Objective To investigate the relationship between age-adjusted Charlson comorbidity index (aCCI) and ischemic stroke in patients with ophthalmic artery occlusion (OAO) or retinal artery occlusion (RAO). MethodsA single center retrospective cohort study. Seventy-four patients with OAO or RAO diagnosed by ophthalmology examination in Shenzhen Second People's Hospital from June 2004 to December 2020 were included in the study. The baseline information of patients were collected and aCCI was used to score the patients’ comorbidity. The outcome was ischemic stroke. The median duration of follow-up was 1 796.5 days. According to the maximum likelihood ratio of the two-piecewise COX regression model and the recursive algorithm, the aCCI inflection point value was determined to be 6, and the patients were divided into low aCCI group (＜6 points) and high aCCI group (≥6 points). A Cox regression model was used to quantify the association between baseline aCCI and ischemic stroke. ResultsAmong the 74 patients, 53 were males and 21 were females, with the mean age of (55.22±14.18) (19-84) years. There were 9 patients of OAO and 65 patients of RAO. The aCCI value ranges from 1 to 10 points, with a median of 3 points. There were 63 patients (85.14%, 63/74) in the low aCCI group and 11 patients (14.86%, 11/74) in the high aCCI group. Since 2 patients could not determine the time from baseline to the occurrence of outcome events, 72 patients were included for Cox regression analysis. The results showed that 16 patients (22.22%, 16/72) had ischemic stroke in the future. The baseline aCCI in the low aCCI group was significantly associated with ischemic stroke [hazard ratio (HR)=1.76, 95% confidence interval (CI) 1.21-2.56, P=0.003], and for every 1 point increase in baseline aCCI, the risk of future ischemic stroke increased by 76% on average. The baseline aCCI in the high aCCI group had no significant correlation with the ischemic stroke (HR=0.66, 95%CI 0.33-1.33, P=0.247). ConclusionsaCCI score is an important prognostic information for patients with OAO or RAO. A higher baseline aCCI score predicts a higher risk of ischemic stroke, and the association has a saturation effect.
Objective To verifying the characteristics of optical coherence tomography(OCT) in exudative age-related macular degeneration (AMD). Methods The patients being investigated in this series included 16 cases (19 eyes) of exudative age-related macular degeneration diagnosed by FFA and OCT examinations, among them 4 cases (6 eyes) were examined with ICGA. The color photographs of ocular fundi, FFA, ICGA and OCT were investigated by contrasting each other. Results As compared with the FFA and ICGA examinations, the characteristic findings found in OCT in patients with exudative AMD in this series were as the following:①serous detachment of neurosensory epithelium in 11 eyes,②retinal hemorrhage in 2 eyes,③serous detachment of retinal pigment epithelium in 5 eyes,④hemorrhagic detachment of retinal pigment epithelium in 10 eyes,⑤disciform scar in 4 eyes,⑥fibrovascular pigment epithelial detachment and occult CNV in 12 eyes. Conclusion OCT can supply a comprehensive survey of exudative AMD, in making the diagnosis as an important complementary examination of FFA and ICGA. (Chin J Ocul Fundus Dis,2000,16:220-223)
Objective To explore the accuracy and practicability of bone age assessment for the diagnosis of idiopathic precocious puberty (IPP). Methods According to the “Gold Standard”, we selected 55 girls with IPP for the study group, and 83 normal girls for the control group. We retrospectively analyzed the first left hand-wrist radiographs at the first visit. Bone ages were assessed by using a single-blind method according to the RUS (Radius Ulna and Short bones), carpale and 20 bones method (TW2). Each had 5 decision thresholds (gt;97th percentile, gt;90th percentile, gt;75th percentile, gt;50th percentile and ≤50th percentile). The diagnostic values from RUS, carpale and 20 bones methods assessing bone age were analyzed to identify the best decision threshold. Results ① Both sensitivity and specificity of the four decision thresholds were relatively higher, including gt;90th percentile of RUS (sensitivity 0.836, specificity 0.916), gt;90th percentile of carpale (sensitivity 0.746, specificity 0.916), gt;90th and gt;75th percentile of 20 bone (sensitivity 0.746, specificity 0.964 and sensitivity 0.982, specificity 0.783, respectively). ② Area under receiver operator characteristic curve (AUR): AUR of RUS 0.939 ± 0.019 (95%CI 0.902 to 0.977), AUR of carpale 0.899 ± 0.028 (95%CI 0.845 to 0.954), AUR of 20 bone 0.958 ± 0.014 (95%CI 0.930 to 0.986). No significant difference was found (F=2.03, P=0.13). ③ Agreement assessment within-observer reliability was 89.28%, and between-observer reliability was 80.3% (Kappa 0.68, u=6.87, P＜0.01). Conclusions RUS and 20 bones methods have high accuracy for the diagnosis of idiopathic precocious puberty. Considering sensitivity and specificity, we think that ＞90th percentile of RUS is the best decision threshold.
