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1.
BMC Cancer ; 19(1): 984, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640608

RESUMO

BACKGROUND: Ovarian cancer (OC) is the seventh most common malignancy worldwide and the most lethal gynaecological malignancy. We aimed to explore global geographical patterns and temporal trends from 1973 to 2015 for 41 countries in OC incidence and especially to analyse the birth cohort effect to gain further insight into the underlying causal factors of OC and identify countries with increasing risk of OC. METHODS: OC data were drawn from the Cancer Incidence in Five Continents databases and online databases published by governments. The joinpoint regression model was applied to detect changes in OC trends. The age-period-cohort model was applied to explore age and birth cohort effects. RESULTS: The age-standardized rate of OC incidence ranged from 3.0 to 11.4 per 100,000 women worldwide in 2012. The highest age-standardized rate was observed in Central and Eastern Europe, with 11.4 per 100,000 women in 2012. For the most recent 10-year period, the increasing trends were mainly observed in Central and South America, Asia and Central and Eastern Europe. The largest significant increase was observed in Brazil, with an average annual percentage change of 4.4%. For recent birth cohorts, cohort-specific increases in risk were pronounced in Estonia, Finland, Iceland, Lithuania, the United Kingdom, Germany, the Netherlands, Italy, Malta, Slovenia, Bulgaria, Russia, Australia, New Zealand, Brazil, Costa Rica, Ecuador, India, Japan, the Philippines and Thailand. CONCLUSIONS: Disparities in the incidence and risk of OC persist worldwide. The increased risk of birth cohort in OC incidence was observed for most countries in Asia, Central and Eastern Europe, and Central and South America. The reason for the increasing OC risk for recent birth cohorts in these countries should be investigated with further epidemiology studies.

2.
Comput Math Methods Med ; 2019: 6915850, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31281411

RESUMO

Hepatitis B surface antigen (HBsAg) seroclearance during treatment is associated with a better prognosis among patients with chronic hepatitis B (CHB). Significant gaps remain in our understanding on how to predict HBsAg seroclearance accurately and efficiently based on obtainable clinical information. This study aimed to identify the optimal model to predict HBsAg seroclearance. We obtained the laboratory and demographic information for 2,235 patients with CHB from the South China Hepatitis Monitoring and Administration (SCHEMA) cohort. HBsAg seroclearance occurred in 106 patients in total. We developed models based on four algorithms, including the extreme gradient boosting (XGBoost), random forest (RF), decision tree (DCT), and logistic regression (LR). The optimal model was identified by the area under the receiver operating characteristic curve (AUC). The AUCs for XGBoost, RF, DCT, and LR models were 0.891, 0.829, 0.619, and 0.680, respectively, with XGBoost showing the best predictive performance. The variable importance plot of the XGBoost model indicated that the level of HBsAg was of high importance followed by age and the level of hepatitis B virus (HBV) DNA. Machine learning algorithms, especially XGBoost, have appropriate performance in predicting HBsAg seroclearance. The results showed the potential of machine learning algorithms for predicting HBsAg seroclearance utilizing obtainable clinical data.

3.
BMJ Open ; 9(5): e028007, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31147367

RESUMO

OBJECTIVES: There are country and regional variations in the prevalence of hyperuricaemia (HUA). The prevalence of HUA and non-valvular atrial fibrillation (NVAF) in southern China is unknown. DESIGN: A cross-sectional study. SETTING AND PARTICIPANTS: A total of 11 488 permanent residents aged 35 or older from urban and rural areas of Guangzhou, China were enrolled. A questionnaire was used to compile each participant's demographic information and relevant epidemiological factors for HUA and NVAF. All participants were assessed using a panel of blood tests and single-lead 24-hour ECG. MAIN OUTCOME MEASURES: HUA was defined as serum uric acid level >420 µmol/L in men and >360 µmol/L in women. NVAF was diagnosed as per guidelines. RESULTS: The prevalence of HUA was 39.6% (44.8% in men and 36.7% in women), and 144 residents (1.25%) had NVAF. Prevalence of HUA increased with age in women but remained stably high in men. After adjusting for potential confounders, age, living in urban areas, alcohol consumption, central obesity, elevated fasting plasma glucose level, elevated blood pressure, lower high-density lipoprotein cholesterol level and elevated triglycerides level were associated with increased risk of HUA. Residents with HUA were at higher risk for NVAF. Serum uric acid level had a modest predictive value for NVAF in women but not men. CONCLUSIONS: HUA was highly prevalent among citizens of southern China and was a predictor of NVAF among women.

