Objective The aim of this study was to analyze the incidence trend and age-specific characteristics of esophage-al cancer in cancer registration areas of Gansu Province from 2010 to 2021,and predict the incidence of esophageal cancer from 2022 to 2030.Methods Based on the incidence data of esophageal cancer in 15 cancer registries in Gansu Province from 2010 to 2021,the incidence was calculated by age,sex,urban and rural areas.The age-standardized incidence by Chinese standard population(ASIRC)was standardized using the 2000 Chinese standard population.Joinpoint regression model was used to analyze the change trend of esophageal cancer incidence,and the average annual percentage change(AAPC)was calculated to quantify the overall rate of change.A birth cohort model was constructed to analyze incidence trend of different birth groups from 1930 to 2021,and the Bayesian age-period-cohort(BAPC)model was used to predict incidence.Results From 2010 to 2021,the ASIRC of esophageal cancer in Gansu Province showed a significant downward trend(AAPC=-14.47％,95％CI:-18.72％--9.99％,P＜0.001).The ASIRC in men decreased at an annual rate of 13.02％(AAPC=-13.02％,95％CI:-17.28％--8.54％,P＜0.001),the incidence of esophage-al cancer in women at a rate of 15.80％per year(AAPC=-15.80％,95％CI:-20.69％--10.61％,P＜0.001).The ASIRC of e-sophageal cancer in urban areas decreased at an annual rate of 15.32％(AAPC=-15.32％,95％CI:-21.04％--9.18％,P＜0.001);ASIRC of esophageal cancer in rural areas decreased at a rate of 5.33％per year(AAPC=-5.33％,95％CI:-8.94％--1.58％,P＜0.001).From 2010 to 2021,the incidence of esophageal cancer in all age groups showed a significant downward trend(AAPC:-19.59％to-9.18％).The birth cohort analysis revealed that the incidence of esophageal cancer in people over 40 years old in the province,men,women,urban and rural areas showed a downward trend with increase of birth years.BAPC model predicted that that the ASIRC of esophageal cancer for the total province population,men and women would decrease from 6.47/100,000,10.02/100,000,and 2.95/100,000 in 2021 to 1.31/100,000,1.72/100,000,and 0.91/100,000 in 2030,respectively.Conclu-sions The incidence of esophageal cancer in Gansu Province showed a downward trend from 2010 to 2021,but men and rural areas were still the focus of high incidence.The prediction indicates that the incidence of esophageal cancer in Gansu Province will further decline by 2030,suggesting that the prevention and control measures have achieved results;however,it is still necessary to strengthen the intervention and long-term monitoring of high-risk groups.

Objective:To evaluate the clinical value of high-risk human papillomavirus (HPV) viral load for the cervical cancer screening and triage of high-risk HPV positive populations without additional tests.Methods:(1) This study conducted a retrospective analysis of 29 720 women aged 35-64 years who received cervical cancer screening in Quanzhou, China, in 2021. Fourteen high-risk HPV types (including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) were detected for cervical cancer primary screening using hybrid capture-chemiluminescence method. High-risk HPV positive samples were further subjected to HPV 16/18 genotyping using hybrid capture-chemiluminescence method. Among them, HPV 16/18 positive women were directly referred to colposcopy, while the other 12 high-risk HPV positive samples were further subjected to liquid based cytology test. Those with abnormal or suspicious cytology were referred to colposcopy. Biopsies were taken for histopathological examination of suspicious or abnormal individuals under colposcopy. (2) Ten cases of colposcopy loss or refusal to undergo examination were excluded, and the data from the 29 710 cases were analyzed. The HPV viral loads of the other 12 high-risk HPV positive populations were focused and evaluated their HPV viral loads for further cervical intraepithelial neoplasia (CIN) Ⅱ and above lesions (CINⅡ +) triage in cervical cancer screening. Results:(1) Among 29 720 women, 2 487 women (8.37%, 2 487/29 720) were positive for high-risk HPV, including 807 women (2.72%, 807/29 720) were positive for HPV 16/18 and 1 680 patients (5.65%, 1 680/29 720) were positive for the other 12 high-risk HPV types. Among 1 680 women who tested positive for the other 12 high-risk HPV types, 573 patients were atypical squamous cell carcinoma of unclear significance or above, 346 patients were CIN Ⅰ, 122 patients were CIN Ⅱ-Ⅲ, 9 patients were squamous cell carcinoma patients, and 4 patients were adenocarcinoma in situ. The immediate risk of CIN Ⅱ + in HPV 16/18 positive women (11.13%) was approximately four times higher than that of other 12 high-risk HPV positive women (2.74%). (2) Through the viral load analysis of the other 12 high-risk HPV types, we found that the viral load of the other 12 high-risk HPV provide a good value for the pathological results, with a clinical cutoff (CO) value of 11.21 relative light unit/CO (RLU/CO) for the CINⅡ + detection. Except for HPV 16/18 positive patients, when the viral load values of the other 12 high-risk HPV types were greater than 10 RLU/CO, these patients had a higher risk of CINⅡ +, with a positive predictive value of 31.29%. CINⅡ + was not found in any of the other 12 high-risk HPV positive with viral load values less than or equal to 10 RLU/CO. Conclusions:Using hybrid capture-chemiluminescence HPV tests for HPV 16/18 genotyping, combined with the viral loads (>10 RLU/CO) of the other 12 high-risk HPV analysis, one could triage HPV positive population without additional tests. Such triage strategy could promote the coverage of cervical cancer screening, particularly where cytology pathologists or economic resources are limited.

