A restrictive use of episiotomy was recommended by the obstetric society in China, but limited information on the epidemiology and the effects of restrictive use of episiotomy on maternal and fetal ...outcomes have been published.
The China Labor and Delivery Survey is a cross-sectional investigation with a cluster random sampling scheme in 2015-2016 with the aim to describe detailed epidemiology of labor and delivery in China. We calculated the episiotomy rate by parity using the survey data. Associated factors of episiotomy were selected using mixed models with a random effect for the hospital-level clustering. Logistic regression models were fitted to examine the effects of mediolateral episiotomy on maternal and neonatal outcomes among the propensity score-matched women.
The episiotomy rate among vaginal births was 41·7% 95% confidence interval (CI): 40·1% - 43·2% in nulliparae and 21·5% (95% CI: 19·4% - 23·5%) in multiparae in China. Associated factors of episiotomy included prepregnancy BMI, maternal diseases, and obstetric factors. More than half of episiotomies in nulliparae and one-fourth in multiparae had no indications. Mediolateral episiotomy without indicators increased the risk of 3rd or 4th degree perineal laceration odds ratio (OR) =2·64, 95% CI: 1·08-6·48) in nulliparae without neonatal benefits.
Episiotomy was performed more than medically necessary in China. Mediolateral episiotomy without indications more than doubled the risk of 3rd and 4th degree perineal laceration in nulliparae without neonatal benefits.
National Natural Science Foundation of China and Shanghai Health Commission Programme.
Summary To analyze the differentiation characteristics of extranodal natural killer/T-cell lymphoma, nasal type, one nude mouse model, cell lines SNK6 and SNT8, and 16 fresh human samples were ...analyzed by flow cytometry immunophenotyping and immunohistochemistry staining; and 115 archived cases were used for phenotypic detection and prognostic analysis. We found that CD25 was expressed by most tumor cells in all samples, and CD56+ CD25+ cells were the predominant population in the mouse model, the 2 cell lines, and 10 of the 16 fresh tumor samples; in the other 6 fresh tumor samples, the predominant cell population was of the CD16+ CD25+ phenotype, and only a minor population showed the CD56+ CD25+ phenotype. The phenotype detected by immunohistochemistry staining generally was consistent with the phenotype found by flow cytometry immunophenotyping. According to the expression of CD56 and CD16, 115 cases could be classified into 3 phenotypic subtypes: CD56− CD16− , CD56+ CD16− , and CD56dim/− CD16+ . Patients with tumors of the CD56dim/− CD16+ phenotype had a poorer prognosis than patients with tumors of the other phenotypes. Differentiation of extranodal natural killer/T-cell lymphoma, nasal type apparently resembles the normal natural killer cell developmental pattern, and these tumors can be classified into 3 phenotypic subtypes of different aggressiveness. Expression of CD56dim/− CD16+ implies a poorer prognosis.
The aim of the present review was to investigate the association between the use of oral β-blockers and prognosis in patients with acute myocardial infarction (AMI) who underwent percutaneous ...coronary intervention (PCI) treatment. A systematic literature search was conducted in Pubmed (from inception to September 27, 2014) and Embase (Ovid SP, from 1974 to September 29, 2014) to identify studies that compared the outcome of patients with AMI taking oral β-blockers with that of patients not taking after PCI. Systematic review and meta-analysis were performed with random-effects model or fixed-effects model. Ten observational studies with a total of 40,873 patients were included. Use of β-blockers was associated with a reduced risk of all-cause death (unadjusted relative risk 0.58, 95% confidential interval 0.48 to 0.71; adjusted hazard ratio 0.76, 95% confidential interval 0.62 to 0.94). The potential benefit of β-blockers in preventing all-cause death was not similar in all population but was restricted to those with reduced ejection fraction, with low use proportion of other secondary prevention drugs or with non–ST-segment elevation myocardial infarction. The association between the use of β-blockers and improved survival rate was significant in ≤1-year follow-up duration. Rates of cardiac death, myocardial infarction, and heart failure readmission in patients using β-blockers were not significantly different from those in patients without β-blocker therapy. In conclusion, there is lack of evidence to support routine use of β-blockers in all patients with AMI who underwent PCI. Further trials are urgently needed to address the issue.
