The hospitalization burden of inflammatory bowel disease in China: a nationwide study from 2013 to 2018

BACKGROUND

The past decade has witnessed a dramatic increase in the number of patients with inflammatory bowel disease (IBD) in China. The nationwide burden of hospitalization remains unclear, however. We aimed to address this gap by conducting analysis using a nationwide database.

METHODS

Population-based hospitalization rates from 2013 to 2018 were calculated by extrapolating the number of patients in the database to the national level. Surgical rates, annual hospital charges, and length of stay were also used for quantification of hospitalization burden. The Poisson regression analysis and the Cochran-Armitage trend test were conducted to analyze temporal trends as expressed as annual percentage of change (APC) with 95% confidential intervals (CIs).

RESULTS

From 2013 to 2018, the hospitalization rates for Crohn's disease (CD) and ulcerative colitis (UC) in China increased from 2.20 (95% CI = 2.17-2.22) to 3.62 (3.59-3.65) per 100,000 inhabitants (p < 0.0001) with an APC of 10.68% (6.00-15.36%) and from 6.24 (6.20-6.28) to 8.29 (8.23-8.33) per 100,000 inhabitants (p < 0.0001) with an APC of 5.73% (2.32-9.15%), respectively. Surgical rates decreased from 7.96% (7.29-8.63%) to 5.56% (5.11-6.00%) for CD patients (p < 0.0001) with APC of -6.30% (-11.33 to -1.27%) and from 3.54% (3.26-3.82%) to 2.52% (2.32-2.72%) for UC patients (p < 0.0001) with APC of -6.35% (-16.21 to 3.51). In 2018, there were estimated 166,000 IBD patients hospitalized costing a total of $426.37 million ($149.91 + $276.46 million) across the entire China.

CONCLUSION

The population-based hospitalization rate of IBD increased, whereas the surgical rate decreased from 2013 to 2018 in China.

Can artificial intelligence support the clinical decision making for Barcelona clinic liver cancer stage 0/a hepatocellular carcinoma in China?

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Background: Artificial intelligence (AI) is emerging as a revolutionary technology with the power to transform healthcare. IBM Watson for Oncology (WFO), as an AI clinical decision support system (CDSS), has been investigated about its impact on clinical decision making in some cancer types and shown potential to be an effective CDSS in cancer care. However, the feasibility of WFO in Chinese patients with hepatocellular carcinoma (HCC) has not been reported. Methods: Artificial intelligence (AI) is emerging as a revolutionary technology with the power to transform healthcare. IBM Watson for Oncology (WFO), as an AI clinical decision support system (CDSS), has been investigated about its impact on clinical decision making in some cancer types and shown potential to be an effective CDSS in cancer care. However, the feasibility of WFO in Chinese patients with hepatocellular carcinoma (HCC) has not been reported. Results: The overall concordance rate was 60.5%, with 53.7% and 61.4% in BCLC stage 0 and A respectively. After the MDT re-review, the overall, BCLC stage 0 and A concordance rate increased to 67.3%, 65.9% and 67.3%. The main discordance was that MDT recommended more aggressive treatment options (eg. hepatectomy) than WFO did. The increase in concordance rate may be due to the progress of treatment of HCC in the past 5 years. Conclusions: With the concordance and reasonability verified by MDT in this study, WFO may provide practical reference in BCLC stage 0/A HCC. Localization is required to cover the disparity in guideline and patient characteristics between China and the US.

[Evaluation of quality of life on children with cochlear implants]

Objective:To provide theoretical basis for developing comprehensive and individualized rehabilitation programs,we evaluate the quality of life on children with cochlear implants（CI）and explore the influencing factors.Method:One hundred and three children with CI using the Mandaren children with cochlear implants: parental perspectives questionnaire were rated from communication, basic functions,independence ability, well-being,social relations, education, effect and influence of cochlear implants,and the support for children.The comparison was made according to different groups between duration of cochlear implants and age at assessment.Result:With the increasing of age at evaluation and the duration of cochlear implants,the scores of children in each dimension were also increased gradually.Four important factors affecting the quality of life of children with cochlear implants were the age at implantation,the duration of cochlear implants,the level of education with parents and the place of residence.Conclusion:The children with hearing impairment should use the cochlear implants as early as possible.While paying attention to the effect of postoperative hearing and speech rehabilitation,we should pay more attention to the evaluation of the quality of life,so that the children with cochlear implants can return to the mainstream society better.

[An analysis of electrocochleography in patients with OSAHS]

Objective:To investigate the values of electrocochleograph（ECochG）in patients with OSAHS. Method:ECochG was performed in 31 (62 ears) OSAHS patients (moderately 5 cases, severely 26 cases) and 28 healthy adults (56 ears). AP latency ，AP amplitude and SP/AP were measured and analyzed. Result:There was no difference between the two groups in SP/AP amplitude ratio（P>0.05） while both AP latency（P<0.05） and AP amplitude（P<0.05） were significantly different. Conclusion:ECochG can confirm the damage of cochlear and auditory nerve near the cochlear segment in patients with moderate to severe OSAHS.

