Cancer has become the most common cause of death in China.Owing to rapid economic development,improved livelihood,and shifts in risk factors,cancer epidemiology has experienced substantial changes during the past seve...Cancer has become the most common cause of death in China.Owing to rapid economic development,improved livelihood,and shifts in risk factors,cancer epidemiology has experienced substantial changes during the past several decades.In this review,we aim to describe the current cancer epidemiology of the main types of cancer in China,report major risk factors associated with cancer development,and summarize the contributions of the Chinese government to controlling the cancer burden.A total of 4,064,000 new cases were diagnosed in China in 2016.The most frequent types are lung cancer(828,100;20.4%),colorectal cancer(408,000;10.0%),and gastric cancer(396,500;9.8%).Lung(657,000;27.2%),liver(336,400,13.9%),and stomach(288,500;12.0%)cancers are the 3 most deadly cancers in the general population.The 5-year survival rate for cancer has dramatically increased in recent decades.However,liver and particularly pancreatic cancers still have the poorest prognosis.The main modifiable risk factors associated with cancer development include infectious agents,smoking,alcohol consumption,obesity,unhealthful dietary habits,and inadequate physical activity.The Chinese government has made unremitting efforts to decrease the cancer burden,including cancer education and investment in cancer screening programs.展开更多
In 2020, stomach cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. Due to the relatively huge population base and the poor survival rate, stomach cance...In 2020, stomach cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. Due to the relatively huge population base and the poor survival rate, stomach cancer is still a threat in China, and accounts for nearly half of the cases worldwide. Fortunately, in China, the incidence and mortality rates of stomach cancer presented a declining trend owing to the change of individual life styles and the persistent efforts to prevent stomach cancer from the governments at all levels. Helicobacter pylori(H. pylori)infection, poor eating habits, smoking, history of gastrointestinal disorders, and family history of stomach cancer are the main risk factors for stomach cancer in China. As a result, by taking risk factors for stomach cancer into account, specific preventive measures, such as eradicating H. pylori and implementing stomach cancer screening projects, should be taken to better prevent and decrease the burden of stomach cancer.展开更多
In this review,we offer a concise overview of liver cancer epidemiology in China and worldwide from the official databases of GLOBOCAN 2020 and the National Cancer Registry in China.We also summarized the evidence for...In this review,we offer a concise overview of liver cancer epidemiology in China and worldwide from the official databases of GLOBOCAN 2020 and the National Cancer Registry in China.We also summarized the evidence for the main risk factors associated with liver cancer risk and discuss strategies implemented in China to control the liver cancer burden.Overall,liver cancer was the sixth most commonly diagnosed cancer and the third leading cause of cancer-related death worldwide in 2020.Although China contributed to nearly half of cases across the world alone,the incidence and mortality rates of liver cancer presented a declining trend owing to the persistent efforts from the governments at all levels.The current liver cancer burden in China still faces an arduous challenge due to the relatively large population base as well as the substantially low survival rate(12.1%).To better control the liver cancer burden with the lowest cost,specific measures should be conducted by reducing exposure to established risk factors such as hepatitis B infection and aflatoxin.The promotion of surveillance is also an important method to prolong the survival of liver cancer.This review will provide basic information for future direction on the control of liver cancer burden.展开更多
Objective:This study aimed to provide a comprehensive overview of the global burden of esophageal cancer(EC)and determine the temporal trends and factors influencing changes in the global burden.Methods:The latest inc...Objective:This study aimed to provide a comprehensive overview of the global burden of esophageal cancer(EC)and determine the temporal trends and factors influencing changes in the global burden.Methods:The latest incidence and mortality data for EC worldwide were obtained from GLOBALCAN 2022.The mortality and disability-adjusted life years(DALYs)rates for EC from 1990±2019 were sourced from the 2019 Global Burden of Diseases.Trends in EC mortality and DALYs attributable to 11 risk factors or clusters of risk were analyzed using the joinpoint regression model.The trends in age-related EC burden were