4.
Arch Cardiovasc Dis ; 112(6-7): 420-429, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31133543

RESUMO

INTRODUCTION: Chronic kidney disease (CKD) has been associated with incident atrial fibrillation (AF) and its complications, but data from Asian cohorts are limited. AIM: To explore the relationship of AF recurrence after catheter ablation (CA) with eGFR as a continuous variable, and with different renal function categories (normal: estimated glomerular filtration rate [eGFR] ≥90mL/min/1.73 m2; mild CKD: eGFR 60-89mL/min/1.73 m2; moderate CKD: eGFR 45-59mL/min/1.73 m2; severe CKD: <45mL/min/1.73 m2), using data from the Guangzhou Atrial Fibrillation Ablation Registry. METHODS: We studied consecutive symptomatic adult patients with non-valvular AF, refractory to at least one antiarrhythmic drug and eligible for CA, in Guangdong General Hospital between June 2011 and August 2015. RESULTS: Data were available from 1407 consecutive patients (mean age 57.3±11.5 years; 68% men) with non-valvular AF undergoing radiofrequency or cryoballoon ablation. During a mean follow-up of 20.7±8.8 months, 18.6% of patients with paroxysmal AF and 50.5% with non-paroxysmal AF had AF recurrence. On multivariable analysis, eGFR (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.96-0.97) was an independent risk factor for AF recurrence, with a good predictive value (area under the curve 0.74, 95% CI 0.72-0.77; P<0.01). In the normal renal function, and mild, moderate and severe CKD categories, AF recurrence rates were 11.5%, 29.3%, 72.0% and 93.3%, respectively. Compared with normal renal function, there were stepwise increased risks of AF recurrence with mild CKD (HR 3.30, 95% CI 2.55-4.26; P<0.01), moderate CKD (HR 9.43, 95% CI 6.76-13.16; P<0.01) and severe CKD (HR 12.35, 95% CI 6.93-21.99; P<0.01). CONCLUSIONS: In a large cohort of Asian patients with AF, renal dysfunction increased the risk of AF recurrence after CA. AF recurrence gradually increased with worsening kidney function in this cohort.

5.
BMJ Open ; 9(5): e024197, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31129573

RESUMO

OBJECTIVE: Dengue is a mosquito-transmitted virus infection that remains rampant across the tropical and subtropical areas worldwide. However, the spatial and temporal dynamics of dengue transmission are poorly understood in Chao-Shan area, one of the most densely populated regions on China's southeastern coast, limiting disease control efforts. We aimed to characterise the epidemiology of dengue and assessed the effect of seasonal climate variation on its dynamics in the area. DESIGN: A spatio-temporal descriptive analysis was performed in three cities including Shantou, Chaozhou and Jieyang in Chao-Shan area during the period of 2014-2017. SETTING: Data of dengue cases of three cities including Shantou, Chaozhou and Jieyang in Chao-Shan area during 2014-2017 were extracted. Data for climatic variables including mean temperature, relative humidity and rainfall were also compiled. METHODOLOGY: The epidemiology and dynamics of dengue were initially depicted, and then the temporal dynamics related to climatic drivers was assessed by a wavelet analysis method. Furthermore, a generalised additive model for location, scale and shape model was performed to study the relationship between seasonal dynamics of dengue and climatic drivers. RESULTS: Among the cities, the number of notified dengue cases in Chaozhou was greatest, accounting for 78.3%. The median age for the notified cases was 43 years (IQR: 27.0-58.0 years). Two main regions located in Xixin and Chengxi streets of Chaozhou with a high risk of infection were observed, indicating that there was substantial spatial heterogeneity in intensity. We found an annual peak incidence occurred in autumn across the region, most markedly in 2015. This study reveals that periods of elevated temperatures can drive the occurrence of dengue epidemics across the region, and the risk of transmission is highest when the temperature is between 25°C and 28°C. CONCLUSION: Our study contributes to a better understanding of dengue dynamics in Chao-Shan area.

