Hazards Model Research Articles

Correlations between systemic immune inflammation index and prognosis of patients with gallbladder carcinoma

Objective To investigate the correlations between the systemic immune inflammatory index (SII) and prognosis of patients with gallbladder cancer. Methods From April 2005 to January 2019, patients with gallbladder cancer underwent surgical treatment in the Department of Hepatobiliary and Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University were followed up and their SII values were analyzed. The receiver operating characteristic curve (ROC) was used to determine the best clinical boundary value of SII. According to the boundary value, patients were divided into two groups: low SII and high SII. Survival curves were drawn by Kaplan-Meier method. The overall survival time of the two groups was analyzed, and univariate analysis of postoperative survival was performed using log-rank test. Cox regression proportional hazard model was used for multivariate analysis of clinical prognosis. Results A total of 312 patients were included, including 120 males and 192 females, aged 30.0 to 86.0 (61.5±9.9) years. The best clinical cut off value of preoperative SII was determined by ROC curve to be 510.42. A total of 312 patients with gallbladder cancer were divided into low SII group (SII≤510.42) and high SII group (SII>510.42). Kaplan-Meier survival curve was used to analyze the 1, 3 and 5-year survival rates of gallbladder cancer patients in low SII group and high SII group after operation. The survival rates were 65.7%, 39.6% and 30.2%, and 27.9%, 12.0% and 9.6% respectively. The median survival time was 25 months (95% CI: 16.9-33.1) and 9 months (95% CI: 8.1-9.9), respectively. The survival rate of gallbladder cancer patients in low SII group was better. There were significant differences of the overall survival rate between the two groups (P 510.42 (HR=0.086, 95% CI: 0.032-0.289) was a risk factor for overall survival of gallbladder cancer patients. Cox multivariate analysis confirmed that preoperative SII (HR=2.649, 95% CI: 1.981-3.543) was an independent risk factor for overall survival of gallbladder cancer patients. Conclusions SII can be used as an independent prognostic factor to predict the prognosis of patients with gallbladder cancer. The higher the preoperative SII, the worse the prognosis of patients with gallbladder cancer. Key words: Gallbladder neoplasms; Systemic immune-inflammation index; Prognostic facts

Prognostic value of pretreatment 18F-FDG PET/CT imaging metabolic parameters in patients with early-stage extranodal natural killer/T cell lymphoma

Objective To investigate the prognostic value of metabolic parameters calculated from pretreatment 18F-fluorodeoxyglucose (FDG) PET/CT images in patients with extranodal natural killer/T cell lymphoma (ENKTL) of stage Ⅰ-Ⅱ. Methods From August 2010 to April 2018, 67 patients with ENKTL of stage Ⅰ-Ⅱ disease (47 males, 20 females; median age 57 years) in the First Affiliated Hospital of Nanjing Medical University were enrolled, and the clinic data and pretreatment 18F-FDG PET/CT imaging data were retrospectively analyzed. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of tumor tissue were calculated from PET/CT images with the threshold value of 40% of maximum standardized uptake value (SUVmax). The optimal cut-off values of progression-free survival (PFS) and overall survival (OS) of SUVmax, MTV and TLG were investigated by using receiver operating characteristic (ROC) curve analysis. Kaplan-Meier method, log-rank test and Cox proportional hazards model were used for data analysis. Results SUVmax, MTV and TLG of 67 patients were 12.32(8.65, 16.96), 13.13(7.37, 22.74) ml, 92.17(46.54, 198.46), respectively. ROC curve analysis showed that the cut-off values of SUVmax, MTV and TLG were 13.09, 18.05 ml and 152.81, respectively. Univariate analysis showed that B symptoms, lactate dehydrogenase (LDH) level, β2-microglobulin, Eastern Cooperative Oncology Group (ECOG) score, Korean prognostic index (KPI), SUVmax, MTV, TLG and treatment mode (chemotherapy or chemoradiotherapy) were relative factors affecting PFS (χ2: 5.466-27.163, all P 0.05). Multivariate analysis showed that ECOG score, MTV and TLG were independent prognostic predictors of PFS (relative ratio (RR): 5.107-6.802, all P<0.05), and ECOG score, MTV, TLG and treatment mode were independent prognostic predictors of OS (RR: 0.221-9.106, all P<0.05). Conclusions MTV and TLG from pretreatment 18F-FDG PET/CT images are independent prognostic factors for PFS and OS in patients with ENKTL of stage Ⅰ-Ⅱ. MTV and TLG may be more useful than SUVmax for prognosis. Key words: Lymphoma, extranodal NK-T cell; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose

