This speech was delivered at the Banquet and Award Ceremony June 17, 2018, during SAE 2018– an international conference on ‘Small Area Estimation and Other Topics of Current Interest inSurveys, Official Statistics, ...This speech was delivered at the Banquet and Award Ceremony June 17, 2018, during SAE 2018– an international conference on ‘Small Area Estimation and Other Topics of Current Interest inSurveys, Official Statistics, and General Statistics: A Celebration of Professor Danny Pfeffermann’s75th Birthday.展开更多
AIM: To retrospectively analyze factors affecting the long-term survival of patients with pancreatic cancer who underwent pancreatic resection.METHODS: From January 2000 to December 2011,195 patients underwent pancrea...AIM: To retrospectively analyze factors affecting the long-term survival of patients with pancreatic cancer who underwent pancreatic resection.METHODS: From January 2000 to December 2011,195 patients underwent pancreatic resection in our hospital.The prognostic factors after pancreatic resection were analyzed in all 195 patients.After excluding the censored cases within an observational period,the clinicopathological characteristics of 20 patients who survived ≥ 5(n = 20) and < 5(n = 76) years were compared.For this comparison,we analyzed the patients who underwent surgery before June 2008 and were observed for more than 5 years.For statistical analyses,the log-rank test was used to compare the cumulative survival rates,and the χ2 and Mann-Whitney tests were used to compare the two groups.The CoxHazard model was used for a multivariate analysis,and P values less than 0.05 were considered significant.A multivariate analysis was conducted on the factors that were significant in the univariate analysis.RESULTS: The median survival for all patients was 27.1 months,and the 5-year actuarial survival rate was 34.5%.The median observational period was 595 d.With the univariate analysis,the UICC stage was significantly associated with survival time,and the CA19-9 ≤ 200 U/m L,DUPAN-2 ≤ 180 U/m L,t u m o r s i ze ≤ 2 0 m m,R 0 re s e c t i o n,a b s e n c e o f lymph node metastasis,absence of extrapancreatic neural invasion,and absence of portal invasion were favorable prognostic factors.The multivariate analysis showed that tumor size ≤ 20 mm(HR = 0.40; 95%CI: 0.17-0.83,P = 0.012) and negative surgical margins(R0 resection)(HR = 0.48; 95%CI: 0.30-0.77,P = 0.003) were independent favorable prognostic factors.Among the 96 patients,20 patients survived for 5 years or more,and 76 patients died within 5 years after operation.Comparison of the 20 5-year survivors with the 76 non-survivors showed that lower concentrations of DUPAN-2(79.5 vs 312.5 U/mL,P = 0.032),tumor size ≤ 20 mm(35% vs 8%,P = 0.008),R0 resection(95% vs 61%,P = 0.004),and absence of lymph nodemetastases(60% vs 18%,P = 0.036) were significantly associated with the 5-year survival.CONCLUSION: Negative surgical margins and a tumor size ≤ 20 mm were independent favorable prognostic factors.Histologically curative resection and early tumor detection are important factors in achieving long-term survival.展开更多
Pet owner compliance is essential for the success of veterinary healthcare strategies. As some parasites are zoonotic, consistent parasite control is an integral part of the One-Health strategy. Highly palatable formu...Pet owner compliance is essential for the success of veterinary healthcare strategies. As some parasites are zoonotic, consistent parasite control is an integral part of the One-Health strategy. Highly palatable formulations help ensure compliance, as they offer a positive experience for the dog and the owner. This study was conducted to ascertain if dogs exhibited a preference between two commercially available oral formulations of broad-spectrum endectoparasiticides, NexGard Spectra (afoxolaner and milbemycin oxime) and Simparica Trio (sarolaner, moxidectin and pyrantel). For four consecutive days, 100 healthy dogs were offered both products and consumption was recorded. If one product was more consumed than the other, it was defined as the preferred product. No adverse event was recorded throughout the study. A total of 358 chewable tablets were consumed over four study days;78.5% of dogs voluntarily consumed NexGard Spectra (281 chews), while 21.5% of dogs voluntarily consumed Simparica Trio (77 chews, <i>p</i> < 0.01). Among 75 dogs which demonstrated a preference for a product, significantly more dogs preferred NexGard Spectra (94.7%) compared to Simparica Trio (5.3%) (<i>p</i> < 2.2 × 10<sup>-16</sup>), resulting in a preference ratio of 17.75 to 1 for NexGard Spectra.展开更多
BACKGROUND Liver cirrhosis and hepatocellular carcinoma(HCC)are highly prevalent in Australia’s Northern Territory.Contributing factors include high levels of alcohol consumption,viral hepatitis and metabolic syndrom...BACKGROUND Liver cirrhosis and hepatocellular carcinoma(HCC)are highly prevalent in Australia’s Northern Territory.Contributing factors include high levels of alcohol consumption,viral hepatitis and metabolic syndrome.Rural Aboriginal residents form a significant proportion of the Central Australian population and present a challenge to traditional models of liver care.HCC surveillance and variceal screening are core components of liver cirrhosis management.AIM To assess participation in HCC and variceal surveillance programmes in a Central Australian liver cirrhosis patient cohort.METHODS Retrospective cohort study of patients with liver cirrhosis presenting to Alice Springs Hospital,Australia between January 1,2012 and December 31,2017.Demographic data,disease severity,attendance at hepatology clinics,participation in variceal and/or HCC surveillance programmes was recorded.Regression analyses were conducted to assess factors associated with two independent outcomes:Participation in HCC and variceal surveillance.RESULTS Of 193 patients were identified.82 patients(42.4%)were female.154 patients(80%)identified as Aboriginal.Median Model for End-stage Liver Disease Score at diagnosis was 11.Alcohol was the most common cause of cirrhosis.Aboriginal patients were younger than non-Aboriginal patients(48.4 years vs 59.9 years,P<0.001).There were similar rates of excess alcohol intake(72.6%vs 66.7%,P=0.468)and obesity(34.5%vs 38.4%,P=0.573 across non-Aboriginal and Aboriginal cohorts.20.1%of patients took part in HCC surveillance and 42.1%of patients completed variceal screening.Aboriginal patients were less likely to engage with either HCC surveillance(OR:0.38,95%CI:0.16-0.9,P=0.025)or undergo variceal screening(OR:0.31,95%CI:0.14-0.65,P=0.002).CONCLUSION HCC or variceal surveillance programmes had less uptake amongst Aboriginal patients.Greater emphasis needs to be placed on eliminating cultural obstacles to accessing hepatology services.展开更多