6.
Sci Total Environ ; 668: 825-834, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-30870751

RESUMO

BACKGROUND: At present, there are few studies on the effect of short-term interactions between ambient air pollutants and temperature on cause-specific emergency department visits in China. This study aimed to explore their short-term interactions on cause-specific emergency department visits using data collected from a total of 65 public hospitals in Guangzhou city, south China. MATERIAL AND METHODS: We included a total of 226,443 emergency department visits which were diagnosed as neurological, respiratory and circulatory disease in Guangzhou from January 1, 2014 to December 31, 2017. Average daily concentrations of air pollutants including carbon monoxide (CO), particulate matter having a median diameter of 2.5 µm or less (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3) were collected from the Guangzhou Environmental Protection Bureau. We employed quasi-Poisson varying coefficient regression models to assess the interaction effects between air pollutants and daily temperature levels (DTLs) on emergency department visits for neurological, respiratory and circulatory diseases, respectively. RESULTS: Average number of emergency department visits for neurological, respiratory and circulatory diseases were 92, 26 and 38, respectively. After controlling for other pollutants, meteorological factors and other time-varying confounders, we found the interactions between NO2 and the 1st DTL (3.4-17.1 °C), NO2 and the 2nd DTL (17.1-23.5 °C) for neurological emergency department visits were statistically significant, displaying a nonlinear relationship. Additionally, we found that the interactions between SO2 and the 4th DTL (27.4-31.1 °C) also had a significantly adverse effect on respiratory emergency department visits. CONCLUSIONS: Our findings provide novel evidence on SO2-by-temperature interactions, and NO2-by-temperature interactions for emergency department visits of cause-specific diseases.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Temperatura Ambiente , Monóxido de Carbono , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Cidades , Humanos , Conceitos Meteorológicos , Dióxido de Nitrogênio , Ozônio , Material Particulado , Estações do Ano , Dióxido de Enxofre , Tempo (Meteorologia)
7.
BMJ Open ; 9(2): e024708, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30772855

RESUMO

OBJECTIVE: To examine the total non-accidental mortality burden attributable to ambient temperatures and assess the effect modification of the burden by specific causes of death and individual characteristics in a high plateau area in southwest China. METHODS: Using daily mortality and meteorological data from 2009 to 2016, we applied a quasi-Poisson model combined with a distributed lag non-linear model to estimate the temperature-mortality association with the assessment of attributable fraction and number. We calculated attributable fractions and deaths with 95% empirical CIs (eCIs), that were due to cold and heat, defined as temperatures below and above the median temperature, and for mild and extreme temperatures, defined by cut-offs at the 2.5th and 97.5th temperature percentiles. RESULTS: We analysed 89 467 non-accidental deaths; 4131 were attributable to overall temperatures, with an attributable fraction of 4.75% (95% eCI 2.33% to 6.79%). Most of the mortality burden was caused by cold (4.08%; 0.86% to 7.12%), whereas the burden due to heat was low and non-significant (0.67%; -2.44% to 3.64%). Extreme cold (1.17%; 0.58% to 1.69%) was responsible for 24.6% (ie, 1.17% divided by 4.75%) of the total death burden. In the stratification analyses, attributable risk due to cold was higher for cardiovascular than respiratory disease (6.18% vs 3.50%). We found a trend of risk of increased death due to ambient temperatures with increasing age, with attributable fractions of 1.83%, 2.27% and 6.87% for age ≤64, 65-74 and ≥75 years old, respectively. The cold-related burden was slightly greater for females, farmers, ethnic minorities and non-married individuals than their corresponding categories. CONCLUSIONS: Most of the burden of death was attributable to cold, and specific causes and individual characteristics might modify the mortality burden attributable to ambient temperatures. The results may help make preventive measures to confront climate change for susceptible population in this region.