Background:
More than 30% of estrogen receptor-positive breast cancers are resistant to primary hormone therapy, and about 40% that initially respond to hormone therapy eventually acquire resistance. ...Although the mechanisms of hormone therapy resistance remain unclear, aberrant DNA methylation has been implicated in oncogenesis and drug resistance.
Purpose:
We investigated the relationship between methylome variations in circulating tumor DNA and exemestane resistance, to track hormone therapy efficacy.
Methods:
We prospectively recruited 16 patients who were receiving first-line therapy in our center. All patients received exemestane-based hormone therapy after enrollment. We collected blood samples at baseline, first follow-up (after 2 therapeutic cycles) and at detection of disease progression. Disease that progressed within 6 months under exemestane treatment was considered exemestane resistance but was considered relatively exemestane-sensitive otherwise. We obtained circulating tumor DNA-derived methylomes using the whole-genome bisulfide sequencing method. Methylation calling was done by BISMARK software; differentially methylated regions for exemestane resistance were calculated afterward.
Results:
Median follow-up for the 16 patients was 19.0 months. We found 7 exemestane resistance-related differentially methylated regions, located in different chromosomes, with both significantly different methylation density and methylation ratio. Baseline methylation density and methylation ratio of chromosome 6 32400000-32599999 were both high in exemestane resistance. High baseline methylation ratios of chromosome 3 67800000-67999999 (P = .013), chromosome 3 140200000-140399999 (P = .037), and chromosome 12 101200000-101399999 (P = .026) could also predict exemestane resistance. During exemestane treatment, synchronized changes in methylation density and methylation ratio in chromosome 6 32400000-32599999 could accurately stratify patients in terms of progression-free survival (P = .000033). Cutoff values of methylation density and methylation ratio for chromosome 6 149600000-149799999 were 0.066 and 0.076, respectively.
Conclusion:
Methylation change in chromosome 6 149600000-149799999 is an ideal predictor of exemestane resistance with great clinical potential.
Background:
Traditional Chinese medicine (TCM) is widely integrated into cancer care in China. An overview in 2011 identified 2384 randomized and non-randomized controlled trials (RCTs, non-RCTs) on ...TCM for cancer published in the Chinese literature. This article summarizes updated evidence of RCTs on TCM for cancer care.
Methods:
We searched 4 main Chinese databases: China National Knowledge Infrastructure, Chinese Scientific Journal Database, SinoMed, and Wanfang. RCTs on TCM used in cancer care were analyzed in this bibliometric study.
Results:
Of 5834 RCTs (477 157 cancer patients), only 62 RCTs were indexed in MEDLINE. The top 3 cancers treated were lung, stomach, and breast cancer. About 4752 RCTs (81.45%) tested TCM combined with conventional treatment, and 1082 RCTs (18.55%) used TCM alone for treating symptoms and side-effects. Herbal medicine was the most frequently used TCM modality (5087 RCTs; 87.20%). The most frequently reported outcome was symptom improvement (3712 RCTs; 63.63%) followed by quality of life (2725 RCTs; 46.71%), and biomarkers (2384 RCTs; 40.86%). The majority of RCTs (4051; 69.44%) concluded there were beneficial effects using either TCM alone or TCM plus conventional treatment compared with conventional treatment.
Conclusion:
Substantial randomized trials demonstrated different types/stages of cancer were treated by various TCM modalities, alone or in combination with conventional medicine. Further evaluation on the effects and safety of TCM modalities focusing on outcomes such as quality of life is required.
