Eastern Hospital Research Articles

Predictive Value of Clinicopathological Characteristics for Sentinel Lymph Node Metastasis in Early Breast Cancer.

BackgroundSentinel lymph node biopsy (SLNB) is one of the preferred treatments for breast cancer including clinically negative lymph node breast cancer. However, for 60–70% of patients this invasive axilla surgery is unnecessary. Our study aimed to identify the predictors for sentinel lymph node (SLN) metastasis in early breast cancer patients and provide evidence for rational decision-making in specified clinical situations.Material/MethodsMedical records of 417 breast cancer patients who were treated with a breast surgical procedure and SLNB in Ningbo Medical Center Lihuili Eastern Hospital were retrospectively reviewed. Univariate analysis and multivariate logistic regression analysis were used to analyze the correlation between SLN metastasis and clinicopathological characteristics, including patient age, menstrual status, body mass index (BMI), family history, tumor size, laterality of tumor, histological grade, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2), Ki67 index, and molecular subtypes of the tumor.ResultsIn the cohort of 417 cases, the ratio of SLNM was 23.0%. Univariate analysis found that age, tumor size, histological grade, and Ki67 index were associated with SLN metastasis. However, age, tumor size, and histological grade were the only three independent predictors for SLN metastasis by multivariate logistic regression analysis. When these three factors were considered together, three different levels of SLN metastasis groups could be classified: low-risk group with the ratio of 14.3%, moderate-risk group with the ratio of 31.4%, and high-risk group with the ratio of 66.7%.ConclusionsOur study demonstrated that age, tumor size, and histological grade were three independent predictive factors for SLN metastasis in early breast cancer patients. This finding may help surgeons in the decision-making process for early breast cancer patients before considering axilla surgical procedure.

Profile of Syndromic Kraniosinostosis for 5 Years in RSUD dr.Soetomo Surabaya

Craniosynostosis is a premature cover of one or more sutures, which may occur as part of syndrome (syndromic) or as a separate defect / isolated defect (nonsyndromic). Cohen and Kreirborg state the incidence of Apert and Crouzon syndromes of 15.5: 1,000,000 and 16.5: 1,000,000 per birth. The incidence of craniosynostosis in Indonesia still not handled properly, as well as low recognition in this disorder. RSUD Dr. Soetomo as an eastern referral hospital, which has one of the centers of plastic surgery education in Indonesia, where craniosynostosis syndromic often occurs, so we have the most total cases handled in Indonesia. This is a retrospective descriptive study discusses more about the profile of patients syndromic craniosinostosis for 5 years in dr. Soetomo Surabaya, performed on twenty-four first syndromic craniosinostosis patients at Dr. Soetomo Surabaya period 1 January 2008 - 31 December 2013. Out of 24 total patients, 12 cases of apert (29%), 6 crouzon cases (54%) and 3 cases of pfeiffer (17%) were obtained. Based on sex, more commonly found in women (54%). With the most common age the patient comes first is aged 5-10 years (37%). Each patient has an average of 2 surgeries, with a type of surgical action on cranial vault remodeling patients. Abnormalities of syndromic craniosinostosis found the most common in women and apert syndrome in RSUD dr.Sutomo. Where the most common age when the arrival of 5-10 years, caused by the late diagnosis of the disorder

Revision adenoidectomy in children: a population-based cohort study in Taiwan

There is a lack of population-level analysis of revision adenoidectomy in children. This study reveals the revision rates and factors associated with paediatric revision adenoidectomy in Taiwan. From the Taiwan National Health Insurance Research Database, we identified all in-hospital children (age <18years) who underwent adenoidectomy between 2000 and 2007. All children had received at least 5years of follow-up from the index date, and the clinical records until 2012 were examined. Factors affecting the paediatric revision adenoidectomy were analysed using the multivariable Cox proportional hazards model. A total of 10,396 children were enrolled (mean age 7.3years; 66% boys; mean follow-up period 8.7years). Two hundred and seventy-five children underwent revision adenoidectomy, and the mean interval between primary adenoidectomy and revision surgery was 2.97years. Only 58.5% of children underwent revision surgery at the initial hospital. The incidence of revision surgery was highest in the second year (0.69%), followed by the third year (0.53%) after primary adenoidectomy. The multivariable Cox proportional hazards model revealed that young age [hazard ratio (HR)=0.8], male gender (HR=1.57), surgery at an eastern hospital (HR=2.08), surgical indication of adenoid hypertrophy (HR=1.51), and concurrent ventilation tube insertion (HR=2.61) or nasal surgeries (HR=4.84) were associated with revision adenoidectomy. The incidence of revision adenoidectomy in Taiwan was 2.6%. Male gender, young age, concurrent nasal or ventilation tube insertion, and surgery at an eastern hospital increased the risk of revision.