Objective:This study aimed to evaluate the therapeutic effect of intratympanic injection of ganglioside in patients with refractory sudden deafness. Methods:A total of 120 patients with sudden deafness, aged 18-65 years, whose onset was within 11-42 days, failed to respond to conventional treatment, and had an average hearing threshold（500-4 000 Hz）>60 dB were selected. They were prospectively and randomly divided into a control group of 61 cases and an experimental group of 59 cases. The control group was treated according to the recommended protocol of the Chinese Medical Association（postauricular injection of methylprednisolone）, while the experimental group was treated with intratympanic injection of monosialotetrahexosylganglioside sodium+postauricular injection of methylprednisolone. Both groups were simultaneously administered oral ginkgo biloba extract and citicoline tablets. Hearing was re-examined two weeks after the completion of treatment, and the therapeutic effects of the two different treatment methods were compared and analyzed. Results:The effective rate was 29.51% in the control group and 54.24% in the experimental group（P<0.01）. The average hearing threshold improved by 11.57 dB HL in the control group and 22.50 dB HL in the experimental group（P<0.05）. Conclusion:The combination of postauricular injection of methylprednisolone and intratympanic injection of ganglioside is more effective than postauricular injection of methylprednisolone alone in the treatment of refractory sudden deafness. The earlier the treatment, the better the therapeutic effect.
Humans ; Middle Aged ; Hearing Loss, Sudden/drug therapy* ; Adult ; Prospective Studies ; Young Adult ; Aged ; Adolescent ; Male ; Female ; Injection, Intratympanic ; Gangliosides/administration & dosage* ; Methylprednisolone/therapeutic use* ; Treatment Outcome

Objective:To analyze application effect of Failure Mode and Effects Analysis(FMEA)in the maintenance and upkeep for equipment in operating room.Methods:The process of FMEA mode was analyzed,and a strategy about maintenance and upkeep for equipment in operating room on the basis of FMEA was formulated from some aspects included preparation stage,analysis for failure mode(FM),construction for the system of prevention,maintenance and upkeep,and improvement and analysis for results.Sixty used equipment in the operating room of Shiyan Taihe Hospital(Affiliated Hospital of Hubei University of Medicine)from January to December 2023 were selected.According to different management methods for equipment,the conventional management mode and the FMEA management mode were respectively selected to conduct maintenance and upkeep for equipment in operating room,with 30 equipment in each management mode.The incidences of adverse events,the satisfaction scores of operators,and the qualities of maintenance and upkeep for equipment of the two kinds of management modes were compared.Results:The number of occurring inadequate preparation of surgical associated facilities,non-standardized operation of surgical equipment,and incidence of faliures in surgical equipment were respectively in 30 equipment in operating room that adopted FMEA management mode,and the total incidence of adverse events was 6.67%(2/30),which was lower than 36.67%(11/30)that adopted conventional management mode,and the difference was statistically significant(x2=7.954,P<0.05).The satisfaction scores of the operators of operating equipment for the operational quality,usage operation,and maintenance and upkeep of the equipment that received the FMEA management mode in operating room were respectively(92.22±3.36),(91.69±2.25)and(93.25±3.69)points,all of which were higher than those that received conventional management mode,and the differences were statistically significant(t=15.418,17.415,16.639,P<0.05).The average increase extents of the response time for fault,repair time for fault,and the cost of operation and maintenance that adopted FMEA management mode were respectively(2.36±0.59)h,(4.25±2.11)h and(1.89±0.14)%for equipment in operating room,all of which were less than those that adopted conventional management mode,and the differences were statistically significant(t=9.943,12.050,11.069,P<0.05).The failure frequency of equipment of adopting FMEA management mode was(1.54±0.21)times per year,which was lower than that of adopting conventional management mode.The average success rate of opening equipment of adopting FMEA management mode was(90.69±3.59)%,which was higher than that of adopting conventional management mode,and the differences of the above two indicators between two modes were statistically significant(t=15.184,18.779,P<0.05).Conclusion:The application of FMEA in the maintenance and upkeep for medical equipment in the operating room can assess the operational quality of the equipment,and carry out preventive operation and maintenance,and reduce the incidence of failures in equipment,and decrease costs for maintenance,and improve the clinical service level for the equipment.

