1.Survival benefit of radiation in high-risk, early-stage endometrioid carcinoma
Michael XIANG ; Elizabeth A. KIDD
Journal of Gynecologic Oncology 2020;31(4):e39-
Objective:
To better delineate optimal management of high-risk, early-stage endometrial cancer, as national guidelines permit substantial practice variations.
Methods:
Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB grade 3 and stage II endometrioid carcinoma who underwent at least total hysterectomy were identified in SEER-Medicare. Adjuvant treatments were brachytherapy (BT), external beam radiation therapy (EBRT), and chemotherapy. Death from endometrial cancer (cancerspecific mortality [CSM]) and local recurrence were analyzed using Gray's test and FineGray regression.
Results:
In total, 1,095 patients were identified: 52% received BT, 56% received EBRT, 16% received chemotherapy, and 29% received no adjuvant treatment. Survival outcomes were significantly worse for stage IB grade 3 and stage II grade 3 relative to stage II grades 1–2 (5-year CSM: 18% and 23% vs. 10%; p<0.001 and p=0.003, respectively), while there was no difference between stage IB grade 3 and stage II grade 3 (p=0.618). BT had a local control benefit across all patients (p<0.001) that translated into a survival benefit in stage IB grade 3 (adjusted hazard ratio [HR] for CSM=0.47, p=0.003). EBRT had a survival benefit in stage II grade 3 (adjusted HR for CSM=0.36; p=0.031), as did lymph node dissection (p=0.015).Chemotherapy was not significantly correlated with CSM.
Conclusions
High-risk, early-stage endometrioid carcinoma is a heterogeneous population.BT was associated with a survival benefit in stage IB grade 3, whereas regional treatment with EBRT and lymphadenectomy was associated with a survival benefit in stage II grade 3.
2.Survey of suicidal ideation and suicide attempts in outpatients at 50 general hospitals in Beijing.
Ye LIANG ; Chun-ling JIANG ; Zhi-qing WANG ; Xiang-qun WANG ; Michael R PHILLIPS
Chinese Journal of Epidemiology 2006;27(1):19-24
OBJECTIVEDescribe the prevalence and risk factors for suicidal ideation and suicide attempt among outpatients at general hospitals in Beijing.
METHODSTrained psychiatric nurses obtained data about the characteristics of suicidal thoughts and suicide attempts from 2877 persons 15 years of age or older who were consecutive outpatients at 35 level-1, 8 level-2 and 7 level-3 general hospitals selected from all hospitals in Beijing by stratified random sampling. Logistic regression analysis was used to identify risk factors for suicidal ideation and suicide attempt.
RESULTSThe lifetime prevalence of suicidal ideation and suicide attempt were 6.08% (95% CI: 5.25% - 7.25%) and 1.18% (0.82% - 1.65%), respectively. Mutivariate logistic analysis found that the most important risk factors for suicidal ideation were hopelessness in the prior year (OR = 7.96), current depression (OR = 3.41), younger age (OR for < 35 = 2.83; OR for 35 - 55 = 2.08), having a blood relative with prior suicidal behavior (OR = 2.58), and so forth; the most important risk factors for suicide attempt were younger age (OR for < 35 = 4.96; OR for 35 - 55 = 4.40), hopelessness in the prior year (OR = 4.02), self-report of health status in last weeks as poor (OR = 2.81), not currently married (never married, divorced, widowed, etc) (OR = 2.80), and so forth. Four variables were independent risk factors for both suicidal ideation and suicide attempt: hopelessness in the last year, younger age, having associates with prior suicidal behavior and female gender.
CONCLUSIONSMany patients treated at medical, surgical and other outpatient departments of general hospitals in Beijing are depressed and at risk for suicide; this is particularly true of young female patients who feel hopeless about their future. Outpatient clinicians need to be trained to identify such patients, to assess the severity of their psychological problems and, if necessary, to provide appropriate treatment or refer them for psychiatric evaluation.
Adult ; Age Factors ; China ; epidemiology ; Depression ; epidemiology ; Female ; Health Surveys ; Hospitals, General ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Outpatients ; psychology ; statistics & numerical data ; Prevalence ; Risk Factors ; Sex Factors ; Suicide ; psychology ; statistics & numerical data ; Suicide, Attempted ; psychology ; statistics & numerical data
3.Impact of dispatcher-assisted cardiopulmonary resuscitation and myResponder mobile app on bystander resuscitation.