Retrospective study describing the mode of hand injuries in Eastern Nepal

Background: This retrospective review was performed to identify the incidence, causes, and details of hand injuries in patients presenting to a tertiary hospital in Eastern Nepal.Objective: To identify the incidence, causes, and details of hand injuries in patients.Method: Records of all patients who had sustained hand injuries for last 5 years were collected from the medical record section. Altogether 832 injuries of hand in 484 patients were reported in this review. These patients were reviewed for age at the time of injury, gender, location of the incident, mechanism of injury, and fracture specifies.Result: 414 (85.5%) males with mean age of 28.79 ± 12.81 and in female with 30.43 ±17.13 yrs were found. Machinery injuries (25.2%) were the most common causes of injuries followed by RTA (14.5%). Metacarpal bone fractures (34.6%) were the commonest injury of the hand. Most of the patients were treated with open reduction and fixation with K wires.Conclusion: The study reveals the aetio-epidemiological and clinical aspect of hand injuries with its alarming burden in Nepal.Health Renaissance 2015;13(2): 125-133

SURVEILLANCE OF MORTALITY: FROM A TERTIARY CARE TEACHING HOSPITAL OF EASTERN INDIA IN PERSONS WITH AND WITHOUT DIABETES MELLITUS

Objective: There is abundant knowledge about the gravity of global load of diabetes mellitus (DM). There are conflicting reports on the cause of death from different parts of the world. In India, there are not enough studies to establish the cause of death in DM. To find out the mortality pattern in DM and non-DM (NDM) in a tertiary care teaching hospital in Eastern India.Methods: Retrospective analysis of in-hospital mortality in a tertiary care hospital in Eastern India, from January 2012 to December 2015.Results: There were a total of 1590 deaths of which 442 were having DM and 1148 did not have DM (NDM). Mean age of death for nondiabetics was 66.4 years (M:F = 67.5:65.3) and that for diabetics were 62.7 years (M:F = 63.5:60.04) which was not statistically significant (p=0.9) though diabetics died younger by 4 years. On analyzing the specific cause of death, coronary artery disease (CAD) was 14.71% in DM and 1.57% in NDM (p=0.0001). Chronic kidney disease (CKD) was 18.55% in DM and 1.92% in NDM (p=0.0001). Congestive heart failure was 7.27% in DM and 1.83% in NDM (p=0.0001). CVA was 13.57% in DM and 1.66% in NDM (p=0.0001). Infection was the most common cause of death (39.37%) in DM, but in NDM also this was quite high 34.41% (p=0.21). The death due to CVA in DM was more in hemorrhage as compared to ischemic (p=0.00001).Conclusion: We found causes of death in DM were an infection, CKD, CAD, CVA, and CHF in descending order in this part of the world. The diabetes patients had lesser hospital stay than nondiabetes patients (p=0.009).

Case Article—Miller Pain Treatment Center—Eastern Hospital Outpatient Center

Introductory courses in operations management typically introduce students to process analysis and queuing theory. We apply these tools to consider patient flows in an outpatient clinic where processes are made more complex by inclusion of the teaching mission of an Academic Medical Center. The case narrative deals with a physician who moved his practice from a setting with no teaching mission to the academic setting. This created a natural experiment because he began treating the same patients using a different process flow. Students are asked to use data collected at both settings to compare and contrast these flows. The protagonist weighs options designed to improve an appointment schedule, change patient punctuality, and introduce a type of pre-processing of patients. Evaluation of these proposals calls for a different style of analysis. Students are introduced to the use of discrete event simulation to address such questions. Simulation models are provided corresponding to the two clinic settings. This allows students to conduct and learn from virtual experiments using calibrated models. The case fills a need for material that covers issues in healthcare delivery, which the basic tools of process analysis and queuing theory are insufficient to fully address. The simulation tool and the teaching note are available at https://www.informs.org/Publications/Subscribe/Access-Restricted-Materials .