8.
Arch Cardiovasc Dis ; 112(3): 171-179, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30683618

RESUMO

BACKGROUND: Female sex has been linked with worse prognosis in patients with atrial fibrillation (AF). Clinical risk stratification of women with AF may help decision-making before catheter ablation (CA). AIM: To evaluate arrhythmia outcomes and the predictive value of clinical scores for arrhythmia recurrence in a large cohort of Chinese patients with AF undergoing CA. METHODS: A total 1410 of patients (68.1% men) who underwent AF ablation with scheduled follow-up were analysed retrospectively. Baseline characteristics and ablation outcome were compared between men and women. The predictive values of risk scoring systems for AF recurrence were assessed in women. RESULTS: Recurrence, early recurrence and complications after CA were similar in women and men over similar follow-up periods (20.7±8.0 vs 20.7±9.1 months; P>0.05). Compared with men, women with AF recurrence were older and had a larger left atrial diameter (LAD), less paroxysmal AF, lower left ventricular ejection fraction, lower estimated glomerular filtration rate (eGFR) and higher serum concentrations of B-type natriuretic peptide (BNP) and C-reactive protein (CRP) (all P<0.01). Multivariable analysis showed that age, non-paroxysmal AF, body mass index, coronary artery disease, LAD, early recurrence, eGFR, BNP and CRP were independent risk factors with sex differences (all P<0.05) in the whole cohort. In women, only non-paroxysmal AF, early recurrence, BNP, CRP (all P<0.01) and history of stroke/transient ischaemic attack (P=0.016) were independent risk factors. Of the clinical scoring systems tested, MB-LATER, APPLE, CAAP-AF and BASE-AF2 scores (C-indexes 0.73, 0.72, 0.68 and 0.72, respectively; all P<0.01) had a modest predictive value for AF recurrence after CA in women. CONCLUSIONS: CA for AF has similar recurrence risks in women and men, but there are sex differences in the clinical characteristics and risk factors associated with AF recurrence.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
9.
Sci Total Environ ; 647: 752-762, 2019 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-30092532

RESUMO

BACKGROUND: China experienced an unprecedented outbreak of dengue in 2014, and the number of dengue cases reached the highest level over the past 25 years. There is a significant delay in the release of official case count data, and our ability to timely track the timing and magnitude of local outbreaks of dengue remains limited. MATERIAL AND METHODS: We developed an ensemble penalized regression algorithm (EPRA) for initializing near-real time forecasts of the dengue epidemic trajectory by integrating different penalties (LASSO, Ridge, Elastic Net, SCAD and MCP) with the techniques of iteratively sampling and model averaging. Multiple streams of near-real time data including dengue-related Baidu searches, Sina Weibo posts, and climatic conditions with historical dengue incidence were used. We compared the predictive power of the EPRA with the alternates, penalized regression models using single penalties, to retrospectively forecast weekly dengue incidence and detect outbreak occurrence defined using different cutoffs, during the periods of 2011-2016 in Guangzhou, south China. RESULTS: The EPRA showed the best or at least comparable performance for 1-, 2-week ahead out-of-sample and leave-one-out cross validation forecasts. The findings indicate that skillful near-real time forecasts of dengue and confidence in those predictions can be made. For detecting dengue outbreaks, the EPRA predicted periods of high incidence of dengue more accurately than the alternates. CONCLUSION: This study developed a statistically rigorous approach for near-real time forecast of dengue in China. The EPRA provides skillful forecasts and can be used as timely and complementary ways to assess dengue dynamics, which will help to design interventions to mitigate dengue transmission.


Assuntos
Dengue/epidemiologia , Mídias Sociais , China/epidemiologia , Surtos de Doenças , Humanos , Estudos Retrospectivos
10.
Pancreas ; 48(2): 199-208, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30589831

RESUMO

OBJECTIVES: We aim to provide a global geographical picture of pancreatic cancer incidence and temporal trends from 1973 to 2015 for 41 countries. METHODS: Joinpoint regression and age-period-cohort model was used. RESULTS: In 2012, the highest age-adjusted rate was in Central and Eastern Europe for males and North America for females. Most regions showed sex disparities. During the recent 10 years, increasing trends were observed in North America, Western Europe, and Oceania. The greatest increase occurred in France. For recent birth cohorts, cohort-specific increases in risk were pronounced in Australia, Austria, Brazil, Canada, Costa Rica, Denmark, Estonia, France, Israel, Latvia, Norway, Philippines, Republic of Korea, Singapore, Spain, Sweden, the Netherlands, United States, and US white male populations and in Australia, Austria, Brazil, Bulgaria, Canada, China, Czech Republic, Finland, France, Italy, Japan, Lithuania, Norway, Republic of Korea, Singapore, Spain, The Netherlands, United Kingdom, United States, and US white female populations. CONCLUSIONS: In contrast to the favorable effect of the decrease in smoking prevalence, other factors, including the increased prevalence of obesity and diabetes and increased physical inactivity, increased intake of red or processed meat and inadequate intake of fruits and vegetables are likely to have an unfavorable role in pancreatic cancer incidence worldwide.