Objective To observe the effect of ultrasound-guided sacral canal injection of Neurotropin combined with comprehen-sive rehabilitation on severe sacral plexus injury after sacral fracture.Methods A case with severe sacral plexus injury ten months after sacral fracture was reviewed.He accepted ultrasound-guided sacral canal injection of Neurotropin along with comprehensive rehabilitation,and was assessed with American Spinal Injury Association Impairment Scale(AIS)impairment scale,manual muscle testing,Visual An-alog Scale(VAS),modified Barthel Index(MBI),Short-form of Health Survey(SF-36)and Functional Gait As-sessment(FGA),and measured the nerve conduction velocity and the structural organization of the sacrococcy-geal ligament using nerve conduction velocity tests,electromyography(EMG)and ultrasound examination be-fore and after treatment.Results After four weeks and ten weeks of treatment,the muscle strength,and scores of MBI,FGA and SF-36 increased,while the ASIA score improved from grade D to grade E,and VAS score decreased.During follow-up,the VAS score and physical pain and general health status scores of the SF-36 increased.After ten weeks of treatment,nerve conduction velocity increased,latency shortened,and the amplitude of evoked action potentials increased.The presence of spontaneous sharp waves decreased,and the peak of active potentials increased.The peak of ac-tive potentials in the right gluteus maximus,vastus lateralis and gastrocnemius muscles increased.The structural organization of the sacrococcygeal ligament appeared clearer and more orderly.No adverse reaction was ob-served.Conclusion Ultrasound-guided sacral canal injection of Neurotropin combined with comprehensive rehabilitation is ef-fective on pain,activities of daily living and quality of life for patients with severe sacral plexus injury during the sequelae period.

Objective The aim of this study was to analyze the incidence trend and age-specific characteristics of esophage-al cancer in cancer registration areas of Gansu Province from 2010 to 2021,and predict the incidence of esophageal cancer from 2022 to 2030.Methods Based on the incidence data of esophageal cancer in 15 cancer registries in Gansu Province from 2010 to 2021,the incidence was calculated by age,sex,urban and rural areas.The age-standardized incidence by Chinese standard population(ASIRC)was standardized using the 2000 Chinese standard population.Joinpoint regression model was used to analyze the change trend of esophageal cancer incidence,and the average annual percentage change(AAPC)was calculated to quantify the overall rate of change.A birth cohort model was constructed to analyze incidence trend of different birth groups from 1930 to 2021,and the Bayesian age-period-cohort(BAPC)model was used to predict incidence.Results From 2010 to 2021,the ASIRC of esophageal cancer in Gansu Province showed a significant downward trend(AAPC=-14.47％,95％CI:-18.72％--9.99％,P＜0.001).The ASIRC in men decreased at an annual rate of 13.02％(AAPC=-13.02％,95％CI:-17.28％--8.54％,P＜0.001),the incidence of esophage-al cancer in women at a rate of 15.80％per year(AAPC=-15.80％,95％CI:-20.69％--10.61％,P＜0.001).The ASIRC of e-sophageal cancer in urban areas decreased at an annual rate of 15.32％(AAPC=-15.32％,95％CI:-21.04％--9.18％,P＜0.001);ASIRC of esophageal cancer in rural areas decreased at a rate of 5.33％per year(AAPC=-5.33％,95％CI:-8.94％--1.58％,P＜0.001).From 2010 to 2021,the incidence of esophageal cancer in all age groups showed a significant downward trend(AAPC:-19.59％to-9.18％).The birth cohort analysis revealed that the incidence of esophageal cancer in people over 40 years old in the province,men,women,urban and rural areas showed a downward trend with increase of birth years.BAPC model predicted that that the ASIRC of esophageal cancer for the total province population,men and women would decrease from 6.47/100,000,10.02/100,000,and 2.95/100,000 in 2021 to 1.31/100,000,1.72/100,000,and 0.91/100,000 in 2030,respectively.Conclu-sions The incidence of esophageal cancer in Gansu Province showed a downward trend from 2010 to 2021,but men and rural areas were still the focus of high incidence.The prediction indicates that the incidence of esophageal cancer in Gansu Province will further decline by 2030,suggesting that the prevention and control measures have achieved results;however,it is still necessary to strengthen the intervention and long-term monitoring of high-risk groups.