Case—Miller Pain Treatment Center

On a cool Saturday morning Dr. Keith Weems walked briskly down the hallway toward the main entrance to Eastern Hospital (JHH). He was on his way to visit in-patients in several wards as part of his duties as the pain specialist on call for that weekend. However, his mind kept drifting to issues he was facing as the new manager of the Miller Pain Treatment Center in the neighboring Eastern Outpatient Center (E-HOC). Dr. Weems had been working as part of the Eastern system for several years. However, he recently merged his successful private practice into the Miller Pain Treatment Center and was appointed as its director. In so doing he moved from a setting where he was the clear boss to one in which he was dealing with a collection of more established doctors already set in their ways. He also had to figure out how to improve the care delivery process in this environment, which considered itself to be part of the premier teaching hospital in the world. After reviewing the operations and meeting the staff he was coming to grips with the fact that this new setting was much more complex than his old practice in a myriad of ways. Additionally, between treating outpatients and in-patients, managing the clinic, teaching medical students, and conducting research, it was clear that the complexity of the job mirrored the complexity of the operating environment. However, he was confident that he could find ways to get this larger clinic to surpass the success of his old, simpler practice. The online spreadsheet supplement is available at https://doi.org/10.1287/ited.2017.0176cs .

Bacteriological Profile of Blood Culture Positive Sepsis in Newborn at BPKIHS, Dharan Nepal

Background &amp; Objectives: Neonatal infections currently cause about 1.6 million deaths annually in developing countries. Sepsis and meningitis is responsible for most of these deaths. This study was undertaken to determine the bacteriological profiles and antibiotic sensitivity patterns of isolates from blood cultures of neonates admitted in a tertiary care hospital in Eastern Nepal.Materials &amp; Methods: A retrospective study was conducted at pediatric department from January, 2014 to December 2014. Total 1009 newborns blood sample with suspected and clinical sepsis were cultured by using standard microbiological technique and antibiotic sensitivity patterns were studied. Results: The positive blood culture was 32.4% (327/1009). Gram positive bacteria were more common 231(71%) than gram negative bacteria 96(29%). Staphylococcus aureus 174 (53.2%) and acinetobacter 46(14.1%) were the commonest isolates in blood culture. Most of the organisms showed sensitivity with aminoglycosides (gentamicin and amikacin) and third generation cephalosporins.Conclusion: Staphylococcus aureus, Acinetobacter and Klebsiella species remain the principal organisms causing neonatal sepsis and antibiotics like amino glycosides should be first choice of drugs.

Risk Factors for Hemorrhagic Transformation After Intravenous Thrombolysis in Acute Cerebral Infarction: A Retrospective Single-Center Study.

To investigate the risk factors for hemorrhagic transformation (HT) after intravenous thrombolysis using a recombinant tissue plasminogen activator (r-tPA) in acute cerebral infarction. Patients with acute cerebral infarction receiving r-tPA thrombolysis in Shanghai Eastern Hospital were retrospectively studied. Based on the cranial computed tomography or magnetic resonance imaging examination, after the intravenous thrombolysis, the patients were divided into 2 groups: an HT group and a non-HT group. The information was collected before or after thrombolysis. A total of 162 patients were included in the analysis. The age ranged from 25 to 86 years, with an average age of 65.6 ± 10.6 years. The average time from disease onset to thrombolysis was 188 ± 53.1 minutes. Cranial computed tomography or magnetic resonance imaging showed that 20 patients (12.3%) had HT after thrombolysis. Using univariate analysis, history of atrial fibrillation, positive expression of urinary protein, and high National Institutes of Health Stroke Scale (NIHSS) score before thrombolysis, we found that there was a significant difference between the HT and non-HT group (P< 0.05) in the level of mean systolic pressure (MSP) 24hours after thrombolysis. Multivariate logistic regression analysis indicated that age ≥80 years, MSP ≥140 mm Hg, NIHSS score, and fibrinogen concentration before thrombolysis were risk factors for HT after thrombolysis in patients with acute cerebral infarction. Age, MSP, NIHSS score, and fibrinogen concentration before thrombolysis are risk factors for HT after thrombolysis in acute cerebral infarction. These 4 factors should be carefully taken into account before thrombolysis.