A model of hazard and risk analysis for bread production and the awareness of food safety

A physical, chemical, biological or allergenic substance associated with a food commodity from harvesting to the consumer’s hand could contaminate food processing. Hazard analysis and critical control points (HACCP) ensures product protection. Though many manufacturers obtain a HACCP certificate easily, they may not apply the systematic food screening programs during all stages of the process. The purpose of this study was to evaluate the HACCP implementation for the roll bread production line and determine the education level of food safety and legal requirements in Samsun, Turkey. Verification procedures, record keeping and workflow in the roll bread manufacturing plant was screened and hence the HACCP chart was revised, by the HACCP team. The critical control points (CCPs) were determined by going through the decision tree of the method specified in ISO 22000:2005. The level of awareness of staff for good hygiene practices and food safety was determined via face-to-face method questionnaire. Within all stages of the process, cooling (stage 10) was considered as CCP in the manufacturing plant. The control and preventive activities created including pre-requisite programmes for the other processing steps. In addition, label information of the product was re-evaluated according to the present production conditions and was revised. Regarding the education level of the food hygiene practices and quality control applications was determined to be inadequate; personnel need to be informed and technical support is required to ensure internal control.

Prognostic impact of atrial rhythm and dimension in patients with structural heart disease undergoing cardiac sympathetic denervation for ventricular arrhythmias

Cardiac sympathetic denervation (CSD) is a promising treatment for patients with structural heart disease (SHD) and refractory ventricular tachyarrhythmias (VTs). The effect of CSD on atrial rhythm as well as the prognostic impact of atrial arrhythmias (AAs) or left atrial volume index (LAVI) on CSD outcome are unknown. The goals of this study were to evaluate the impact of AAs and LAVI on CSD outcome and to assess changes in AAs burden and in atrial pacing after CSD. Patients with SHD undergoing CSD for VTs were analyzed. Hazards models were built to assess predictors of sustained VT/implantable cardioverter-defibrillator (ICD) shock recurrences and death/orthotopic heart transplant (OHT). Changes before vs after CSD were assessed using ICD, clinical, and echocardiographic data. A drug index was devised to correct for medication use. Between 2009 and 2018, 91 patients (mean age 56 ± 13 years; mean left ventricular ejection fraction 34% ± 14%; 47% with a history of AAs) underwent left CSD (16%) or bilateral CSD (BCSD). The median follow-up was 14 months (interquartile range 4-37 months). Using multivariable analysis, neither LAVI nor AAs were associated with recurrences; LAVI was an independent predictor of death/OHT. AAs burden did not change after BCSD, but atrial pacing increased from a median of 28% to 72% (P < .01). Left ventricular end-diastolic diameter slightly increased; however, sustained VT/ICD shocks were reduced. In patients with SHD undergoing CSD, LAVI predicts death/OHT. AAs burden, already low at baseline, was unchanged after BCSD, while the need for atrial pacing increased, suggesting an impact of BCSD on sinus node chronotropism.