Xiang Yi WONG ; Qiao FAN ; Nur SHAHIDAH ; Carl Ross DE SOUZA ; Shalini ARULANANDAM ; Yih Yng NG ; Wei Ming NG ; Benjamin Sieu Hon LEONG ; Michael Yih Chong CHIA ; Marcus Eng Hock ONG
Annals of the Academy of Medicine, Singapore 2021;50(3):212-221
INTRODUCTION:
Bystander cardiopulmonary resuscitation (B-CPR) is associated with improved out-of hospital cardiac arrest survival. Community-level interventions including dispatcher-assisted CPR (DA-CPR) and myResponder were implemented to increase B-CPR. We sought to assess whether these interventions increased B-CPR.
METHODS:
The Singapore out-of-hospital cardiac arrest registry captured cases that occurred between 2010 and 2017. Outcomes occurring in 3 time periods (Baseline, DA-CPR, and DA-CPR plus myResponder) were compared. Segmented regression of time-series data was conducted to investigate our intervention impact on the temporal changes in B-CPR.
RESULTS:
A total of 13,829 out-of-hospital cardiac arrest cases were included from April 2010 to December 2017. Higher B-CPR rates (24.8% versus 50.8% vs 64.4%) were observed across the 3 time periods. B-CPR rates showed an increasing but plateauing trend. DA-CPR implementation was significantly associated with an increased B-CPR (level odds ratio [OR] 2.26, 95% confidence interval [CI] 1.79-2.88; trend OR 1.03, 95% CI 1.01-1.04), while no positive change was detected with myResponder (level OR 0.95, 95% CI 0.82-1.11; trend OR 0.99, 95% CI 0.98-1.00).
CONCLUSION
B-CPR rates in Singapore have been increasing alongside the implementation of community-level interventions such as DA-CPR and myResponder. DA-CPR was associated with improved odds of receiving B-CPR over time while the impact of myResponder was less clear.
4.Research progress in trauma registration system
Zhenxia GUO ; Shiyao WANG ; Yatao LIU ; Xingwen HAN ; Wenji WANG ; Pei CHU ; Yongwei LIU ; Xiang LI ; Michael NERLICH ; Wenjin WANG ; Liping LIU
Chinese Journal of Trauma 2022;38(4):374-379
Trauma registration is an important tool to record the process and timeline in the treatment of trauma patients. The operation of trauma database is of great significance for reducing the mortality of patients, promoting the construction of trauma treatment system, and providing reference for policy-making. Trauma registration system has been established in the United States, United Kingdom, Germany and other developed countries for many years. However, the domestic system is still at an initial stage, and there are problems like data deficiencies, data incoherence, no item of complications, no treatment data after discharge and limits of human and financial resources. Therefore, there is room for improvements in terms of personnel fixation, financial support and continuous data monitoring should be further improved. In this study, the authors summarize the traum registration system from aspects of basic situation both at home and abroad, data analysis, clinical value, operation mechanism and challenges so as to provide important data for clinical researches.
5.Adalimumab induction and maintenance therapy achieve clinical remission and response in Chinese patients with Crohn's disease.
Kai Chun WU ; Zhi Hua RAN ; Xiang GAO ; Minhu CHEN ; Jie ZHONG ; Jian Qiu SHENG ; Michael A KAMM ; Simon TRAVIS ; Kori WALLACE ; Nael M MOSTAFA ; Marisa SHAPIRO ; Yao LI ; Roopal B THAKKAR ; Anne M ROBINSON
Intestinal Research 2016;14(2):152-163
BACKGROUND/AIMS: This was a Phase 2 study (NCT02015793) to evaluate the pharmacokinetics, safety, and efficacy of adalimumab in Chinese patients with Crohn's disease (CD). METHODS: Thirty, adult Chinese patients with CD (CD Activity Index [CDAI] 220-450; high-sensitivity [hs]-C-reactive protein [CRP] ≥3 mg/L) received double-blind adalimumab 160/80 mg or 80/40 mg at weeks 0/2, followed by 40 mg at weeks 4 and 6. An open-label extension period occurred from weeks 8-26; patients received 40 mg adalimumab every other week. Serum adalimumab concentration and change from baseline in fecal calprotectin (FC) were measured during the double-blind period. Clinical remission (CDAI <150), response (decrease in CDAI ≥70 points from baseline), and change from baseline in hs-CRP were assessed through week 26. Nonresponder imputation was used for missing categorical data and last observation carried forward for missing hs-CRP/FC values. No formal hypothesis was tested. Adverse events were monitored. RESULTS: Mean adalimumab serum concentrations during the induction phase were 13.9-18.1 µg/mL (160/80 mg group) and 7.5-9.5 µg/mL (80/40 mg group). During the double-blind period, higher remission/response rates and greater reductions from baseline in hs-CRP and FC were observed with adalimumab 160/80 mg compared to that with 80/40 mg. Adverse event rates were similar among all treatment groups. CONCLUSIONS: Adalimumab serum concentrations in Chinese patients with CD were comparable to those observed previously in Western and Japanese patients. Clinically meaningful remission rates and improvement in inflammatory markers were achieved with both dosing regimens; changes occurred rapidly with adalimumab 160/80 mg induction therapy. No new safety signals were reported.
