Objective To study the distribution of HIV/AIDS high-risk population, HIV infection and the main risk factors for developing HIV/AIDS’ controllable measures and exploring appropriate health education and behavior intervention models. Methods A total of 360 commercial sex workers (CSW) joined together through convenience sampling and 360 drug users (DU) joined together through convenience sampling or snow-balling sampling whose relevant behavior factors were investigated by questionnaires. Results The general rate of knowing knowledge about AIDS was 75.2% among 360 CSW, 67.8% CSW used condom in commercial sex activities; none of 149 CSW blood samples was detected HIV or syphilis antibody positive. The general rate of knowing knowledge about AIDS was 83.7% among 360 DU who injected drugs last month, the rate of sharing needles was 47.6% and the low rate of condom used; 1 HIV antibody and 5 syphilis antibodies positive were found among 198 DU blood samples, so HIV and syphilis infection rate were 0.51%and 2.53%, respectively. Conclusion The rate of HIV infection is a very low level and there are many risk factors among CSW and DU. A good job should be done to integrate AIDS health education with behavioral intervention and the monitoring system for the AIDS/HIV high-risk population should be improved.
Objective To study the major postoperative complications of abdominal aortic aneurysm （AAA） repair in high-risk patients， analyze its causes， and suggest the prevention methods. Methods From January 2009 to September 2011， 57 cases of high-risk AAA patients underwent AAA repair in our hospital were analyzed retrospectively. High-risk patients were defined as age≥60 years，the American Society of Anesthesiologists grade three or four，and at least one of complications about heart， lung， and kidney. Major postoperative complications were rated， and preoperative cardiac，pulmonary， and renal condition，anesthesia and surgical impact were taken into account while evaluating the risk factors of major postoperative complications. Results Forty-one of 57 high-risk patients with AAA were repaired by endovascular repair，16 of 57 high-risk patients with AAA were repaired by traditional open surgery. The early mortality （within 30d） was 1.8% （1/57）. The major postoperative complications rate of AAA repair was 19.3% （11/57） in total，and 8.8% （5/57），8.8% （5/57），and 1.8% （1/57） for cardiac complication，pulmonary complication， and acute renal failure，respectively. The patients with coronary heart disease had a higher cardiac complication rate 〔19.0% （4/21） versus 2.8% （1/36），χ2=4.387，P＜0.05〕 ， while with hypertension had no such effect for that〔10.3% （4/39） versus 5.6% （1/18），χ2=0.340，P＞0.05〕. Patients with abnormal pulmonary function was responsible for postoperative respiratory complications 〔20.0% （4/20） versus 5.6% （1/18）， χ2=4.387， P＜0.05〕 ， while with chronic obstructive pulmonary disease history was not responsible for that 〔13.2% （5/38） versus 0 （0/19），χ2=2.740，P＞0.05〕．Patients with preoperative renal function was not related to postoperative acute renal failure 〔0 （0/4） versus 1.9% （1/53）， χ2=0.077，P＞0.05〕. Compared with traditional open surgery，endovascular repair could effectively reduce the incidence of postoperative complications 〔12.2% （5/41） versus 37.5% （6/16）， χ2=3.980，P＜0.05〕. The incidence of postoperative respiratory complications in the local anesthesia patients was less than that in the general anesthesia patients 〔0（0/20）versus 19.0% （4/21），χ2=4.221，P＜0.05〕. Conclusions Cardiac and pulmonary complications are commonly seen after AAA repair in high-risk patients．Preoperative cardiac，pulmonary condition，anesthesia and surgical aspects greatly influence the major postoperative complications. Exhaustively assessment of each system before surgery，appropriate anesthesia and surgical options，postoperative active and effective symptomatic，and supportive treatment are the key to reducing the incidence of postoperative complications.
ObjectiveTo investigate the high-risk factors for death in infants with severe pneumonia. MethodsWe analyzed hospitalized infants and young children diagnosed with severe pneumonia from January 2011 to December 2013, and investigated the risk factors for death. ResultsA total of 1 411 infants with severe pneumonia were included in the analysis. The mortality rate was 3.12%. In single factor analysis, the following factors were significant:age, severe infection, artificial feeding, congenital heart diseases, bad habitation, repeated infection history, surgical history, multi-organ dysfunction, internal environment disorder, multiple drug-resistant strains infection. The results of Logistic multiple regression analysis showed that there were statistical significance in severe infection, repeated infection history, Multiple drug-resistant strains infection, multi-organ dysfunction, and internal environment disorder. ConclusionInfants with severe pneumonia should be intensively monitored and actively treated for reducing the mortality rate if they have one of the following high-risk factors:age, congenital heart diseases, repeated infection history, multiple drug-resistant strains infection, surgical history, multi-organ dysfunction, and internal environment disorder.