18F-FDG PET-CT在评估局部晚期非小细胞肺癌预后中的应用

Objective To explore the value of 18F-FDG PET-CT in evaluating the prognosis of locally advanced non-small cell lung cancer (NSCLC) patients. Methods The clinical characteristics and 18F-FDG PET-CT parameters of 138 locally advanced NSCLC patients from 2013 to 2016 in Suzhou Municipal Hospital and People′s Hospital of Suzhou New District were analyzed retrospectively. The maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured. Area under the curve (AUC) of SUVmax, MTV and TLG were calculated to determine optimal cut-off value for patients grouping, with receiver-operating characteristic curve (ROC) analysis. Progression-free survival (PFS) and overall survival (OS) were assessed by Kaplan-Meier method and the survival difference between the two groups was estimated by log-rank test. Multivariate survival analysis was performed by Cox proportional hazard model. Results According to ROC analysis, SUVmax (AUC=0.716, cut-off value was 11.8, P<0.001) had a better predictive value for OS, whereas the predictive values of MTV (AUC=0.580, P=0.101) and TLG (AUC=0.635, P=0.005) were less. There was no significant correlation between SUVmax and patients′ age (χ2=1.222, P=0.269), gender (χ2=0.029, P=0.865), TNM stage (χ2=0.073, P=0.787), pathologic subtype (χ2=0.541, P=0.462), smoking (χ2=0.266, P=0.606), differentiation (χ2=0.285, P=0.593) or tumor location (χ2=0.509, P=0.476). The 1-year, 2-year and 3-year OS rates of low SUVmax group (n=59) were 93.2%, 67.0% and 15.6% respectively, and those of high SUVmax group (n=79) were 77.2%, 25.0% and 5.62% respectively. The OS rate of low SUVmax group was higher than that of high SUVmax group (χ2=19.153, P<0.001). The 1-year and 2-year PFS rates of low SUVmax group were 79.3% and 56.9% respectively, and those of high SUVmax group were 46.2%, 13.0% respectively. The PFS rate of low SUVmax group was higher than that of high SUVmax group (χ2=25.945, P<0.001). Single factor analysis showed that differentiation (HR=1.839, 95%CI: 1.161-2.913, P=0.017), SUVmax (HR=0.357, 95%CI: 0.231-0.550, P<0.001), MTV (HR=0.470, 95%CI: 0.270-0.819, P=0.001) and TLG (HR= 0.508, 95%CI: 0.327-0.789, P=0.002) were independent influencing factors of OS. The degree of differentiation (HR=1.909, 95%CI: 1.167-3.123, P=0.018) and SUVmax (HR=0.250, 95%CI: 0.160-0.410, P<0.001) were the independent influencing factors of PFS. Multivariate analysis showed that only SUVmax was an independent influencing factor of OS (HR=2.189, 95%CI: 1.222-3.189, P=0.008)and PFS (HR=4.412, 95%CI: 2.318-8.398, P<0.001). Conclusion PET-CT SUVmax of primary tumor is significantly correlated with OS and PFS of patients. It has important guiding value for prognosis judgment and treatment plan selection of patients with locally advanced NSCLC. Key words: Carcinoma, non-small-cell lung; 18F-FDG PET-CT; Prognosis

The impact of intraoperative pancreatic resection margin status on prognosis of patients with pancreatic head cancer