BACKGROUND Hepatitis C is a global epidemic and an estimated 230000 Australians were living with chronic hepatitis C in 2016.Through effective public health policy and state commitment,Australia has utilised the adven...BACKGROUND Hepatitis C is a global epidemic and an estimated 230000 Australians were living with chronic hepatitis C in 2016.Through effective public health policy and state commitment,Australia has utilised the advent of direct acting antiviral(DAA)therapy to transform the therapeutic landscape for hepatitis C virus(HCV).However,treatment rates are falling and novel public health approaches are required to maintain momentum for HCV elimination.Contemporary discourse in cascades of care have focused on expanding testing capabilities but less attention has been given to linking previously diagnosed patients back to care.Our simple and focused study rests on the premise that hospital admissions are an excellent opportunity to identify and refer previously diagnosed patients for HCV treatment.AIM To assess whether inpatients with HCV are appropriately referred on for treatment.METHODS We conducted a retrospective single centre cohort study that examined all patients with HCV presenting to The Queen Elizabeth Hospital(QEH)inpatient service between January 1 and December 31,2017.QEH is a tertiary care hospital in South Australia.The main inclusion criteria were patients with active HCV infection who were eligible for DAA therapy.Our study cohort was identified using a comprehensive list of diagnosis based on international classification of diseases-10 AM codes for chronic viral hepatitis.Patients were excluded from the analysis if they had previously received DAA therapy or spontaneously cleared HCV.Patients presenting with decompensated liver cirrhosis or other systemic medical conditions conferring poor short-term prognosis were also excluded from the analysis.The primary outcome of our study was referral of patients for HCV treatment.Secondary outcomes included assessment of factors predicting treatment referral.RESULTS There were 309 inpatients identified with hepatitis C as a principal or additional diagnosis between January 1 and December 31,2017.Of these patients,148 had active HCV infection without prior treatment or spontaneous clearance.Overall,131 patients were deemed eligible for DAA treatment and included in the main analysis.Mean patient age was 47.75±1.08 years,and 69%of the cohort were male and 13%identified as Aboriginal or Torres Strait Islander.Liver cirrhosis was a complication of hepatitis C in 7%of the study cohort.Only 10 patients were newly diagnosed with HCV infection during the study period with the remainder having been diagnosed prior to the study.CONCLUSION Under 25%of hepatitis C patients presenting to an Australian tertiary hospital were appropriately referred for treatment.Advanced age,cirrhosis and admission under medical specialties were predictors of treatment referral.展开更多
This article utilizes a large amount of statistical data to analyze the global distribution of foreign trade in China since 1990,as well as the factors involved and the changes in trends.The research results indicate ...This article utilizes a large amount of statistical data to analyze the global distribution of foreign trade in China since 1990,as well as the factors involved and the changes in trends.The research results indicate that China has gained a favourable balance against developed countries and a disadvantageous balance against developing countries;China enjoys a trade surplus with North American and European countries while suffering deficits with those in the Asia.pacific region,as well as with resource-abundant Australia,Africa and South America. With regard to trends,the structure of China’s foreign trade will not undergo fundamental changes in the short term,but in the long run will be transformed in line with restructuring of the growth pattern.展开更多
Objective: In a randomized, double-blind, exploratory, active-controlled trial, the efficacy and safety of a patent-pending combination of Ginger and Goldenrod extracts (BDI-630) in alleviating cold symptoms in commun...Objective: In a randomized, double-blind, exploratory, active-controlled trial, the efficacy and safety of a patent-pending combination of Ginger and Goldenrod extracts (BDI-630) in alleviating cold symptoms in community-dwelling adults was compared to a combination of standardized amounts of Echinacea (EC) components. Methods: 44 healthy adults, experiencing new onset of cold symptoms were randomly assigned to receive either BDI-630 (900 mg) or EC (500 mg) twice daily for 10 days. The severity of cold symptoms and the quality of life was assessed by self-reporting of subjects using the Wisconsin Upper Respiratory Symptom Survey (WURSS-21? 2004). Results: The intent-to-treat population (ITT) consisted of 44 subjects (n = 22 for BDI-630;n = 22 for EC). The modified ITT (mITT) population consisted of 40 subjects, excluding four subjects with major protocol deviations related to inclusion/exclusion criteria and/or use of prohibited drugs from the efficacy analysis (n = 3 for BDI-630 and n = 1 for EC). Results indicated a sig-nificant difference between the two groups: the superiority of BDI-630 over EC was particularly noticeable between Day 1 and Day 7, as demonstrated by a 14-fold difference of the mean percentage of change of total score from baseline in the mITT population. Adverse events (AEs) following the intake of BDI-630 were mostly limited to mild gastrointestinal intolerance in less than 10% of the subjects. Conclusions: BDI-630 was shown to be more effective than EC in alleviating cold symptoms in the adult population, particularly during the first 7 days of treatment. BDI-630 was very well tolerated by all subjects.展开更多