ObjectiveTo investigate the screening value of cervical fluid-based cytology test (TCT), high-risk human papillomavirus (HR-HPV) test, and colposcopy for cervical intraepithelial neoplasia (CIN) and cervical cancer in high-risk populations. MethodsA total of 466 patients between January 2013 and January 2015 with a history of intercourse bleeding were enrolled in this study, and the screening value of TCT, HR-HPV test and colposcopy for CIN and cervical cancer were retrospectively evaluated. ResultsIn the 466 patients, 165 were diagnosed with cervical inflammation, 116 with CIN, 182 with grade 2-3 CIN, and 3 with cervical cancer. The colposcopy had the highest sensitivity (84.1%), the lowest specificity (59.4%), high false positive rate (40.6%), low false negative rate (15.9%), and the highest negative predictive value (67.1%). The TCT had the highest specificity (84.8%) and the lowest false positive rate (15.2%). The indicators of HR-HPV were between those of TCT and colposcopy. There were significant differences in terms of these indicators among the three methods (P < 0.05). And the positive prediction value of HR-HPV was the highest (84.5%), while the negative prediction value of colposcopy was the highest (67.1%). There was a significant difference in the predictive value among the three methods (P < 0.05). The consistency of either TCT or HR-HPV alone with pathological diagnosis was poor (K=0.213, 0.343), while that of colposcopy was moderate (K=0.446). Combination of TCT and HR-HPV could significantly improve the diagnosis sensitivity (93.0%) with a lower false negative rate (7.0%); Youden index was 0.736, and the consistency with pathological examination was high (K=0.748). ConclusionsFor high-risk population with a history of intercourse bleeding or other abnormal cervical disorders, the screening sensitivity of TCT and HR-HPV alone for CIN and cervical cancer is low with a high false negative rate. Colposcopy has a high sensitivity and a low specificity. By combination of TCT and HR-HPV, the validity, reliability and predictive values can be improved significantly, and the sensitivity is high with a low false negative rate and a high consistency with pathological examination.
ObjectiveTo evaluate the effect of health economics of census versus high-risk population screening for tuberculosis in Mianyan city, in order to provide references for the selection of suitable tuberculosis screening method in western region of China. MethodsWe included active tuberculosis patients by residents health screening of 21 villages and towns in Mianyan city from June 2013 to March 2013. Relevant data was analyzed by referencing the National Assessment of Tuberculosis Control Program in 2001-2010. Results184047 residents were screened by tuberculosis census and 128 active tuberculosis patients were diagnosed while 61045 residents were screened by high-risk population screening and 76 active tuberculosis patients were diagnosed. The cost-utility ratio and benefit-cost ratio of tuberculosis census were 6174.17 and 3.84, respectively. The cost-utility ratio and benefit-cost ratio of high risk population screening were 3106.16 and 7.62, respectively. ConclusionHigh-risk population screening has higher cost-utility ratio and benefit-cost ratio than tuberculosis census with higher missed diagnosis. Benefits and harms of tuberculosis detection rate and cost should be fully balanced before tuberculosis screening method were chosen in western underdeveloped region of China.
ObjectiveTo sort out the historical evolution of diagnostic screening methods for pancreatic cancer, and to explore how to achieve early diagnosis and treatment of pancreatic cancer in the context of China’s large population base and economic development.MethodsSystematic review was performed. The computer was used to search databases inchuding CNKI, VIP, WanFang Data, Web of Science, PubMed and EMbase. Two researchers independently searched Baidu search engine to collect relevant reports on screening methods and effect evaluation of pancreatic cancer published before February 28, 2018, and a qualitative descroption was made.ResultsA total of 117 articles were included in the study. The exploration of screening methods for pancreatic cancer in China has experienced three stages: germination, enlightenment and growth. Current screening methods include clinical manifestations, imaging screening methods, serum tumor markers and molecular biology gene diagnosis, each of which had its advantages and disadvantages. Single method could not achieve higher specificity and sensitivity, and joint detection had become an inevitable trend. Considering the benefit of practical application, screening among high-risk groups could effectively reduce the population size and achieve accurate screening.ConclusionThere was a big gap between domestic and foreign research in screening for pancreatic cancer. Screening methods are diverse, and joint detection is an inevitable trend. Screening for pancreatic cancer in high-risk population will become a breakthrough under the technical bottleneck.