Objective To study the impact of intraoperative pancreatic resection margin status on prognosis in patients with pancreatic head cancer. Methods The clinical and follow-up data of 109 patients who underwent pancreaticoduodenectomy at Ningbo Lihuili Hospital from March 2012 to October 2018 were analyzed retrospectively. The association of intraoperative resection margin status and other clinicopathological factors on prognosis was analyzed by the Kaplan-Meier method and the Cox proportional hazard model. Logistic multivariate analysis was used to study factors influencing the margin status. Results Of 109 patients, 20 had a positive intraoperative resection margin, and 89 had a negative margin. Postoperative pathological examination showed that all the patients had a negative surgical margin. Univariate analysis suggested that CA19-9 before operation, preoperative adjuvant chemotherapy, intraoperative pancreatic resection margin status, maximum diameter of tumor, perineural invasion, lymphovascular invasion, tumor differentiation, and N staging were significantly related to survival in the entire cohort (all P 0.05). Analysis of the clinicopathological factors between the two groups showed that in the positive pancreatic neck margin group, the distribution of adverse pathologic factors like low tumor differentiation, tumor diameter ≥4 cm, perineural invasion and lymphovascular invasion were significantly different compared with the negative group (P<0.05). Tumor diameter ≥4 cm (OR=5.72, 95%CI: 1.60~20.49) and low tumor differentiation (OR=3.79, 95%CI: 1.20~11.95) were independent influencing factors of positive margin on logistic multivariate analysis. Conclusions Intraoperative pancreatic positive margin was not an independent risk factor of prognosis, but it was meaningful in predicting survival. Presence of positive margins was often combined with existence of some adverse pathological features, such as large tumor diameter and low tumor differentiation. Prognosis of patients with a positive margin was often poor. A positive pancreatic margin was an intraoperative marker of poor tumor biology in patients with pancreatic ductal adenocarcinoma. Key words: Pancreatic neoplasms; Positive margin; Pancreaticoduodenectomy; Prognosis

Using a machine learning algorithm to predict acute graft-versus-host disease following allogeneic transplantation

AbstractAcute graft-versus-host disease (aGVHD) is 1 of the critical complications that often occurs following allogeneic hematopoietic stem cell transplantation (HSCT). Thus far, various types of prediction scores have been created using statistical calculations. The primary objective of this study was to establish and validate the machine learning–dependent index for predicting aGVHD. This was a retrospective cohort study that involved analyzing databases of adult HSCT patients in Japan. The alternating decision tree (ADTree) machine learning algorithm was applied to develop models using the training cohort (70%). The ADTree algorithm was confirmed using the hazard model on data from the validation cohort (30%). Data from 26 695 HSCT patients transplanted from allogeneic donors between 1992 and 2016 were included in this study. The cumulative incidence of aGVHD was 42.8%. Of >40 variables considered, 15 were adapted into a model for aGVHD prediction. The model was tested in the validation cohort, and the incidence of aGVHD was clearly stratified according to the categorized ADTree scores; the cumulative incidence of aGVHD was 29.0% for low risk and 58.7% for high risk (hazard ratio, 2.57). Predicting scores for aGVHD also demonstrated the link between the risk of development aGVHD and overall survival after HSCT. The machine learning algorithms produced clinically reasonable and robust risk stratification scores. The relatively high reproducibility and low impacts from the interactions among the variables indicate that the ADTree algorithm, along with the other data-mining approaches, may provide tools for establishing risk score.

Punch-Through Risk of Jack-Up Under the Dual Uncertainty of Structure and Foundation

Abstract The preload operation of Jack-up in complex multi-layered foundation requires an enhanced understanding of its behavior in punch-through accident and suitable safety analysis tools for the assessment of their reliability in a particular site. In order to evaluate punch-through risk, a risk-consistent method is proposed based on the model of foundation hazard and structural vulnerability. Besides, foundation bearing capacity is evaluated to quantify foundation hazard. Third, to improve the solution efficiency, higher-order moment method (HOMM)-Pushover method has been developed for assessing the structural vulnerability. In addition, case studies are presented to demonstrate the advantages of these techniques and important trends are highlighted by the results of parametric sensitivity studies. More specifically, failure probability analysis has been undertaken using improved method and the punch-through risk is evaluated quantitatively in different hazard levels. The results show that the dual uncertainty of both structure and foundation is crucial for assessment of foundation hazard and structural vulnerability. The randomness of foundation parameters is the dominant factor affecting the punch-through risk, and the risk increases with the increase of preload weight. The time-varying risk in the process of preload operation can be revealed using the risk analysis method mentioned in this paper.

Tree-based modeling of time-varying coefficients in discrete time-to-event models.