[Acute effect of fine particulate matters on daily cardiovascular disease mortality in seven cities of China]

Objective: To explore the effect of fine particulate matters with an aerodynamic diameter less than 2.5 μm (PM(2.5)) on daily cardiovascular disease mortality in seven cities of China. Methods: Daily average concentrations of PM(2.5), cardiovascular disease mortality data and environmental data were collected from January 1, 2013 to December 31, 2015 in seven cities of China, including Shijiazhuang, Haerbin, Shanghai, Wuhan, Guangzhou, Chengdu and Xi' an. We linked generalized additive model with Quasi-Poisson distribution to evaluate the association between daily concentrations of PM(2.5) and cardiovascular disease mortality at single-city level and multi-city level, after adjusting for the long-term and seasonal trend, as well as meteorological factors and the effect of " days of week" . Results: The single-pollutant model indicated that there were marked differences in association strength in these cities, among which the effect in Guangzhou was strongest. At multi-city level, a 10 μg/m(3) increase of PM(2.5) was associated with an increase of 0.315% (95%CI: 0.133%-0.497%) of daily cardiovascular disease mortality. From lag0 to lag2, the effect of PM(2.5) on cardiovascular disease mortality decreased, while it was strongest on lag01. In the two-pollutant model, the estimated effect decreased in all the cities with the adjustments of SO(2) or NO(2). The insignificant combined results suggested that PM(2.5) might have combined effect with other pollutants. Each 10 μg/m(3) increase of PM(2.5) was associated with increases of 0.371% (95%CI: 0.141%-0.600%) and 0.199% (95% CI: 0.077%-0.321%) of cardiovascular disease mortality in males and females, respectively. The effect of PM(2.5) on cardiovascular disease mortality increased with age and decreased with educational level, although the differences between different subgroups were insignificant. The dose-response relationship between PM(2.5) and cardiovascular disease mortality was non-linear and non-threshold, with a steeper curve at lower concentrations. Conclusion: The increases of PM(2.5) concentration can result in the increase of daily cardiovascular mortality.

A biotechnological process efficiently co-produces two high value-added products, glucose and xylooligosaccharides, from sugarcane bagasse

In this study, a co-production of two high value-added products, glucose and xylooligosaccharides (XOS), was investigated by utilizing sugarcane bagasse (SB) within a multi-product bio-refinery framework optimized by Box-Behnken design-based response surface methodology. The developed process resulted in a maximum cellulose conversion of xylan-removed SB, 98.69±1.30%, and a maximum extracted SB xylan conversion into XOS (xylobiose and xylotriose) of 57.36±0.79% that was the highest SB xylan conversion reported in the literature, employing cellulase from Penicillium oxalicum EU2106 and recombinant endo-β-1,4-xylanase in Pichia pastoris. Consequently, a mass balance analysis showed that the maximum yields of glucose and XOS were 34.43±0.32g and 5.96±0.09 g per 100 g raw SB. Overall, this described process may be a preferred option for the comprehensive utilization of SB.

Immunohistochemical study of hepatitis E virus antigen in liver tissues from patients with hepatitis E

Hepatitis E virus antigen (HEVAg) has been identified in liver tissue of 6 out of 14 patients with hepatitis E using anti-HEV-IgG-horseradish peroxidase (HRP) and direct immunoperoxidase staining methods. HEVAg was found only in the cytoplasm of hepatocytes, but nor in the nuclei. The HEVAg positive hepatocytes were scattered singly, but in a few parts, where the liver damage was severe, the HEVAg positive cells were quite concentrated. We also observed the invasion of lymphocytes into the HEVAg positive hepatocytes. These phenomena suggest that the liver damage may be related to the immune reaction. No HEVAg was found in the liver tissues of stillborn fetus and neonate from woman patients with hepatitis E.

[Immunohistochemical study of hepatitis E virus antigen in liver tissues from patients with type E hepatitis]

Hepatitis E virus antigen (HEV Ag) has been identified in liver tissues of 6 out of 14 patients with type E hepatitis by direct immunoperoxidase staining, using anti-HEV-IgG-HRP. HEV Ag was found to be diffusive or inclusive in the cytoplasm of hepatocytes were scattered and isolated, but might aggregate in some parts where the liver damage was severe. We found that lymphocyte invaded the HEV Ag positive hepatocyte. These phenomena suggest that the liver damage is related to immunoreaction. HEV Ag was not found in the liver tissues of stillborn fetus and newborn baby from woman patients with hepatitis E. To detect HEV Ag in liver with direct immunoperoxidase method, using anti-HEV-IgG-HRP is more efficient than using anti-HEV-IgM-HRP.