BACKGROUND Duodenal adenocarcinoma(DA),a rare gastrointestinal malignancy,lacks clear natural history and management strategies.This study aimed to investigate the long-term outcomes of patients with DA,focusing on lo...BACKGROUND Duodenal adenocarcinoma(DA),a rare gastrointestinal malignancy,lacks clear natural history and management strategies.This study aimed to investigate the long-term outcomes of patients with DA,focusing on long-term survival and the impact of tumor characteristics,surgery,and adjuvant therapy.AIM To bridge this knowledge gap,we conducted a hospital-based cohort study in our 15-year experience with DA aimed at investigating the long-term outcomes of the patients with DA,along with analyzing the impact of the tumor characteristics,operations and adjuvant therapy on survival outcomes.METHODS A retrospective analysis of 208 patients diagnosed with non-ampullary DA at a single institution between 2009 and 2023 was performed.This study used SPSS 26.0 software to make a comprehensive statistical analysis of demographic characteristics,clinical presentation,treatment modalities,and survival outcomes.The effectiveness of surgical resection and adjuvant therapy in 5-year oval survival(OS)and disease-free survival was evaluated using Kaplan-Meier survival curves,the Cox proportional hazards model,and statistical comparisons of survival distributions.RESULTS The median OS time for the cohort was 39 months,with 3-and 5-year OS rates of 51.2%and 43.6%,respectively.Radical resection was performed in 82.6%of cases,and was significantly associated with an improved 5-year OS,with a rate of 57.8%.Adjuvant therapy showed a survival benefit in the specific patient subsets,particularly in tumor stage Ⅱ or Ⅲ tumors,with an improved OS.Adjuvant therapy(hazard ratio=2.71,95%confidence interval:1.30-5.62,P=0.008),pancreatic invasion and advanced tumor stage were identified as significant predictors of OS in multivariate analyses.CONCLUSION Radical operation for DA is associated with a remarkable improvement in the 5-year OS.Importantly,postoperative adjuvant therapy can significantly prolong the OS time in patients with radical operation,especially in patients with stage III.It highlights the necessity for early diagnosis,tailored surgical approaches,and a nuanced understanding of the role of adjuvant therapy.展开更多
Objective:This study protocol identifies the basic research route and framework of psychological and behavioral surveys among Chinese residents,aims establishing a database through a multicenter,large-sample cross-sec...Objective:This study protocol identifies the basic research route and framework of psychological and behavioral surveys among Chinese residents,aims establishing a database through a multicenter,large-sample cross-sectional survey in China to provide strong data support for research development in various fields and a more comprehensive and systematic understanding of the physical and mental health status of the public.Method:The study was conducted from June 20,2022 to August 31,2022,using stratified sampling and quota sampling methods,a total of 148 cities,202 districts and counties,390 townships/towns/sub-districts,and 780 communities/villages(excluding Hong Kong,Macao,and Taiwan)from 23 provinces,5 autonomous regions,and 4 municipalities directly under the central government in China were selected.The questionnaire was distributed one-on-one and face-to-face to the public by trained investigators,and the questionnaire included eight aspects:personal basic information,personal health status,family basic information,social environment in which they were located,psychological level scale,behavioral level scale,other scales,and attitude towards social hot issues.Data analysis will be performed after questionnaire return.Results:Data collection is ongoing.These findings will support physical and mental health research and strategy development in China and even globally,guiding policy-makers and health care organizations to reform their programs to ensure the best interests of residents and their families.展开更多
COVID-19 vaccine-induced protection declines over time.This waning of immunity has been described in modelling as a lower level of protection.This study incorporated finescale vaccine waning into modelling to predict ...COVID-19 vaccine-induced protection declines over time.This waning of immunity has been described in modelling as a lower level of protection.This study incorporated finescale vaccine waning into modelling to predict the next surge of the Omicron variant of the SARS-CoV-2 virus.In Hong Kong,the Omicron subvariant BA.2 caused a significant epidemic wave between February and April 2022,which triggered high vaccination rates.About half a year later,a second outbreak,dominated by a combination of BA.2,BA.4 and BA.5 subvariants,began to spread.We developed mathematical equations to formulate continuous changes in vaccine boosting and waning based on empirical serological data.These equations were incorporated into a multi-strain discrete-time Susceptible-Exposed-Infectious-Removed model.The daily number of reported cases