Objective To investigate the feasibility of collecting exhaled breath condensate ( EBC)fromartificially ventilated patients with modified EcoScreen condenser. Methods ①In vitro test with lung simulator: the modified EcoScreen condenser was connected to lung simulator and mechanically ventilated for 60 min through three different types of connected tube as follows: dry ventilator pipe disconnected to humidifier, connected to the unheated humidifier, and connected to heated humidifier.Meanwhile, the changes of the peak pressure of inspiration ( PI) and tidal volume ( VT ) were observed. The volume of condensate was measured at last. ②In vivo test from artificially ventilated patients: 10 patients were artificially ventilated and their EBCs were collected with the modified EcoScreen condenser through dry pipe disconnected to humidifier for 20 min. The changes of PI, VT , respiratory frequency( f) , heart rate( HR) , mean arterial blood pressure ( MAP) , and blood oxygen saturation ( SpO2 ) were observed. Results ①In vitro test with lung simulator: At the end of the ventilating through the dry pipe disconnected to humidifier for 60 min,2. 2 mL condensate wascollected. Neither the change of PI or VT nor the obstruction of the collecting tube by iced condensate were observed. The ventilating through dry pipe connected to unheated humidifier had to stop at 50 min as the obstruction of the collecting tube caused by ice. 5 mL condensate was collected. It was observed that VTdecreased and PI increased. After ventilation through dry pipe connected to heated humidifier for 60 min,10. 5 mL condensate was collected while PI slightly increased and VT decreased. ② In vivo test from artificially ventilated patients: After ventilation through dry pipe disconnected to humidifier for 20 min, 2 mL EBC was collected without significance changes in PI, VT, f, HR, MAP, and SpO2 . Conclusions The modified EcoScreen condenser can be favourably applied to artificially ventilated patients for collecting EBC.It is recommended to performfor 20 min through the pipe disconnected to humidifier to obtain sufficient EBC without condensate dilution and airway obstruction. It is warranted more attention to the clinical and mechanical monitoring in this procedure.
Objective To evaluate the value of Epworth sleepiness scale ( ESS) in evaluating the severity of obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods A total of 340 cases with suspected OSAHS were enrolled. The ESS scores and polysomnography ( PSG) monitoring data were analyzed. According to the PSG monitoring results the patients were classified into non-OSAHS, mild, moderate and severe OSAHS groups. The average ESS scores and the ratio of patients whose ESS score was ≥9 were compared among the four groups. The diagnostic value of ESS score was evaluated by ROC curve. The correlation of ESS scores with age, apnea hypopnea index ( AHI) , the lowest SpO2( LSpO2 ) and microarousal index was analyzed. Results The ESS scores had an ascending tendency as the severity of OSAHS was increased but only in the severe OSAHS cases the difference was significant statistically compared with the other three groups ( P lt; 0. 05) . The mean ESS scores in the four groups were 9. 96 ± 4. 81,10. 21 ±5. 48, 11. 48 ±5. 28 and 13. 52 ±5. 84, respectively. There was no statistical significance while comparing the ratio of patients whose ESS scores were ≥9 among the four groups. The analysis of ROC curve showed the area under the ROC curve ( AUC) was lesser( 0. 601) and a best cutoff could not be obtained. When ESS score ≥9 was made as the cutoff in screening OSAHS patients the sensitivity was 70. 0% and the misdiagnosis rate was 63. 21% . The ESS scores had positive correlation with the apnea hypopnea index ( AHI)( r =0. 240, P lt; 0. 01) and negative correlation with LSpO2 ( r = - 0. 198, P lt;0. 01) . The ESSscores had no correlation with age or the microarousal index ( P gt; 0. 05) . Conclusions The ESS score has some significance in screening severe OSAHS patients but can not exactly reflect the severity of OSAHS patients among Chinese population, suggesting ESS score has limited value in the evaluation of OSAHS severity. The ESS score ≥9 as a cutoff is not a reliable parameter to estimate the severity of OSAHS. A more effective scoring system need to be established for better screening of OSAHS patients.
Objective To investigate the incidence of retinopathy of prematuri ty (ROP) in the area of Shanghai, and to provide the preliminary data for the ev aluation of present criteria for ROP screening. Methods Record s of 289 prematur e infants who had undergone ROP screening from the four NICU in Shanghai between February 2004 and January 2005 were analyzed. Screening criteria included prete rm infants or low birth weight (LBW) infants with BW of 2000g or less. The first examination starts at 4 to 6 weeks chronologic age or 32 weeks post conceptual age. Results In the 289 screened infants, 19 had developed acu te ROP. There we re 3 threshold ROP, 7 prethreshold ROP and 9 developed ROP less than prethreshol d. The incidence of ROP was 6.6%. According to the British recommended guideline s（BWle;1500 g or GAle;31 weeks）, only 119 out of 289 needed screening and one ca se of stage 1 ROP was missed; the incidence of ROP was 15.1% (18/119). When lowered sc reening criteria to the American guidelines（BWle;1500g or GAle;28 weeks）, t here were only 83 infants needed screening, and we missed 2 stage 1 and 1 prethreshold ROP and the incidence of ROP was 19.3% (16/83). Conclusions The i ncidence of ROP i s 6.6% according to our study. It is lower than other reports and it has somethi ng to do with our present screening guideline. Further epidemiological data are needed to modify the guideline accordingly.