Background Degradable collagen-chitosan composite materials have been used to fabricate tissue engineered heart valves. The aims of this study were to demonstrate that the collagen-chitosan composite ...scaffolds are cytocompatible, and endothelial cells can be differentiated from bone marrow mesenchymal stem cells (BMSCs) when seeded onto the scaffolds. The adhesion and biological activities of the seeded cells were also investigated. Methods Collagen-chitosan composite material was used as the cell matrix, and smooth muscle cells, fibroblasts and BMSCs were used as seed cells. After four weeks of in vitro culture, the smooth muscle cells, fibroblasts, and BMSCs were sequentially seeded into the collagen-chitosan composite material. After four weeks in culture, the cellular density and activity were assessed on segments of the tissue engineered heart valve scaffolds to determine the cell viability and proliferation in the collagen-chitosan composite material. Results The tissue engineered heart valves stained positively for both smooth muscle actin and endothelial cell factor VIII, suggesting that the seeded cells were in fact smooth muscle cells, fibroblasts, and endothelial cells. The 6-ketone prostaglandin content, as measured by radioimmunoassay, of the collagen-chitosan cell culture fluid was higher than that of the serum-free medium ( P <0.01). Light and electron microscopy showed that the seeded cells had shapes similar to the morphology of smooth muscle cells, fibroblasts, and endothelial cells. Conclusions Endothelial cells can be differentiated from BMSCs when seeded onto the collagen-chitosan composite scaffolds. The seeded cells retained their biological activity after being cultured in vitro and seeded into the collagen-chitosan composite material.
Purpose To explore long-term recovery of elbow flexion and extension after transferring the phrenic nerve and intercostal nerves, respectively, in adults with global brachial plexus avulsion ...injuries. Methods Seven adults with global brachial plexus avulsion injuries had the phrenic nerve transferred to the musculocutaneous nerve (or to the anterior division of upper trunk) and intercostal nerves transferred to the triceps branch of the radial nerve at our hospital 7 to 12 years ago. The results of elbow motor strength testing using the Medical Research Council grading scale, and electrodiagnostic findings using electromyogram examinations, were studied retrospectively. Pulmonary function tests were also performed at final visits. Results Functional elbow flexion was obtained in most of the 7 cases (M2, 1; M3, 3; M4, 2; and M5, 1) but elbow extension was absent or insufficient in all subjects (M0, 1; M1, 3; and M2, 3). Electrical results showed successful biceps reinnervation in 6 patients and successful triceps reinnervation in 5. No patient experienced breathing problems, and pulmonary function results were within normal range. Conclusions In the long term, after brachial plexus avulsion injury in most patients who underwent both phrenic nerve and intercostal nerve transfer to achieve elbow flexion and extension eventually obtained satisfactory elbow flexion but poor elbow extension. We recommend against transferring the intercostal nerves to the triceps branch of radial nerve in conjunction with primary phrenic to musculocutaneous nerve transfer. Type of study/level of evidence Therapeutic IV.
Abstract Low-density lipoprotein cholesterol (LDL-C) has been demonstrated as an independent risk factor of ischemic stroke, but the association of LDL-C with ischemic stroke in patients with ...nonvalvular atrial fibrillation (AF) remains uncertain. Our objective was to explore whether LDL-C could refine stroke stratification in AF patients. A total of 424 nonvalvular AF patients with ischemic stroke and 391 ones without ischemic stroke were enrolled. No patient had received antithrombotic therapy. Multivariate logistic regression analysis showed that LDL-C was an independent predictor of ischemic stroke in AF patients, with the adjusted odds ratio (OR) of 2.004 (95% confidence interval, 1.624-2.473; p < 0.001). The receiver operating characteristic analysis revealed that the best cut-off value of LDL-C to predict ischemic stroke in AF patients was 2.48 mmol/l with 56.3% sensitivity and 66.3% specificity (area under the curve: 0.651, p < 0.001). In the subgroup analysis based on different CHA2 DS2 -VASc scores, the predictive value of LDL-C remained significant in patients with a CHA2 DS2 -VASc score of ≤ 5. In conclusion, LDL-C was an independent predictor of ischemic stroke, which could potentially refine stroke stratification in AF patients. A prospective study with a large number of patients is required to validate the current findings.