Assuntos
Saúde Global/estatística & dados numéricos , Saúde Global/tendências , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/epidemiologia , Fatores Etários , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Incidência , Masculino , Obesidade/epidemiologia , Prevalência , Fatores de Risco , Fumar/epidemiologia
11.
Sci Rep ; 8(1): 17829, 2018 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-30546024

RESUMO

Precise prevalence of atrial fibrillation (AF) and the associated risk factors in southern China are rarely reported. This large population-based follow-up study, the Guangzhou Heart Study, was conducted from 2015 to 2017 to fill up this gap. Permanent residents aged 35 years and above in Guangzhou city were enrolled and demographic factors of participants were collected by a structured questionnaire. Examinations of physical, electrocardiographic and biochemical indicators were performed following a standard operation procedure designed prior to the field investigation. Descriptive statistics were used to evaluate basic characteristics of the study participants, and multivariate logistic regression model was performed to assess the AF prevalence-related factors. The detailed study design, the baseline characteristics and the prevalence of AF were reported here. In total, 12,013 residents were enrolled, and the percentage of participants from rural and urban areas was 53.92% and 46.08%, respectively. In total, 90.57% participants aged 40-79 years old and the proportion of women was more than men (64.98% vs. 35.02%). Overall, the prevalence of AF among the participants was 1.46%. Increasing age, male sex and widowed marital status were associated with higher AF prevalence (P-value < 0.05). The prevalence of AF increased with age and climbed to approximately 5% in residents aged 80 years and over. Residents with abnormal higher blood level of total cholesterol tended to have a lower AF prevalence but a higher prevalence of AF was observed in female participants with lower level of high density lipoprotein cholesterol land higher level uric acid (all P-value < 0.05). Personal illness such as hypertension, diabetes mellitus, dyslipidemia, myocardial infarction, heart failure, stroke and transient ischemic were significantly linked to the attack of AF (all P-value < 0.05). This study will be rich resource for investigating environmental exposure and individual genetic diathesis of AF and other common cardiovascular diseases in Chinese population.


Assuntos
Fibrilação Atrial/epidemiologia , Modelos Biológicos , População Rural , População Urbana , Adulto , Fatores Etários , Idoso , Fibrilação Atrial/fisiopatologia , China/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais
12.
EBioMedicine ; 35: 40-45, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30174278

RESUMO

BACKGROUND: Obesity or overweight is related to worse outcomes in patients with atrial fibrillation (AF) following catheter ablation (CA). The role of being underweight in relation to recurrent arrhythmias post AF ablation is less certain. We conducted a retrospective study to investigate the association of body mass index (BMI) with arrhythmia outcomes in AF patients undergoing CA. METHODS: In a cohort of 1410 AF patients (mean age 57.2 ±â€¯11.6 years; 68% male) undergoing single CA, the association between BMI and AF ablation outcome was analyzed using BMI as a continuous variable and by four BMI categories (<18.5 kg/m2, 18.5-24 kg/m2, 25-29 kg/m2, and ≥ 30 kg/m2). RESULT: We observed a positive association between a cut off value of BMI and risk of AF recurrence post AF ablation. BMI ≥26.36 kg/m2 was related to more AF recurrence (c-statistic 0.55, 95%CI 0.51-0.58; P < 0.01) with 50% increased risk of AF recurrence (HR 1.50, 95% CI 1.22-1.86; P < 0.01). Recurrence rates in the four BMI categories were 33.3%, 23.2%, 27.2 and 41.8%, respectively (P < 0.01). Kaplan-Meier analysis showed that BMI categories of <18.5 kg/m2 and ≥ 30 kg/m2 were all associated with more AF recurrence (P = 0.01). Both underweight (HR 1.85, 95%CI 1.12-3.08; P = 0.02) and obesity (HR 1.78, 95%CI 1.17-2.72; P = 0.01) significantly increased the risk of AF recurrence in a Cox proportional hazard model. CONCLUSION: BMI had good predictive value for AF ablation outcomes with a cut off value of ≥26.36 kg/m2. Apart from being obese/overweight, being underweight might also be a risk factor for AF recurrence post ablation.

13.
Nat Commun ; 9(1): 2230, 2018 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-29884785

RESUMO

Patients with hepatocellular carcinoma (HCC) always require routine surveillance and repeated treatment, which leads to accumulation of huge amount of clinical data. A predictive model utilizes the time-series data to facilitate dynamic prognosis prediction and treatment planning is warranted. Here we introduced an analytical approach, which converts the time-series data into a cascading survival map, in which each survival path bifurcates at fixed time interval depending on selected prognostic features by the Cox-based feature selection. We apply this approach in an intermediate-scale database of patients with BCLC stage B HCC and get a survival map consisting of 13 different survival paths, which is demonstrated to have superior or equal value than conventional staging systems in dynamic prognosis prediction from 3 to 12 months after initial diagnosis in derivation, internal testing, and multicentric testing cohorts. This methodology/model could facilitate dynamic prognosis prediction and treatment planning for patients with HCC in the future.