Objective To evaluate the cost-effectiveness of three LTBI screening strategies: the tuberculin skin test (TST), the T-SPOT.TB and the combination of TST and T-SPOT (TST+T.SPOT), to provide economic evidence for T.SPOT application in China. Methods A decision analysis model evaluated three strategies among a cohort of 1000 tuberculosis (TB) close contacts, using incremental cost-effectiveness of prevention a active TB patient (1 year post contact). Meta analyses were conducted to calculate the key parameters of T.SPOT and TST. The official data or literature was searched and the unaccessible data was to specify other parameters, such as cost, LTBI prevalence, etc. The one-way sensitivity analysis was performed, varying key parameters over a wide range of reasonable values to evaluate the impact of data uncertainties and to determine the robustness of our overall conclusion. Results a) As for the total cost, the TST+T.SPOT strategy (?212 213.81 per 1 000 contacts) cost the least, while the single T.SPOT strategy cost the most; b) Subsequently, the TST+T.SPOT strategy required less contacts to be treated to prevent an active case of TB (8.31) than the single TST strategy (25.67); c) the TST+T.SPOT strategy shared the most cost-effectiveness (?3 063.50 per active TB case prevented) than the single TST or T.SPOT strategy; and d) The results of one-way sensitivity analyses showed that cost-effectiveness values were sensitive to changes in LTBI prevalence (gt;60%), Sen and Spn of TST test (gt;70%), with the single TST being superior to the single T.SPOT. Conclusion The Single T.SPOT strategy enjoys the most cases prevented from active TB, while the TST+S.SPOT strategy is the most cost-effective. The conclusion is sensitive to a few parameters, such as LTBI prevalence, but the TST+T.SPOT strategy is always the best.
Prostate cancer is a common disease in the USA and Europe, with a gradually increasing incidence in China, and presents a significant health burden for older men. The lack of modifiable risk factors has made early detection as a strategy to reduce mortality. Current methods of screening involve the measurement of serum prostate-specific antigen (PSA) and digital rectal examination followed by biopsy. With PSA screening evidence of level I absent, the evidence on the use of PSA as a screening test is still highly controversial. Furthermore, there is controversy over whether screen-detected lesions will become clinically significant. There are three major treatment options for localized disease: radical prostatectomy, radical radiotherapy and monitoring with treatment if required. There is no evidence of randomized controlled trial (RCT) to suggest a survival advantage of any of these treatments. Opinions about the related benefits and risks of screening vary widely. In the absence of RCT of benefit for screening, many now suggest “informed consensus” screening, which encourages a discussion between the patient and his physician with both sides informed of all of the issues.
ObjectiveTo investigate the diagnosis and classification of chronic obstructive pulmonary disease (COPD) in high risk populations living in metropolitan communities of Beijing. MethodsDuring January 2011 to December 2012,a cross-sectional survey including questionnaires and pulmonary function tests were performed in high risk populations of COPD (aged≥40 years with a history of smoking or chronic bronchitis) at 6 communities in Dongcheng District of Beijing. For those confirmed to have COPD,the dyspnea was rated by the modified Medical Research Council Dyspnea Scale (mMRC),and the frequency of acute exacerbations in the last year was recorded. The patients were classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2011) classification criteria. ResultsA total of 932 individuals,including 689 males (73.9%,aged 60.8±12.5 years) and 243 females(26.1%,aged 59.8±12.1 years),who had risk factors of COPD were included in the screening. COPD was confirmed in 203 patients,with the prevalence of 21.8%,and among whom only 31 cases (15.3%) had been diagnosed as COPD in the past. According to the revised GOLD classification in 2011,96(47.2%),38(18.7%),56(27.5%),and 13(6.4%) patients were classified into group A,B,C and D,respectively. The proportion of subgroup C1 (FEV1%pred <50% and the number of exacerbation in the last year <2) in group C was 71.4% (40/56). ConclusionIn the metropolitan communities of Beijing,screening the population with predisposing factors can increase the early diagnosis of COPD,which is often delayed by the lack of significant symptoms. The high proportion of patients in group C in this population implies that disease screening in high risk populations may be helpful for the prevention and treatment of COPD.