assessed using a decomposition approach.Results:An estimated 511,054 new cases of EC were diagnosed in 2022 with 445,391 deaths worldwide.Approximately 75%of cases and deaths occurred in Asia.Nearly 50%of global EC deaths and DALYs were attributed to tobacco use in men in 2019,while 20%were attributed to high body mass index(BMI)in women.From 1990±2019,EC deaths and DALYs attributable to almost all risk factors had declining trends,while EC deaths and DALYs attributed to high BMI in men had upward trends.The age-related EC burden exhibited an upward trend driven by population growth and aging,which contributed to 307.4 thousand deaths and 7.2 million DALYs due to EC.Conclusions:The EC burden remains substantial worldwide.Effective tobacco and obesity control measures are critical for addressing the risk-attributable burden of EC.Population growth and aging pose challenges for EC prevention and control efforts.展开更多
Objective:China and the United States(the U.S.)have the heaviest colorectal cancer(CRC)burden with considerable variations in temporal trends.This study aims to analyze the temporal patterns of CRC burden and its risk...Objective:China and the United States(the U.S.)have the heaviest colorectal cancer(CRC)burden with considerable variations in temporal trends.This study aims to analyze the temporal patterns of CRC burden and its risk factors in China and the U.S.across the past three decades.Methods:Data were extracted from the Global Burden of Disease(GBD)Study in 2019,including cases,deaths,disability-adjusted life-years(DALYs),age-standardized rate(ASR),and summary exposure value(SEV)of CRC in China and the U.S.between 1990 and 2019.Annual average percentage changes(AAPCs)of CRC burden were calculated using the Joinpoint regression model.The mortality in CRC attributable to potential risk factors was characterized by countries,gender,and age groups.Results:In 2019,there were 607,900 and 227,241 CRC cases,and 261,777 and 84,026 CRC deaths in China and the U.S.,respectively.The age-standardized incidence rate(ASIR)was 30.55 per 100,000 in China and 41.86 per100,000 in the U.S.,and the age-standardized mortality rate(ASMR)was 13.86 per 100,000 in China and 14.77 per100,000 in the U.S.CRC incidence,mortality,and DALY rate in the U.S.showed downward trends in the past three decades(AAPC=-0.47,-1.06,and-0.88,respectively),while upward trends were observed in China(AAPC=3.11,1.05,and 0.91,respectively).Among the cause of CRC,the leading risk factor contributing to CRC death was low milk in China and smoking in the U.S.,respectively.Conclusions:From 1990 to 2019,the burden of CRC in China increased dramatically,particularly for males and middle-aged and elderly people.The management of the major risk factors associated with the high burden of CRC should be enhanced.展开更多
Objective:Population-level economic burden is essential for prioritizing healthcare resources and healthcare budget making in the future.However,little is known about the economic burden of lung cancer in China.Method...Objective:Population-level economic burden is essential for prioritizing healthcare resources and healthcare budget making in the future.However,little is known about the economic burden of lung cancer in China.Methods:A prevalence-based approach was adopted to estimate the economic burden of lung cancer,including direct expenditure(medical and non-medical)and indirect cost(disability and premature death).Data on direct expenditure and work-loss days per patient in each year post-diagnosis were obtained from two primary surveys.Other parameters were obtained from literatures and official reports.Projections were conducted based on varying parameters.All expenditure data were reported in United States dollars(USD)using 2017 value(exchange rate:1 USD=6.760 CNY),with the discount rate of 3%.Results:The total economic burden of lung cancer was estimated to be 25,069 million USD in China in 2017(0.121%of gross domestic productivity,GDP).The estimated direct expenditure was 11,098 million USD,up to1.43%of total healthcare expenditure for China,covering 10,303 million USD and 795 million USD for medical and non-medical expenditure,respectively.The estimated indirect cost was 13,971 million,including 1,517 million USD due to disability and 12,454 million USD due to premature death.Under current assumptions,the projected total economic burden would increase to 30.1 billion USD,40.4 billion USD,and 53.4 billion USD in 2020,2025,and 2030,accounting for 0.121%,0.131%,and 0.146%of China's GDP,respectively.However,if China meets the United Nation sustainable development goal of reducing premature death from non-communicable diseases by one-third by 2030,the total economic burden in 2030 would be 31.9 billion USD,0.087%of China's GDP.Conclusions:The economic burden of lung cancer in China in 2017 is substantial and more likely to increase significantly in the future.Policy makers need to take urgent actions in budget making for health systems.The economic burden could be alleviated by reducing the disease burden of lung cancer via effective control and prevention actions.展开更多