Predicting Unsuccessful Electrical Cardioversion for Acute Atrial Fibrillation (from the AF-CVS Score)

Electrical cardioversion (ECV) is the standard treatment for acute atrial fibrillation (AF), but identification of patients with increased risk of ECV failure or early AF recurrence is of importance for rational clinical decision-making. The objective of this study was to derive and validate a clinical risk stratification tool for identifying patients at high risk for unsuccessful outcome after ECV for acute AF. Data on 2,868 patients undergoing 5,713 ECVs of acute AF in 3 Finnish hospitals from 2003 through 2010 (the FinCV study data) were included in the analysis. Patients from western (n= 3,716 cardioversions) and eastern (n= 1,997 cardioversions) hospital regions were used as derivation and validation datasets. The composite of cardioversion failure and recurrence of AF within 30days after ECV was recorded. A clinical scoring system was created using logistic regression analyses with a repeated-measures model in the derivation data set. A multivariate analysis for prediction of the composite end point resulted in identification of 5 clinical variables for increased risk: Age (odds ratio [OR] 1.31, confidence interval [CI] 1.13 to 1.52), not the First AF (OR 1.55, CI 1.19 to 2.02), Cardiac failure (OR 1.52, CI 1.08 to 2.13), Vascular disease (OR 1.38, CI 1.11 to 1.71), and Short interval from previous AF episode (within 1 month before ECV, OR 2.31, CI 1.83 to 2.91) [hence, the acronym, AF-CVS]. The c-index for the AF-CVS score was 0.67 (95% CI 0.65 to 0.69) with Hosmer-Lemeshow p value 0.84. With high (>5) scores (i.e., 12% to 16% of the patients), the rate of composite end point was ∼40% in both cohorts, and among low-risk patients (score <3), the composite end point rate was ∼10%. In conclusion, the risk of ECV failure and early recurrence of AF can be predicted with simple patient and disease characteristics.

High incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes among Polish children aged 10-12 and under 5 years of age: A multicenter study.

Despite its characteristic symptoms, type 1 diabetes (T1D) is still diagnosed late causing the development of diabetic ketoacidosis (DKA). The aim of this study was to estimate the incidence of DKA and factors associated with the development of acidosis at T1D recognition in Polish children aged 0-17. The study population consisted of 2100 children with newly diagnosed T1D in the years 2010-2014 in 7 hospitals in eastern and central Poland. The population living in these areas accounts for 35% of the Polish population. DKA was defined as a capillary pH < 7.3, blood glucose > 11 mmol/L. The analyzed data included age, sex, diabetes recognition, pH, glycated hemoglobin (HbA1c), fasting C-peptide, and body mass index standard deviation score (BMI-SDS). We observed DKA in 28.6% of children. There were 2 peaks in DKA occurrence: in children <5 years of age (33.9%) and aged 10-12 (34%). The highest incidence of DKA was noted in children aged 0-2 (48.4%). In the group with DKA, moderate and severe DKA occurred in 46.7% of children. Girls and children <2 years of age were more prone to severe DKA. The multiple logistic regression analysis showed the following factors associated with DKA: age (P = .002), fasting C-peptide (P = .0001), HbA1c (P = .0001), no family history of T1D (P = .0001), and BMI-SDS (P = .0001). The incidence of DKA is high and remained unchanged over the last 5 years. Increasing the awareness of symptoms of DKA is recommended among children <5 years of age (especially <2 years of age) and aged 10-12. Children <2 years of age and girls were at the highest risk of severe DKA.