Adult
;
Asian Continental Ancestry Group*
;
Crohn Disease*
;
Humans
;
Leukocyte L1 Antigen Complex
;
Pharmacokinetics
6.The application of National AIDS spending assessment in a county of Dehong prefecture, Yunnan province, China.
Duo SHAN ; Jiang-ping SUN ; Anna YAKUSIK ; Zhong-dan CHEN ; Jian-hua YUAN ; Tao LI ; Song DUAN ; Xing YANG ; Mei WEI ; Sante MICHAEL ; Run-hua YE ; Li-fen XIANG ; Yue-cheng YANG ; Da REN
Chinese Journal of Preventive Medicine 2012;46(11):967-971
OBJECTIVETo calculate the actual expenditures in a county of Dehong prefecture, Yunnan province, China by using the method of National AIDS Spending Assessment (NASA) in 2010.
METHODSData were collected through NASA data collection form based on adapted NASA classification in the county of Dehong prefecture from October to December, 2011, and complemented by semi-structured interview with 16 well trained programmatic and financial representatives in 8 spending units. Data were entered in Resource Tracking Software (RTS) V 2009.3.0, and SPSS 13.0 was used for data processing and analysis.
RESULTSThe NASA estimations showed that the county spent a total of ¥16 235 954 on HIV/AIDS in 2010. Public funds constituted 96.3% of the total expenditure (¥15 630 937), followed by Global Fund which accounted for 3.0% (¥484 585) and private sources which accounted for 0.7% (¥120 432). Findings based on NASA categories showed that AIDS spendings were mainly on 4 areas, and expenditure on Care & Treatment was ¥12 401 382 (76.4% of total expenditure), followed by Prevention which accounted for 14.3% (¥2 325 707), Program Management & Administration which accounted for 7.8% (¥1 268 523) and human resources which accounted for 1.5% (¥240 342). The most beneficial population group was People Living with HIV (PLHIV), accounting for 84.7% of total expenditure. (¥13 753 428), followed by 4.8% for high risk population, including female sex workers and their partners (¥297 333), injection drug users and their partners (¥293 143), men having sex with men and their partners (¥185 136) and 1.5% (¥241 429) for the general population.
CONCLUSIONThe local funds for HIV/AIDS in this county was insufficient. The local government should increase corresponding funds based on central government funding. Care and treatment was the first spending priority in the county and the investment of prevention services needs to be increased. Prevention and treatment and care should be combined to ensure the effectiveness of comprehensive prevention and treatment of AIDS.