Hazard models are popular tools for the modeling of discrete time-to-event data. In particular two approaches for modeling time dependent effects are in common use. The more traditional one assumes a linear predictor with effects of explanatory variables being constant over time. The more flexible approach uses the class of semiparametric models that allow the effects of the explanatory variables to vary smoothly over time. The approach considered here is in between these modeling strategies. It assumes that the effects of the explanatory variables are piecewise constant. It allows, in particular, to evaluate at which time points the effect strength changes and is able to approximate quite complex variations of the change of effects in a simple way. A tree-based method is proposed for modeling the piecewise constant time-varying coefficients, which is embedded into the framework of varying-coefficient models. One important feature of the approach is that it automatically selects the relevant explanatory variables and no separate variable selection procedure is needed. The properties of the method are investigated in several simulation studies and its usefulness is demonstrated by considering two real-world applications.

Does Mothers’ Parental Leave Uptake Stimulate Continued Employment and Family Formation? Evidence for Belgium

Parental leave schemes undoubtedly facilitate the combination of work and family life during leave-taking. In addition to this instantaneous effect of parental leave uptake, a growing yet limited body of research addresses the question of subsequent effects of parental leave uptake. As work-family policies, such as parental leave, are geared towards stimulating family formation and (female) employment, this study assessed whether the individual uptake of parental leave by employed mothers after the birth of a child yielded differential parity progression and employment patterns compared to eligible employed mothers that did not take leave. Using data from the Belgian Administrative Socio-Demographic panel, we applied dynamic propensity score matching and hazard models. Our results indicate that previous leave uptake is a differentiating factor in subsequent fertility and employment outcomes, but also that (self-)selection strongly affects this relation. Descriptive analyses indicate that mothers who use leave shortly after childbearing exhibit a similar progression to second births, more third births and less fourth births, while displaying substantially lower hazards of exiting the labour force regardless of parity. However, when controlling for the fact that mothers who use parental leave exhibit a stronger pre-birth attachment to the labour force, work for larger employers in specific employment sectors, and also differ from non-users in terms of household characteristics (e.g., higher household income, more likely to be married and less likely to have a non-Belgian background), many associations between leave uptake and subsequent fertility and employment outcomes turn neutral or even negative. No indication for higher parity progression among leave users was found and the hazard of exiting the labour force was moderately higher for leave users. These empirical results are discussed in the Belgian context of low parental leave benefits, short leave entitlements and low uptake of parental leave, features which are also displayed by other Western European countries and contrast with the Nordic European countries studied in previous research.

Clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic analysis

Clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic analysis

Factors associated with CD4+/CD8+ T lymphocyte ratio normalization in acquired immunodeficiency syndrome patients after antiretroviral therapy

Objective To investigate the factors associated with CD4+ /CD8+ T lymphocyte ratio normalization in acquired immunodeficiency syndrome (AIDS) patients after antiretroviral therapy (ART). Methods The data of 1 188 human immunodeficiency virus (HIV)/AIDS patients from the national ART reporting system in Yuxi City, Yunnan Province between January 1, 2006 and December 31, 2016 were retrospectively collected and analyzed. The rate of CD4+ /CD8+ T lymphocyte ratio normalization after ART was calculated by lifetable. Cox proportional hazard models were used to analyze the factors associated with CD4+ /CD8+ T lymphocyte normalization in AIDS patients after ART. The Wilcoxon rank sum test was used for comparison between groups. Results The follow-up time was 3.8 (1.0-10.8) years. CD4+ /CD8+ T lymphocyte ratio normalization was documented in 95 patients with the rate of 1.89 per 100 person-years (95% confidence interval(CI) 1.52-2.27) after ART. The average time from ART to CD4+ /CD8+ T lymphocyte ratio normalized was 9.4 years. The cumulative normalization rate was 0.02 for the first year, 0.06 for the third year, 0.11 for the fifth year, 0.19 for the seventh year and 0.37 for the ninth year. By Cox proportional hazard models, the probability of CD4+ /CD8+ T lymphocyte ratio normalization in patients infected HIV by heterosexual contacts was 3.709 (95%CI 1.781-7.726) times higher than those by intravenous injection. The probability of CD4+ /CD8+ T lymphocyte ratio normalization in patients with baseline CD4+ T lymphocytes of 350-499 and more than 500 cell/μL groups were 2.792 (95%CI 1.196-6.519) and 3.832 (95%CI 1.648-8.913) times higher than those with baseline CD4+ T lymphocytes less than 200 cell/μL, respectively. The probability of normalization after ART in patients with higher baseline CD4+ /CD8+ T lymphocyte ratio was higher than those with baseline CD4+ /CD8+ T lymphocyte ratio≤ 0.20 (hazard ratio>1, all P<0.01). Conclusion The CD4+ /CD8+ T lymphocyte ratio normalization in AIDS patients after ART is associated with baseline CD4+ T lymphocyte counts, baseline CD4+ /CD8+ T lymphocyte ratio and HIV transmission mode. Key words: Acquired immunodeficiency syndrome; CD4-positive T-lymphocytes; CD8-positive T-lymphocytes; Antiretroviral therapy; Influencing factors