Background: Spotted Fever (SF) is an acute febrile zoonosis of variable severity that typically occurs in an endemic manner with worldwide distribution. Considering that SF is a disease of significant public health im...Background: Spotted Fever (SF) is an acute febrile zoonosis of variable severity that typically occurs in an endemic manner with worldwide distribution. Considering that SF is a disease of significant public health importance, this study aims to identify the mortality profile due to SF in Brazil from 2018 to 2022. Methods: Quantitative and descriptive cross-sectional approach. Data were collected from Brazilian Spotted Fever (BSF) cases registered in the Notifiable Diseases Information System (SINAN-DATASUS) across all regions of Brazil. The data collected includes information on the following variables: year of symptom, evolution, sex, race, environment of infection, region of notification, and age group. Subsequently, the data was entered into Microsoft Excel to create tables and graphs. The chi-square test was then applied to statistically analyze the associations between qualitative variables. A modified Poisson regression model with robust variance was constructed to analyze the age group data and determine which categories had different probabilities of death. The results show the estimates obtained for prevalence ratios, as well as their respective confidence intervals and p-values. The statistical software SAS version 9.4 was used to perform the analysis and a significance level of 5% was considered. Results: From 2018 to 2022, a total of 1126 cases of BSF were reported. Out of these cases, 59.3% (668) were cured, 32.4% (364) resulted in death, 1.1% (13) died from other causes and 7.2% (81) had no recorded outcome. Regarding the region with the highest death rate, the Southeast region led with 99.45% (362) of cases, followed by the Northeast region with 0.45% (2). As for the age group, the majority (63.7%) fell between the ages of 20 and 59 years old. In terms of race/color, 52.7% of the population identified as white. Regarding the contamination environment, 39.3% were in leisure areas. The outcome of death by BSF showed statistically significant associations with sex (p-value = 0.03) and age group (p-value = 0.003). Conclusion: The profile of deaths from Brazilian Spotted Fever primarily affects individuals from the Southeast region of the country, particularly men, and whites aged 20 years or older being contaminated mainly in leisure environments. This study provides a detailed understanding of the pattern of BSP-related deaths, providing crucial information for public health authorities. These insights provide valuable support for formulating informed policies and effective BSP control and prevention strategies.展开更多
Iatrogenic hepatic arterial injury during organ recovery increases ischaemic times and risk of hepatic artery thrombosis. A review of CT imaging prior to organ recovery would alert retrieving surgeons to the presence ...Iatrogenic hepatic arterial injury during organ recovery increases ischaemic times and risk of hepatic artery thrombosis. A review of CT imaging prior to organ recovery would alert retrieving surgeons to the presence of anatomical variants. This study aimed to identify the proportion of donors with coincidental CT scans for review and the ability of organ retrieval surgeons to interpret these images. Consecutive organ donors with coincidental abdominal contrast enhanced CT scans were assessed by review of an electronic radiology database. These images, with additional cases, were blindly reviewed by organ recovery surgeons to assess their ability to define anatomy. 13/156 donors had coincidental imaging for review. Using 23 CT sequences, the median positive and negative predictive value of surgeons to correctly describe right hepatic arterial anatomy was 0.83 and 0.94, of the left hepatic anatomy was 0.75 and 0.94 respectively. The availability of CT imaging for review prior to donation is low. However, when available, surgeons can correctly define hepatic arterial anatomy in the majority of cases. A practice of routinely reviewing available imaging prior to organ recovery would be expected to decrease iatrogenic arterial injury.展开更多
Introduction: We wished to see the effects of inhaled PGE1 on diastolic dysfunction, left ventricular end diastolic pressure (LVEDP), pulmonary hypertension and hypoxia in ARDS patients. Methods: This is a randomized,...Introduction: We wished to see the effects of inhaled PGE1 on diastolic dysfunction, left ventricular end diastolic pressure (LVEDP), pulmonary hypertension and hypoxia in ARDS patients. Methods: This is a randomized, prospective, clinical trial conducted in the main adult intensive care unit of a tertiary care University hospital. A total of 67 patients were recruited. Inclusion criteria included all adult patients with a P/F ratio 35 mmHg on Pulmonary artery catheter or suspected on clinical grounds. A transthoracic echo was performed to record the diastolic function, LVEDP and Pa pressures. Subsequently patients were randomized by a block computerized randomization to either cases (n = 34) or controls (n = 33). Cases received nebulised PGE1 over 30 minutes in the ICU and normal saline was administered to controls blindly. Following this the echo and arterial blood gases were repeated. Our primary outcomes were an improvement in diastolic function and P/F ratio of greater than 20% and a decrease in pulmonary pressure and LVEDP of >20%. Results: At baseline, mean diastolic dysfunction was grade II, with a mean LVEDP of >15 and the PaO2/FiO2 ratio was 148.38 ± 60.05 with a mean pulmonary artery pressure of 81.35 ± 16.91. Inhaled PGE1 was followed by an improvement in diastolic dysfunction (grade I, p = 0.001) with a resulting improvement in LVEDP (12 +/? 2, p = 0.001) as well as Pa pressures (97.09 ± 30.06, p = 0.04) and a non significant improvement in PaO2/FiO2 ratio (161.45 ± 77.52, p = 0.21). There were no side effects observed in any patients. Conclusion: Our study shows that there is a significant improvement in diastolic dysfunction, LVEDP and Pa pressures after administration of nebulised PGE1, and an improvement although non-significant in hypoxia in ARDS patients. The trial was registered with Clinicaltrials.gov (NCT00314548) and funded by the Pakistan medical research council.展开更多
Severe sepsis (SS) is one of the principal causes of admission in intensive care units (ICU), with an associated high morbidity and mortality. This study intends to characterize epidemiology of community-acquired SS (...Severe sepsis (SS) is one of the principal causes of admission in intensive care units (ICU), with an associated high morbidity and mortality. This study intends to characterize epidemiology of community-acquired SS (CASS) with special emphasis in the prevalence of multidrug resistant organisms and independent prognostic factors associated with ICU mortality. Methods: A prospective cohort study was conducted over 3.5 years, including all consecutive adult patients with CASS admitted to a mixed ICU, in a 600-bed university-affiliated hospital. Results: 1221 patients were admitted into the ICU, 25% with CASS. The mean age was 59 years and the mean SAPS (simplified acute physiological score) was II 48. Most had septic shock (67%). Respiratory (57%), intra-abdominal (22%) and urinary tract (8%) infections were the main sources of infection. The overall isolation rate was 56%. The most common identified microorganisms were Streptococcus pneumoniae (27%), Escherichia coli (22%), Staphylococcus aureus methicillin sensitive (8%) and Haemophilus influenzae (7%). The median ICU and hospital length of stay were 8 and 16 days, respectively. The ICU mortality rate was 33. Independent risk factors associated with higher mortality were older age, higher SAPS II, septic shock and chronic hepatic disease. Female gender was independently associated with lower mortality. The type of microorganism was not significantly associated with prognosis. Conclusion: CASS was highly prevalent among ICU admissions. Independent risk factors associated with ICU mortality included older age and previous comorbidities, but mainly severity of acute illness reinforcing the need for early recognition and treatment. Multidrug resistant organisms were implicated in considerable proportion of community-acquired sepsis.展开更多
