or severe burns, the use of nurse-centered pain management mode and the standardized use of nitrous oxide and oxygen mixed inhalation technology can safely and effectively control pain and sedation.

[Network meta-analysis comparing the clinical outcomes and safety of robotic, laparoscopic, and transanal total rectal mesenteric resection for rectal cancer].

Objective: To methodically assess the clinical effectiveness and safety of robot-assisted total rectal mesenteric resection (RTME), laparoscopic-assisted total rectal mesenteric resection (laTME), and transanal total rectal mesenteric resection (taTME). Methods: A computer search was conducted on PubMed, Embase, Cochrane Library, and Ovid databases to identify English-language reports published between January 2017 and January 2022 that compared the clinical efficacy of the three surgical procedures of RTME, laTME, and taTME. The quality of the studies was evaluated using the NOS and JADAD scales for retrospective cohort studies and randomized controlled trials, respectively. Direct meta-analysis and reticulated meta-analysis were performed using Review Manager software and R software, respectively. Results: Twenty-nine publications comprising 8,339 patients with rectal cancer were ultimately included. The direct meta-analysis indicated that the length of hospital stay was longer after RTME than after taTME, whereas according to the reticulated meta-analysis the length of hospital stay was shorter after taTME than after laTME (MD=-0.86, 95%CI: -1.70 to -0.096, P=0.036). Moreover, the incidence of anastomotic leak was lower after taTME than after RTME (OR=0.60, 95%CI: 0.39 to 0.91, P=0.018). The incidence of intestinal obstruction was also lower after taTME than after RTME (OR=0.55, 95%CI: 0.31 to 0.94, P=0.037). All of these differences were statistically significant (all P<0.05). There were no statistically significant differences between the three surgical procedures regarding the number of lymph nodes cleared, length of the inferior rectal margin, or rate of positive circumferential margins (all P>0.05). An inconsistency test using nodal analysis revealed no statistically significant differences between the results of direct and indirect comparisons of the six outcome indicators (all P>0.05). Furthermore, we detected no significant overall inconsistency between direct and indirect evidence. Conclusion: taTME has advantages over RTME and laTME, in terms of radical and surgical short-term outcomes in patients with rectal cancer.

[Effect of rotigotine on the quality of emergence from general anesthesia in patients undergoing deep brain stimulation].

Objective: To investigate the effect of rotigotine on the quality of emergence from general anesthesia in patients undergoing deep brain stimulation (DBS). Methods: A total of 42 patients (31 males and 11 females, aged 55-85 years) undergoing DBS surgery under general anesthesia in the First Affiliated Hospital of Zhengzhou University from March 2020 to October 2021 were selected. The patients were divided into non-rotigotine group (n=21) and rotigotine group (n=21) by using a random number table according to whether rotigotine patch was used. Postoperative recovery time, extubation time, length of postanesthesia care unit (PACU) stay, and grades of muscle tension, swallowing function and salivary secretion during recovery were compared between the two groups. Meanwhile, the incidence of adverse events during extubation was also compared. Results: The postoperative recovery time, extubation time and length of PACU stay in rotigotine group were (20.3±2.6) min, (30.6±3.1) min and (46.4±3.9) min, respectively, which were shorter than those of non-rotigotine group [(29.0±5.8) min, (42.6±10.0) min and (63.0±18.9) min, respectively] (all P<0.05). The grades of postoperative muscle tension, swallowing function and salivary secretion in rotigotine group [M(Q1, Q3)] were 1(1, 2), 1(1, 2) and 1(1, 1), respectively, which were lower than those of non-rotigotine group [2(2, 3), 2(2, 2) and 2(1, 2), respectively] (P=0.001, 0.002 and 0.011). The incidence of adverse events during anesthesia extubation in rotigotine group was 14.3% (3/21), which was lower than that of non-rotigotine group [42.9% (9/21), P=0.040]. Conclusion: Rotigotin patch is helpful to improve the quality of emergence from general anesthesia in patients undergoing DBS and reduce the occurrence of adverse events during extubation.

[Study on increase of average life expectancy of residents in Tianjin from 1999 to 2018].