Comparison of Earthquake-Triggered Landslide Inventories: A Case Study of the 2015 Gorkha Earthquake, Nepal

Despite landslide inventories being compiled throughout the world every year at different scales, limited efforts have been made to critically compare them using various techniques or by different investigators. Event-based landslide inventories indicate the location, distribution, and detected boundaries of landslides caused by a single event, such as an earthquake or a rainstorm. Event-based landslide inventories are essential for landslide susceptibility mapping, hazard modeling, and further management of risk mitigation. In Nepal, there were several attempts to map landslides in detail after the Gorkha earthquake. Particularly after the main event on 25 April 2015, researchers around the world mapped the landslides induced by this earthquake. In this research, we compared four of these published inventories qualitatively and quantitatively using different techniques. Two principal methodologies, namely the cartographical degree of matching and frequency area distribution (FAD), were optimized and applied to evaluate inventory maps. We also showed the impact of using satellite imagery with different spatial resolutions on the landslide inventory generation by analyzing matches and mismatches between the inventories. The results of our work give an overview of the impact of methodology selection and outline the limitations and advantages of different remote sensing and mapping techniques for landslide inventorying.

An interdisciplinary approach to assess human health risk in an urban environment: A case study in temperate Argentina

Unplanned urbanization increases the exposure of people to environmental hazards. Within a landscape ecology framework, this study is a diagnosis of human health risk in San Martín, an urban district of Buenos Aires, Argentina. Risk was estimated by combining four hazard indexes (water and air pollution, and mosquito and rodent infestation) and a vulnerability index. Each index was obtained by integrating environmental and socio-demographic layers in a Geographic Information System. Spatial autocorrelation was assessed for each hazard, vulnerability and risk indexes using Moran's tests. Also, spatial associations between pairs of variables were addressed by means of Geographically Weighted Regressions. The robustness of hazard and vulnerability indexes was checked by a sensitivity analysis. In General San Martín district, 83.3% of the population is exposed to relatively high levels of at least one hazard; 7.4% is exposed to relatively high levels of all hazards (11.5% of the total area) and only 16.7% lives in areas of relatively low levels of all hazards (15.4% of the total area). Areas where hazard intensity was relatively high corresponded to those areas where the most vulnerable population lives, enhancing human health risk. The models for hazards and vulnerability were reasonably robust to changes in the weights of the variables considered. Our results highlight the spatially heterogeneous nature of human health risk in an urban landscape, and reveal the location of critical risk hotspots where reduction or mitigation actions should be focused.