The author estimated and analyzed China's urban and rural economically active,employed and unemployed populations as well as the labor-force participation ratio and employment and unemployment rates from 2000-2008...The author estimated and analyzed China's urban and rural economically active,employed and unemployed populations as well as the labor-force participation ratio and employment and unemployment rates from 2000-2008 by referring to population census data and establishing estimation models in this paper.The research results indicate changing trends in China's urban and rural economically active population from 2000-2008.展开更多
Following the order of events, this paper makes a systematic and comprehensive summary of how the global financial crisis of 2008 affected China. It includes an econometric assessment using by-industry and by-region d...Following the order of events, this paper makes a systematic and comprehensive summary of how the global financial crisis of 2008 affected China. It includes an econometric assessment using by-industry and by-region data, and describes the role of government regulation from a new perspective. China's economic recovery is a result of regulatory intervention, and enhancing economic momentum created conditions for such intervention to phase out.展开更多
Our study shows that China could contribute to an orderly global rebalancing using a package of policies to stimulate its domestic consumption. These policies include a progressive appreciation of the RMB, fiscal stim...Our study shows that China could contribute to an orderly global rebalancing using a package of policies to stimulate its domestic consumption. These policies include a progressive appreciation of the RMB, fiscal stimulation by increasing expenditure on education, health care, social safety nets and poverty reduction, income policies to reduce inequality and to strengthen wage income, and reforms of the financial system to improve financial efficiency and to mitigate financial constraints. By implementing such policies, China＇ s external surplus could be narrowed and its domestic imbalances improved. The excessively high savings rate could be lowered and the share of household consumption increased, even though GDP growth would moderate slightly.展开更多
Background: Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis(RA). This study assessed the efficacy and safety of tofacitinib in Chinese patients with RA enrolled in Phase 3 and l...Background: Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis(RA). This study assessed the efficacy and safety of tofacitinib in Chinese patients with RA enrolled in Phase 3 and long?term extension(LTE) studies.Methods: ORAL Sync was a 1?year, randomized, placebo?controlled, Phase 3 trial. Patients received tofacitinib 5 or 10 mg twice daily(BID) or placebo advanced to tofacitinib 5 or 10 mg BID at 3 or 6 months. All patients remained on ≥1 background conventional synthetic disease?modifying antirheumatic drug. ORAL Sequel is an open?label LTE study(data?cut: March 2015; data collection and analyses were ongoing, and study database was not locked at the time of analysis; study was closed in 2017). Efficacy outcomes: American College of Rheumatology(ACR) 20/50/70 response rates and Disease Activity Score in 28 joints using erythrocyte sedimentation rate(DAS28?4 [ESR]). Patient? and physician?reported outcomes: Health Assessment Questionnaire?Disability Index(HAQ?DI), Patient and Physician Global Assessment of Arthritis, and pain(visual analog scale). Safety was assessed throughout.Results: ORAL Sync included 218 patients; 192 were subsequently enrolled into ORAL Sequel. In ORAL Sync, more patients achieved ACR20(tofacitinib 5 mg BID, 67.4%; 10 mg BID, 70.6%; placebo, 34.1%) and DAS28?4(ESR) <2.6(tofacitinib 5 mg BID, 7.1%;10 mg BID, 13.1%; placebo, 2.3%) with tofacitinib versus placebo at Month 6. Mean changes from baseline in HAQ?DI were greater with tofacitinib versus placebo at Month 6. In ORAL Sequel, efficacy was consistent to Month 48. Incidence rates for adverse events of special interest in tofacitinib?treated patients were similar to the global population.Conclusions: Tofacitinib significantly reduced signs/symptoms and improved physical function and quality of life in Chinese patients with moderate?to?severely active RA up to Month 48. The safety profile was consistent with the global population.Clinical Trial Identifier: NCT00856544 and NCT00413699.展开更多
We consider multivariate small area estimation under nonignorable, not missing at random(NMAR) nonresponse. We assume a response model that accounts for the different patterns ofthe observed outcomes, (which values ar...We consider multivariate small area estimation under nonignorable, not missing at random(NMAR) nonresponse. We assume a response model that accounts for the different patterns ofthe observed outcomes, (which values are observed and which ones are missing), and estimatethe response probabilities by application of the Missing Information Principle (MIP). By this principle, we first derive the likelihood score equations for the case where the missing outcomes areactually observed, and then integrate out the unobserved outcomes from the score equationswith respect to the distribution holding for the missing data. The latter distribution is definedby the distribution fitted to the observed data for the respondents and the response model. Theintegrated score equations are then solved with respect to the unknown parameters indexingthe response model. Once the response probabilities have been estimated, we impute the missing outcomes from their appropriate distribution, yielding a complete data set with no missingvalues, which is used for predicting the target area means. A parametric bootstrap procedure isdeveloped for assessing the mean squared errors (MSE) of the resulting predictors. We illustratethe approach by a small simulation study.展开更多
文摘This speech was delivered at the Banquet and Award Ceremony June 17, 2018, during SAE 2018– an international conference on ‘Small Area Estimation and Other Topics of Current Interest inSurveys, Official Statistics, and General Statistics: A Celebration of Professor Danny Pfeffermann’s75th Birthday.