Objective: To assess the trend and the factors responsible for the increase of life expectancy of residents in Tianjin over the past two decades. Methods: Abridged Life Table and Arriaga's decomposition method was applied to quantify the influence of the age structure and the leading causes of death on the increase of life expectancy of residents in Tianjin from 1999 to 2018. Results: In the past 20 years, the life expectancy of residents in Tianjin increased by 4.97 years, the life expectancy of men and women increased by 4.11 years and 5.86 years, respectively. The decrease of mortality rate in 0-year-old group contributed 19.17% to the increase of the life expectancy, while the decrease of mortality rate in residents aged ≥55 years contributed more to the increase of life expectancy, with the cumulative contribution rate of 67.38%. The major contribution to the increase of life expectancy was the mortality reduction of cerebrovascular disease, respiratory disease, cardiovascular disease, perinatal diseases, congenital malformations and injury, with the contribution percentage of 27.27%, 21.37%, 15.76%, 12.22%, 6.44% and 4.86%, respectively. The increase of mortality of malignant tumor, injury and poisoning, diabetes and nervous system diseases and others had a negative effect on the increase of life expectancy of people aged ≥75 years. From 1999 to 2018, the life expectancy increased from 76.72 years to 81.46 years (t=9.11, P<0.001), the annual percent change (APC) was 0.58%. From 2011 to 2018, it was stable, ranging from 81.46 years to 81.69 years (t=0.89, P=0.387, APC=0.13%). Conclusion: From 1999 to 2018, the increase of life expectancy was attributed to the decrease of mortalities in infants and the elderly and the decrease of mortalities of cerebro-cardiovascular disease, respiratory disease, perinatal disease, congenital malformations and injury. However, these positive contributions were partly offset by the negative contribution of malignant tumor, injury, diabetes and nervous system disease in those aged ≥75 years. Comprehensive prevention and control of key diseases should be strengthened in key population in order to further improve the life expectancy of the population.

[Research status and prospect on autologous tissue-engineered skin as permanent graft].

To date, skin substitute that can provide permanent wound closure is still autologous tissue-engineered skin using autologous skin cells as seed cells. The development of cultured epithelial autograft has experienced a long and tortuous process. Autologous tissue-engineered composite skin is closer to autologous split-thickness skin graft in terms of structure, function, and efficacy, which has become a research focus in recent years. Based on the actual status of research on tissue-engineered skin application, this paper reviewed the main research progresses and existing problems, and the prospect of research and development and clinical application of autologous tissue-engineered skin as permanent graft in order to provide a reference for the improvement and application of autologous tissue-engineered skin.

[Analysis on long-term trend of mortality and years of life lost of breast cancer in women in Tianjin, 1999-2017].

Objective: To analyze the trends of mortality and years of life lost (YLL) of breast cancer in women in Tianjin and provide references for the development of intervention strategies. Methods: The crude mortality rate, standard mortality rate, cumulative rate (0-74 years old) and truncated rate (35-64 years old) of breast cancer in women in Tianjin from 1999 to 2017 were calculated. The annual percentage change of the mortality rate and YLL rate were analyzed by Joinpoint regression. Results: From 1999 to 2017, a total of 8 356 deaths of breast cancer were reported in Tianjin, resulting in a YLL of 262 835.53 person-years. The average crude mortality rate was 9.15/100 000. The average age standardized rate(ASR) (World) was 6.14/100 000. The ratio of ASR (World) between urban and rural areas was 1.73∶1. The peak mortality ratio of age groups between urban area and rural area was 3.13∶1. From 1999 to 2017, both the crude mortality rate and ASR of breast cancer in Tianjin had rising trends. In 2017, the crude mortality rate and the ASR of breast cancer increased by 113.7% and 44.4% respectively compared with 1999. The increase of urban mortality mainly came from elderly group aged ≥75 years, and the mortality of young age groups in rural area showed an fast increases, which was most obvious in age group 45-59 years (average annual percentage change=3.6%, P<0.01). Conclusions: The mortality rate of breast cancer and disease burden in women in Tianjin are still in rapid increase. We should continue to implement the prevention and control strategies such as lifestyle intervention and screening of key groups. More attention need to be paid to the increase of breast cancer incidence in rural area.

[Analysis of the long-term trend of mortality and years of life lost of gastric cancer in Tianjin from 1999 to 2015].