ObjectivesTo investigate the level of ankle-brachial index (ABI) of health examination population in Chongqing municipality and analyze the risk factors related to the level of ABI, so as to provide basis for effective evaluation of atherosclerotic lesions and their severity, as well as early detection, intervention and treatment of clinical cardiovascular diseases. MethodsA total of 22 886 subjects aged from 20 to 85 undergoing health examination in the medical examination center of First Affiliated Hospital of Chongqing Medical University in Chongqing municipality from January to December in 2016 were retrospectively analyzed. ABI and related physiological and biochemical data were collected. The relationship between ABI and age was analyzed using stepwise logistic regression model combined with restricted cubic splines. ResultsThe detection rate of abnormal ABI was 3.31% in 22 886 subjects undergoing health examination with 2.90% in males and 3.92% in females. The subjects aged below 40 presented the highest detection rate of abnormal ABI (6.17%) with 4.72% in males and 8.66% in females. The subjects were divided into two groups, one with ABI≤0.9 and one with ABI>0.9; the differences in age and levels of body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) between the two groups were statistically significant (allP<0.05). Multivariate stepwise logistic regression combined with restricted cubic splines showed that age, gender and BMI were presented as independent factors affecting ABI, among which the age below 40 (OR=2.885, 95%CI (2.445, 3.404),P<0.0001) was the main risk factor. A curve relating age to probability of abnormal ABI was produced after correcting for the influences of sex and BMI, stratified by gender and BMI into different subgroups, showing a U-shaped curve of decreasing initially and then increasing between the probability of abnormal ABI and age. ConclusionsThe detection rate of abnormal ABI based on individuals undergoing health examination in Chongqing municipality was 3.31%. A U-shaped curve of downward trend followed by an upward one was shown between probability of abnormal ABI and age after correcting for the influences of gender and BMI. The clinical significance of ABI≤0.9 for youth population (20 to 40 years old) without cardiovascular risk factors requires further exploration.
ObjectivesTo analyze the trend of incidence and mortality of bladder cancer from 1990 to 2017 and the effects of age, time period and birth cohort on bladder cancer incidence and mortality.MethodsData on age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) of bladder cancer from 1990 to 2017 were extracted from the Global Burden of Disease 2017 (GBD 2017) database. Joinpoint regression model was used to analyze the average annual percentage change of ASIR and ASDR of bladder cancer. The age-period-cohort model was established to analyze the age, period and birth cohort effects on ASIR and ASDR of bladder cancer.ResultsFrom 1990 to 2017, both ASIR and ASDR of bladder cancer decreased slightly. ASIR decreased from 6.42 per 100 000 in 1990 to 6.04 per 100 000 in 2017, with an average annual percentage change of −0.9% (−1.0% to −0.8%), and ASDR decreased from 3.15 per 100 000 in 1990 to 2017 2.57/100 000, with an average annual percentage change of −0.4% (−0.4% to −0.3%). The age-period-cohort model results showed that as age increased, the risk of bladder cancer incidence and mortality increased; as the birth cohort progressed, the risk of bladder cancer morbidity and mortality decreased. The time period had little effect on the incidence and mortality of bladder cancer.ConclusionsThe incidence and mortality of bladder cancer are declining globally. On the other hand, the increase of the aging global population could reverse the incidence and mortality trend, active measures should be taken to address the adverse effects of aging.
Objective To analyze the epidemic trend of prostate cancer in China from 1992 to 2021, and predict its epidemic trends from 2022 to 2032. Methods Based on the data of Chinese population and prostate cancer incidence and mortality from Global Burden of Disease Database, the Joinpoint log-linear model was used to analyze the trends of prostate cancer incidence and mortality, use the age-period-cohort model to analyze the effects of age, period and cohort on changes in incidence and mortality, and the gray prediction model was used to predict the trends of prostate cancer. Results From 1992 to 2021, the incidence and mortality of prostate cancer in China showed an upward trend, with AAPC of 5.652% (P<0.001) and 3.466% (P<0.001), and the AAPC of age-standardized incidence decreased to 1.990% (P<0.001), the age-standardized mortality showed a downward trend and was not statistically significant. The results of the age-period-cohort model showed that the net drift values of prostate cancer incidence and mortality were 3.03% and −1.06%, respectively, and the risk of incidence and mortality gradually increased with age and period. The results of the grey prediction model showed that the incidence and mortality of prostate cancer showed an upward trend from 2022 to 2032, and the incidence trend was more obvious. Conclusion The incidence and mortality of prostate cancer in China showed an increasing trend, with a heavy disease burden and severe forms of prevention and control, so it is necessary to do a good job in monitoring the incidence and mortality of prostate cancer, and strengthen the efficient screening, early diagnosis and treatment of prostate cancer.