文摘AIM: To retrospectively analyze factors affecting the long-term survival of patients with pancreatic cancer who underwent pancreatic resection.METHODS: From January 2000 to December 2011,195 patients underwent pancreatic resection in our hospital.The prognostic factors after pancreatic resection were analyzed in all 195 patients.After excluding the censored cases within an observational period,the clinicopathological characteristics of 20 patients who survived ≥ 5(n = 20) and < 5(n = 76) years were compared.For this comparison,we analyzed the patients who underwent surgery before June 2008 and were observed for more than 5 years.For statistical analyses,the log-rank test was used to compare the cumulative survival rates,and the χ2 and Mann-Whitney tests were used to compare the two groups.The CoxHazard model was used for a multivariate analysis,and P values less than 0.05 were considered significant.A multivariate analysis was conducted on the factors that were significant in the univariate analysis.RESULTS: The median survival for all patients was 27.1 months,and the 5-year actuarial survival rate was 34.5%.The median observational period was 595 d.With the univariate analysis,the UICC stage was significantly associated with survival time,and the CA19-9 ≤ 200 U/m L,DUPAN-2 ≤ 180 U/m L,t u m o r s i ze ≤ 2 0 m m,R 0 re s e c t i o n,a b s e n c e o f lymph node metastasis,absence of extrapancreatic neural invasion,and absence of portal invasion were favorable prognostic factors.The multivariate analysis showed that tumor size ≤ 20 mm(HR = 0.40; 95%CI: 0.17-0.83,P = 0.012) and negative surgical margins(R0 resection)(HR = 0.48; 95%CI: 0.30-0.77,P = 0.003) were independent favorable prognostic factors.Among the 96 patients,20 patients survived for 5 years or more,and 76 patients died within 5 years after operation.Comparison of the 20 5-year survivors with the 76 non-survivors showed that lower concentrations of DUPAN-2(79.5 vs 312.5 U/mL,P = 0.032),tumor size ≤ 20 mm(35% vs 8%,P = 0.008),R0 resection(95% vs 61%,P = 0.004),and absence of lymph nodemetastases(60% vs 18%,P = 0.036) were significantly associated with the 5-year survival.CONCLUSION: Negative surgical margins and a tumor size ≤ 20 mm were independent favorable prognostic factors.Histologically curative resection and early tumor detection are important factors in achieving long-term survival.
文摘Pet owner compliance is essential for the success of veterinary healthcare strategies. As some parasites are zoonotic, consistent parasite control is an integral part of the One-Health strategy. Highly palatable formulations help ensure compliance, as they offer a positive experience for the dog and the owner. This study was conducted to ascertain if dogs exhibited a preference between two commercially available oral formulations of broad-spectrum endectoparasiticides, NexGard Spectra (afoxolaner and milbemycin oxime) and Simparica Trio (sarolaner, moxidectin and pyrantel). For four consecutive days, 100 healthy dogs were offered both products and consumption was recorded. If one product was more consumed than the other, it was defined as the preferred product. No adverse event was recorded throughout the study. A total of 358 chewable tablets were consumed over four study days;78.5% of dogs voluntarily consumed NexGard Spectra (281 chews), while 21.5% of dogs voluntarily consumed Simparica Trio (77 chews, <i>p</i> < 0.01). Among 75 dogs which demonstrated a preference for a product, significantly more dogs preferred NexGard Spectra (94.7%) compared to Simparica Trio (5.3%) (<i>p</i> < 2.2 × 10<sup>-16</sup>), resulting in a preference ratio of 17.75 to 1 for NexGard Spectra.