Objective: To analyze the long-term trend of mortality and years of life lost (YLL) of gastric cancer in Tianjin from 1999 to 2015. Methods: From January 1, 1999 to December 31, 2015, the data of gastric cancer deaths was collected from the Tianjin death surveillance system. The inclusion criteria of death due to gastric cancer were coded by using 151 in the 9(th) edition of the international classification of diseases (ICD) (1999-2002) and C16 in the 10(th) edition of ICD (2003-2015). The crude and age-standardized mortality rate (ASR) of gastric cancer was calculated according to Segi's world standard population. YLL was calculated according to the standard method of the disease burden of WHO. The Joinpoint regression was used to calculate the average annual percentage change (AAPC) to indicate the trend of mortality and YLL of gastric cancer. Results: From 1999 to 2015, there were 20 000 deaths of gastric cancer in Tianjin. The proportion of gastric cancer death in the population aged 0-44 years old, 45-64 years old, and 65 years old and above was 4.9%, 30.4%, and 64.8%, respectively. The proportion of males and urban was 67.1% and 67.5%, respectively. From 1999 to 2015, the crude mortality rate was from 12.10/100 000 to 12.58/100 000. The ASR was from 11.04/100 000 to 7.24/100 000. The average annual YLL number was 29 625.83 person-years and the rate was 3.09 person-years per thousand people. From 1999 to 2015, the crude mortality rate and the PYLL of gastric cancer in Tianjin were stable (the AAPC was 0.34% and -0.24%, all P values >0.05). The ASR showed a downward trend (AAPC=-2.58%, P<0.001). Conclusion: From 1999 to 2015, the ASR of gastric cancer in Tianjin showed a downward trend, and the YLL of gastric cancer was stable.

[Status quo on smoking and related change pattern of smoking related behavior in past 20 years in urban residents in Tianjin].

Objective: To understand the status quo of smoking and change pattern of smoking related behaviors in the past 20 years in the urban adults in Tianjin. Methods: Data was from the study of Chinese Chronic Disease and Risk Factors (2015). Multi stage stratified random sampling method was used to conduct a questionnaire survey in 7 surveillance sites in Tianjin. Results: in the urban residents aged>20 years were compared with those in surveys in 1996 and 2010. Results In 2015, the smoking rate in men and women aged>20 years in Tianjin were 41.1% and 4.5% respectively. The average age of starting smoking was (19.2±4.7) years for men and (24.8±10.9) years for women, showing a younger age trend. Compared with the data from 1996 and 2010, the smoking rate in the urban residents was in decrease, but the rate of successful smoking cessation was in increase in 2015, the differences were significant. Conclusions: Since 1996, the rate of smoking in the urban residents of Tianjin has been in decline, however it is still at a high level, especially in women. The average age of starting smoking remains to be younger. It is necessary to strengthen the health education about harm of smoking in adolescents.

[Analysis on the alterative trend of colorectal cancer mortality from 1999 to 2015 in Tianjin of China].

Objective: To investigate the mortality of colorectal cancer and its trend from 1999 to 2015 in Tianjin, China, and to explore the mortality features in different populations in order to provide data for prevention and control strategies of colorectal cancer. Methods: Colorectal cancer mortality data between 1999 and 2015 were collected from Tianjin population - based mortality surveillance system maintained by the Tianjin Centers for Disease Control and Prevention (CDC). Population data of permanent residents were collected from Tianjin Municipal Public Security Bureau. The number of new cases and deaths, incidence [including crude incidence, age-adjusted standardized incidence and 95% confidence interval (95% CI)], and mortality (including crude mortality, age-adjusted standardized mortality and 95% CI) of colorectal cancer were calculated. Standardized incidence and mortality of colorectal cancer were calculated using the Segi's world standard population, adjusted with age and gender. JoinPoint regression and Cochran-Armitage trend test were used to determine the statistical significance of differences in mortality trend. Results: A total of 31 376 new onset cases and 14 893 death cases of colorectal cancer were observed in Tianjin from 1999 to 2015. Colorectal cancer incidence increased from 1999 to 2015 with a standardized rate from 9.66/100 000 to 15.36/100 000 [annual percent change(APC)=3.48%, Z=23.21, P<0.001]. Colorectal cancer mortality increased from 1999 to 2015 with a standardized rate from 5.18/100 000 to 6.11/100 000 (APC=1.24%, Z=5.69, P<0.001). Both showed an increasing trend. The death proportion of colon cancer increased (39.67% in 1999 and 50.33% in 2015), while the death proportion of rectal caner decreased (60.33% in 1999 and 48.57% in 2015). The median age of colorectal cancer onset fluctuated steadily around 66 years old (APC=0.16, T=1.75, P=0.100); the median age of death increased from 69 to 73 years old (APC=0.43, T=8.81, P<0.001). From 1999 to 2015, the mortality of colorectal cancer showed a downward trend (all P<0.05) in the age groups of <35 and 35-44 years, while an upward trend (all P<0.05) in the age groups of 45-54 years, 55-64 years and ≥ 65 years. Colorectal cancer mortality in males increased with a standardized rate of 5.53/100 000 in 1999 to 7.33/100 000 in 2015(APC=2.29%, Z=7.86, P<0.001), while colorectal cancer mortality in females flatted with a standardized rate of 4.83/100 000 in 1999 to 4.89/100 000 in 2015 (APC=0.10%, Z=-0.30, P=0.752). Colorectal cancer mortality increased with a standardized rate of 6.75/100 000 in 1999 to 7.33/100 000 in 2015 (APC=0.54%, Z=1.98, P=0.048) in urban areas and of 3.18/100 000 in 1999 to 4.38/100 000 in 2015 (APC=2.47, Z=6.46, P<0.001) in rural areas, whose differences were significant. Standardized mortality rate in rural area was lower but the rising velocity was faster as compared to urban area. Conclusions: Crude mortality and standardized mortality of colorectal cancer increase from 1999 to 2015 in Tianjin population. The people of elder, male and urban area have higher mortality. The mortality in people of male and rural area presents a faster rising state. Further efforts to reduce colorectal cancer mortality in Tianjin are needed to prevention and control of colorectal cancer.