Acquired Immunodeficiency Syndrome ; economics ; prevention & control ; China ; Financing, Government ; economics ; Health Expenditures ; Humans ; Outcome and Process Assessment (Health Care) ; Surveys and Questionnaires
7.New situation and new strategies——research and development and internationalization of new drugs and health products of traditional Chinese medicine
Ning JIANG ; Chun-Hui QI ; Liang CAO ; Lan-Ying CHEN ; Jin-Hui GU ; Yong KANG ; Inkyeom KIM ; Xiao-Yuan LIAN ; Yin LU ; Gui-Yuan LYU ; Ke NIE ; Yun QI ; SCHINI-KERTH VALÉRIE ; SPEDDING MICHAEL ; WAINWRIGHT CHERRY ; Yue-Hua WANG ; Wei XIAO ; Yong YANG ; Lin-Zhong YU ; Dan-Shen ZHANG ; Yong-He ZHANG ; Wen-Xia ZHOU ; Guan-Hua DU ; Yong-Xiang ZHANG
Chinese Journal of Pharmacology and Toxicology 2018;32(1):1-50
The 2017 China (Lianyungang) International Medical Technology Conference was held in Lianyungang,Jiangsu Province during November 15-17,2017.During this conference,the Division for Traditional Chinese Medicine and Natural Products Pharmacology of Chinese Pharmacological Society (CNPHARS) and Jiangsu Kanion Pharmaceutical Co. Ltd.jointly held the Forum on R&D and Interna-tionalization of New Drugs and Health Products of Traditional Chinese Medicine.The forum was co-chaired by Professor ZHANG Yong-xiang, President of CNPHARS, Chair of Division for Traditional Chinese Medicine and Natural Products Pharmacology of CNPHARS,and Chair of the Natural Product Section of Inter-national Union of Basic&Clinical Pharmacology(IUPHAR), Professor DU Guan-hua,former President of CNPHARS and Vice-Chair of Division for Traditional Chinese Medicine and Natural Products Pharmacology of CNPHARS,and Dr.XIAO Wei,Chairman of the Board of Jiangsu Kanion Pharmaceutical Co. Ltd. And Vice-Chair of Division for Traditional Chinese Medicine and Natural Products Pharmacology of CNPHARS. More than 70 scholars attended the forum, including four foreign experts [Michael SPEDDING, Secretary-General of IUPHAR; Professor Valérie B. SCHINI-KERTH, Vice-Chair of the Natural Product Section of IUPHAR; Professor Cherry WAINWRGHT, Director of Centre for Natural Product Drugs of Robert Gordon University; Professor InKyeom KIM, Director of the Korean Society of Pharmacology], members of the Division for Traditional Chinese Medicine and Natural Products Pharmacology of CNPHARS and leading researchers at Jiangsu Kanion Pharmaceutical Co.,Ltd.GU Jin-hui,Director of the Division of National Science and Technology Major Project for Drug Innovation,Department of Health Science,Technology and Education,National Health and Family Planning Commission of the People's Republic of China was also invited to attend the forum. Representatives discussed the R&D and internationalization of new drugs and health products of traditional Chinese medicine.The summary of views and advice of some experts was published here for the purpose of promoting domestic and overseas academic exchange, and playing an active role in improving the level of R&D and internationalization of new drugs and health products of traditional Chinese medicine in China.
8. The preliminary report of a registration clinical trial of proton and heavy ion irradiation
Jiade LU ; Ming YE ; Xiaomao GUO ; Shen FU ; F. Michael MOYERS ; Qing ZHANG ; Jingfang MAO ; Lin KONG ; Wen Chien HSI ; Kambiz SHAHNAZI ; Jingfang ZHAO ; Zhen ZHANG ; Xiumei MA ; Songtao LAI ; Xiaomeng ZHANG ; Ningyi MA ; Yunsheng GAO ; Xin CAI ; Xiyin GUAN ; Junhua ZHANG ; Bin WU ; Jingyi CHENG ; Yin-xiang-zi SHENG ; Wei REN ; Jun ZHAO ; Lining SUN ; Guoliang JIANG
Chinese Journal of Oncology 2018;40(1):52-56
Objective:
To verify the safety and efficacy of IONTRIS particle therapy system (IONTRIS) in clinical implementation.
Methods:
Between 6.2014 and 8.2014, a total of 35 patients were enrolled into this trial: 31 males and 4 females with a median age of 69 yrs (range 39-80). Ten patients had locally recurrent head and neck tumors after surgery, 4 cases with thoracic malignancies, 1 case with hepatocellular carcinoma, 1 case with retroperitoneal sarcoma, and 19 cases with non-metastatic prostate carcinomas. Phantom dose verification was mandatory for each field before the start of radiation.
Results:
Twenty-two patients received carbon ion and 13 had proton irradiation. With a median follow-up time of 1 year, all patients were alive. Among the 16 patients with head and neck, thoracic, and abdominal/pelvic tumors, 2, 1, 12, and 1 cases developed complete response, partial response, stable disease, or disease progression, respectively. Progression-free survival rate was 93.8% (15/16). Among the 19 patients with prostate cancer, biological-recurrence free survival was 100%. Particle therapy was well tolerated in all 35 patients. Twenty-five patients (71.4%) experienced 33 grade 1 acute adverse effects, which subsided at 1 year follow-up. Six (17.1%) patients developed grade 1 late adverse effects. No significant change in ECOG or body weight was observed.
Conclusions
IONTRIS is safe and effective for clinical use. However, long term follow-up is needed to observe the late toxicity and long term result.