ObjectiveTo compare the short-term effectiveness of medial unicompartmental knee arthroplasty (UKA) between patients younger or older than 60 years of age, and to investigate the impact of age on the effectiveness. Methods The clinical data of 182 patients (182 knees) who underwent medial UKA between July 2016 and June 2018 were retrospectively analyzed, of which 72 patients were less than 60 years old (group A) and 110 patients were more than 60 years old (group B). There was a significant difference in age between groups (t=−20.198, P<0.001). No significant difference was found in gender, body mass index, surgical sides, Kellgren-Lawrence grading, disease duration, and preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between groups (P>0.05). The postoperative hospital stay and complications were recorded, and the WOMAC score, satisfaction score, and prosthesis revision were compared between groups. Results The length of postoperative hospital stay was (4.50±1.09) days in group A, and (4.46±1.29) days in group B, with no significant difference between groups (t=0.198, P=0.844). All incisions healed by first intention. The incidences of early postoperative complications in groups A and B were 5.6% and 3.6%, respectively, and the difference was not significant (χ2=0.061, P=0.804). All patients were followed up. The follow-up time were 28-50 months (mean, 36 months) in group A and 28-50 months (mean, 35 months) in group B. At last follow-up, the WOMAC scores of both groups significantly improved when compared with those before operation (P<0.05), and there was no significant difference between groups (P>0.05) in the difference before and after operation. The satisfaction scores were 6.6±1.7 in group A and 6.9±1.6 in group B, with no significant difference between groups (t=−1.326, P=0.186). There was no revision surgery in both groups during follow-up period. ConclusionAge has no significant effect on the prognosis of medial UKA, and patients younger than 60 years of age can also obtain good short-term effectiveness.
Objective To determine whether the basal characteristics and survival of young patients undergoing surgical resection of nonsmall cell lung cancer (NSCLC) differ from those of elderly patients. And, we would discuss the special perioperative management in elderly patients with NSCLC. Methods 178 NSCLC patients who underwent surgery in our hospital between Jan. to Dec. in 2002 were divided into two groups according to age. Young group comprised 89 patients aged 50 years or younger and elderly group comprised 89 patients aged 70 years or older. The patients’ clinical data, operative style,postoperative complications and survival results were reviewed and analysed. Results The proportion of the elderly group squamous cell carcinoma patients was higher than that of the younger group （χ2=9.281,P=0.000.）,but there was no significant difference between the gender, smoking, histology, TNM stage, type of resection, post operation chemotherapy or radiotherapy（χ2≤5.569，Pgt;0.05）. The incidence of the preoperative cardiovascular disease, chronic bronchitis in the elderly group patients were higher than those of younger group（χ2=14.053，P=0.000;χ2=13.044，P=0.000）.The incidence of postoperative complications was significantly higher in elderly group than those of younger group（χ2=12842，P=0.000）. The 1, 3 and 5year survival rates were 71.43％，33.53％ and 27.83％ in elderly group, and 77.78％，46.67％ and 44.07％ in young group, respectively. However, the 1, 3 and 5year survival rates for patients in two groups showed no difference between two groups（Pgt;0.05）. Conclusion The elderly patients have higher operative risk than that of young patients. We should pay more attention to the perioperative management of elderly patients. The elderly patients could get acceptable long term survival rates through surgical treatment. Operation is still the first choice for elderly patients with NSCLC.
Objective To investigate the early and long-outcomes of coronary artery bypass grafting(CABG) in acute myocardial infarction (AMI) patients with coronary artery disease(CAD)(age≤45 years). Methods Data of 596 adult CAD patients (include AMI and Angina) who underwent CABG in our hospital were collected retrospectively from May 2010 to October 2018. In an AMI group, 234 were male patients with an average age of 41.59±3.79 years; 26 were female patients with an average age of 41.64±3.03 years. In an angina group, 280 were male patients with an average age of 42.19±2.90 years; 56 were female patients with an average age of 41.54±3.52 years. Preoperative baseline variables, perioperative mortality, major adverse cardiac and cerebrovascular events (MACCE) were compared between two group. Results There was no significant difference in all preoperative variables. Seven patients were died and the hospital mortality rate was 1.23% (1.54% vs. 0.89%, P=0.477). The complications including reoperation for bleeding, cerebral infarction, renal failure and atrial fibrillation arrhythmia were without significant difference between two group (P>0.05). The intensive care unit stay duration (30.66±27.46 h vs. 23.96±15.11 h), intubation duration (22.54±22.31 h vs. 18.64±11.81 h) and hospitalization costs (97 186±33 741¥ vs. 90 081±24 537¥, P=0.003) were greater in the AMI group. The hospital mortality rate and complications rate were without significant difference between STEMI (ST segment elevated myocardial infarction) and NSTEMI (non-ST-segment elevated myocardial infarction) subgroups (P>0.05). The follow-up rate was 92.6% (546 patients) and the follow-up time was 4 (0.5 to 8.5) years. All cause-mortality rate was 3.85% (21 patients), and freedom MACCE was 72.2%. The freedom from MACCE, recurred angina and cerebral infarction were without significant difference, but AMI was associated with higher rate of PCI procedure. Conclusion CABG procedure in CAD patients under 45 years accompanied AMI is safety and reliable both in early and the long-term outcomes.