[Analysis on trend of leukemia mortality from 1999 to 2015 in Tianjin, China].

From 1999 to 2015, there were 6 186 cases of leukemia deaths in tianjin residents, the males accounted for 58.28% (3 605) and 52.31% (3 236) deaths lived in urban areas; the crude mortality rate of Leukemia increased from 3.47/100 000 to 4.28/100 000 [t=7.09, P<0.001, annual percent change (APC)=1.30%] and the standardized mortality rate decreased from 3.15/100 000 to 3.01/100 000 (t=-2.95, P=0.006, APC=-0.65%). Special attention should be focused on children, the elderly, males and rural residents.

[The trend of chronic lower respiratory disease mortality of the residents in Tianjin, China, 2000-2016].

Objective: To explore the trends and distribution of chronic obstructive pulmonary disease (COPD) mortality of the residents with different characteristics from 2000 to 2016 in Tianjin. Methods: COPD mortality data in 2000-2016 were from Tianjin population based mortality surveillance system. The mortality rate of COPD, difference in the rate by gender, age, and geographic distribution, and the trend over years were analyzed. Age-sex-standardized mortality rates of COPD were calculated using the year 2000 world standard population. Joinpoint regression and Cochran-Armitage trend analysis were used to examine the trend of mortality. Results: The crude COPD mortality rate in Tianjin decreased from 57.57/100 000 in 2000 to 28.23/100 000 in 2016 (annual percent change (APC)=-5.01%, Z=-64.76, P<0.001), and the standardized mortality rate decreased from 56.53/100 000 in 2000 to13.88/100 000 in 2016 (APC=-9.17%, Z=-100.83, P<0.001). The crude COPD mortality rate of males decreased from 54.57/100 000 to 27.77/100 000 (APC=-4.89%, Z=-43.63, P<0.001) and the standardized mortality rate decreased from 57.52/100 000 to 14.63/100 000 (APC=-9.07%, Z=-71.48, P<0.001). The crude COPD mortality rate of females decreased from 60.63/100 000 to 28.68/100 000 (APC=-5.12%, Z=-47.92, P<0.001) and the standardized mortality rate decreased from 55.53/100 000 to 13 13/100 000 (APC=-9.27%, Z=-71.13, P<0.001). The crude mortality rate of COPD in urban areas decreased from 45.07/100 000 to 19.54/100 000 (APC=-5.35%, Z=-42.38, P<0.001) and the standardized mortality rate decreased from 39.24/100 000 to 7.45/100 000 (Z=-63.97, P<0.001, APC=-10.22%). The crude mortality rate of COPD in rural areas decreased from 70.20/100 000 to 37.24/100 000 (APC=-4.77%, Z=-48.77, P<0.001) and the standardized mortality rate decreased from 78.88/100 000 to 25.70/100 000 (APC=-7.59%, Z=-72.43, P<0.001). The COPD mortality rate in rural areas was higher than that in urban areas (P<0.001). The COPD mortality rate in 35 years old and over decreased from 2000 to 2016 (P<0.001). Conclusion: The COPD mortality in Tianjin decreased from 2000 to 2016. More efforts are need to reduce COPD mortality in Tianjin, in particular people in rural areas.