文摘BACKGROUND Liver cirrhosis and hepatocellular carcinoma(HCC)are highly prevalent in Australia’s Northern Territory.Contributing factors include high levels of alcohol consumption,viral hepatitis and metabolic syndrome.Rural Aboriginal residents form a significant proportion of the Central Australian population and present a challenge to traditional models of liver care.HCC surveillance and variceal screening are core components of liver cirrhosis management.AIM To assess participation in HCC and variceal surveillance programmes in a Central Australian liver cirrhosis patient cohort.METHODS Retrospective cohort study of patients with liver cirrhosis presenting to Alice Springs Hospital,Australia between January 1,2012 and December 31,2017.Demographic data,disease severity,attendance at hepatology clinics,participation in variceal and/or HCC surveillance programmes was recorded.Regression analyses were conducted to assess factors associated with two independent outcomes:Participation in HCC and variceal surveillance.RESULTS Of 193 patients were identified.82 patients(42.4%)were female.154 patients(80%)identified as Aboriginal.Median Model for End-stage Liver Disease Score at diagnosis was 11.Alcohol was the most common cause of cirrhosis.Aboriginal patients were younger than non-Aboriginal patients(48.4 years vs 59.9 years,P<0.001).There were similar rates of excess alcohol intake(72.6%vs 66.7%,P=0.468)and obesity(34.5%vs 38.4%,P=0.573 across non-Aboriginal and Aboriginal cohorts.20.1%of patients took part in HCC surveillance and 42.1%of patients completed variceal screening.Aboriginal patients were less likely to engage with either HCC surveillance(OR:0.38,95%CI:0.16-0.9,P=0.025)or undergo variceal screening(OR:0.31,95%CI:0.14-0.65,P=0.002).CONCLUSION HCC or variceal surveillance programmes had less uptake amongst Aboriginal patients.Greater emphasis needs to be placed on eliminating cultural obstacles to accessing hepatology services.
文摘BACKGROUND Hepatitis C is a global epidemic and an estimated 230000 Australians were living with chronic hepatitis C in 2016.Through effective public health policy and state commitment,Australia has utilised the advent of direct acting antiviral(DAA)therapy to transform the therapeutic landscape for hepatitis C virus(HCV).However,treatment rates are falling and novel public health approaches are required to maintain momentum for HCV elimination.Contemporary discourse in cascades of care have focused on expanding testing capabilities but less attention has been given to linking previously diagnosed patients back to care.Our simple and focused study rests on the premise that hospital admissions are an excellent opportunity to identify and refer previously diagnosed patients for HCV treatment.AIM To assess whether inpatients with HCV are appropriately referred on for treatment.METHODS We conducted a retrospective single centre cohort study that examined all patients with HCV presenting to The Queen Elizabeth Hospital(QEH)inpatient service between January 1 and December 31,2017.QEH is a tertiary care hospital in South Australia.The main inclusion criteria were patients with active HCV infection who were eligible for DAA therapy.Our study cohort was identified using a comprehensive list of diagnosis based on international classification of diseases-10 AM codes for chronic viral hepatitis.Patients were excluded from the analysis if they had previously received DAA therapy or spontaneously cleared HCV.Patients presenting with decompensated liver cirrhosis or other systemic medical conditions conferring poor short-term prognosis were also excluded from the analysis.The primary outcome of our study was referral of patients for HCV treatment.Secondary outcomes included assessment of factors predicting treatment referral.RESULTS There were 309 inpatients identified with hepatitis C as a principal or additional diagnosis between January 1 and December 31,2017.Of these patients,148 had active HCV infection without prior treatment or spontaneous clearance.Overall,131 patients were deemed eligible for DAA treatment and included in the main analysis.Mean patient age was 47.75±1.08 years,and 69%of the cohort were male and 13%identified as Aboriginal or Torres Strait Islander.Liver cirrhosis was a complication of hepatitis C in 7%of the study cohort.Only 10 patients were newly diagnosed with HCV infection during the study period with the remainder having been diagnosed prior to the study.CONCLUSION Under 25%of hepatitis C patients presenting to an Australian tertiary hospital were appropriately referred for treatment.Advanced age,cirrhosis and admission under medical specialties were predictors of treatment referral.
文摘This article utilizes a large amount of statistical data to analyze the global distribution of foreign trade in China since 1990,as well as the factors involved and the changes in trends.The research results indicate that China has gained a favourable balance against developed countries and a disadvantageous balance against developing countries;China enjoys a trade surplus with North American and European countries while suffering deficits with those in the Asia.pacific region,as well as with resource-abundant Australia,Africa and South America. With regard to trends,the structure of China’s foreign trade will not undergo fundamental changes in the short term,but in the long run will be transformed in line with restructuring of the growth pattern.
文摘Objective: In a randomized, double-blind, exploratory, active-controlled trial, the efficacy and safety of a patent-pending combination of Ginger and Goldenrod extracts (BDI-630) in alleviating cold symptoms in community-dwelling adults was compared to a combination of standardized amounts of Echinacea (EC) components. Methods: 44 healthy adults, experiencing new onset of cold symptoms were randomly assigned to receive either BDI-630 (900 mg) or EC (500 mg) twice daily for 10 days. The severity of cold symptoms and the quality of life was assessed by self-reporting of subjects using the Wisconsin Upper Respiratory Symptom Survey (WURSS-21? 2004). Results: The intent-to-treat population (ITT) consisted of 44 subjects (n = 22 for BDI-630;n = 22 for EC). The modified ITT (mITT) population consisted of 40 subjects, excluding four subjects with major protocol deviations related to inclusion/exclusion criteria and/or use of prohibited drugs from the efficacy analysis (n = 3 for BDI-630 and n = 1 for EC). Results indicated a sig-nificant difference between the two groups: the superiority of BDI-630 over EC was particularly noticeable between Day 1 and Day 7, as demonstrated by a 14-fold difference of the mean percentage of change of total score from baseline in the mITT population. Adverse events (AEs) following the intake of BDI-630 were mostly limited to mild gastrointestinal intolerance in less than 10% of the subjects. Conclusions: BDI-630 was shown to be more effective than EC in alleviating cold symptoms in the adult population, particularly during the first 7 days of treatment. BDI-630 was very well tolerated by all subjects.