14.
EBioMedicine ; 31: 54-65, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29655996

RESUMO

Preoperative lymph node (LN) status is important for the treatment of bladder cancer (BCa). Here, we report a genomic-clinicopathologic nomogram for preoperatively predicting LN metastasis in BCa. In the discovery stage, 325 BCa patients from TCGA were involved and LN-status-related mRNAs were selected. In the training stage, multivariate logistic regression analysis was used to developed a genomic-clinicopathologic nomogram for preoperative LN metastasis prediction in the training set (SYSMH set, n=178). In the validation stage, we validated the nomogram using two independent sample sets (SYSUCC set, n=142; RJH set, n=104) with respect to its discrimination, calibration and clinical usefulness. As results, we identified five LN-status-related mRNAs, including ADRA1D, COL10A1, DKK2, HIST2H3D and MMP11. Then, a genomic classifier was developed to classify patients into high- and low-risk groups in the training set. Furthermore, a nomogram incorporating the five-mRNA-based classifier, image-based LN status, transurethral resection (TUR) T stage, and TUR lymphovascular invasion (LVI) was constructed in the training set, which performed well in the training and validation sets. Decision curve analysis demonstrated the clinical value of our nomogram. Thus, our genomic-clinicopathologic nomogram shows favorable discriminatory ability and may aid in clinical decision-making, especially for cN-patients.


Assuntos
Genômica , Proteínas de Neoplasias , RNA Mensageiro , RNA Neoplásico , Neoplasias da Bexiga Urinária , Idoso , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Proteínas de Neoplasias/genética , Proteínas de Neoplasias/metabolismo , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , RNA Neoplásico/genética , RNA Neoplásico/metabolismo , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/metabolismo , Neoplasias da Bexiga Urinária/patologia
15.
Sci Total Environ ; 613-614: 306-313, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-28917169

RESUMO

BACKGROUND: Evidence of association of ambient air pollution with cause-specific emergency department visits in China is still limited. This study aimed to investigate short-term associations between exposures to air pollutants and daily cause-specific emergency department visits using a large-scale multicenter database involving a total of 65 sentinel hospitals in Guangzhou, the most densely-populated city in south China, during 2013-2015. MATERIAL AND METHODS: We obtained data on 162,771 emergency department visits from 65 hospitals from the Emergency Medical Command Center in Guangzhou between January 1, 2013 and December 31, 2015. Daily air pollution data on particulate matter (PM) of aerodynamic diameter<10 and 2.5µm (PM10, and PM2.5, respectively), sulfur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3) were collected from the Daily Quality Report of the Guangzhou Environmental Protection Bureau during the study period. Visits for neurologic, respiratory and circulatory diseases were assessed in relation to air pollutants using Poisson generalized additive models. RESULTS: Mean daily number of emergency department visits for neurologic, respiratory and circulatory diseases was 89, 24 and 35, respectively. After adjustment for other pollutants (PM2.5, PM10, NO2 and O3), meteorological factors and time-varying confounders, a 7.98-µg/m3 (interquartile range) increment in 2-day moving average of same-day and previous-day SO2 concentrations was associated with the statistically significant increase of 4.89% (95% confidence interval: 2.86, 6.95) in neurologic emergency department visits; elevation in SO2 level (per 7.98µg/m3) was linked to a 5.19% (95% confidence interval: 2.03, 8.44) increase in circulatory emergency department visits. Most positive links were seen during the cold season. CONCLUSIONS: The results of this study contribute to the evidence of the significant associations between SO2 and specific neurologic and circulatory conditions, and also provide insight into the planning of clinical services and emergency contingency response for air pollution exposures in Guangzhou.