Objective To provide a clinical basis for the prevention of diabetic foot ulcers by analyzing the clinical data and prognosis of high-risk diabetic foot patients. Methods A retrospective analysis was performed on high-risk diabetic foot patients who were hospitalized in West China Hospital of Sichuan University between January 1, 2012 and December 31, 2018. Patients were divided into high-risk group and low-risk group according to whether they hada history of foot ulcer or amputation. The clinical characteristics of the two groups of patients were compared. The patients were followed up from hospital discharge to January 31, 2021, and their survival and ulcer recurrence or new-onset status were evaluated. Results Finally, 123 patients were included, including 29 patients in the high-risk group and 94 patients in the low-risk group. There was no statistical difference in the duration of diabetes, smoking history, drinking history, education level, proportion of receiving regular treatment, proportion of regular blood glucose monitoring, body mass index, proportion of diabetic peripheral neuropathy, callus, foot deformity, diabetic nephropathy, diabetic retinopathy, diabetic cardiac autonomic neuropathy, diabetic gastrointestinal autonomic neuropathy, hypertension, coronary heart disease and laboratory test results between the two groups (P>0.05). The proportion of women (51.7% vs. 29.8%), age [(69.8±10.3) vs. (64.4±11.3) years], proportion of lower extremity arterial disease (62.1% vs. 34.4%), proportion of hyperuricemia (27.6% vs. 10.6%) in the high-risk group were higher than the low-risk group (P<0.05). After follow-up (67±20) months, 25.8% of the patients had ulcer recurrence or new onset, and 24.2% of the patients died. The most common cause of death was diabetes complications (43.8%). The overall 1-, 3-, and 5-year cumulative mortality rates of the patients were 4.5%, 12.7%, and 20.6%, respectively. The 3- and 5-year recurrence or new ulcer rates were 8.3% and 18.2%, respectively. The 5-year recurrence or new ulcer rates in the low-risk group and high-risk group were 10.3% and 40.3%, respectively, and there was a difference in ulcer recurrence between the two groups (P=0.004). Conclusions Compared with high-risk diabetic foot patients without ulcer or amputation, patients with a history of ulcer or amputation have higher rates of lower extremity arterial disease and hyperuricemia. Patients with a history of ulceration or amputation have a higher risk of recurrent or new ulceration than patients without a history of ulceration or amputation.
ObjectiveTo evaluate the pathological features of bilateral retinoblastoma (RB) and the relationship between different treatments and high-risk histopathologic features (HHF). MethodsRetrospective series of case studies. From 1999 to 2018, 73 patients with binocular RB diagnosed by pathological examination in Department of Ophthalmology, Peking University People's Hospital were included in the study. Among them, 50 patients were male (68.5%, 50/73), 23 patients were females (31.5%, 23/73); 11 patitents had a family history of RB. The mean age at the first diagnosis was 14.8±15.6 months. The average time between first diagnosis and first intervention was 3.97±4.74 months. According to the international classification standard of intraocular RB staging, among the 73 eyes, C, D and E stages were 2 (2.7%, 2/73), 15 (20.5%, 15/73), and 56 (76.7%, 56/73) eyes, respectively. Ocular images for each patient were obtained using a wide-angle contact fundus camera during examination under general anaesthesia. The treatment protocol (globe salvaging or enucleation) depended on the result of several clinical features. Globe salvaging treatment included chemotherapy combined with local therapy such as intra-arterial chemotherapy (IAC), intravitreal chemotherapeutics injection, cryotherapy, laser, transpupillary thermotherapy and radiotherapy. If globe salvaging failed, enucleation was offered and histopathologic analysis was conducted of the enucleated eye, the ophthalmic pathologist read and evaluated the presence of HHF. Independent samples t-test was performed to compare the continuous variables. The pathological features and the relationship between different treatments and HHF were analyzed. Group difference was calculated with chi-square. Results Among the 73 eyes, the first treatment was enucleation in 21 eyes (28.8%, 21/73); 52 eyes (71.2%, 52/73) were treated with eye protection. After enucleation, 9 cases (12.3%, 9/73) had recurrence and metastasis, and 7 cases (9.6%, 7/73) died. The intervention time of patients with recurrence and metastasis and those without recurrence and metastasis were 7.4±7.3 and 3.5±4.1 months respectively; the first intervention time of patients with recurrence and metastasis was significantly later than that of patients without recurrence and metastasis, but the difference was not statistically significant (t=－1.561, P=0.154). The pathological examination results showed that there were 26 eyes (35.6%, 26/73) with HHF, 4 (26.7%, 15/26) and 22 (39.3%, 22/56) eyes were in stage D and E, respectively. Those who received other treatments before enucleation had lower HHF percentages after enucleation than those who did not receive corresponding treatments, but the difference was not statistically significant (χ2=1.852, 0.074, 0.000, 1.007, 0.007, 2.729; P＞0.05). Among the 26 eyes, 5 (83.3%, 5/6) and 21 (31.3%, 21/67) eyes were treated with systemic chemotherapy combined with and without IAC, respectively, and there was a significant difference in the percentage of HHF (χ2=4.422, P=0.035). ConclusionsIAC eye-preserving therapy before enucleation has a significant effect on HHF.