文摘Background: Spotted Fever (SF) is an acute febrile zoonosis of variable severity that typically occurs in an endemic manner with worldwide distribution. Considering that SF is a disease of significant public health importance, this study aims to identify the mortality profile due to SF in Brazil from 2018 to 2022. Methods: Quantitative and descriptive cross-sectional approach. Data were collected from Brazilian Spotted Fever (BSF) cases registered in the Notifiable Diseases Information System (SINAN-DATASUS) across all regions of Brazil. The data collected includes information on the following variables: year of symptom, evolution, sex, race, environment of infection, region of notification, and age group. Subsequently, the data was entered into Microsoft Excel to create tables and graphs. The chi-square test was then applied to statistically analyze the associations between qualitative variables. A modified Poisson regression model with robust variance was constructed to analyze the age group data and determine which categories had different probabilities of death. The results show the estimates obtained for prevalence ratios, as well as their respective confidence intervals and p-values. The statistical software SAS version 9.4 was used to perform the analysis and a significance level of 5% was considered. Results: From 2018 to 2022, a total of 1126 cases of BSF were reported. Out of these cases, 59.3% (668) were cured, 32.4% (364) resulted in death, 1.1% (13) died from other causes and 7.2% (81) had no recorded outcome. Regarding the region with the highest death rate, the Southeast region led with 99.45% (362) of cases, followed by the Northeast region with 0.45% (2). As for the age group, the majority (63.7%) fell between the ages of 20 and 59 years old. In terms of race/color, 52.7% of the population identified as white. Regarding the contamination environment, 39.3% were in leisure areas. The outcome of death by BSF showed statistically significant associations with sex (p-value = 0.03) and age group (p-value = 0.003). Conclusion: The profile of deaths from Brazilian Spotted Fever primarily affects individuals from the Southeast region of the country, particularly men, and whites aged 20 years or older being contaminated mainly in leisure environments. This study provides a detailed understanding of the pattern of BSP-related deaths, providing crucial information for public health authorities. These insights provide valuable support for formulating informed policies and effective BSP control and prevention strategies.
文摘Iatrogenic hepatic arterial injury during organ recovery increases ischaemic times and risk of hepatic artery thrombosis. A review of CT imaging prior to organ recovery would alert retrieving surgeons to the presence of anatomical variants. This study aimed to identify the proportion of donors with coincidental CT scans for review and the ability of organ retrieval surgeons to interpret these images. Consecutive organ donors with coincidental abdominal contrast enhanced CT scans were assessed by review of an electronic radiology database. These images, with additional cases, were blindly reviewed by organ recovery surgeons to assess their ability to define anatomy. 13/156 donors had coincidental imaging for review. Using 23 CT sequences, the median positive and negative predictive value of surgeons to correctly describe right hepatic arterial anatomy was 0.83 and 0.94, of the left hepatic anatomy was 0.75 and 0.94 respectively. The availability of CT imaging for review prior to donation is low. However, when available, surgeons can correctly define hepatic arterial anatomy in the majority of cases. A practice of routinely reviewing available imaging prior to organ recovery would be expected to decrease iatrogenic arterial injury.
文摘Introduction: We wished to see the effects of inhaled PGE1 on diastolic dysfunction, left ventricular end diastolic pressure (LVEDP), pulmonary hypertension and hypoxia in ARDS patients. Methods: This is a randomized, prospective, clinical trial conducted in the main adult intensive care unit of a tertiary care University hospital. A total of 67 patients were recruited. Inclusion criteria included all adult patients with a P/F ratio 35 mmHg on Pulmonary artery catheter or suspected on clinical grounds. A transthoracic echo was performed to record the diastolic function, LVEDP and Pa pressures. Subsequently patients were randomized by a block computerized randomization to either cases (n = 34) or controls (n = 33). Cases received nebulised PGE1 over 30 minutes in the ICU and normal saline was administered to controls blindly. Following this the echo and arterial blood gases were repeated. Our primary outcomes were an improvement in diastolic function and P/F ratio of greater than 20% and a decrease in pulmonary pressure and LVEDP of >20%. Results: At baseline, mean diastolic dysfunction was grade II, with a mean LVEDP of >15 and the PaO2/FiO2 ratio was 148.38 ± 60.05 with a mean pulmonary artery pressure of 81.35 ± 16.91. Inhaled PGE1 was followed by an improvement in diastolic dysfunction (grade I, p = 0.001) with a resulting improvement in LVEDP (12 +/? 2, p = 0.001) as well as Pa pressures (97.09 ± 30.06, p = 0.04) and a non significant improvement in PaO2/FiO2 ratio (161.45 ± 77.52, p = 0.21). There were no side effects observed in any patients. Conclusion: Our study shows that there is a significant improvement in diastolic dysfunction, LVEDP and Pa pressures after administration of nebulised PGE1, and an improvement although non-significant in hypoxia in ARDS patients. The trial was registered with Clinicaltrials.gov (NCT00314548) and funded by the Pakistan medical research council.
基金supported by an unrestricted grant from ASSUCIP-Associacao dos Amigos da Unidade de Cuidados Intensivos Polivalente,Hospital de Santo António,Porto,Portugal(Intensive Care Unit Support Association).