The effect of an e-health web-based support programme on psychological outcomes and health related quality of life among Chinese patients with coronary heart disease: a parallel-group randomised controlled trial

BackgroundCoronary heart disease is the leading global cause of death, and e-health web-based programmes are effective to support patients. However, fewstudieshave reported psychological outcomes and health related quality of life (HRQoL) in Chinese populations. This study aimed to investigate the effect of an e-health web-based support programme for patients with coronary heart disease on anxiety, depression, and HRQoL across six months. MethodsThis parallel-group, randomised controlled trial was conducted in two specialist clinics in Hong Kong, China. Chinese patients with coronary heart disease, older than 18 years who were able to use computer were randomly assigned 1:1 to control or intervention groups using block randomisation. All patients received standard care, but the intervention group also received the e-health web-based support programme to promote physical activity and general health monitoring. Data was collected at baseline, 3 months, and 6 months. The outcomes were Hospital Anxiety and Depression scale (HAD) and HRQoL as measured by SF12. The data was analysed by Generalised Estimating Equations Model in SPSS (version 22.0). Ethical approval was obtained from the The Chinese University of Hong Kong and Tung Wah Eastern Hospital Ethics Committee. Signed written consent was obtained from participants. The study was registered at Clinicaltrials.gov, number NCT02350192. Findings441 eligible patients (mean age 51·34 years [SD 5·02]; 66% (291) men) with coronary artery disease were randomly assigned to either control (N=221) or intervention (N=220) groups. We found significant differences in anxiety between groups (p=0·004); anxiety was also lower over time in the intervention group (β=–0·428, p=0·03 at 3 months; β=–0·806, p<0·0001 at 6 months). We found no significant effect on depression. Regarding HRQoL, a significant difference between the control and intervention groups was seen over time (β=1·377, p=0·01 at 3 months; β=2·99, p<0·0001 at 6 months), but there was no difference between groups or interaction effect between physical and mental health components. InterpretationThe findings indicate a trend of positive psychological outcomes and HQoL in patients with coronary heart disease over 6 months, although the changes did not depend on the type of intervention given. In a future study, a booster dose or more intensive approaches to enhance the intervention effect could be recommended. FundingHealth and Medical Research Fund, Food and Health Bureau of Hong Kong

Epidemiological comparison of adult lumbar fractures between Eastern and Western China from 2010 to 2011

Objective To compare and analyze the epidemiological features of adult patients with lumbar fracture between Eastern and Western China from 2010 through 2011. Methods The data of adult patients with lumbar fracture treated from January 2010 to December 2011 in 63 hospitals in Eastern and Western China were collected through the PACS system and case reports checking system. The data of 35 hospitals in Eastern China were classified as group A while the data of 28 hospitals in Western China were classified as group B. The analytic items included gender, age, age distribution and type of AO classification. Results A total of 23,311 cases were collected. The total male/female ratio was 1.04∶1. The adult lumbar fractures predominated in an age range from 51 to 60 years (19.93%). There were 21,289 cases of type 53-A (91.33%), 1,435 ones of type 53-B (6.61%) and 587 ones of 53-C (2.52%). There were 5,984 (48.77%) males and 6,287 (51.23%) females in group A of 12,271 cases, and 5,912 (53.55%) males and 5,128 (46.45%) females in group B of 11,040 cases, showing a significant difference in gender constituent ratio (χ2=53.255, P 60 years old) were respectively 57.21% (7,020/12,271) and 42.79% (5,251/12,271) in group A, and 61.45% (6,784/11,040) and 38.55% (4,256/11,040) in group B, showing a signifi-cant difference (χ2=43.286, P<0.01). The most common segment was 53.01 in both groups, with a proportion of 55.25% (6,780/12,271) in group A and a proportion of 57.52% (6,350/11,040) in group B, showing a significant difference in the constituent ratio of high-risk fracture segment (χ2=49.840, P<0.01). In both groups, the high-risk type of lumbar fracture was type 53-A, with a proportion of 91.20% (11,191/12,271) in group A and a proportion of 91.47% (10,098/11,040) in group B, showing no sig-nificant difference in constituent ratio of fracture type between the 2 groups (χ2=2.833, P=0.243). Conclusions The proportion of male adult lumbar fractures was larger than that of female ones in Eastern China while there were more female ones in Western China. The peak age was from 51 to 60 years old in both Eastern and Western China. The high risk fracture type was type 53-A and the most common fracture segment was 53.01 in both Western and Eastern China too. Key words: Lumbar vertebrae; Fractures, bone; Epidemiology studies; Case-control studies

Survey of medical care resources of acute myocardial infarction in different regions and levels of hospitals in China