ObjectiveTo analyze the sensitivity of peak flow meter screening in different subgroups of chronic obstructive pulmonary disease (COPD). MethodsA total of 156 outpatients with COPD from Peking Union Medical Hospital from May 2013 to December 2014 were recruited in the study. Each patient's symptoms,history of exposure to risk factors,and the times of exacerbation in last year was recorded. All patients completed CAT,mMRC,the St George's Respiratory Questionnaire (SGRQ),6 minutes walking test,spirometry,and peak expiratory flow (PEF) by peak flow meter. ResultsUsing the cut-off of PEF%pred=80%,the PEF detected 120 COPD patients in 156 subjects. The predictive factors of abnormal PEF%pred in COPD was FEV1%pred and the total score of SGRQ (P<0.05). PEF screening could identify 76.9% of COPD patients,30.0%-60.0% of patients of less symptoms (mMRC<2 or CAT<10 or SGRQ<25),83.3%-90.9% of COPD patients with more symptoms (mMRC ≥ 2 or CAT ≥ 10 or SGRQ ≥ 25),27.7% of COPD patients with mild airflow limitation,68.5% of COPD patients with moderate airflow limitation,83.3% of COPD patients with moderate to very severe airflow limitation. When grouped by GOLD combined assessment method,PEF screening could identify 35.2% of patients of group A,75.0% of patients of group B,and 95.9% of patients of group C and D. The cut-off value of PEF% pred=80% showed low sensitivity to early stage of COPD,but when using the cut-off value of PEF% pred=95%,that sensitivity increased signifcantly. ConclusionsPeak flow meter may be used as a tool to screen COPD. It can identify part of COPD patients especially for those patients with more symptoms,requiring regular treatment,with deteriorated pulmonary function and high risk of exacerbation.
Currently,lung cancer (LC) has one of the highest incidence rates among various malignant tumors worldwide,and the annual mortality rate of LC has ranked first among all malignant tumors. About 80% of LC patients present to the hospital in a late advanced stage and lose the chance of surgical resection. Among all the patients who receive surgical treatment,the 5-year mortality rate of patients with early TNM stages is far lower than that of patients with advanced stage LC. With the advancement of medical equipment and more people who receive routine medical examination,more and more patients with small pulmonary nodules are discovered. Limited lung resection,including wedge resection and segmental resection,can be performed with minimally invasive video-assisted thoracoscopic surgery for these patients to acquire equivalent surgical outcomes as traditional lobectomy and a much better postoperative quality of life. LC screening increases the chances of early detection and diagnosis of LC patients,so these patients can receive reasonable diagnosis and treatment at an early stage. This strategy can greatly reduce treatment cost and mortality,and achieve maximal treatment benefits with minimal economic and medical cost. This review focuses on the necessity,high-risk groups,evaluation criteria and methods of LC screening with some LC screening guidelines and research studies in order to provide reasonable and feasible screening strategies and references for clinical LC screening.
ObjectiveTo investigate the status-quo of urban and rural residents' depression in the communities of Chengdu city and its influencing factors. MethodsA multi-stage stratified cluster sampling survey was carried out from February to October 2010. Residents aged from 35 to 70 years in 4 urban and rural communities of Chengdu were investigated in the incidence of depression. The health survey questionnaire and PHQ-2 Depression Screening Scale were used for the household investigation. Data was analyzed using SPSS 18.0 software, and the risk factors were also analyzed using multivariate logistic methods. ResultsA total of 2 027 residents were interviewed, including 1 015 urban (616 women and 399 men, with mean age of 58.90 ±9.48 years) and 1 012 rural residents (582 women and 430 were men, with mean age of 54.94 ±9.64 years). The results showed that the overall depression prevalence rate of residents aged from 35 to70 years old in Chengdu was 2.91% (59/2 027); and the prevalence was 4.33% (44/1 015) in urban and 1.48% (15/1 012) in rural. The prevalence was significantly higher in urban areas than that in rural areas (χ2=13.296, P < 0.001). The results of multivariate analysis showed that a significant difference was found in the prevalence of depression among the different marital status groups, and more divorced people suffered from depression. No statistically significant correlation was found between the factors (including occupation, education level and family income status) and depression. ConclusionThe prevalence of depression among residents in urban and rural communities of Chengdu was high, and the divorced population should be paid more attention to in the prevention and treatment of depression.
ObjectiveTo systematically review the value of mass screening of serum pepsinogen test for Asian population with high-risk gastric carcinoma. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 12, 2013), CNKI, WanFang Data, VIP and CBM for diagnostic tests on serum pepsinogen test versus with pathological biopsy/X-ray examination (gold standard) between January 2004 and January 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was conducted using Meta-DiSc software (version 1.4). ResultsA total of 15 studies involving 180 934 subjects were included. ROC curve showed "shoulder-arm shape" distribution. The results of Spearman correlation analysis suggested a significance of the threshold effect (P=0.001). The results of meta-analysis showed that, the area under curve (AUC) was 0.74. ConclusionSerum pepsinogen has good value in the screening of gastric carcinoma among Asian permanent residents. Due to limited quality of studies, the above conclusion should be verified by conducting more high quality studies.