Assuntos
Poluição do Ar/efeitos adversos , Serviço Hospitalar de Emergência , China , Cidades , Humanos , Dióxido de Nitrogênio/efeitos adversos , Ozônio/efeitos adversos , Material Particulado/efeitos adversos , Dióxido de Enxofre/efeitos adversos
16.
PLoS Negl Trop Dis ; 11(10): e0005973, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29036169

RESUMO

BACKGROUND: In China, dengue remains an important public health issue with expanded areas and increased incidence recently. Accurate and timely forecasts of dengue incidence in China are still lacking. We aimed to use the state-of-the-art machine learning algorithms to develop an accurate predictive model of dengue. METHODOLOGY/PRINCIPAL FINDINGS: Weekly dengue cases, Baidu search queries and climate factors (mean temperature, relative humidity and rainfall) during 2011-2014 in Guangdong were gathered. A dengue search index was constructed for developing the predictive models in combination with climate factors. The observed year and week were also included in the models to control for the long-term trend and seasonality. Several machine learning algorithms, including the support vector regression (SVR) algorithm, step-down linear regression model, gradient boosted regression tree algorithm (GBM), negative binomial regression model (NBM), least absolute shrinkage and selection operator (LASSO) linear regression model and generalized additive model (GAM), were used as candidate models to predict dengue incidence. Performance and goodness of fit of the models were assessed using the root-mean-square error (RMSE) and R-squared measures. The residuals of the models were examined using the autocorrelation and partial autocorrelation function analyses to check the validity of the models. The models were further validated using dengue surveillance data from five other provinces. The epidemics during the last 12 weeks and the peak of the 2014 large outbreak were accurately forecasted by the SVR model selected by a cross-validation technique. Moreover, the SVR model had the consistently smallest prediction error rates for tracking the dynamics of dengue and forecasting the outbreaks in other areas in China. CONCLUSION AND SIGNIFICANCE: The proposed SVR model achieved a superior performance in comparison with other forecasting techniques assessed in this study. The findings can help the government and community respond early to dengue epidemics.


Assuntos
Dengue/epidemiologia , Previsões/métodos , Aprendizado de Máquina , Saúde Pública/métodos , Algoritmos , China/epidemiologia , Clima , Dengue/virologia , Surtos de Doenças , Humanos , Incidência , Modelos Lineares , Valor Preditivo dos Testes , Temperatura Ambiente
17.
Artigo em Inglês | MEDLINE | ID: mdl-28930181

RESUMO

Data on the association between air pollution and risk of ischemic stroke in China are still limited. This study aimed to investigate the association between short-term exposure to ambient air pollution and risk of ischemic strokes in Guangzhou, the most densely-populated city in south China, using a large-scale multicenter database of stroke hospital admissions. Daily counts of ischemic stroke admissions over the study years 2013-2015 were obtained from the Guangzhou Cardiovascular and Cerebrovascular Disease Event Surveillance System. Daily particulate matter <2.5 µm in diameter (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and meteorological data were collected. The associations between air pollutants and hospital admissions for stroke were examined using relative risks (RRs) and their corresponding 95% confidence intervals (CIs) based on time-series Poisson regression models, adjusting for temperature, public holiday, day of week, and temporal trends in stroke. Ischemic stroke admissions increased from 27,532 to 35,279 through 2013 to 2015, increasing by 28.14%. Parameter estimates for NO2 exposure were robust regardless of the model used. The association between same-day NO2 (RR = 1.0509, 95% CI: 1.0353-1.0668) exposure and stroke risk was significant when accounting for other air pollutants, day of the week, public holidays, temperature, and temporal trends in stroke events. Overall, we observed a borderline significant association between NO2 exposure modeled as an averaged lag effect and ischemic stroke risk. This study provides data on air pollution exposures and stroke risk, and contributes to better planning of clinical services and emergency contingency response for stroke.


Assuntos
Poluição do Ar/análise , Exposição Ambiental/análise , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Poluentes Atmosféricos/análise , China/epidemiologia , Cidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dióxido de Nitrogênio/análise , Ozônio/análise , Material Particulado/análise , Risco , Dióxido de Enxofre/análise , Temperatura Ambiente , Adulto Jovem
18.
Int J Infect Dis ; 63: 74-76, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28797591

RESUMO

China experienced an unprecedented outbreak of dengue fever in 2014, and the number of cases reached the highest level over the past 25 years. Traditional sentinel surveillance systems of dengue fever in China have an obvious drawback that the average delay from receipt to dissemination of dengue case data is roughly 1-2 weeks. In order to exploit internet search queries to timely monitor dengue fever, we analyzed data of dengue incidence and Baidu search query from 31 provinces in mainland China during the period of January 2011 to December 2014. We found that there was a strong correlation between changes in people's online health-seeking behavior and dengue fever incidence. Our study represents the first attempt demonstrating a strong temporal and spatial correlation between internet search trends and dengue epidemics nationwide in China. The findings will help the government to strengthen the capacity of traditional surveillance systems for dengue fever.