Summary Hepatosplenic T-cell lymphoma is a highly aggressive tumor with a poor outcome. About 210 cases were identified through PubMed, of which fewer than 20 originated in Asia. We reviewed 17 ...Chinese cases of hepatosplenic T-cell lymphoma, including an unusual one with cutaneous pink papules, for clinicopathologic, immunophenotypic, and genotypic features; Epstein-Barr virus status; treatment; and outcome. The median age of the patients was 23 years. All patients had splenomegaly, and 88.2% of them had hepatomegaly as well. Bone marrow involvement was present in 53.3%. Eleven patients underwent splenectomy for diagnosis and treatment. Twelve specimens were collected by image-guided liver core biopsy or wedge resection. Histologically, the homogeneous small- to medium-size neoplastic lymphoid cells infiltrated the sinuses or sinusoids of the spleen, bone marrow, and liver. Diagnosis was based on image-guided core-needle biopsy of the liver alone in 41.2% of the cases. Immunohistochemically, 15 of the lesions were hepatosplenic γδ T-cell lymphoma, and the remaining 2 were hepatosplenic αβ T-cell lymphoma. Epstein-Barr virus was detected in both cases of hepatosplenic αβ T-cell lymphoma and one case of hepatosplenic γδ T-cell lymphoma. Most of the patients received cyclophosphamide, doxorubicin, vincristine, and prednisone therapy or regimens similar to it. Follow-up data were available in 70.6% of the patients; half of them died of the tumor, and the median survival time was 6 months. The frequency of bone marrow involvement was lower than that reported in the literature. Image-guided core-needle biopsy of the liver is recommended for diagnosis.
Abstract Background The measurement of quality-adjusted life-years (QALYs) forms a key component of cost–utility evaluation in cancer intervention; however, detailed data for utility weights by ...cancer type and health status are still scarce both in China and other regions. The aim of this study was to systematically evaluate utility scores in relation to the most common six cancers in China in 2012 (lung, breast, colorectal, oesophageal, liver, and stomach cancer). Methods As a part of a Screening Program in Urban China (CanSPUC) supported by the central government of China, we undertook a cross-sectional survey in 13 provinces across China from 2013 to 2014. Two generic instruments, EQ-5D (EuroQol 5-dimensions) and SF-12 (12-item Short Form Health Survey), and a cancer-specific instrument, FACTs (Function Assessment of Cancer Therapy) were applied. 46 394 participants were interviewed in five groups: general population (n=11 699, group A), individuals who had attended single cancer screening (n=11 805, group B), individuals who had attended multiple screenings (n=6838, group C), patients with precancerous lesions (n=1942, group D), and patients with cancer (n=14 110, group E). All participants had no psychosis and provided written consent to participate in the study. The survey was approved by the Institutional Review Board of the Cancer Hospital of Chinese Academy of Medical Sciences. Findings The EQ-5D utility scores were 0·96 (95% CI 0·96–0·96) for group A, 0·94 (0·94–0·94) for group B, 0·94 (0·94–0·94) for group C, 0·85 (0·84–0·86) for group D, and 0·77 (0·77–0·77) for group E. Cancer-specific analysis showed that EQ-5D utility scores were 0·77 (0·76–0·78) for lung cancer, 0·78 (0·77–0·79) for breast cancer, 0·75 (0·74–0·76) for colorectal cancer, 0·75 (0·74–0·76) for oesophageal cancer, 0·80 (0·79–0·81) for liver cancer, and 0·76 (0·75–0·77) for stomach cancer. The utility scores for cancer at different clinical stages also differed; for example, the scores for patients with breast cancer were estimated as 0·79 (0·77–0·80) at stage I, 0·79 (0·78–0·80) at stage II, 0·77 (0·76–0·79) at stage III, and 0·69 (0·65–0·72) at stage IV. Compared with data from EQ-5D, results from SF-12 on differences among subgroups seemed narrower; for example, the utility score among the six cancers ranged from 0·60 to 0·62. Interpretation These data will be applied to future cost–utility evaluation on various cancer screening strategies in China, and could contribute more precise evaluation of burden of disease related to disability-adjusted life-years globally. Funding The National Health and Family Plan Committee of China.
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