[The trend of intracerebral hemorrhage mortality of the residents with different characteristics in Tianjin, China, 1999-2015].

Objective: To explore the trends and distribution of intracerebral hemorrhage (ICH) mortality of the residents with different characteristics from 1999 to 2015 in Tianjin. Methods: ICH mortality data in 1999-2015 were from Tianjin population based mortality surveillance system. The mortality rate of ICH, difference in the rate by gender, age, and geographic distribution, and trends over the years were analyzed. Standardized mortality rates of ICH were calculated using the year 2000 world standard population. Joinpoint regression and Cochran-Armitage trend were used to examine the trends in mortality. Results: A total of 102 279 ICH death cases were observed in Tianjin from year 1999 to 2015. The crude ICH mortality rate in Tianjin decreased from 76.35/100 000 in 1999 to 51.46/100 000 in 2015 (annual percent change (APC)=-1.96%, Z=-31.08, P<0.001) , and the standardized mortality rate decreased from 72.41/100 000 to 29.00/100 000 (APC=-5.20%, Z=-70.91, P<0.001). The crude mortality rate of ICH mortality in males decreased from 87.26/100 000 to 59.89/100 000 (APC=-1.79%, Z=-21.71, P<0.001) and the standardized mortality rate decreased from 85.65/100 000 to 35.75/100 000 (APC=-4.93%, Z=-52.32, P<0.001). The crude mortality rate of ICH mortality in females decreased from 65.21/100 000 to 42.98/100 000 (APC=-2.18%, Z=-22.28, P<0.001) and the standardized mortality rate decreased from 59.17/100 000 to 22.26/100 000 (APC=-5.63%, Z=-48.15, P<0.001). The ICH mortality rate under 35 years old increased from 0.78/100 000 to 0.92/100 000 (APC=4.41%, Z=5.07, P<0.001), especially in males increasing from 0.90/100 000 to 1.54/100 000 (APC=6.59%, Z=6.52, P<0.001). The crude mortality rate of ICH in urban areas decreased from 69.74/100 000 to 41.79/100 000 (APC=-3.18%, Z=-31.43, P<0.001) and the standardized mortality rate decreased from 57.56/100 000 to 20.42/100 000 (APC=-6.59%, Z=-53.43, P<0.001). The crude mortality rate of ICH in rural areas decreased from 82.99/100 000 to 61.49/100 000 (APC=-1.10%, Z=-14.06, P<0.001) and the standardized mortality rate decreased from 91.55/100 000 to 43.14/100 000 (APC=-3.78%, Z=-43.21, P<0.001). The ICH mortality rate in rural areas was higher than that in urban areas (P<0.05). Conclusion: ICH mortality rate in Tianjin decreased from 1999 to 2015. Further efforts to reduce ICH mortality in Tianjin is needed, in particular males, under 35 years old, and people in rural areas.

[Analysis on trend of cerebral infarction mortality from 1999 to 2015 in Tianjin of China].

