Purpose: The purpose of the study was to investigate the diagnostic value of SPECT, PET and PET/CT in the diagnosis of coronary artery disease, based on a systematic review. Material and Methods: A search of PubMed/Medline and Sciencedirect databases in the English-language literature published over the last 24 years was performed. Only studies with at least 10 patients comparing SPECT, PET or combined PET/CT with invasive coronary angiography in the diagnosis of coronary artery disease (50% stenosis) were included for analysis. Sensitivities and specificities estimates pooled across studies were analysed using a Chisquare test. Results: Twenty-five studies met the selection criteria and were included for the analysis. Ten studies were performed with SPECT alone; while another six studies were performed with PET alone. Five studies were carried out with both PET and SPECT modalities, and the remaining four studies were investigated with integrated PET-CT. The mean value of sensitivity, specificity and accuracy of these imaging modalities for the diagnosis of coronary artery disease was 82% (95%CI: 76 to 88), 76% (95%CI: 70 to 82) and 83% (95%CI: 77 to 89) for SPECT; 91% (95%CI: 85 to 97), 89% (95%CI: 83 to 95) and 89% (95%CI: 83 to 95) for PET; and 85% (95%CI: 79 to 90), 83% (95%CI: 77 to 89) and 88% (95%CI: 82 to 94) for PET/CT, respectively. The diagnostic accuracy of these imaging modalities was dependent on the radiotracers used in these studies, with ammonia resulting in the highest diagnostic value. Conclusion: Our review shows that PET has high diagnostic value for diagnosing coronary artery disease, and this indicates that it is a valuable technique for both detection and prediction of coronary artery disease.

The ageing population is posing new challenges to Singapore's healthcare system. The rise of dual income and the decline of extended families, as well as an increase in age-related degenerative disorders due to increased longevity render it difficult for the family to remain the primary social safety net to care for our elderly in their own homes. Consequently, nursing homes may become increasingly relevant for resource and expertise-challenged families to cope with the burden of caring for a frail and dependent elderly. However, as the recent Nightingale Nursing Home elderly mistreatment incident attests, the standards of some have been found wanting. This paper will trace the history of nursing homes in Singapore and the evolution of government policies towards them, discuss the challenges and trade-offs of nursing home regulation, and provide suggestions for better care and governance.
Aged ; Forecasting ; Guidelines as Topic ; History, 20th Century ; History, 21st Century ; Humans ; Nursing Homes ; history ; legislation & jurisprudence ; standards ; trends ; Singapore

Objective: Chronic obstructive pulmonary disease, asthma, interstitial lung disease and pulmonary thromboembolism are the most common and severe respiratory diseases, which seriously jeopardizing the health of the Chinese citizens. Large-scale prospective cohort studies are needed to explore the relationships between potential risk factors and respiratory disease outcomes and to observe disease prognoses through long-term follow-ups. We aimed to develop a common data model (CDM) for cohort studies on respiratory diseases, in order to harmonize and facilitate the exchange, pooling, sharing, and storing of data from multiple sources to serve the purpose of reusing or uniforming those follow-up data appeared in the cohorts. Methods: The process of developing this CDM of respiratory diseases would follow the steps as: ①Reviewing the international standards, including the Clinical Data Interchange Standards Consortium (CDISC), Clinical Data Acquisition Standards Harmonization (CDASH) and the Observational Medical Outcomes Partnership (OMOP) CDM; ②Summarizing four cohort studies of respiratory diseases recruited in this research and assessing the data availability; ③Developing a CDM related to respiratory diseases. Results: Data on recruited cohorts shared a few similar domains but with various schema. The cohorts also shared homogeneous data collection purposes for future follow-up studies, making the harmonization of current and future data feasible. The derived CDM would include two parts: ①thirteen common domains for all the four cohorts and derived variables from disparate questions with a common schema, ②additional domains designed upon disease-specific research needs, as well as additional variables that were disease-specific but not initially included in the common domains. Conclusion: Data harmonization appeared essential for sharing, comparing and pooled analyses, both retrospectively and prospectively. CDM was needed to convert heterogeneous data from multiple studies into one harmonized dataset. The use of a CDM in multicenter respiratory cohort studies would make the constant collection of uniformed data possible, so to guarantee the data exchange and sharing in the future.
Data Collection/standards* ; Databases, Factual/standards* ; Delivery of Health Care/organization & administration* ; Humans ; Information Dissemination ; Pulmonary Disease, Chronic Obstructive