during the first Omicron outbreak,with daily vaccination rates,the population mobility index and daily average temperature,were used to train the model.The model successfully predicted the size and timing of the second surge and the variant replacement by BA.4/5.It estimated 655,893 cumulative reported cases from June 1,2022 to 31 October 2022,which was only 2.69%fewer than the observed cumulative number of 674,008.The model projected that increased vaccine protection(by larger vaccine coverage or no vaccine waning)would reduce the size of the second surge of BA.2 infections substantially but would allow more subsequent BA.4/5 infections.Increased vaccine coverage or greater vaccine protection can reduce the infection rate during certain periods when the immune-escape variants cocirculate;however,new immune-escape variants spread more by out-competing the previous strain.展开更多
Objective Patients with chronic kidney disease(CKD)without atherosclerotic cardiovascular disease(ASCVD)have high mortality rates.Guidelines indicate that statin therapy can reduce mortality in CKD patients with ASCVD...Objective Patients with chronic kidney disease(CKD)without atherosclerotic cardiovascular disease(ASCVD)have high mortality rates.Guidelines indicate that statin therapy can reduce mortality in CKD patients with ASCVD;however,its benefits for CKD patients without ASCVD remain unclear.This study examined the survival benefits of statin therapy in CKD patients without ASCVD in American and Chinese cohorts.Methods A total of 4369 patients diagnosed with CKD without concurrent ASCVD were included from the American Medical Information Mart for Intensive Care(MIMIC)-Ⅳ database(n=1786)and the Chinese Multicenter Registry Cohort for Cardiorenal Improvement Ⅱ(CIN-Ⅱ,n=2583).Participants were grouped by statin use(treated and untreated).The two groups were compared for key indicators,including:(1)statin use rate;(2)4-year all-cause mortality;(3)4-year cardiovascular mortality(assessed in the CIN-Ⅱ cohort).Statistical analyses included Kaplan–Meier survival curves(with log-rank test for group differences)and Cox proportional hazard models(adjusted for confounders)to estimate the association between statin use and mortality.Results In the MIMIC-Ⅳ cohort,37.6%of CKD patients received statins,with a 4-year all-cause mortality of 36.3%.After adjustment,statin therapy was associated with lower all-cause mortality(adjusted hazard ratio[aHR]:0.61;95%confidence interval[CI]:0.51–0.72;P<0.001).In the CIN-Ⅱ cohort,33.9%of patients received statins;the 4-year all-cause and cardiovascular mortalities were 10.5%and 5.3%,respectively.Adjusted analyses demonstrated that statin therapy reduced both all-cause mortality(aHR:0.74;95%CI:0.56–0.99;P=0.037)and cardiovascular mortality(aHR:0.64;95%CI:0.42–0.97;P=0.031).Conclusion Approximately two-thirds of CKD patients without ASCVD in both the American(MIMIC-Ⅳ)and Chinese(CIN-Ⅱ)cohorts did not receive statins.However,statin therapy reduced 4-year all-cause mortality by 26%and 39%in the American and Chinese cohorts,respectively.These findings highlight a clear survival benefit of statin therapy and warrant future randomized controlled trials.展开更多
Purpose To establish a competing-risks model and compare it with traditional survival analysis,aiming to identify more precise prognostic factors for angiosarcoma.The presence of competing risks suggests that prognost...Purpose To establish a competing-risks model and compare it with traditional survival analysis,aiming to identify more precise prognostic factors for angiosarcoma.The presence of competing risks suggests that prognostic factors derived from the conventional Cox regression model may exhibit bias.Methods Patient data pertaining to angiosarcoma cases diagnosed from 2000 to 2019 were extracted from the Sur-veillance,Epidemiology,and End Results(SEER)database.Multivariate analysis employed both the Cox regression model and the Fine-Gray model,while univariate analysis utilized the cumulative incidence function and Gray’s test.Results A total of 3,905 enrolled patients diagnosed with angiosarcoma were included,out of which 2,781 suc-cumbed to their condition:1,888 fatalities resulted from angiosarcoma itself,and 893 were attributed to other causes.The Fine-Gray model,through multivariable analysis,identified SEER stage,gender,race,surgical status,chemotherapy status,radiotherapy status,and marital status as independent prognostic factors for angiosarcoma.The Cox regression model,due to the occurrence of competing-risk events,could not accurately estimate the effect values and yielded false-negative outcomes.Clearly,when analyzing clinical survival data with multiple endpoints,the competing-risks model demonstrates superior performance.Conclusion This current investigation may enhance clinicians’comprehension of angiosarcoma and furnish refer-ence data for making clinical decisions.展开更多
基金Supported by Natural Science Foundation of Guangdong Province of China,No.2023A1515010785Key Clinical Technique of Guangzhou,No.2023P-ZD01Clinical Research Program of Nanfang Hospital,Southern Medical University,No.2021CR003.
