Objective To evaluate the predictive effect of three machine learning methods, namely support vector machine (SVM), K-nearest neighbor (KNN) and decision tree, on the daily number of new patients with ischemic stroke in Chengdu. Methods The numbers of daily new ischemic stroke patients from January 1st, 2019 to March 28th, 2021 were extracted from the Third People’s Hospital of Chengdu. The weather and meteorological data and air quality data of Chengdu came from China Weather Network in the same period. Correlation analyses, multinominal logistic regression, and principal component analysis were used to explore the influencing factors for the level of daily number of new ischemic stroke patients in this hospital. Then, using R 4.1.2 software, the data were randomly divided in a ratio of 7∶3 (70% into train set and 30% into validation set), and were respectively used to train and certify the three machine learning methods, SVM, KNN and decision tree, and logistic regression model was used as the benchmark model. F1 score, the area under the receiver operating characteristic curve (AUC) and accuracy of each model were calculated. The data dividing, training and validation were repeated for three times, and the average F1 scores, AUCs and accuracies of the three times were used to compare the prediction effects of the four models. Results According to the accuracies from high to low, the prediction effects of the four models were ranked as SVM (88.9%), logistic regression model (87.5%), decision tree (85.9%), and KNN (85.1%); according to the F1 scores, the models were ranked as SVM (66.9%), KNN (62.7%), decision tree (59.1%), and logistic regression model (57.7%); according to the AUCs, the order from high to low was SVM (88.5%), logistic regression model (87.7%), KNN (84.7%), and decision tree (71.5%). Conclusion The prediction result of SVM is better than the traditional logistic regression model and the other two machine learning models.
Objective To analyze the incidence and mortality of acute viral hepatitis in China, project its trends from 2022 to 2030, and provide valuable insights for the prevention and control of viral hepatitis. Methods The incidence and mortality rates of acute viral hepatitis in China from 1990 to 2021 were extracted from the Global Burden of Disease 2021 database. The change rates and the estimated annual percentage change (EAPC) for each indicator were calculated. Additionally, an autoregressive integrated moving average (ARIMA) model was used to project the incidence and mortality of acute viral hepatitis in China from 2022 to 2030. Results From 1990 to 2021, the incidence rates of acute hepatitis A (AHA), acute hepatitis B (AHB), acute hepatitis C (AHC), and acute hepatitis E (AHE) in China all showed a declining trend (EAPC=−1.980%, −2.664%, −2.078%, −1.686%; P<0.05), with a particularly marked decrease in mortality (EAPC=−11.662%, −7.411%, −12.541%, −7.504%; P<0.05). According to ARIMA model projections, the incidence rates of AHA and AHB were expected to continue declining from 2022 to 2030, while the incidence rates of AHC and AHE were expected to rise. In 2030, the projected incidence rates of AHA, AHB, AHC, and AHE were 890.425/100000, 824.158/100000, 59.202/100000, and 300.377/100000, respectively. The mortality rates of AHA, AHC, and AHE were projected to remain stable from 2022 to 2030, while the mortality rate of AHB was expected to decline. In 2030, the projected mortality rates of AHA, AHB, AHC, and AHE were 0.002/100000, 0/100000, 0.004/100000, and 0.011/100000, respectively. Conclusions From 1990 to 2021, the overall incidence and mortality of acute viral hepatitis in China showed a downward trend. However, the incidence rates of AHC and AHE may present an upward trend in the future, which suggests that the government and relevant health authorities should adjust their prevention and control strategies in a timely manner.