Objective:To evaluate the clinical value of high-risk human papillomavirus (HPV) viral load for the cervical cancer screening and triage of high-risk HPV positive populations without additional tests.Methods:(1) This study conducted a retrospective analysis of 29 720 women aged 35-64 years who received cervical cancer screening in Quanzhou, China, in 2021. Fourteen high-risk HPV types (including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) were detected for cervical cancer primary screening using hybrid capture-chemiluminescence method. High-risk HPV positive samples were further subjected to HPV 16/18 genotyping using hybrid capture-chemiluminescence method. Among them, HPV 16/18 positive women were directly referred to colposcopy, while the other 12 high-risk HPV positive samples were further subjected to liquid based cytology test. Those with abnormal or suspicious cytology were referred to colposcopy. Biopsies were taken for histopathological examination of suspicious or abnormal individuals under colposcopy. (2) Ten cases of colposcopy loss or refusal to undergo examination were excluded, and the data from the 29 710 cases were analyzed. The HPV viral loads of the other 12 high-risk HPV positive populations were focused and evaluated their HPV viral loads for further cervical intraepithelial neoplasia (CIN) Ⅱ and above lesions (CINⅡ +) triage in cervical cancer screening. Results:(1) Among 29 720 women, 2 487 women (8.37%, 2 487/29 720) were positive for high-risk HPV, including 807 women (2.72%, 807/29 720) were positive for HPV 16/18 and 1 680 patients (5.65%, 1 680/29 720) were positive for the other 12 high-risk HPV types. Among 1 680 women who tested positive for the other 12 high-risk HPV types, 573 patients were atypical squamous cell carcinoma of unclear significance or above, 346 patients were CIN Ⅰ, 122 patients were CIN Ⅱ-Ⅲ, 9 patients were squamous cell carcinoma patients, and 4 patients were adenocarcinoma in situ. The immediate risk of CIN Ⅱ + in HPV 16/18 positive women (11.13%) was approximately four times higher than that of other 12 high-risk HPV positive women (2.74%). (2) Through the viral load analysis of the other 12 high-risk HPV types, we found that the viral load of the other 12 high-risk HPV provide a good value for the pathological results, with a clinical cutoff (CO) value of 11.21 relative light unit/CO (RLU/CO) for the CINⅡ + detection. Except for HPV 16/18 positive patients, when the viral load values of the other 12 high-risk HPV types were greater than 10 RLU/CO, these patients had a higher risk of CINⅡ +, with a positive predictive value of 31.29%. CINⅡ + was not found in any of the other 12 high-risk HPV positive with viral load values less than or equal to 10 RLU/CO. Conclusions:Using hybrid capture-chemiluminescence HPV tests for HPV 16/18 genotyping, combined with the viral loads (>10 RLU/CO) of the other 12 high-risk HPV analysis, one could triage HPV positive population without additional tests. Such triage strategy could promote the coverage of cervical cancer screening, particularly where cytology pathologists or economic resources are limited.