Objective: This study aims to provide an analysis of the current status and trends of lung cancer incidence and mortality rates in China, comparing trends with those in the United States(U.S.).Methods: Data on lung ca...Objective: This study aims to provide an analysis of the current status and trends of lung cancer incidence and mortality rates in China, comparing trends with those in the United States(U.S.).Methods: Data on lung cancer incidence and mortality rates spanning 2000 to 2018 were extracted from the China Cancer Registry Annual Report and the Surveillance, Epidemiology, and End Results database for China and the U.S., respectively. Crude incidence and mortality rates were calculated by sex and age, with age-standardized incidence rates(ASIR) and mortality rates(ASMR) calculated using the Segi-Doll world standard population.Trend analyses employed Joinpoint regression models to determine average annual percentage change(AAPC).The study also assessed the proportion of new cases and deaths by sex and age.Results: In 2018, the ASIR of lung cancer for males in China was 50.72 per 100,000 and the ASMR was 39.69 per 100,000, the ASIR for females was 26.25 per 100,000 and the ASMR was 15.24 per 100,000. Both ASIR and ASMR were higher in males and the highest in the population aged 65 years and older, with the lowest among those aged 20-49 years. In China, female ASIR demonstrated an increasing trend(AAPC: 1.16%), while ASMR decreased in both sexes(AAPCs:-0.48% for males,-1.00% for females). The U.S. exhibited decreasing trends in both ASIR and ASMR across sexes and age groups.Conclusions: The study identified an increasing trend in lung cancer incidence among females and a decreasing mortality trend in both sexes in China. These trends are likely linked to factors such as smoking prevalence,advancements in cancer screening, and improved medical care. The findings underscore the need for tailored lung cancer prevention measures in China, particularly the reinforcement of anti-smoking policies.展开更多
Objective: The burden of gastric cancer(GC) across different age groups needs updating. We determined the GC global, regional, and national burden profiles and changes in incidence for 3 sequential 5-year intervals fr...Objective: The burden of gastric cancer(GC) across different age groups needs updating. We determined the GC global, regional, and national burden profiles and changes in incidence for 3 sequential 5-year intervals from 2003 to 2017.Methods: The latest incidence and mortality estimates of GC from 185 countries and regions were extracted from the GLOBOCAN 2022 database. The 5-year interval age-standardised incidence rates(ASIRs) were evaluated using cancer registry data from volumes X±XII of the Cancer Incidence in Five Continents(CI5). Correlation analysis was used to evaluate the relationship between ASIR or the age-standardised mortality rate(ASMR) and the Human Development Index(HDI).Results: There was an estimated global 968,000 new GC cases and 660,000 deaths in 2022, with male predominance. GC ASIRs and ASMRs were 9.2 and 6.1 per 100,000 persons, respectively. East Asia had the highest burden, with 53.8% of cases and 48.2% of deaths among all geographic regions. There was a significant correlation between ASIR and HDI. Over three 5-year intervals from 2003 to 2017, the incidence of GC notably decreased in most countries but peaked at 2008±2012 in New Zealand, Turkey, and South Africa. Several countries in Europe, Oceania, and America suggest an increasingly concerning trend among younger individuals, especially females.Conclusions: GC is a significant health issue, especially among males and in geographic regions with an HDI, such as eastern Asia. While the incidence of GC is decreasing in many countries due to prevention efforts and improved treatments, a rising trend persists among younger individuals. Comprehensive prevention strategies tailored to different age patterns are clearly needed.展开更多
Objective: Liver cancer is a major health concern globally and in China. This analysis investigated deaths and disability-adjusted life years(DALYs) with respect to etiologies and risk factors for liver cancer in Chin...Objective: Liver cancer is a major health concern globally and in China. This analysis investigated deaths and disability-adjusted life years(DALYs) with respect to etiologies and risk factors for liver cancer in China and worldwide.Methods: Global and China-specific data were collected on liver cancer deaths, DALYs, and age-standardized rates(ASRs) from the Global Burden of Disease Study 2019 database. Liver cancer etiologies were classified into five groups and risk factors were categorized into three levels. Each proportion of liver cancer burden was calculated