To investigate the medical care resources of acute myocardial infarction (AMI) in Chinese hospitals of different regions and levels. We selected 115 hospitals in China, including 61 northern hospitals, 54 southern hospitals, 52 eastern hospitals, 26 central hospitals, 37 western hospitals, 79 tertiary hospitals, 36 secondary hospitals, 34 pro vincial-level hospitals, 46 prefectural-level hospitals and 35 county hospitals. From November 2012 to August 2013, we sent questionnaire to the cardiologists in each hospital, to collect related information. (1) The number of AMI admitted each year of northern hospital was more than the number of southern hospital (220 (120, 400) cases vs. 220 (80, 350) cases, P=0.033), while number of coronary care unit (CCU), thrombolytic therapy, percutaneous coronary intervention (PCI), primary PCI and coronary artery bypass grafting (CABG) were similar (all P> 0.05). (2) The number of AMI admitted each year of eastern, central and western hospital was 295(150, 501) cases, 175(75, 300) cases and 170(50, 250) cases respectively(P=0.007), with no significant difference among them for setting CCU, carrying out thrombolytic therapy, PCI, primary PCI and CABG (all P>0.05). (3) The total number of the in-patient beds and AMI admitted each year of tertiary hospitals were significantly higher than that in the secondary hospitals(104(70, 152)vs. 47(30, 52), P<0.001) and (300(200, 460)cases vs.80(47, 135)cases, P<0.001) respectively. There was a significant difference between tertiary and secondary hospitals for the number of CCU (97.5% (77/79)and 75.0%(27/36)), PCI (98.7%(78/79)and 27.8%(10/36)), primary PCI (96.2%(76/79)and 22.2%(8/36)), CABG (81.0%(64/79)and 11.1%(4/36)), intra-aortic balloon pump (IABP) (91.1%(72/79) and 13.9%(5/36)) respectively (all P<0.001). (4) There were obvious differences among provincial-level, prefectural-level and country-level hospitals for the admitted AMI patient numbers annually which was 400(250, 600), 232(100, 380)and 80(50, 162)cases, CCU proportion which was 100 %(34/34), 95.7%(44/46) and 74.3%(26/35), thrombolytic therapy proportion which was 88.2%(30/34), 100%(46/46)and 91.4%(32/35), PCI proportion which was 100%(34/34), 89.1%(41/46)and 37.1%(13/35), primary PCI proportion which was 100%(34/34), 84.8%(39/46)and 31.4%(11/35), CABG proportion which was 97.1%(33/34), 67.4%(31/46) and 11.4%(4/35)respectively (P<0.01 or 0.05) . Different regional hospitals have no significant difference in number of CCU and reperfusion therapies, while there is a big difference on medical care resources of AMI between different-level hospitals, which may affect the diagnosis and treatment effect of patients with AMI. Clinical Trail Registry: National Institutes of Health, NCT01874691.

Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy.

The objective of this study was to develop a nomogram for refining prognostication for patients with nondisseminated nasopharyngeal cancer (NPC) staged with the proposed 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system. Consecutive patients who had been investigated with magnetic resonance imaging, staged with the proposed 8th edition of the AJCC/UICC staging system, and irradiated with intensity-modulated radiotherapy from June 2005 to December 2010 were analyzed. A cohort of 1197 patients treated at Fujian Provincial Cancer Hospital was used as the training set, and the results were validated with 412 patients from Pamela Youde Nethersole Eastern Hospital. Cox regression analyses were performed to identify significant prognostic factors for developing a nomogram to predict overall survival (OS). The discriminative ability was assessed with the concordance index (c-index). A recursive partitioning algorithm was applied to the survival scores of the combined set to categorize the patients into 3 risk groups. A multivariate analysis showed that age, gross primary tumor volume, and lactate dehydrogenase were independent prognostic factors for OS in addition to the stage group. The OS nomogram based on all these factors had a statistically higher bias-corrected c-index than prognostication based on the stage group alone (0.712 vs 0.622, P <.01). These results were consistent for both the training cohort and the validation cohort. Patients with <135 points were categorized as low-risk, patients with 135 to <160 points were categorized as intermediate-risk, and patients with ≥160 points were categorized as high-risk. Their 5-year OS rates were 92%, 84%, and 58%, respectively. The proposed nomogram could improve prognostication in comparison with the TNM stage group. This could aid in risk stratification for individual NPC patients. Cancer 2016;122:3307-3315. © 2016 American Cancer Society.