AN INDICATOR-BASED APPROACH FOR MICRO-SCALE PHYSICAL FLOOD VULNERABILITY MAPPING

Abstract. Map representation of vulnerability is a crucial step in evaluating flood impact and all vulnerability indicators that are the final product of risk assessment. So far, in flood risk assessment, this is probably the weakest link. Flood risk mapping suffers from inequality in the level of development in presenting the different components: where exposure and hazard modelling and mapping is well developed and advanced, while vulnerability analysis and mapping are underdeveloped. Therefore, the objective of this paper is to discuss a newly developed GIS-based approach on micro-scale flood vulnerability mapping of physical elements at risk using an indicator-based method. Micro-scale flood vulnerability is used to eliminate flood vulnerability in an area with a high probability of occurrences. The approach is suitable for cost-benefit analysis of structures protection measures. At micro-scale flood vulnerability mapping, it is more suitable to adopt indicator-based vulnerability assessment methods. Because it provides an opportunity for incorporating all the factors and characteristics of elements at risk that contribute to generating their flood vulnerability. Likewise, a considerable amount of studies argue that vulnerability assessment and its representation on maps should focus on the identification of variables that influence the vulnerability of an element at risk. Flood vulnerability mapping at micro-scale provides critical information for the decision-makers on why specific infrastructures are susceptible more than the others. Moreover, assessing and managing flood risk is crucial in order to reduce the loss and adapt to the combined effects of rapid urbanization and climate changes.

Prognostic factors for breast cancer squamous cell carcinoma and nomogram development for prediction: population-based research

Background: To investigate the prognostic survival factors of breast squamous cell carcinoma (BSqCC) and develop a comprehensive nomogram for predicting the survival of breast cancer squamous cell carcinoma. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with BSqCC from 1973 to 2015. The data was obtained using SEER Stat 8.3.4 software, collated, and analyzed by Excel 2016 software and SPSS (v25.0). Kaplan-Meier curves were used for survival analysis. The variables obtained by univariate analysis were introduced into the Cox proportional hazard model for multivariate analysis. The risk factors affecting the prognosis of BSqCC were obtained. P Results: A total of 739 patients with BSqCC was included. The median age of diagnosis was 66 years. In most cases, the expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) was negative. One-third of the cases underwent breast-conserving surgery, and more than half of the cases underwent mastectomy (unilateral or bilateral). The 1-year survival rate was 81.2%, the 3-year survival rate was 62.9%, the 5-year survival rate was 54.4%, and the 10-year survival rate was 41.4%. Age ( χ 2 =71.050, P χ 2 =37.560, P χ 2 =27.931, P χ 2 =74.185, P χ 2 =38.542, P χ 2 =59.217, P Conclusions: BSqCC was a malignant tumor with a low survival rate. Age of onset was typically at an older age; mostly middle-aged and seniors. Marital status, age, surgical procedure, tumor size, and several positive lymph nodes were independent predictors of patient survival. At the same time, we developed a prognostic nomogram with excellent discrimination for breast cancer squamous cell carcinoma; therefore, it could help clinicians make decisions on a personal basis.

A prospective study on the influence of metabolic syndrome on the risks of cardiovascular disease events and all-cause mortality for urban residents aged 40-79 years in Guiyang

Objective To explore the influence of metabolic syndrome on the risks of cardiovascular disease (CVD) events and all-cause mortality. Methods In this prospective cohort study, urban residents aged 40-79 years in Guiyang were followed-up for three years. The end-points were CVD events and all-cause mortality. COX proportional hazards model were used for the corresponding hazard ratios (HRs) of CVD events and all-cause mortality. Metabolic syndrome was defined according to the 2005 International Diabetes Federation (IDF) criteria. Results A total of 7 313 subjects were included. 146 cases of CVD events and 80 cases of all-cause mortality were recorded. After adjusting for gender, age, smoking, alcohol consumption, and blood lipid levels, the metabolic syndrome increased the risks of CVD events and all-cause mortality. The HRs were 1.43 (P=0.037) and 1.25 (P=0.418), respectively. As compared metabolic syndrome with non-metabolic syndrome, an increased risk of CVD events was found. The HR was 1.43 (P=0.013). No significantly increased risk of all-cause mortality was found in subjects with metabolic syndrome. Conclusion The metabolic syndrome was associated with increased risk of CVD events and there was no significant increase in all-cause mortality. Metabolic syndrome is an important risk factor for CVD events. Key words: Metabolic syndrome; Cardiovascular disease events; All-cause mortality; Cohort study