in different geographic regions. The joinpoint regression model were used to assess the trends from 1990±2019.Results: Liver cancer accounted for 484,577 deaths worldwide in 2019 with an ASR of 5.9 per 100,000 population. China had an elevated liver cancer death ASR in 2019 and males had an ASR 1.7 times the global rate. The global ASR for DALYs peaked at 75±79 years of age but peaked earlier in China. Hepatitis B virus was the prominent etiology globally(39.5%) and in China(62.5%), followed by hepatitis C virus and alcohol consumption. In high sociodemographic index countries, non-alcoholic steatohepatitis has gained an increasing contribution as an etiologic factor. The liver cancer burden due to various etiologies has decreased globally in both genders. However, metabolic risk factors, particularly obesity, have had a growing contribution to the liver cancer burden, especially among males.Conclusions: Despite an overall decreasing trend in the liver cancer burden in China and worldwide, there has been a rising contribution from metabolic risk factors, highlighting the importance of implementing targeted prevention and control strategies that address regional and gender disparities.展开更多
Interfacial magnetic field structures induced by transverse electron-scale shear instability(mushroom instability)are found to be strongly associated with electron and ion dynamics,which in turn will influence the dev...Interfacial magnetic field structures induced by transverse electron-scale shear instability(mushroom instability)are found to be strongly associated with electron and ion dynamics,which in turn will influence the development of the instability itself.We find that high-frequency electron oscillations are excited normal to the shear interface.Also,on a larger time scale,the bulk of the ions are gradually separated under the influence of local magnetic fields,eventually reaching an equilibrium related to the initial shear conditions.Wepresent a theoretical model of this behavior.Such separation on the scale of the electron skin depth will prevent different ions from mixing and will thereafter restrain the growth of higher-order instabilities.We also analyze the role of electron thermal motion in the generation of the magnetic field,and we find an increase in the instability growth rate with increasing plasma temperature.These results have potential for providing a more realistic description of relativistic plasma flows.展开更多
A good Ti-based joint implant should prevent stress shielding and achieve good bioactivity and anti-infection performance.To meet these requirements,the low-elastic-modulus alloy—Ti–35Nb–2Ta–3Zr—was used as the s...A good Ti-based joint implant should prevent stress shielding and achieve good bioactivity and anti-infection performance.To meet these requirements,the low-elastic-modulus alloy—Ti–35Nb–2Ta–3Zr—was used as the substrate,and functional coatings that contained bioceramics and Ag ions were prepared for coating on TiO_(2)nanotubes(diameter:(80±20)nm and(150±40)nm)using anodization,deposition,and spin-coating methods.The effects of the bioceramics(nano-β-tricalcium phosphate,microhydroxyapatite(micro-HA),and meso-CaSiO_(3))and Ag nanoparticles(size:(50±20)nm)on the antibacterial activity and the tribocorrosion,corrosion,and early in vitro osteogenic behaviors of the nanotubes were investigated.The tribocorrosion and corrosion results showed that the wear rate and corrosive rate were highly dependent on the features of the nanotube surface.Micro-HA showed great wear resistance with a wear rate of(1.26±0.06)×10^(−3)mm^(3)/(N·m)due to adhesive and abrasivewear.Meso-CaSiO_(3)showed enhanced cell adhesion,proliferation,and alkaline phosphatase activity.The coatings that contained nano-Ag exhibited good antibacterial activity with an antibacterial rate of≥89.5%against Escherichia coli.These findings indicate that hybrid coatings may have the potential to accelerate osteogenesis.展开更多
With the continuous development of science and technology,artificial intelligence(AI)is coming into our lives and changing our lives.Since China entered the aging society in 2000,the degree of population aging has dee...With the continuous development of science and technology,artificial intelligence(AI)is coming into our lives and changing our lives.Since China entered the aging society in 2000,the degree of population aging has deepened.Comprehensive geriatric assessment(CGA)is now the accepted gold standard for the care of older people in hospitals.However,some problems limit the clinical application,such as complexity and time consuming.Therefore,by analyzing previous studies,we summarize some existing AI tools in order to find a more optimized assessment tool to complete the entire CGA process.展开更多