Epidemiological comparison of adult clavicle fractures from 2010 to 2011 between Eastern and Western areas in China

Objective To compare the epidemiological features of adult patients with clavicle fracture from 2010 through 2011 between the Eastern and Western areas in China. Methods The data of adult patients with clavicle fracture who had been treated from January 2010 through December 2011 at 63 hospitals in the Eastern and Western areas in China were collected through the PACS system and case reports checking system. The data from the 35 Eastern hospitals were classified as group A, and those from the 28 Western hospitals as group B. The analytic items included gender, age and Allman classification. Results A total of 10, 337 cases were collected. The mean age of the 7, 110 cases in Group A was 43. 82 ± 16. 14 years. Their peak age of fracture was from 41 to 50 years old. The male to female ratio in group A was 2. 37: 1. The mean age of the 3, 227 cases in Group B was 41. 14±15. 65 years. Their peak age of fracture was from 31 to 40 years old. The male to female ratio in group B was 2. 56: 1. There was no significant difference in male to female ratio between the 2 groups(P> 0. 05). The proportion of patients from 16 to 40 years old in group B was significantly higher than in group A; the proportion of patients from 50 to 70 was in group B was significantly lower than in group A(P< 0. 05). Of all the fractures, Allman type I accounted for 71. 95%, Allman type II for 24. 74%, and Allman type Ⅲ for 3. 32%. The proportions of Allman types I and Ⅲ in group A were significantly higher than in group B while the proportion of Allman type II in group A was significantly lower than in group B(P< 0. 05). Conclusions Most clavicle fractures occurred in male patients under 60 years old. Displaced or comminuted fractures of the mid clavicle were the most common. There were fewer young and middle-aged patients in the Eastern area than in the Western area but there were more elderly patients in Eastern area than in the Western area. Key words: Clavicle; Fractures, bone; Epidemiologic studies; Eastern area; Western area

Epidemiologic characteristics of 10 years hospitalized patients with glaucoma at shanghai eye and ear, nose, and throat hospital.

To analyze the epidemiologic characteristics of hospitalized patients with glaucoma at Shanghai Eye and Ear, Nose, and Throat Hospital in the relative well economic condition area Eastern China.Researchers reviewed the 10 years charts of patients with a discharge diagnosis of glaucoma at this hospital from January 2004 to December 2013. With the criteria used for diagnoses of different types of glaucoma, the constitution of this disease between the first and last 5 years was compared and analyzed.A total of 11,864 cases were enrolled according to the criteria of diagnoses for 10 years. Primary angle-closure glaucoma (PACG) was the main type (51.69%) followed by secondary glaucoma (SG, 28.14%), primary open-angle glaucoma (POAG) (10.41%), and congenital glaucoma (7.16%). Other glaucoma types were less prevalent (2.61%). PACG has seen a declining trend (from 57.75% to 48.41%), while the proportion of SG has increased (from 23.68% to 34.21%). For the POAG group, there is no increasing trend and the same is true of CG. The mean age of PACG patients was 62.28 year-old, while it was 46 year-old for the POAG and SG groups. The patients of PACG had more women than men (M/F ratio: 1:1.92). The reverse was the case with regard to POAG (M/F ratio: 1.97:1).In Eastern China, although PACG has some decreased, but still is the most commonly encountered type of glaucoma, while SG has significantly increased, and POAG has slightly decreased in hospitalized patients during recent 10 years.

Epidemiological survey of adult proximal ulnoradial fractures in eastern coast and western inland areas in China from 2010 through 2011