Damage risk assessment of a high-rise building against multihazard of earthquake and strong wind with recorded data

The high-rise buildings designed with a long lifetime may be exposed to one or more extreme hazards. Traditionally, specifications separately treated the multiple extreme hazards according to the controlling load case. Thus, the ability of high-rise buildings designed by the current codes to face the combined threats of earthquake and wind is rather vague. This paper presents a multihazard-based framework to assess the damage risk of a high-rise building subjected to earthquake and wind hazards separately and concurrently, which can be broken into three parts: the modeling of hazards, the structural fragility analysis and the damage probability computation. Firstly, based on the earthquake and wind data from 1971 to 2017 recorded in the Dali region of China, the hazard curves of single earthquake and wind, and the copula-based surface of bi-hazards are well established. Secondly, the multihazard-based fragility analysis of a high-rise building in Dali Prefecture is performed with the consideration of various load conditions. Lastly, upon completing the hazard models and fragility analyses, quantifications of the damage probabilities for the separate and concurrent hazards are determined directly. Numerical results indicate that the damage probability and contributions of each hazard circumstance are sensitive to damage severity. Furthermore, the damage probability induced by the bi-hazards dominates the total probability under most damage states conflicted with the common assumptions presented in the available researches. The comprehensive application highlights the necessity of examining the responses of high-rise buildings subjected to multihazard. The potential of the presented framework is of great help for decision-making.

Labour Market Status at Ages 50–64 and All-Cause Mortality at Ages 65–70

Individuals’ labour market status and health are known to be highly correlated. To investigate this association beyond prime working ages, we study how all-cause mortality at ages 65–70 relates to different labour market positions at ages 50–64. The data stem from random samples of the Finnish population, which make it possible to follow 33,000 individuals in the period 1987–2011. Hazard models are estimated to quantify the associations. For both men and women, disability pensioners have a hazard of dying at age 65+ that is approximately twice that of persons who were employed, and this ratio still exceeds 1.5 when socioeconomic and demographic variables are included. Also male unemployment, but not female, is associated with an elevated mortality risk, but this interrelation depends greatly on socioeconomic position.

Prognostic values of preoperative albumin to globulin ratio for predicting clinical outcome in patients with high-grade gliomas

Background: Gliomas was the most common primary central nervous system tumors which have an increased morbidity in recent years. And the clinical prognosis of high-grade gliomas (HGG, WHO grade III to IV) was most with an average survival rate of only dozens of months. Many researchers concluded that the level of preoperative albumin-to-globulin ratio (AGR) could predict the clinical outcome of patients with solid malignant tumors. Methods: Two hundred and thirty-two cases of patients who were diagnosed HGG by pathology were enrolled in the study. The relevant data of the cohort included sex, age, preoperative Karnofsky performance score (KPS), extent of resection, albumin count and globulin count, isocitrate dehydrogenase (IDH) and survival time were collected. The survival rate was obtained by using the Kaplan-Meier method. The cut-off value of AGR was determined by X-tile software. Univariate survival analysis was performed by the log-rank method. Proportional hazards model (Cox model) was performed for multivariate analysis. Results: The optimal cut-off value of AGR was 1.32. Results showed that the preoperative AGR was correlated with clinical prognosis of patients with HGG, and the survival time of the patients with high AGR (AGR >1.32) was significantly longer. Moreover, the prognosis of patients with high AGR was better in IDH wild-type HGG. Conclusions: Preoperative AGR might predict the clinical prognosis of patients with HGG.