Oil dispersible suspension concentrates are safe,green,and environmentally friendly formulations.Problems such as layering,pasting,and bottoming are frequently encountered during the production,storage,and transportat...Oil dispersible suspension concentrates are safe,green,and environmentally friendly formulations.Problems such as layering,pasting,and bottoming are frequently encountered during the production,storage,and transportation process.Polyisobutylene succinimide functions as a dispersant and exhibits great potential to improve the physical stability of the oil dispersible suspension concentrate.From a microscopic perspective,the sorption characteristics of the polyisobutylene succinimide dispersant T151 on penoxsulam particle surfaces were comprehensively evaluated with XPS,FTIR,and SEM.The T151 adsorption procedure complied with a pseudo-second-order kinetic adsorption model,and it was a kind of physical sorption with an Ea of 22.57 kJ⋅mol^(−1).The T151 sorption model was consistent with the Langmuir isotherm.The adsorption process was spontaneous and followed by an entropy increase.TheΔH^(θ)of dispersant T151 on the surface of penoxsulam particles was 31.59 kJ⋅mol^(−1).The adsorption procedure was endothermic,and the primary force was hydrogen bonding.The XPS results showed that the F and S electronic peaks at the penoxsulam interface decreased,and that the C electronic peak increased significantly after the adsorption of dispersant T151,indicating the adsorption on the surface of penoxsulam particles.The results of this study provide a vital theoretical basis for the application of polyisobutylene succinimide dispersants in oil dispersible suspension systems.展开更多
To the Editor:Contemporary guidelines recommend primary percutaneous coronary intervention(PPCI)as the gold-standard reperfusion modality in patients with ST-segment elevation myocardial infarction(STEMI)within 12 h o...To the Editor:Contemporary guidelines recommend primary percutaneous coronary intervention(PPCI)as the gold-standard reperfusion modality in patients with ST-segment elevation myocardial infarction(STEMI)within 12 h of symptom onset.However,in realworld clinical practice,the implementation of PPCI faces substantial operational challenges,particularly in resource-limited settings,such as inadequate availability of specialized cardiac catheterization teams with requisite procedural expertise or the complete absence of coronary intervention capabilities in numerous rural healthcare facilities across China.Consequently,fibrinolytic therapy remains the predominant reperfusion strategy for STEMI management in county-level hospitals,with particularly high utilization rates observed in geographically remote regions.[3,4]Furthermore,our previous study revealed that 42.5%of STEMI patients fail to receive any form of evidence-based reperfusion therapy,representing a critical gap in optimal care delivery.To elucidate the prognostic implications of these treatment pathways within China’s unique healthcare system,this study aimed to compare the long-term outcomes among STEMI patients receiving PPCI,fibrinolysis,and no reperfusion therapy using data from the China Acute Myocardial Infarction Registry(CAMI Registry,clinicaltrials.gov,NCT01874691).展开更多
Family history(FH)of cancer is an established risk factor for early onset of cancer.However,reliable estimates on the difference in onset age between familial and sporadic cancers remain scarce in the Chinese populati...Family history(FH)of cancer is an established risk factor for early onset of cancer.However,reliable estimates on the difference in onset age between familial and sporadic cancers remain scarce in the Chinese population.;This multicenter,hospital-based,cross-sectional study included 23 hospitals across 12 provinces in China.Patients diagnosed with cancers of the lung,stomach,esophagus,or colorectum between January 1,2016 and December 31,2017 were identified.Detailed information on sociodemographic characteristics,lifestyle factors,stage at diagnosis,and onset age was collected.We analyzed the association between FH and onset age across different cancer types using quantile regressions.;Among 41,072 eligible patients,3054(7.44%)reported a first-degree FH of cancer,and they were diagnosed at younger ages than those without FH(median difference:-1.19,95%confidence interval[CI]:-1.59 to-0.79).Stratified by cancer type,the most pronounced difference was observed in colorectal cancer(median difference:-2.25,95%CI:-3.31 to-1.19).Failure to account for lead time bias resulted in an overestimation of the FH effect,ranging from 3.4%to 15.4%across cancer types.Quantile regression analysis revealed that the impact of FH on age at diagnosis was more pronounced at the upper tail of the age distribution for all cancers combined and for each cancer type individually.;Our findings suggest that FH of cancer is associated with the early onset of lung,stomach,esophageal,and colorectal cancers in China.Cancer screening at earlier ages is needed for individuals with an FH.展开更多
