2.Survivorship Analysis in Asymptomatic COVID-19+ Hip Fracture Patients: Is There an Increase in Mortality?
Mason D. VIALONGA ; Luke G. MENKEN ; Alex TANG ; John W. YUREK ; Li SUN ; John J. FELDMAN ; Frank A. LIPORACE ; Richard S. YOON
Hip & Pelvis 2022;34(1):25-34
Purpose:
Mortality rates following hip fracture surgery have been well-studied. This study was conducted to examine mortality rates in asymptomatic patients presenting for treatment of acute hip fractures with concurrent positive COVID-19(+) tests compared to those with negative COVID-19(–) tests.
Materials and Methods:
A total of 149 consecutive patients undergoing hip fracture surgery during the COVID-19 pandemic at two academic medical centers were reviewed retrospectively. Patients were divided into two groups for comparative analysis: one group included asymptomatic patients with COVID-19+ tests versus COVID-19– tests. The primary outcome was mortality at 30-days and 90-days.
Results:
COVID-19+ patients had a higher mortality rate than COVID-19– patients at 30-days (26.7% vs 6.0%, P=0.005) and 90-days (41.7% vs 17.2%, P=0.046) and trended towards an increased length of hospital stay (10.1 ±6.2 vs 6.8±3.8 days, P=0.06). COVID-19+ patients had more pre-existing respiratory disease (46.7% vs 11.2%,P=0.0002). Results of a Cox regression analysis showed an increased risk of mortality at 30-days and 90-days from COVID-19+ status alone without an increased risk of death in patients with pre-existing chronic respiratory disease.
Conclusion
Factors including time to surgery, age, preexisting comorbidities, and postoperative ambulatory status have been proven to affect mortality and complications in hip fracture patients; however, a positive COVID-19 test result adds another variable to this process. Implementation of protocols that will promote prompt orthogeriatric assessments, expedite patient transfer, limit operating room traffic, and optimize anesthesia time can preserve the standard of care in this unique patient population.
3.Predictive value of MRI pelvic measurements for "difficult pelvis" during total mesorectal excision.
Z SUN ; W Y HOU ; J J LIU ; H D XUE ; P R XU ; B WU ; G L LIN ; L XU ; J Y LU ; Y XIAO
Chinese Journal of Gastrointestinal Surgery 2022;25(12):1089-1097
Objective: Total mesorectal resection (TME) is difficult to perform for rectal cancer patients with anatomical confines of the pelvis or thick mesorectal fat. This study aimed to evaluate the ability of pelvic dimensions to predict the difficulty of TME, and establish a nomogram for predicting its difficulty. Methods: The inclusion criteria for this retrospective study were as follows: (1) tumor within 15 cm of the anal verge; (2) rectal cancer confirmed by preoperative pathological examination; (3) adequate preoperative MRI data; (4) depth of tumor invasion T1-4a; and (5) grade of surgical difficulty available. Patients who had undergone non-TME surgery were excluded. A total of 88 patients with rectal cancer who underwent TME between March 2019 and November 2021 were eligible for this study. The system for scaling difficulty was as follows: Grade I, easy procedure, no difficulties; Grade II, difficult procedure, but no impact on specimen quality (complete TME); Grade III, difficult procedure, with a slight impact on specimen quality (near-complete TME); Grade IV: very difficult procedure, with remarkable impact on specimen quality (incomplete TME). We classified Grades I-II as no surgical difficulty and grades III-IV as surgical difficulty. Pelvic parameters included pelvic inlet length, anteroposterior length of the mid-pelvis, pelvic outlet length, pubic tubercle height, sacral length, sacral depth, distance from the pubis to the pelvic floor, anterior pelvic depth, interspinous distance, and inter-tuberosity distance. Univariate and multivariate logistic regression analyses were performed to identify the factors associated with the difficulty of TME, and a nomogram predicting the difficulty of the procedure was established. Results: The study cohort comprised 88 patients, 30 (34.1%) of whom were classified as having undergone difficult procedures and 58 (65.9%) non-difficult procedures. The median age was 64 years (56-70), 51 patients were male and 64 received neoadjuvant therapy. The median pelvic inlet length, anteroposterior length of the mid-pelvis, pelvic outlet length, pubic tubercle height, sacral length, sacral depth, distance from the pubis to the pelvic floor, anterior pelvic depth, interspinous distance, and inter-tuberosity distance were 12.0 cm, 11.0 cm, 8.6 cm, 4.9 cm, 12.6 cm, 3.7 cm, 3.0 cm, 13.3 cm, 10.2 cm, and 12.2 cm, respectively. Multivariable analyses showed that preoperative chemoradiotherapy (OR=4.97,95% CI: 1.25-19.71, P=0.023), distance between the tumor and the anal verge (OR=1.31, 95% CI: 1.02-1.67, P=0.035) and pubic tubercle height (OR=3.36, 95% CI: 1.56-7.25, P=0.002) were associated with surgical difficulty. We then built and validated a predictive nomogram based on the above three variables (AUC = 0.795, 95%CI: 0.696-0.895). Conclusion: Our research demonstrated that our system for scaling surgical difficulty of TME is useful and practical. Preoperative chemoradiotherapy, distance between tumor and anal verge, and pubic tubercle height are risk factors for surgical difficulty. These data may aid surgeons in planning appropriate surgical procedures.