ObjectiveTo analyze the incidence and mortality of cirrhosis in China from 1992 to 2021, and to explore the impacts of age, period, and birth cohort factors on the incidence and mortality of cirrhosis. MethodsBy means of the Global Burden of Disease (GBD) 2021 database, the incidence and mortality of cirrhosis in China from 1992 to 2021 were analyzed. The Joinpoint software was used to analyze the temporal trends of the standardized incidence rate and standardized mortality rate of cirrhosis, and the average annual percentage change was calculated. An age-period-cohort model was constructed to deeply explore the effects of age, period, and birth cohort factors on the changing trends of the incidence and mortality of cirrhosis. ResultsIn 2021, the incidence of cirrhosis in China was 772.07 per 100 000, and the mortality was 10.99 per 100 000, representing decreases of 5.53% and 26.98%, respectively, compared with 1992. By gender, in 2021, the incidence of cirrhosis in males (727.95 per 100 000) was lower than that in females (818.32 per 100 000), but the mortality in males (15.53 per 100 000) was higher than that in females (6.24 per 100 000). From 1992 to 2021, the age-standardized incidence rate (ASIR) of cirrhosis in China showed a decreasing trend, with an average annual decrease of 0.31%, which was statistically significant (P=0.014). Similarly, the age-standardized mortality rate (ASMR) of cirrhosis also showed a decreasing trend, with an average annual decrease of 3.21%, which was statistically significant (P=0.021). The age effect results showed that the incidence of cirrhosis in China generally followed a trend of first decreasing, then increasing, and then decreasing again. There was a significant downward trend in incidence in the 5–14 years old group, a significant upward trend in the 15–24 years old group, and a fluctuating downward trend after 25 years old. Mortality rates gradually increased, from 2.32 per 100 000 in the 0–4 years old group to 27.72 per 100 000 in the 85–89 years old group. The period effect results showed that the period relative risk (RR) for cirrhosis incidence first decreased and then increased, with the highest risk from 1992 to 1996 [RR=1.19, 95%CI (1.10, 1.29)]. The period RR for cirrhosis mortality showed a decreasing trend, with the highest mortality risk occurring from 1992 to 1996 [RR=1.41, 95%CI (1.36, 1.45)]. The cohort effect results indicated that the later the birth cohort, the lower the risk of cirrhosis incidence and mortality. In 2021, among the five types of cirrhosis, nonalcoholic fatty liver disease (NAFLD)-induced cirrhosis had the highest incidence (672.02 per 100 000), while cirrhosis caused by hepatitis B had the highest mortality (8.15 per 100 000). From 1992 to 2021, alcohol-related cirrhosis showed the most significant increase in incidence (37.50%), and NAFLD-induced cirrhosis showed the most significant increase in mortality (25.00%). ConclusionsFrom 1992 to 2021, the ASIR and ASMR of cirrhosis in China show a declining trend. Age, period, and cohort all have significant effects on the trends of cirrhosis incidence and mortality. NAFLD-induced cirrhosis has the highest incidence, while cirrhosis caused by hepatitis B has the highest mortality.
Objective To comprehensively investigate the incidence of resorption of lumbar disc herniation, and provide reference data for clinical decision-making. Methods Seven electronic databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Wangfang data and Chongqing VIP database) were searched for relevant studies that might have reported morphologic changes in lumbar disc herniation when reporting the follow-up results of patients with lumbar disc herniation treated non-surgically from inception to March, 2020. Articles were screened according to inclusion and exclusion criteria, and the total number of patients, number of patients with resorption, and other important data were extracted for analysis. Random effect models were used for meta-analysis, and subgroup analysis, sensitivity analysis, meta-regression analysis, and Egger’s test were performed. Results A total of 15712 articles were identified from these databases, and 48 were eligible for analysis. A total of 2880 non-surgically treated patients with lumbar disc herniation were included in the meta-analysis, 1740 of whom presented resorption. Meta-analysis revealed that the incidence of resorption was 0.60 [95% confidence interval (CI) (0.46, 0.72)]. In subgroup analyses, studies that quantitatively measured the resorption of lumbar disc herniation yielded statistically higher pooled incidence [0.73, 95%CI (0.60, 0.85)] than those that used qualitative methods [0.51, 95%CI (0.34, 0.69)] (P=0.0252). The pooled incidence gradually increased in randomized controlled trials (RCTs) [0.50, 95%CI (0.15, 0.85)], non-RCT prospective studies [0.59, 95%CI (0.48, 0.70)] and retrospective studies [0.69, 95%CI (0.36, 0.95)], but the difference was not statistically significant (P=0.7523). The pooled incidence varied from 0.58 [95%CI (0.54, 0.71)] to 0.62 [95%CI (0.49, 0.74)] after the sequential omission of each single study. There was no significant change in the pooled incidence [0.62, 95%CI (0.43, 0.79)] when only low-risk RCTs and high-quality non-RCT studies were included, comparing with original meta-analysis results. Meta-regression showed that measurements partially caused heterogeneity (R2=15.34%, P=0.0858). Egger’s test suggested that there was no publication bias (P=0.4622). Conclusions According to current research, there is an overall incidence of resorption of 60% [95%CI (46%, 72%)] among non-surgically treated patients with lumbar disc herniation. The probability of resorption should be fully considered before making a decision on surgery.