Objective: To explore the trends and distribution of cerebral infarction between sexes, ages and urban-rural areas from 1999 to 2015 in Tianjin, China, and provide data for targeted prevention and control strategies of cerebral infarction in Tianjin. Methods: Cerebral infarction mortality data from January 1, 1999 to December 31, 2015 were obtained from Tianjin population based mortality surveillance system established by the Tianjin Centers for Disease Control and Prevention, and population data of permanent residents were obtained from Tianjin Municipal Public Security Bureau. The trends change and affecting factors including gender, age, and geographic distribution on mortality following cerebral infarction were analyzed. Results: (1) Cerebral infarction mortality rate in Tianjin increased from 1999 to 2015 with the crude mortality rate of 57.06/100 000 to 105.22/100 000 (Z=59.65, P<0.01, annual percent change(APC)=3.39%) and decreased with the standardized mortality rate from 55.59/100 000 to 56.12/100 000 (Z=-5.47, P<0.01, APC=-0.35%). (2) The crude mortality rate (64.23/100 000 to 118.72/100 000) and standardized mortality rate (65.44/100 000 to 67.23/100 000) of male cerebral infarction was higher than that of female (crude: 49.73/100 000 to 91.64/1/100 000, standardized: 45.73/100 000 to 45.01/100 000) from 1999 to 2015. (3) With the increase of age, the mortality of cerebral infarction increased gradually from 1999 to 2015 (all Z>0.00,all P<0.01). (4) The mortality rate of cerebral infarction in urban areas increased with the crude mortality rate from 71.43/100 000 to 103.20/100 000 (Z=17.34, P<0.01, APC=1.30%) and decreased with the standardized mortality rate from 61.04/100 000 to 43.77/100 000 (Z=-32.49, P<0.01, APC=-3.06%) from 1999 to 2015. The mortality rate of cerebral infarction in rural areas increased with the crude mortality rate from 42.63/100 000 to 107.32/100 000 (Z=69.14, P<0.01, APC=5.95%) and with the standardized mortality rate from 48.34/100 000 to 77.09/100 000 (Z=36.88, P<0.01, APC=5.95%) from 1999 to 2015. Conclusions: Cerebral infarction crude mortality increased and standardized mortality decreased from 1999 to 2015 in Tianjin. Further efforts to reduce cerebral infarction mortality in Tianjin are needed, special attention should be focused on the elderly, male and rural residents.

[Analysis on the trends in mortality following acute myocardial infarction from 1999 to 2015 in Tianjin of China].

Objective: To explore the trends change in mortality following acute myocardial infarction (AMI) from 1999 to 2015 in Tianjin, China. Methods: AMI mortality data from 1999 to 2015 were obtained from Tianjin population based mortality surveillance system operated by the Tianjin Centers for Disease Control and Prevention (CDC), and population data of permanent residents were obtained from Tianjin Municipal Public Security Bureau. The trends change and affecting factors including gender, age, and geographic distribution on mortality following AMI were analyzed. Results: (1)The standardized mortality rate of AMI in Tianjin from 1999 to 2015 was 52.32/100 000 to 48.62/100 000. Adjusted AMI mortality rate from 1999 to 2013 was 52.32/100 000 to 73.72/100 000, indicating an increased trend(Z=32.15, P<0.001)with an annual percent change (APC) of 2.53%. Adjusted AMI mortality rate was decreased from 2013 to 2015: 73.72/100 000 to 48.62/100 000 (Z=-22.80, P<0.001), and APC was -19.07%. Above trends change was similar for male and female residents (all P<0.001). (2)The AMI standardized mortality rate of male was significantly higher than that of female during the 17 years. The AMI standardized mortality of male was significantly higher than that of female in<35, 35-44, 45-54, 55-64 and ≥65 years old group, respectively. AMI mortality rate increased with age. (3)Except in the year of 2002 and 2003, the AMI mortality rate were significantly higher in rural residents than in urban residents during this study period (P<0.001). Adjusted AMI mortality in urban residents increased from 1999 to 2009(Z=8.05, P<0.001, APC=1.43%), and decreased in the year from 2009 to 2015 (Z=-18.71, P<0.001, APC=-6.32%). Adjusted AMI mortality in rural residents increased in the year of 1999 to 2013(Z=56.05, P<0.001, APC=5.84%), and decreased in the year of 2013 to 2015 (Z=-24.40, P<0.001, APC=-21.35%). Conclusions: Our results suggest that AMI mortality in Tianjin increased from 1999 to 2013, and decreased from 2013 to 2015, and male and rural residents have higher AMI mortality. Related prevention and intervention measures should be taken to decrease AMI mortality, especially for male and rural residents.

[Comparison of application of Cochran-Armitage trend test and linear regression analysis for rate trend analysis in epidemiology study].

We described the time trend of acute myocardial infarction (AMI) from 1999 to 2013 in Tianjin incidence rate with Cochran-Armitage trend (CAT) test and linear regression analysis, and the results were compared. Based on actual population, CAT test had much stronger statistical power than linear regression analysis for both overall incidence trend and age specific incidence trend (Cochran-Armitage trend P value

[Fifteen-year trend in incidence of acute myocardial infarction in Tianjin of China].