文摘BACKGROUND Duodenal adenocarcinoma(DA),a rare gastrointestinal malignancy,lacks clear natural history and management strategies.This study aimed to investigate the long-term outcomes of patients with DA,focusing on long-term survival and the impact of tumor characteristics,surgery,and adjuvant therapy.AIM To bridge this knowledge gap,we conducted a hospital-based cohort study in our 15-year experience with DA aimed at investigating the long-term outcomes of the patients with DA,along with analyzing the impact of the tumor characteristics,operations and adjuvant therapy on survival outcomes.METHODS A retrospective analysis of 208 patients diagnosed with non-ampullary DA at a single institution between 2009 and 2023 was performed.This study used SPSS 26.0 software to make a comprehensive statistical analysis of demographic characteristics,clinical presentation,treatment modalities,and survival outcomes.The effectiveness of surgical resection and adjuvant therapy in 5-year oval survival(OS)and disease-free survival was evaluated using Kaplan-Meier survival curves,the Cox proportional hazards model,and statistical comparisons of survival distributions.RESULTS The median OS time for the cohort was 39 months,with 3-and 5-year OS rates of 51.2%and 43.6%,respectively.Radical resection was performed in 82.6%of cases,and was significantly associated with an improved 5-year OS,with a rate of 57.8%.Adjuvant therapy showed a survival benefit in the specific patient subsets,particularly in tumor stage Ⅱ or Ⅲ tumors,with an improved OS.Adjuvant therapy(hazard ratio=2.71,95%confidence interval:1.30-5.62,P=0.008),pancreatic invasion and advanced tumor stage were identified as significant predictors of OS in multivariate analyses.CONCLUSION Radical operation for DA is associated with a remarkable improvement in the 5-year OS.Importantly,postoperative adjuvant therapy can significantly prolong the OS time in patients with radical operation,especially in patients with stage III.It highlights the necessity for early diagnosis,tailored surgical approaches,and a nuanced understanding of the role of adjuvant therapy.
文摘Objective:This study protocol identifies the basic research route and framework of psychological and behavioral surveys among Chinese residents,aims establishing a database through a multicenter,large-sample cross-sectional survey in China to provide strong data support for research development in various fields and a more comprehensive and systematic understanding of the physical and mental health status of the public.Method:The study was conducted from June 20,2022 to August 31,2022,using stratified sampling and quota sampling methods,a total of 148 cities,202 districts and counties,390 townships/towns/sub-districts,and 780 communities/villages(excluding Hong Kong,Macao,and Taiwan)from 23 provinces,5 autonomous regions,and 4 municipalities directly under the central government in China were selected.The questionnaire was distributed one-on-one and face-to-face to the public by trained investigators,and the questionnaire included eight aspects:personal basic information,personal health status,family basic information,social environment in which they were located,psychological level scale,behavioral level scale,other scales,and attitude towards social hot issues.Data analysis will be performed after questionnaire return.Results:Data collection is ongoing.These findings will support physical and mental health research and strategy development in China and even globally,guiding policy-makers and health care organizations to reform their programs to ensure the best interests of residents and their families.
基金support from grants funded by the City University of Hong Kong[#7005523,#7005748 and#7005876]the General Research Fund[#11203823]from the Research Grants Council of Hong Kong。
文摘COVID-19 vaccine-induced protection declines over time.This waning of immunity has been described in modelling as a lower level of protection.This study incorporated finescale vaccine waning into modelling to predict the next surge of the Omicron variant of the SARS-CoV-2 virus.In Hong Kong,the Omicron subvariant BA.2 caused a significant epidemic wave between February and April 2022,which triggered high vaccination rates.About half a year later,a second outbreak,dominated by a combination of BA.2,BA.4 and BA.5 subvariants,began to spread.We developed mathematical equations to formulate continuous changes in vaccine boosting and waning based on empirical serological data.These equations were incorporated into a multi-strain discrete-time Susceptible-Exposed-Infectious-Removed model.The daily number of reported cases during the first Omicron outbreak,with daily vaccination rates,the population mobility index and daily average temperature,were used to train the model.The model successfully predicted the size and timing of the second surge and the variant replacement by BA.4/5.It estimated 655,893 cumulative reported cases from June 1,2022 to 31 October 2022,which was only 2.69%fewer than the observed cumulative number of 674,008.The model projected that increased vaccine protection(by larger vaccine coverage or no vaccine waning)would reduce the size of the second surge of BA.2 infections substantially but would allow more subsequent BA.4/5 infections.Increased vaccine coverage or greater vaccine protection can reduce the infection rate during certain periods when the immune-escape variants cocirculate;however,new immune-escape variants spread more by out-competing the previous strain.