ObjectiveTo interpret and compare the epidemiologic data of gastric cancer incidence and mortality in the world and China during 2018–2022, and to evaluate the disease burden of gastric cancer in China. MethodBased on the GLOBOCAN 2018–2022 cancer registry data released by the International Agency for Research on Cancer (IARC), both the crude and the age-standardized incidence and mortality data of gastric cancer were retrieved, while the situation of gastric cancer incidence and mortality was compared between China and the world. ResultsComparing with the global incidence and mortality of gastric cancer, although the incidence and mortality of gastric cancer in China showed a consistently declining trend, the numbers of incident cases and deaths kept the greatest in the world, which was one of the important cancer disease burdens in China. In the 2022 report, there were 968 350 incident cases and 660 175 deaths from gastric cancer worldwide. Therein, China had the greatest number of incident cases and deaths from gastric cancer, i.e. 358 000 (37.0% of the global total) and 260 000 (39.5% of the global total), respectively. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) for gastric cancer worldwide were 9.2/100 000 and 6.1/100 000, respectively; in China, the ASIR and ASMR were 13.7/100 000 and 9.4/100 000, respectively, both of which were higher than the global average levels. Similarly, in terms of the assessment on population morbidity index (PMI), the risk of death from gastric cancer in China appeared a declining trend, but it was still at a higher level compared to the global average. In very high and high human development index (HDI) countries/regions, the ASIR and ASMR of gastric cancer were higher than those in medium and low HDI countries/regions, while the trend was similar when stratified by gross national income (GNI) per capita. In countries/regions with very high HDI or high GNI per capita, the PMI was lower than those in other stratified countries/regions. There were certain geographic disparities in the ASMR of gastric cancer in China. The western region, especially the Qinghai-Tibet Plateau region, had the heaviest burden of gastric cancer deaths, and a few provinces in the central and eastern regions also faced a heavy burden of gastric cancer deaths. Similar to the global situation, the incidence and death risk of gastric cancer were higher among males in China. The ASIR and ASMR in males were more than two times to those in females, while the PMI in males and females were comparable. Globally, subpopulation ≥50 years old entered the age-groups with high incidence of gastric cancer, while in China, the high incidence age-groups were since 45 years old. ConclusionsThe burden of gastric cancer is still heavy in China and higher than the global level. HDI, GNI per capita, regional distribution, gender, and age are associated with the incidence and death risks of gastric cancer. The key points of gastric cancer prevention and control in China should be focused on raising awareness of cancer prevention among the public population, establishing tertiary prevention system in subnational areas, supporting large-scale population screening projects, systematically surveilling the high-risk subpopulation, promoting standardized cancer diagnosis and treatment, and whole-life managing and caring cancer patients.