Objective: To evaluate the subjective well-being feelings of people aged ≥50 years in Shanghai by using the Day Reconstruction Method (DRM) and explore the related factors. Methods: A cross-sectional survey was conducted from October 2009 to June 2010 among people aged ≥50 years selected through multistage random cluster sampling in Shanghai. DRM was used to assess participants' subjective well-being by net effect and U-index. Univariate and multivariate linear regression models were used to explore the related factors. Results: A total of 8 075 participants were included, with average age of 63.1 years. The mean net effect value was 1.24 (95%CI:1.15-1.33), and the mean U-index was 1.55% (95%CI:1.10%-1.99%). After adjusted for demographic factors, univariate liner regression model indicated that age, education level, marital status, family wealth, residence, self-rated health status, WHODAS score and prevalence of chronic disease were associated with subjective well-being, and multivariate liner regression model indicated that higher WHODAS score was associated with lower net effect value (P<0.05). Conclusion: The subjective well-being feelings of people aged ≥50 years in Shanghai might be associated with age, education level, marital status, family wealth, residence, self-rated health status and WHODAS score. Enhanced social support and appropriate social security system might facilitate the improvement of the subjective well-being of the elderly.
Aged ; Aged, 80 and over ; China ; Cross-Sectional Studies ; Emotions ; Health Status ; Humans ; Middle Aged ; Social Support

Objective: Through analyzing the epidemiological characteristics of hepatitis A and E and the situation of vaccination, to promote the recommendation profile on Hepatitis E vaccination program, in China. Methods: Three phases of time span were divided as 2004-2007, 2008-2011 and 2012-2015, with age groups divided as <20, 20-29, 30-39 and ≥40. Incidence rates in both different phases and age groups were compared. Numbers of Hepatitis A and E vaccines released and used, were described. Results: Between 2004 and 2015, a declining trend in the reported incidence of hepatitis A (t=-12.15, P<0.001), but an increasing trend in hepatitis E (t=6.63, P<0.001) were noticed. The mean number of hepatitis A cases declined from 6 515 to 1 986 between 2004 and 2007 while the number of hepatitis E cases increased from 1 491 to 2 277 between 2012 and 2015. The peaks of hepatitis E appeared persistent annually, in March. The incidence of hepatitis A declined in three regions, with the western region (3.46/100 000) much higher than the eastern (1.13/100 000) or central regions (1.14/100 000) (χ(2)=32 630, P<0.01). The incidence of hepatitis E increased both in the central (1.74/100 000) and western regions (1.58/100 000), but more in the eastern region (2.66/100 000) (χ(2)=6 009, P<0.01). Incidence of hepatitis A declined in all age groups and declined by 84.36% among the 0-19 group. However, the incidence of hepatitis E showed an increasing trend among the ≥20 group. Incidence rates appeared higher in the older age groups. The coverage of hepatitis A vaccine increased from 62.05% to 93.54%, but with a negative association seen between the coverage of Hepatitis A vaccine and the incidence (F=10.69, χ(2)<0.05). Conclusion: The incidence of Hepatitis A declined sharply in China while hepatitis E was still increasing from 2004 to 2015, calling for the expansion on the coverage of Hepatitis E vaccine in the whole population.
Adolescent ; Adult ; Aged ; China/epidemiology* ; Health Care Surveys ; Hepatitis A/epidemiology* ; Hepatitis A Vaccines/administration & dosage* ; Hepatitis E/epidemiology* ; Humans ; Immunization/statistics & numerical data* ; Immunization Programs ; Incidence ; Middle Aged ; Population Surveillance ; Vaccination/statistics & numerical data* ; Young Adult

Inhalation injury is caused by inhalation of heat, toxic or irritating gases which lead to respiratory and pulmonary parenchyma damage. At present, the clinical understanding about it is still limited and lack of effective diagnosis and treatment standard. Based on the experience of diagnosis and treatment of domestic inhalation injury, combined with reports of international researches, criteria (expert consensus) for inhalation injury were systematically discussed from pathological and pathophysiological changes, clinical diagnosis and evaluation, and clinical treatment, which provides reference for clinical diagnosis and treatment of patients inflicted with inhalation injury.
Burns, Inhalation ; Consensus ; Humans ; Lung ; Smoke Inhalation Injury ; diagnosis ; therapy

Objective: To explore the characteristics of distribution on Chinese adult body mass index (BMI) in different age groups and genders and to provide reference related to obesity and related chronic diseases. Methods: Data from the China Health and Nutrition Survey in 2009 were used. Sequential sample cluster method was used to analyze the characteristics of BMI distribution in different age groups and genders by SAS. Results: Our results showed that the adult BMI in China should be divided into 3 groups according to their age, as 20 to 40 years old, 40 to 65 years old, and> 65 years old, in females or in total when grouped by difference of 5 years. For groupings in male, the three groups should be as 20 to 40, 40 to 60 years old and>60 years old. There were differences on distribution between the male and female groups. When grouped by difference of 10 years, all of the clusters for male, female and total groups as 20-40, 40-60 and>60 years old, became similar for the three classes, respectively, with no differences of distribution between gender, suggesting that the 5-years grouping was more accurate than the 10-years one, and BMI showing gender differences. Conclusions: BMI of the Chinese adults should be divided into 3 categories according to the characteristics of their age. Our results showed that BMI was increasing with age in youths and adolescents, remained unchanged in the middle-aged but decreasing in the elderly.
Adolescent ; Adult ; Age Distribution ; Aged ; Asian People/statistics & numerical data* ; Body Mass Index ; China/epidemiology* ; Female ; Humans ; Male ; Middle Aged ; Nutrition Surveys ; Obesity/ethnology* ; Sex Distribution ; Sex Factors ; Young Adult