Background:Most studies have evaluated disability-adjusted life years(DALYs)of colorectal cancer(CRC)patients based on a set of generic disability weights(DWs).This study aimed to apply local CRC-stage-specific DWs to...Background:Most studies have evaluated disability-adjusted life years(DALYs)of colorectal cancer(CRC)patients based on a set of generic disability weights(DWs).This study aimed to apply local CRC-stage-specific DWs to estimate the burden of DALYs for CRC(CRC-DALYs)in populations in China and consider the influence of local screening coverage of CRC.Methods:A prevalence-based model was constructed using data from various sources.Years lived with disability(YLDs)were estimated mainly via cumulative prevalence data(based on CRC incidence rates,population numbers,and survival rates),stage-specific proportions of CRC,and DWs of the local population.Years of life lost(YLLs)were calculated based on the CRC mortality rates and standard life expectancies.CRC incidence and mortality rates for the years 2020,2025,and 2030 were estimated by joinpoint regression,and the corresponding DALYs were predicted.The main assumption was made for CRC screening coverage.Sensitivity analyses were used to assess the impact of population,DWs,and coverage.Results:In 2017,among the Chinese population,the estimated number of CRC-DALYs was 4,303,314(11.9%for YLDs).If CRC screening coverage rate in China(2.3%)remains unchanged,the overall DALYs in 2030 are predicted to increase by 37.2%(45.1%of those aged≥65 years).More optimistically,the DALYs would then decrease by 0.7%in 2030(from 5,902,454 to 5,860,200)if the coverage could be increased to 25.0%.A sensitivity analysis revealed that using local DWs would change the base-case values by 5.7%.Conclusions:The estimated CRC-DALYs in China using population-specific DWs were considerably lower(with a higher percentage of YLDs)than the global burden of disease(GBD)estimates(5,865,004,of 4.6%for YLDs),suggesting the impact extent of applying local parameters.Sustainable scale-up CRC screening needs to be in place to moderate the growth trend of CRC-DALYs in China.展开更多
To the Editor,A 26-year-old woman with congenital heart disease,postatrial septal defect repair,postarterial catheter ligation,hypoxia-associated pulmonary hypertension,and reduced right heart function,which manifeste...To the Editor,A 26-year-old woman with congenital heart disease,postatrial septal defect repair,postarterial catheter ligation,hypoxia-associated pulmonary hypertension,and reduced right heart function,which manifested as a severe decrease in activity tolerance,chest tightness and shortness of breath,and easy fatigue of breathing,was treated with oxygen,targeting medications such as anisentan,tadalafil,remodulin,and diuretic potassium supplementation to enhance cardiac function,and then her symptoms were slightly improved compared with the previous ones.She was guided with in-hospital respiratory training to the extent that the patient could tolerate it and then was discharged from the hospital to have a home-based respiratory rehabilitation for a period of 3 months.The training plan was as follows:(i)Respiratory muscle function test:the patient's resting maximal inspiratory pressure(MIP)and maximal expiratory pressure(MEPw)ere assessed by the respiratory trainer equipment,and the respiratory muscle weakness/invulnerability was defined as a measured maximal pressure value less than 80 cmH_(2)0 according to the ERS guidelines.展开更多
Surveillance recommendations for gastric cancer(GC)in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions.We aimed to develop a less e...Surveillance recommendations for gastric cancer(GC)in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions.We aimed to develop a less endoscopy-related equipment-dependent risk-stratification tool,and assessed whether mild-precursor-lesion patients can be safely exempt from surveillance.In the multicenter communitybased cohort,75,051 participants receiving baseline endoscopy were enrolled during 2015–2017 and followed-up until 2021.Cumulative incidence rates(CIRs)of GC for precancerous-conditions were calculated by Kaplan-Meier method and compared by Log-rank tests.Mixedeffects Cox regression models were used to detect potential factors for progression towards GC.A risk score was calculated as counts of selected factors.An independent cohort,including 26,586 participants was used for external validation.During a median follow-up of 6.25 years,CIRs of GC were 0.302%,0.436%,and 4.756%for normal group,non-neoplastic(atrophic gastritis/intestinal metaplasia)and neoplastic lesions(low-grade/high-grade dysplasia),respectively(Ptrend<0.001).Four predictors,including male,≥60 years,smoking,and limited vegetable consumption,were selected for risk-stratification.High-risk patients(≥3 risk factors)with non-neoplastic lesions showed higher GC risks(adjusted HR=7.73,95%CI:4.29–13.92),and their four-year CIR reached the one-year CIR of neoplastic lesions.Further categorizing non-neoplastic lesions by histological grade,both patients with moderate-to-severe lesions(aHR=3.07,95%CI:1.67–5.64)and high-risk patients with mild lesions(aHR=7.29,95%CI:3.58–14.86)showed higher risks.Consistent trends were observed in validation cohort.High-risk mild-precursor-lesion patients should receive surveillance within 3–5 years after baseline screening.Our study provides evidence on supplementing current guideline recommendations.展开更多