ObjectiveTo investigate the relationship between lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. MethodsA retrospective analysis was made the clinical data of 120 patients with lumbar degenerative disease, who accorded with the inclusion criteria between June and November 2014. There were 58 males and 62 females with an average age of 53 years (range, 24-77 years). The disease duration ranged from 3 to 96 months (mean, 6.6 months). Affected segments included L3, 4 in 32 cases, L4, 5 in 47 cases, and L5, S1 in 52 cases. The CT and X-ray films of the lumbar vertebrae were taken. The facet joint degeneration was graded based on the grading system of Pathria. The spine-pelvic sagittal balance parameters were measured, including lumbar lordosis (LL), upper lumbar lordosis (ULL), lower lumbar lordosis (LLL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). According to normal range of PI, the patients were divided into 3 groups: group A (PI was 1ess than normal range), group B (PI was within normal range), and group C (PI was more than normal range). The facet joint degeneration was compared;according to the facet joint degeneration degree, the patients were divided into group N (mild degeneration group) and group M (serious degeneration group) to observe the relationship of lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. ResultsAt L4, 5 and L5, S1, facet joint degeneration showed significant difference among groups A, B, and C (P<0.05), more serious facet joint degeneration was observed in group C;no significant difference was found in facet joint degeneration at L3, 4 (P>0.05). There was no significant difference in the other spine-pelvic sagittal balance parameters between groups N and M at each segment (P>0.05) except for PT (P<0.05). ConclusionPI of more than normal range may lead to or aggravate lumbar facet joint degeneration at L4, 5 and L5, S1;PT and PI are significantly associated with facet joint degeneration at the lower lumbar spine.
ObjectiveTo systematically analyze the incidence and mortality of pancreatic cancer globally and in China from 2018–2022 based on GLOBOCAN 2018, 2020, and 2022 editions released by the International Agency for Research on Cancer, and summarize the main influencing factors to provide reference for the formulation of prevention and control strategies and clinical practice of pancreatic cancer in China. MethodsWe collected and organized data on pancreatic cancer incidence cases, death cases, crude incidence, crude mortality, age-standardized incidence rate by world standard population (ASIRW), and age-standardized mortality rate by world standard population (ASMRW) from the GLOBOCAN database. Combined with socioeconomic parameters such as human development index (HDI) and national income levels, we conducted comparative analysis of the distribution characteristics of pancreatic cancer globally and in China across different regions, age groups, and genders. ResultsFrom 2018 to 2022, incidence number of global pancreatic cancer increased from 458 000 cases to 511 000 cases in 2022, with crude incidence rising from 5.4/100 000 to 6.5/100 000. Deaths increased from 432 000 cases to 467 000 cases, with crude mortality rising from 5.7/100 000 to 5.9/100 000, while ASMRW decreased from 4.4/100 000 to 4.3/100 000. In China, incidence number of pancreatic cancer increased from 116 000 cases in 2018 to 119 000 cases in 2022, accounting for 23.3% of global cases, with crude incidence maintained at (8–9)/100 000. Deaths decreased from 110 000 cases to 106 000 cases, with crude mortality declining from 7.8/100 000 to 7.5/100 000 and ASMRW decreasing from 4.9/100 000 to 3.9/100 000. In 2022, countries with very high HDI had pancreatic cancer ASIRW of 7.9/100 000 and ASMRW of 6.9/100 000, significantly higher than low HDI countries at 1.4/100 000 and 1.3/100 000. Pancreatic cancer incidence showed clear age-related patterns, with the ≥75 age group having 191 157 new cases globally (crude incidence of 63.3/100 000) and 37 722 cases in China (crude incidence of 51.2/100 000). Both globally and in China, males showed higher incidence and mortality than females. ConclusionsPancreatic cancer is becoming an important public health challenge globally and in China, with incidence and mortality likely to continue rising in the future. Comprehensive prevention and control measures including tobacco control, obesity management, and diabetes monitoring should be strengthened. Early screening and standardized diagnosis and treatment for high-risk populations are crucial for improving pancreatic cancer survival rates. Improving the national cancer registry system and integrating multidisciplinary collaborative models can lay a solid foundation for precision prevention and treatment of pancreatic cancer.