Objective: To understand the survival of HIV/AIDS patients after receiving antiretroviral therapy for 10 year in Henan province and related factors. Methods: The database of national integrated management system of HIV/AIDS was used to collect the basic information and follow-up information of HIV/AIDS patients who received antiretroviral therapy between 2003 and 2005 in Henan province. Software SPSS 23.0 was used to analyze the patients' survival and related factors based on the life-table method and Cox proportional hazards model. Results: Among the 2 448 HIV/AIDS patients who started antiretroviral therapy during 2003-2005, the men accounted for 53.5%, and women accounted for 46.5%. Up to 70.1% of the patients were aged 40-59 years and 95.5% of the patients had blood borne infections. The patients were observed for 10 years after antiviral treatment, and 719 cases died from AIDS related diseases, with a mortality rate of 3.78/100 per year (719/19 010 per year). The cumulative survival rates of patients within 1-year, 3 years, 5 years and 10 years were 0.94, 0.86, 0.78, 0.69 respectively. Compared with the patients aged <40 years, the HRs of the patients aged 40-, 50-, 60- and ≥70 years were 1.417 (95%CI: 0.903-2.222), 1.834 (95%CI: 1.174-2.866), 2.422 (95%CI: 1.539-3.810) and 3.424 (95%CI: 2.053-5.709) respectively. Compared with patients with baseline CD(4+)T lymphocyte >350 unit/ul, the HRs of the patients with CD(4+)T lymphocyte <50 unit/μl, 50-199 unit/ul and 200-350 unit/ul were 7.105 (95%CI: 5.449-9.264), 4.175 (95%CI: 3.249-5.366) and 2.214 (95%CI: 1.691-2.900) respectively. Compared with the women, the HR of the men was 1.480 (95%CI: 1.273-1.172). Compared with the patients who received second line ART therapy, the HR of patients receiving no second line therapy was 11.923 (95%CI: 9.410-15.104). Conclusions: The cumulative survival rate the HIV/AIDS patients after 10 years of antiretroviral therapy reached 0.69 in Henan. Male, old age, low basic CD(4+)T lymphocyte count and receiving no second line therapy were the risk factors for long-term survival of AIDS patients.
Acquired Immunodeficiency Syndrome ; Adult ; Aged ; Antiretroviral Therapy, Highly Active ; CD4 Lymphocyte Count ; China/epidemiology* ; Female ; HIV/drug effects* ; HIV Infections/mortality* ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Risk Factors ; Survival Analysis ; Survival Rate

The 5th edition WHO classification of B-cell tumors is a systematic update to the fourth revised version of the classification. The changes include updated names of entities, sharpened diagnostic criteria, and upgrades from provisional to definite entities. This review focuses on the changes in the content of each chapter of B-cell tumors, facilitating domestic colleagues engaged in the diagnosis and treatment of lymphohematopoietic tumors to understand the latest progress and guide daily work.
Humans ; World Health Organization ; Lymphoma, B-Cell/diagnosis*

Orthostatic hypotension is most common in elderly people, and its prevalence increases with age. Attenuation of the vestibulo-sympathetic reflex (VSR) is commonly associated with orthostatic hypotension. In this study, we investigated the role of glutamate on the vestibulo-solitary projection of the VSR pathway to clarify the pathophysiology of orthostatic hypotension. Blood pressure and expression of both pERK and c-Fos protein were evaluated in the nucleus tractus solitarius (NTS) after microinjection of glutamate into the medial vestibular nucleus (MVN) in conscious rats with sodium nitroprusside (SNP)-induced hypotension that received baroreceptor unloading via sinoaortic denervation (SAD). SNP-induced hypotension increased the expression of both pERK and c-Fos protein in the NTS, which was abolished by pretreatment with glutamate receptor antagonists (MK801 or CNQX) in the MVN. Microinjection of glutamate receptor agonists (NMDA or AMPA) into the MVN increased the expression of both pERK and c-Fos protein in the NTS without causing changes in blood pressure. These results indicate that both NMDA and AMPA receptors play a significant role in the vestibulo-solitary projection of the VSR pathway for maintaining blood pressure, and that glutamatergic transmission in this projection might play a key role in the pathophysiology of orthostatic hypotension.
Aged ; Animals ; Blood Pressure ; Denervation ; Excitatory Amino Acid Antagonists ; Glutamic Acid* ; Humans ; Hypotension* ; Hypotension, Orthostatic ; Microinjections ; N-Methylaspartate ; Nitroprusside ; Pressoreceptors ; Prevalence ; Rats* ; Receptors, AMPA ; Receptors, Glutamate ; Reflex ; Sodium* ; Solitary Nucleus ; Vestibular Nuclei