Assuntos
Dengue/epidemiologia , Surtos de Doenças , Epidemias , Internet , Vigilância em Saúde Pública/métodos , China/epidemiologia , Dengue/prevenção & controle , Comportamentos Relacionados com a Saúde , Humanos , Incidência
19.
Int J Cancer ; 141(7): 1333-1344, 2017 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-28614909

RESUMO

The cases of stomach cancer (SC) incidence are increasing per year and the SC burden has remained very high in some countries. We aimed to evaluate the global geographical variation in SC incidence and temporal trends from 1978 to 2007, with an emphasis on the effect of birth cohort. Joinpoint regression and age-period-cohort model were applied. From 2003 to 2007, male rate were 1.5- to 3-fold higher than female in all countries. Rates were highest in Eastern Asian and South American countries. Except for Uganda, all countries showed favorable trends. Pronounced cohort-specific increases in risk for recent birth cohorts were seen in Brazil, Colombia, Iceland, New Zealand, Norway, Uganda and US white people for males and in Australia, Brazil, Colombia, Costa Rica, Czech Republic, Ecuador, Iceland, India, Malta, New Zealand, Norway, Switzerland, United Kingdom, Uganda, US black and white people for females. The cohort-specific ratio for male significantly decreased in Japan, Malta and Spain for cohorts born since 1950 and in Austria, China, Croatia, Ecuador, Russia, Switzerland and Thailand for cohorts born since 1960 and for female in Japan for cohorts born since 1950 and in Canada, China, Croatia, Latvia, Russia and Thailand for cohorts born since 1960. Disparities in incidence and carcinogenic risk persist worldwide. The favorable trends may be due to changes in environmental exposure and lifestyle, including decreased Helicobacter pylori prevalence, increased intake of fresh fruits and vegetables, the availability of refrigeration and decreased intake of salted and preserved food and smoking prevalence.


Assuntos
Saúde Global/estatística & dados numéricos , Neoplasias Gástricas/epidemiologia , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ásia/epidemiologia , Canadá/epidemiologia , Estudos de Coortes , Europa (Continente)/epidemiologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Malta/epidemiologia , Pessoa de Meia-Idade , Oceania/epidemiologia , Distribuição por Sexo , América do Sul/epidemiologia , Fatores de Tempo , Estados Unidos/epidemiologia
20.
BMJ Open ; 7(5): e014894, 2017 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-28501813

RESUMO

OBJECTIVE: To investigate the relationship between job satisfaction, work stress, work-family conflict and turnover intention, and explore factors associated with turnover intention, among physicians in Guangdong Province, China. METHODS: From August to October 2013, physicians completed questionnaires and scales with regard to their job satisfaction, work stress, work-family conflict, and turnover intention. Binary logistic regression and structural equation modelling (SEM) were used in data analysis. RESULTS: A total of 3963 physicians were approached, with 3563 completing the questionnaire. The mean score of the overall perception of turnover intention of physicians who worked in Guangdong was 2.71 on a scale ranging from 1 to 6. Hours worked per week, working in an urban/rural area, type of institution, and age significantly impacted on turnover intention. Turnover intention was directly and negatively related to job satisfaction, and it was directly, indirectly and positively related to work stress and work-family conflict. CONCLUSION: Job satisfaction, work stress, work-family conflict, hours worked per week, working in an urban/rural area, types of institution and age are influencing factors of turnover intention. Reducing working hours, raising salary, providing more opportunities for career development and training, supporting and encouraging physicians by senior managers could potentially contribute to the reduction in turnover intention.


Assuntos
Satisfação no Emprego , Estresse Ocupacional/psicologia , Reorganização de Recursos Humanos/estatística & dados numéricos , Médicos , Tolerância ao Trabalho Programado/psicologia , Equilíbrio Trabalho-Vida/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , China/epidemiologia , Estudos Transversais , Feminino , Reforma dos Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Intenção , Masculino , Estresse Ocupacional/epidemiologia , Médicos/estatística & dados numéricos , Inquéritos e Questionários , Carga de Trabalho/estatística & dados numéricos , Adulto Jovem
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