ObjectiveTo investigate the incidence, pathogens, risk factors and clinical outcomes for ventilator- associated pneumonia (VAP) in children after tetralogy of Fallot (TOF) surgical correction, in order to offer reliable data for the prevention of VAP.MethodsThis was a retrospective study performed in Guangdong General Hospital and 181 children (121 males, 60 females, mean age of 11.2±10.4 months) undergoing surgical correction for TOF were included. ALL the children who received mechanical ventilation for 48 hours or longer between January 2013 and December 2017 were classified into a VAP group (n=44) and a non-VAP group (n=137). T test, χ2 test and multiple logistic regression analysis were used to identify the possible risk factors for VAP.ResultsThis study enrolled 181 patients , of which 44 were diagnosed as VAP. And the incidence of VAP was 24.3%. The most frequent isolated pathogen was Gram-negative bacteria (69.7%). Single factor analysis showed that the variables significantly associated with a risk factor of VAP were: hypoxic spells, preoperative pneumonia, preoperative mechanical ventilation support, cardiopulmonary bypass (CPB) time, reintubation, pulmonary atelectasis, low cardiac output syndrome (LCOS), intra-abdominal drainage and transfusion of fresh frozen plasma. The multiple logistic regression showed CPB time (OR=1.011), reintubation (OR=14.548), pulmonary atelectasis (OR=6.139) and LCOS (OR=3.054) were independent risk factors for VAP in children after TOF surgical correction. Patients with VAP had prolonged duration of mechanical ventilation, a longer ICU stay and longer hospitalization time.ConclusionsThe VAP rate in this population is higher than that reported abroad, which leads to prolonged duration of mechanical ventilation and a longer hospital stay. The effective measures for prevention of VAP should be taken according to the related risk factors for VAP to decrease the incidence of VAP in children after TOF surgical correction.
ObjectiveTo provide a basis for timely adjustment of cancer prevention and control measures in China through timely understanding of the latest 2022 global cancer statistics reported in the CA: A Cancer Journal for Clinicians published “Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries”. MethodsThe statistical data of GLOBOCAN in 2022 were systematically analyzed and the incidence and mortality of cancer by age, sex, type, and region were comprehensively interpreted. The changing trends in cancer were compared between China and the rest of the world, and the potential risk factors as well as current cancer prevention and control measures were summarized. Results① Globally, for both sexes combined, there were an estimated 19.976 million new cases and 9.744 million cancer deaths in 2022. The age-standardized incidence rate (ASIR) was 196.9 per 100 000 and the age-standardized mortality rate (ASMR) was 91.7 per 100 000 in 2022. The ASIR of all cancers was highest in Europe (268.1 per 100 000) and lowest in South-East Asia (109.6 per 100 000), as well as the ASMR of all cancers was highest in Europe (106.3 per 100 000) and lowest in South-East Asia (71.0 per 100 000). The top three cancer types of newly diagnosed cancer cases were lung, breast, and colorectal cancer, while the top three leading causes of cancer deaths were lung, colorectal, and liver cancer. The incidence and mortality rates of all cancers increased with advancing age. The numbers of newly diagnosed cancer cases and cancer deaths, as well as the age-standardized rates were consistently higher among men compared to women. The lung cancer and breast cancer ranked first in terms of newly diagnosed cancer cases among men and women, respectively. Consistently, the lung cancer and breast cancer were also the leading causes of cancer-related deaths among men and women, respectively. ② In China, there were an estimated 4.825 million new cases and 2.574 million cancer deaths. The ASIR was 201.6 per 100 000 and the ASMR was 96.5 per 100 000 in 2022. The ASIR and ASMR both ranked 65th out of 185 countries. The top three cancer types among newly diagnosed cases were lung cancer, colorectal cancer, and thyroid cancer, while the top three leading causes of