基金supported by the Guangdong Provincial Science and Technology Project(No.KJ022021049)the Guangdong Basic and Applied Basic Research Foundation(No.2022A1515012126)+1 种基金the National Natural Science Foundation of China(No.82270339 and No.82300278)the AstraZeneca Externally Sponsored Research Project(No.ESR-23–22118).
文摘Objective Patients with chronic kidney disease(CKD)without atherosclerotic cardiovascular disease(ASCVD)have high mortality rates.Guidelines indicate that statin therapy can reduce mortality in CKD patients with ASCVD;however,its benefits for CKD patients without ASCVD remain unclear.This study examined the survival benefits of statin therapy in CKD patients without ASCVD in American and Chinese cohorts.Methods A total of 4369 patients diagnosed with CKD without concurrent ASCVD were included from the American Medical Information Mart for Intensive Care(MIMIC)-Ⅳ database(n=1786)and the Chinese Multicenter Registry Cohort for Cardiorenal Improvement Ⅱ(CIN-Ⅱ,n=2583).Participants were grouped by statin use(treated and untreated).The two groups were compared for key indicators,including:(1)statin use rate;(2)4-year all-cause mortality;(3)4-year cardiovascular mortality(assessed in the CIN-Ⅱ cohort).Statistical analyses included Kaplan–Meier survival curves(with log-rank test for group differences)and Cox proportional hazard models(adjusted for confounders)to estimate the association between statin use and mortality.Results In the MIMIC-Ⅳ cohort,37.6%of CKD patients received statins,with a 4-year all-cause mortality of 36.3%.After adjustment,statin therapy was associated with lower all-cause mortality(adjusted hazard ratio[aHR]:0.61;95%confidence interval[CI]:0.51–0.72;P<0.001).In the CIN-Ⅱ cohort,33.9%of patients received statins;the 4-year all-cause and cardiovascular mortalities were 10.5%and 5.3%,respectively.Adjusted analyses demonstrated that statin therapy reduced both all-cause mortality(aHR:0.74;95%CI:0.56–0.99;P=0.037)and cardiovascular mortality(aHR:0.64;95%CI:0.42–0.97;P=0.031).Conclusion Approximately two-thirds of CKD patients without ASCVD in both the American(MIMIC-Ⅳ)and Chinese(CIN-Ⅱ)cohorts did not receive statins.However,statin therapy reduced 4-year all-cause mortality by 26%and 39%in the American and Chinese cohorts,respectively.These findings highlight a clear survival benefit of statin therapy and warrant future randomized controlled trials.
基金supported by Key Scientific Problems and Medical Technical Problems Research Project of China Medical Education Association[2022KTZ009]Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization[2021B1212040007].
文摘Purpose To establish a competing-risks model and compare it with traditional survival analysis,aiming to identify more precise prognostic factors for angiosarcoma.The presence of competing risks suggests that prognostic factors derived from the conventional Cox regression model may exhibit bias.Methods Patient data pertaining to angiosarcoma cases diagnosed from 2000 to 2019 were extracted from the Sur-veillance,Epidemiology,and End Results(SEER)database.Multivariate analysis employed both the Cox regression model and the Fine-Gray model,while univariate analysis utilized the cumulative incidence function and Gray’s test.Results A total of 3,905 enrolled patients diagnosed with angiosarcoma were included,out of which 2,781 suc-cumbed to their condition:1,888 fatalities resulted from angiosarcoma itself,and 893 were attributed to other causes.The Fine-Gray model,through multivariable analysis,identified SEER stage,gender,race,surgical status,chemotherapy status,radiotherapy status,and marital status as independent prognostic factors for angiosarcoma.The Cox regression model,due to the occurrence of competing-risk events,could not accurately estimate the effect values and yielded false-negative outcomes.Clearly,when analyzing clinical survival data with multiple endpoints,the competing-risks model demonstrates superior performance.Conclusion This current investigation may enhance clinicians’comprehension of angiosarcoma and furnish refer-ence data for making clinical decisions.