文摘Severe sepsis (SS) is one of the principal causes of admission in intensive care units (ICU), with an associated high morbidity and mortality. This study intends to characterize epidemiology of community-acquired SS (CASS) with special emphasis in the prevalence of multidrug resistant organisms and independent prognostic factors associated with ICU mortality. Methods: A prospective cohort study was conducted over 3.5 years, including all consecutive adult patients with CASS admitted to a mixed ICU, in a 600-bed university-affiliated hospital. Results: 1221 patients were admitted into the ICU, 25% with CASS. The mean age was 59 years and the mean SAPS (simplified acute physiological score) was II 48. Most had septic shock (67%). Respiratory (57%), intra-abdominal (22%) and urinary tract (8%) infections were the main sources of infection. The overall isolation rate was 56%. The most common identified microorganisms were Streptococcus pneumoniae (27%), Escherichia coli (22%), Staphylococcus aureus methicillin sensitive (8%) and Haemophilus influenzae (7%). The median ICU and hospital length of stay were 8 and 16 days, respectively. The ICU mortality rate was 33. Independent risk factors associated with higher mortality were older age, higher SAPS II, septic shock and chronic hepatic disease. Female gender was independently associated with lower mortality. The type of microorganism was not significantly associated with prognosis. Conclusion: CASS was highly prevalent among ICU admissions. Independent risk factors associated with ICU mortality included older age and previous comorbidities, but mainly severity of acute illness reinforcing the need for early recognition and treatment. Multidrug resistant organisms were implicated in considerable proportion of community-acquired sepsis.
文摘The author estimated and analyzed China's urban and rural economically active,employed and unemployed populations as well as the labor-force participation ratio and employment and unemployment rates from 2000-2008 by referring to population census data and establishing estimation models in this paper.The research results indicate changing trends in China's urban and rural economically active population from 2000-2008.
文摘Following the order of events, this paper makes a systematic and comprehensive summary of how the global financial crisis of 2008 affected China. It includes an econometric assessment using by-industry and by-region data, and describes the role of government regulation from a new perspective. China's economic recovery is a result of regulatory intervention, and enhancing economic momentum created conditions for such intervention to phase out.
文摘Our study shows that China could contribute to an orderly global rebalancing using a package of policies to stimulate its domestic consumption. These policies include a progressive appreciation of the RMB, fiscal stimulation by increasing expenditure on education, health care, social safety nets and poverty reduction, income policies to reduce inequality and to strengthen wage income, and reforms of the financial system to improve financial efficiency and to mitigate financial constraints. By implementing such policies, China＇ s external surplus could be narrowed and its domestic imbalances improved. The excessively high savings rate could be lowered and the share of household consumption increased, even though GDP growth would moderate slightly.
文摘Background: Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis(RA). This study assessed the efficacy and safety of tofacitinib in Chinese patients with RA enrolled in Phase 3 and long?term extension(LTE) studies.Methods: ORAL Sync was a 1?year, randomized, placebo?controlled, Phase 3 trial. Patients received tofacitinib 5 or 10 mg twice daily(BID) or placebo advanced to tofacitinib 5 or 10 mg BID at 3 or 6 months. All patients remained on ≥1 background conventional synthetic disease?modifying antirheumatic drug. ORAL Sequel is an open?label LTE study(data?cut: March 2015; data collection and analyses were ongoing, and study database was not locked at the time of analysis; study was closed in 2017). Efficacy outcomes: American College of Rheumatology(ACR) 20/50/70 response rates and Disease Activity Score in 28 joints using erythrocyte sedimentation rate(DAS28?4 [ESR]). Patient? and physician?reported outcomes: Health Assessment Questionnaire?Disability Index(HAQ?DI), Patient and Physician Global Assessment of Arthritis, and pain(visual analog scale). Safety was assessed throughout.Results: ORAL Sync included 218 patients; 192 were subsequently enrolled into ORAL Sequel. In ORAL Sync, more patients achieved ACR20(tofacitinib 5 mg BID, 67.4%; 10 mg BID, 70.6%; placebo, 34.1%) and DAS28?4(ESR) <2.6(tofacitinib 5 mg BID, 7.1%;10 mg BID, 13.1%; placebo, 2.3%) with tofacitinib versus placebo at Month 6. Mean changes from baseline in HAQ?DI were greater with tofacitinib versus placebo at Month 6. In ORAL Sequel, efficacy was consistent to Month 48. Incidence rates for adverse events of special interest in tofacitinib?treated patients were similar to the global population.Conclusions: Tofacitinib significantly reduced signs/symptoms and improved physical function and quality of life in Chinese patients with moderate?to?severely active RA up to Month 48. The safety profile was consistent with the global population.Clinical Trial Identifier: NCT00856544 and NCT00413699.
文摘We consider multivariate small area estimation under nonignorable, not missing at random(NMAR) nonresponse. We assume a response model that accounts for the different patterns ofthe observed outcomes, (which values are observed and which ones are missing), and estimatethe response probabilities by application of the Missing Information Principle (MIP). By this principle, we first derive the likelihood score equations for the case where the missing outcomes areactually observed, and then integrate out the unobserved outcomes from the score equationswith respect to the distribution holding for the missing data. The latter distribution is definedby the distribution fitted to the observed data for the respondents and the response model. Theintegrated score equations are then solved with respect to the unknown parameters indexingthe response model. Once the response probabilities have been estimated, we impute the missing outcomes from their appropriate distribution, yielding a complete data set with no missingvalues, which is used for predicting the target area means. A parametric bootstrap procedure isdeveloped for assessing the mean squared errors (MSE) of the resulting predictors. We illustratethe approach by a small simulation study.