cancer deaths were lung cancer, liver cancer, and gastric cancer. ConclusionsThe cancers incidences and deaths worldwide in 2022 have declined from that in 2020 (196.9 per 100 000 versus 201.0 per 100 000, 91.7 per 100 000 versus 100.7 per 100 000, respectively). Lung cancer is the leading type of newly diagnosed cancer both in China and globally. However, the second and third most common cancers in China differ from the global picture. In China, colorectal cancer and thyroid cancer take the second and third spots, respectively; Whereas globally, breast cancer and colorectal cancer occupy these positions. Lung cancer is the first ranked leading cause of death in both China and globally. However, there are differences in the second and third most common causes. In China, liver cancer and gastic cancer take the second and third spots, respectively; While globally, colorectal cancer and liver cancer occupy these positions. This study analyzes the characteristics of the disease burden of cancer in China by comparing the epidemiological features of cancer in China and worldwide, aiming to provide scientific evidences for developing comprehensive cancer prevention and control measures tailored specifically to China’s national conditions.
Objective To study the incidence and etiological distribution of lower respiratory tract infection (LRTI) after airway metal stent implantation in patients with malignant central airway obstruction (MCAO). Methods The clinical data of 149 patients with MCAO who underwent airway metal stent implantation in Department of Pulmonary and Critical Care Medicine of Hunan Provincial People's Hospital from April 2014 to April 2021 were selected for a retrospective study. The incidence of LRTI after treatment was counted. According to whether LRTI occurred after operation, they were divided into infected group and uninfected group. The clinical data of the two groups were compared and the influencing factors of LRTI were analyzed. Sputum samples and/or bronchoalveolar lavage fluid samples from patients infected with LRTI were collected for pathogen detection and drug susceptibility test, and the distribution and drug resistance of main pathogens were analyzed. Results A total of 149 patients who met the criteria were included in this study and the incidence of LRTI was 21.48%. People in the infected group was older than that in the uninfected one, and the proportion of people with a history of smoking, chemoradiotherapy, covered metal stents, and stent-related granulation tissue proliferation was higher, and the proportion of people with postoperative standardized aerosol inhalation was lower (P<0.05). Age, smoking history, chemoradiotherapy, covered metal stents, stent-related granulation tissue hyperplasia and postoperative standardized aerosol inhalation were all influencing factors of LRTI in these patients (P<0.05). A total of 38 pathogens were detected in 32 patients with LRTI. Gram negative bacteria, gram positive bacteria and fungi accounted for 68.42% (26/38), 21.05% (8/38) and 10.53% (4/38) respectively. Pseudomonas aeruginosa, the main Gram-negative bacteria, had no resistance to tobramycin, gentamicin and amikacin, but had high resistance to compound sulfamethoxazole, tigecycline and ampicillin; Klebsiella pneumoniae had low resistance to tobramycin, amikacin and tigecycline, and high resistance to cefotaxime, ciprofloxacin and cefepime; the main Gram-positive Staphylococcus aureus had no drug resistance to vancomycin, linezolid, compound sulfamethoxazole and quinuptin/dafuptin, but had high drug resistance to tetracycline, penicillin G, levofloxacin, oxacillin and ciprofloxacin; the main fungi Candida albicans showed no resistance to fluconazole, itraconazole, voriconazole, 5-fluorocytosine and amphotericin B. These results of pathogenic detection and drug susceptibility test contributed to the improvement of the rational application rate of antibiotics. Conclusions LRTI occurs in about a quarter of patients with MCAO after airway metal stent implantation. The pathogens are mainly Pseudomonas aeruginosa and Staphylococcus aureus. Antimicrobial treatment should be based on the results of etiological detection and drug susceptibility test.