Objective To investigate the epidemiological characteristics of proximal ulnoradial fractures in the eastern coast and western inland areas in China from 2010 through 2011. Methods The data of all the inpatients and outpatients with proximal ulnoradial fracture were collected who had been treated in 16 hospital in 6 provinces in the eastern coast area and in 15 hospitals in 6 provinces in the western inland area from January 2010 through December 2011. The patients from the eastern coast hospitals were assigned into group A and those from the western inland hospitals into group B. The epidemiological characteristics concerning gender, age and injury AO type were compared between the 2 groups. Results From 2010through 2011, a total of 1, 889 patients with proximal ulnoradial fracture were treated in the 31 hospitals, accounting for 9. 97%(1, 889/18, 949)of the ulnoradial fractures and 1. 33%(1, 889/141,474)of all the fractures at the same hospitals during the same period. The proximal ulnoradial fractures occurred more in males(62. 41%)than in females(37. 59%), with a male to female ratio of 1. 66: 1. In males, the highest percentage was in the age range from 21 to 30 years(29. 09%). In females, the highest percentage was in the age range from 41 to 50 years(22. 25%). The most frequent adult proximal ulnoradial fractures were of AO type 21-B(75. 54%), with 1, 024 cases in groups A and 865 ones in group B. The average age in group A(42. 8 years)was significantly older than in group B(37. 6 years)(Z= -7. 005, P< 0. 001). The injury peaked in the age range from 41 to 50 years(21. 39%)in group A, and in the age range from 21 to 30 years(29. 98%)in group B. The high-risk AO type was 21-B in both groups, accounting for 76. 95% in group A and 73. 87% in groups B, showing a significant group difference(P< 0. 05). Conclusions The peak age of adult proximal ulnoradial fractures was from 21 to 30 years in man, and from 41 to 50 years in women. The high-risk AO type was 21-B. There were more male patients than female ones. The proportion of female patients, average age and proportion of type 21-B in the eastern area were higher than those in the western area. Key words: Ulnar fractures; Radial fractures; Epidemiology studies; Small-area analysis

Better Beginnings: At Risk Moms; What Are We Missing?

Abstract BACKGROUND: Since 2005, the number of infants born to mothers using substances has increased 4-fold in an eastern Canadian province. These babies may be at risk of medical problems including a withdrawal syndrome called “neonatal abstinence syndrome”. Previous research has shown that mothers using substances may experience increased rates of domestic violence, mental illness and housing and food insecurity. Currently, these determinants of health are not routinely recorded on medical charts of pregnant women who are patients at the province’s largest maternity facility. OBJECTIVES: The primary goal of this study is to determine the prevalence of smoking, alcohol use, substance use, domestic violence and food/ housing insecurity in mothers delivering in an eastern Canadian province maternity hospital. DESIGN/METHODS: This is a quantitative study involving all postpar-tum women delivering at the major delivery facility in province over a two month period (N=150). Participants were asked to complete an online, anonymous survey about their food/housing situation, domestic violence and substance use before and during pregnancy, as well as sociodemo-graphic questions. RESULTS: Food and Housing Insecurity: The results of the study showed increased healthy eating behaviours during pregnancy; however the number of participants reliant on food banks remained at 4%. Our study found that while the majority of participants lived in a permanent residence, 2% of mothers used shelters or lived in a non-permanent residence. Mental health and Domestic Violence: While the majority of mother felt respected by their partner, family and friends, a significant amount reported feelings of isolation during pregnancy (12%). Women experiencing domestic violence stayed consistent before and during pregnancy at 2%. Smoking: Cigarette use in this population was slightly decreased from previous reports by the provincial perinatal program (12% vs. 14.9% reported) with rates of exposure to cigarette smoke much higher (24.7% vs. 6.4% reported). Alcohol use: Maternal reporting alcohol use during pregnancy was substantially increased from previous reports (13.3% vs. 0.9% reported). Those who reported consuming alcohol most frequently reported 1-2 drinks about 1-3 times per month. Substance Use: Currently, no reports within the province have captured the number of mothers using substances. This study shows approximately 5% of mothers using either marijuana, street/illicit drugs or methadone. Limitations: Mothers who did not speak English were excluded from the study. CONCLUSION: The findings of this research indicate that important determinants of health are not being adequately recorded in Provincial databases thus programs are lacking.

Evaluation of treatment outcomes in pelvic floor muscle training with biofeedback versus intra-vaginal electrical stimulation in women with urinary incontinence in Hong Kong Pamela Youde Nethersole Eastern Hospital

Evaluation of treatment outcomes in pelvic floor muscle training with biofeedback versus intra-vaginal electrical stimulation in women with urinary incontinence in Hong Kong Pamela Youde Nethersole Eastern Hospital