Objective:To analyze application effect of Failure Mode and Effects Analysis(FMEA)in the maintenance and upkeep for equipment in operating room.Methods:The process of FMEA mode was analyzed,and a strategy about maintenance and upkeep for equipment in operating room on the basis of FMEA was formulated from some aspects included preparation stage,analysis for failure mode(FM),construction for the system of prevention,maintenance and upkeep,and improvement and analysis for results.Sixty used equipment in the operating room of Shiyan Taihe Hospital(Affiliated Hospital of Hubei University of Medicine)from January to December 2023 were selected.According to different management methods for equipment,the conventional management mode and the FMEA management mode were respectively selected to conduct maintenance and upkeep for equipment in operating room,with 30 equipment in each management mode.The incidences of adverse events,the satisfaction scores of operators,and the qualities of maintenance and upkeep for equipment of the two kinds of management modes were compared.Results:The number of occurring inadequate preparation of surgical associated facilities,non-standardized operation of surgical equipment,and incidence of faliures in surgical equipment were respectively in 30 equipment in operating room that adopted FMEA management mode,and the total incidence of adverse events was 6.67%(2/30),which was lower than 36.67%(11/30)that adopted conventional management mode,and the difference was statistically significant(x2=7.954,P<0.05).The satisfaction scores of the operators of operating equipment for the operational quality,usage operation,and maintenance and upkeep of the equipment that received the FMEA management mode in operating room were respectively(92.22±3.36),(91.69±2.25)and(93.25±3.69)points,all of which were higher than those that received conventional management mode,and the differences were statistically significant(t=15.418,17.415,16.639,P<0.05).The average increase extents of the response time for fault,repair time for fault,and the cost of operation and maintenance that adopted FMEA management mode were respectively(2.36±0.59)h,(4.25±2.11)h and(1.89±0.14)%for equipment in operating room,all of which were less than those that adopted conventional management mode,and the differences were statistically significant(t=9.943,12.050,11.069,P<0.05).The failure frequency of equipment of adopting FMEA management mode was(1.54±0.21)times per year,which was lower than that of adopting conventional management mode.The average success rate of opening equipment of adopting FMEA management mode was(90.69±3.59)%,which was higher than that of adopting conventional management mode,and the differences of the above two indicators between two modes were statistically significant(t=15.184,18.779,P<0.05).Conclusion:The application of FMEA in the maintenance and upkeep for medical equipment in the operating room can assess the operational quality of the equipment,and carry out preventive operation and maintenance,and reduce the incidence of failures in equipment,and decrease costs for maintenance,and improve the clinical service level for the equipment.

Objective To observe the effect of ultrasound-guided sacral canal injection of Neurotropin combined with comprehen-sive rehabilitation on severe sacral plexus injury after sacral fracture.Methods A case with severe sacral plexus injury ten months after sacral fracture was reviewed.He accepted ultrasound-guided sacral canal injection of Neurotropin along with comprehensive rehabilitation,and was assessed with American Spinal Injury Association Impairment Scale(AIS)impairment scale,manual muscle testing,Visual An-alog Scale(VAS),modified Barthel Index(MBI),Short-form of Health Survey(SF-36)and Functional Gait As-sessment(FGA),and measured the nerve conduction velocity and the structural organization of the sacrococcy-geal ligament using nerve conduction velocity tests,electromyography(EMG)and ultrasound examination be-fore and after treatment.Results After four weeks and ten weeks of treatment,the muscle strength,and scores of MBI,FGA and SF-36 increased,while the ASIA score improved from grade D to grade E,and VAS score decreased.During follow-up,the VAS score and physical pain and general health status scores of the SF-36 increased.After ten weeks of treatment,nerve conduction velocity increased,latency shortened,and the amplitude of evoked action potentials increased.The presence of spontaneous sharp waves decreased,and the peak of active potentials increased.The peak of ac-tive potentials in the right gluteus maximus,vastus lateralis and gastrocnemius muscles increased.The structural organization of the sacrococcygeal ligament appeared clearer and more orderly.No adverse reaction was ob-served.Conclusion Ultrasound-guided sacral canal injection of Neurotropin combined with comprehensive rehabilitation is ef-fective on pain,activities of daily living and quality of life for patients with severe sacral plexus injury during the sequelae period.

Objective To establish a safe disposal management program for home used sharps waste of insulin injection so as to provide a reference for the standardised management of sharps waste after insulin.injection.Methods Based on the model of information-motivation-behavioural skills,the safe disposal management program for insulin needles used at home was developed by literature reviews and semi-structured interviews to investigate the perceptions and requirements of patients.The program was then modified and refined by two rounds of expert consultation with Delphi method.Results The effective retrieval rates of questionnaire for two rounds of expert consultations were 88.89%and 93.75%,with an expert authority coefficient at 0.93.In the second round,the mean importance scores of the items were 4.40 to 5.00,with a coefficient of variation ranged from 0 to 0.168.The established program consisted of three primary items,six secondary items,and 20 tertiary items.Conclusion The safe disposal management program for home used sharps waste of insulin injection established from the perspectives of information,motivation and behavioural skills was scientific and practical,which offered a guidance to healthcare professionals in the clinical practices.