Humans
;
Male
;
Middle Aged
;
Female
;
Retrospective Studies
;
Laparoscopy/methods*
;
Pelvis/pathology*
;
Rectal Neoplasms/pathology*
;
Magnetic Resonance Imaging
;
Treatment Outcome
7.Human leukocyte antigen polymorphism of HIV infected persons without disease progress for long-term in Henan province, 2011-2016.
X J XUE ; J Z YAN ; D CHENG ; C H LIU ; J LIU ; Z LIU ; S A TIAN ; D Y SUN ; B W ZHANG ; Z WANG
Chinese Journal of Epidemiology 2019;40(1):89-92
Objective: To understand the disease progression and human leukocyte antigen (HLA) gene polymorphism of HIV-infected persons without disease progress for long term, also known as long-term non-progressors (LTNPs), in Henan province. Methods: A retrospective study was conducted in 48 LTNPs with complete detection and follow-up information during 2011-2016 in Henan. Changes of CD(4)(+)T cells counts (CD(4)) and viral load (VL) during follow-up period were discussed. Polymerase chain reaction-sequence-specific oligonucleotide probe (PCR-SSOP) was used for the analyses of HLA-A, HLA-B and HLA-DRB1 alleles between LTNPs and healthy controls. Results: From 2011 to 2016, forty-eight LTNPs showed a decrease of the quartile (P(25)-P(75)) of CD(4) from 601.00 (488.50-708.72)/μl to 494.00 (367.00-672.00)/μl, and the difference was significant (P<0.05). The increase of the quartile (P(25)-P(75)) of log(10)VL from 3.40 (2.87-3.97) to 3.48 (2.60-4.37), but the difference was not significant (P>0.05). HLA polymorphism analysis revealed that HLA-B*13:02 and HLA-B*40:06 were more common in LTNPs (P<0.05), while HLA-B*46:01 and HLA-DRB1*09:01 were more common in healthy controls (P<0.05). Conclusions: The CD(4) of LTNPs in Henan showed a downward trend year by year. HLA-B*13:02 and B*40:06 might be associated with delayed disease progression for HIV infected persons in Henan.
Adult
;
Alleles
;
Asian People/genetics*
;
China
;
Disease Progression
;
Female
;
HIV
;
HIV Infections/virology*
;
HIV-1/immunology*
;
HLA-B Antigens/genetics*
;
Humans
;
Middle Aged
;
Polymorphism, Genetic
;
Retrospective Studies
;
Viral Load
8.Spatial-temporal analysis on pulmonary tuberculosis in Beijing during 2005-2015.
S H SUN ; Z D GAO ; F ZHAO ; W Y ZHANG ; X ZHAO ; Y Y LI ; Y M LI ; F HONG ; X X HE ; S Y ZHAN
Chinese Journal of Epidemiology 2018;39(6):816-820
Objective: To analyze the spatial distribution and identify the high risk areas of pulmonary tuberculosis at the township level in Beijing during 2005-2015. Methods: Data on pulmonary tuberculosis cases was collected from the tuberculosis information management system. Global autocorrelation analysis, local indicators of spatial association and Kulldorff's Scan Statistics were applied to map the spatial distribution and detect the space-time clusters of the pulmonary tuberculosis cases during 2005-2015. Results: Spatial analysis on the incidence of pulmonary tuberculosis at the township level demonstrated that the spatial autocorrelation was positive during the study period. The values of Moran's I ranged from 0.224 3 to 0.291 8 with all the P values less than 0.05. Hotspots were primarily distributed in 8 towns/streets as follows: Junzhuang, Wangping, Yongding and Tanzhesi in Mentougou district, Yancun in Fangshan district, Wangzuo town in Fengtai district, Tianqiao street in Xicheng district and Tianzhu town in Shunyi district. Spatiotemporal clusters across the entire study period were identified by using Kulldorff's spatiotemporal scan statistic. The primary cluster was located in Chaoyang and Shunyi districts, including 17 towns/streets, as follows: Cuigezhuang, Maizidian, Dongfeng, Taiyanggong, Zuojiazhuang, Hepingjie, Xiaoguan, Xiangheyuan, Dongba, Jiangtai, Wangjing, Jinzhan, Jiuxianqiao, Laiguangying, Sunhe towns/streets in Chaoyang district, Houshayu and Tianzhu town in Shunyi district, during January to December 2005. Conclusion: Incidence rates of pulmonary tuberculosis displayed spatial and temporal clusterings at the township level in Beijing during 2005-2015, with high risk areas relatively concentrated in the central and southern parts of Beijing.