Objective: To observe the incidence of acute myocardial infarction (AMI) between 1999 and 2013 in Tianjin residents and analyze the incidence differences on residents with various age, gender and living in urban or rural areas. The data might help for targeted prevention strategies among Tianjin residents. Methods: AMI incidence data between 1999 and 2013 were obtained based on Tianjin cardiovascular disease incidence surveillance registry established by the Tianjin Centers for Disease Control and Prevention (CDC). Related information such as permanent residents' population data were obtained from Tianjin Municipal Public Security Bureau. The Chinese population data in 2000 were used for age-sex-standardized rates estimation. Difference between two (or more) independent groups was compared by the Chi Square statistics. The Chi-square test for trend was used for computing the incidence trend in years and ages. Results: AMI incidence rate in Tianjin declined from the year 1999 to 2013 with the rude incidence rate of 80.46/100 000 to 81.29/100 000, and with the standardized incidence rate of 64.85/100 000 to 44.57/100 000 (Z=-35.767, P<0.001). AMI incidence decreased gradually in residents aged over 45 years old (P<0.01), but increased in residents younger than 45 years old (P<0.001) from 1999 to 2013. The AMI incidence rate is consistently higher in male residents (rude incidence 99.89/100 000-102.98/100 000, standardized incidence rate 78.53/100 000-56.61/100 000) than in female residents (rude incidence 61.18/100 000-59.44/100 000, standardized incidence rate 50.31/100 000-31.76/100 000, both P<0.001) and higher in urban residents (rude incidence rate 133.98/100 000-98.02/100 000, standardized incidence rate 99.89/100 000-50.12/100 000) than in rural residents (rude incidence rate 35.57/100 000-66.19/100 000, standardized incidence rate 32.68/100 000-43.51/100 000, Z=6.217, P<0.001). AMI incidence decreased significantly in the urban residents (rude incidence rate 133.98/100 000-98.02/100 000, standardized incidence rate 99.89/100 000-50.12/100 000, Z=-46.968, P<0.001), while significantly increased in rural residents (rude incidence rate 35.57/100 000-66.19/100 000, standardized incidence rate 32.68/100 000-43.51/100 000, Z=6.217, P<0.001) during the study period. Conclusions: The general incidence of AMI decreased during the study period in Tianjin residents. However, AMI incidence significantly increased in young male residents and rural residents. It is necessary to develop corresponding strategies for AMI control for Tianjin residents with different age/gender and living in different areas.

[An epidemiological investigation of pediatric patients under 14 with large area burns: a multicenter study].

Objective: To investigate and evaluate the epidemiological characteristics of patients under 14 with large area burns in China. Methods: Data of pediatric patients aged 0-14yr with ≥30% total body surface area (TBSA) burned admitted into 106 burn centers in the mainland of China in 2014 were retrieved. The children were divided into three age groups: 0-3, 4-6 and 7-14 years according to the age. Information of age, gender, time of burn injury, causes of burns, admission time, prehospital emergency care of burn wound, burn area, inhalation injuries, the case fatality rate and length of hospital stay were collected for analysis. Results: Of the 486 cases included, 285 (58.6%) were boys and 201 (41.4%) were girls. The mean age of the children was (3.4±2.8) years. Children under 3 years old accounted for 67.5% of all the cases. 271 of the burn injuries (55.8%) occurred from April through August. Scalds and flames were the main causes of burns, which were the causes of 394 cases (81.1%) and 71 cases (14.6%), respectively. The burn injuries resulted from scalds and flames accounted for 89.6% and 7.3%, 70.8% and 21.9%, 51.6% and 41.9% in the age group of 0-3, 4-6 and 7-14 years respectively. The distribution of burn etiology in different age groups differed significantly (χ(2)=21.239, 59.442, 7.333, all P<0.01). Most of the patients (57.8%) were admitted within 2 hours after injury. However, when it came to the pre-hospital emergency management of burn wound, 164 patients (33.7%) did not use any drug or wound dressing, whereas the wound area of 236 patients (48.6%) were treated improperly with toothpaste, soy sauce, eggs or other non-standard disposal. The mean TBSA area of the patients was (42.1±14.5)%, while 288 (59.3%) of the patients suffered full thickness burns with mean TBSA of (24.5±17.9)%. The case fatality rate (CFR) was 4.1%, and the CFR of patients complicated with inhalation injury was significantly higher than those without (P<0.01). The average length of stay for pediatric burn patients was (52.3±40.2) days. Conclusions: Children under 3 years old are important target population of severe burns. Scald is the most common type of burns, while the proportion of flames increases as age goes up. Most patients are likely to get clinical treatment in time, however, the pre-hospital emergency burn care is not satisfying at present.