Beijing
;
China
;
Cluster Analysis
;
Humans
;
Incidence
;
Spatial Analysis
;
Spatio-Temporal Analysis
;
Tuberculosis
;
Tuberculosis, Pulmonary/ethnology*
9.Association between lack of care in childhood and cognitive impairment in middle-aged and elderly population.
W S ZHANG ; H Q ZHENG ; C Q JIANG ; L XU ; Y L JIN ; T ZHU ; F ZHU ; D Q LAM
Chinese Journal of Epidemiology 2018;39(8):1106-1111
Objective: To investigate the association between people who were under lack of care in childhood and the development of cognitive impairment in their middle-aged and elderly life spans. Methods: Based on the baseline survey data of the third phase of "Guangzhou Biobank Cohort study" conducted from January 2007 to January 2008, 9 223 residents aged ≥50 years with records on Mini Mental State Examination (MMSE) were included in a retrospective survey on received childhood care of their early lives. Questions would include: feelings of care and support from their close relatives during childhood, the status of separation from their mothers for ≥1 year, and the current status of their parents. Linear regression, unconditional and multinomial logistic regression models were used to analyze the associations between the received childhood care and cognitive function (i.e., MMSE scores and cognitive impairment) in middle and old age, of this population under study. Results: After adjusting for age, gender, education, place of residence, marital status, physical activity, smoking, drinking, occupation, personal income, childhood socioeconomic position and depressive symptoms etc., factors as feeling lack of concern and support from close relatives (LC), status of separation from the mother for ≥1 year (SM), and the current status of their parents etc., were all negatively associated with the MMSE score when in middle and old age, with partial regression coefficient β (95%CI) as -0.44 (-0.65- -0.23), -0.26 (-0.38- -0.14) and -0.61 (-0.96- -0.27), respectively. The presence of LC, SM or PD were associated with the increased risks of cognitive impairment, and the adjusted odds ratio OR (95%CI) appeared as 1.43 (1.15-1.78), 1.26 (1.08-1.47) and 1.64 (1.16-2.31) respectively in all the participants, but 1.27 (1.01-1.62), 1.29 (1.09-1.55) and 1.75 (1.19-2.55) respectively, in those with education level of primary school or below. In those with secondary school education or above, only the presence of item A was associated with an increased risk of cognitive impairment (OR=2.26, 95%CI: 1.41-3.50). Conclusion: We noticed that 'lack of care' in childhood was associated with cognitive impairment during middle and old age, mainly in those population with lower education.
Aged
;
Cognition/physiology*
;
Cognition Disorders/physiopathology*
;
Cognitive Dysfunction/physiopathology*
;
Humans
;
Linear Models
;
Middle Aged
;
Odds Ratio
;
Retrospective Studies
;
Surveys and Questionnaires
10.Progress of research on influencing factors of condom use among female sex workers.
Chinese Journal of Epidemiology 2018;39(8):1135-1142
Heterosexual transmission has become the main route of HIV transmission in China. As the main body of commercial heterosexual transmission, female sex workers (FSW) have a high-risk behavior of inconsistent condom use that increase the risk of HIV infection and spread. This review summarizes associated factors of condom use among FSW such as demographic characteristics, condom negotiation, sexual partner type, sexual intercourse, violence and HIV testing, which can provide reference for the future prevention and research among the FSWs.
Adult
;
China
;
Coitus
;
Condoms/statistics & numerical data*
;
Female
;
HIV Infections/prevention & control*
;
Heterosexuality
;
Humans
;
Male
;
Research/trends*
;
Safe Sex
;
Sex Work
;
Sex Workers
;
Sexual Partners

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