Background:Existing hepatocellular carcinoma(HCC)prediction models lack transferability and generalizability when applied to female populations,resulting in diminished performance and inadequate tools for accurate HCC...Background:Existing hepatocellular carcinoma(HCC)prediction models lack transferability and generalizability when applied to female populations,resulting in diminished performance and inadequate tools for accurate HCC risk stratification among females.This study aims to develop and validate a score-based prediction model for early detection of HCC in female hepatitis B surface antigen(HBsAg)carriers.Methods:Participants were recruited from a multicenter prospective cohort engaged in liver cancer screening across China including seven high-risk rural areas and one additional high-risk rural area.The study involved 7080 females as the derivation cohort and 2069 as the validation cohort,with all participants aged 35-70 years and HBsAg positive.Laboratory tests and epidemiological surveys were conducted.Key predictor variables were identified through LASSO regression analysis,and score-based prediction models were developed based on Cox proportional hazards model.Model performance including discrimination and calibration was evaluated,and compared to existing prediction models and screening strategies.Results:After a median follow-up of 3.69 and 5.42 years,147 and 45 HCC cases were identified in the derivation and validation cohorts,respectively.The female HCC(HCCF)model incorporating five independent variables:age,α-fetoprotein(AFP),albumin,alanine aminotransferase,and platelet,showed excellent performance with an area under the receiver operating characteristic curve(AUC)of 0.82(95%CI:0.78-0.86).The HCCF-Enhanced model which included cirrhosis,achieved an AUC of 0.85(95%CI:0.81-0.89).Both models demonstrated superior predictive performance than existing models,with strong predictive accuracy in the validation cohort:AUCs of 0.83(95%CI:0.77-0.89)and 0.88(95%CI:0.83-0.92),respectively.The HCCF model,at a score threshold of 7,achieved the largest Youden’s index and identified 32.80%of high-risk individuals.When combined with ultrasonography(US),the model detected 37 additional cases,significantly improved screening sensitivity and accuracy compared to the traditional AFP plus US strategy.Conclusions:The developed HCCF models with good performance for HCC prediction in HBsAg-positive females significantly improve screening efficiency and provide an effective tool for surveillance,ultimately helping to optimize prevention and management strategies for HCC.展开更多
基金supported by grants from the Sanming Project of Medicine in Shenzhen(Grant No.SZSM201911015).
文摘Cancer has become the most common cause of death in China.Owing to rapid economic development,improved livelihood,and shifts in risk factors,cancer epidemiology has experienced substantial changes during the past several decades.In this review,we aim to describe the current cancer epidemiology of the main types of cancer in China,report major risk factors associated with cancer development,and summarize the contributions of the Chinese government to controlling the cancer burden.A total of 4,064,000 new cases were diagnosed in China in 2016.The most frequent types are lung cancer(828,100;20.4%),colorectal cancer(408,000;10.0%),and gastric cancer(396,500;9.8%).Lung(657,000;27.2%),liver(336,400,13.9%),and stomach(288,500;12.0%)cancers are the 3 most deadly cancers in the general population.The 5-year survival rate for cancer has dramatically increased in recent decades.However,liver and particularly pancreatic cancers still have the poorest prognosis.The main modifiable risk factors associated with cancer development include infectious agents,smoking,alcohol consumption,obesity,unhealthful dietary habits,and inadequate physical activity.The Chinese government has made unremitting efforts to decrease the cancer burden,including cancer education and investment in cancer screening programs.
基金supported by the National Natural Science Foundation of China(No.81974492)the National Natural Science Foundation of China(No.82273721)the Sanming project of Medicine in Shenzhen(No.SZSM201911015).
文摘In 2020, stomach cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. Due to the relatively huge population base and the poor survival rate, stomach cancer is still a threat in China, and accounts for nearly half of the cases worldwide. Fortunately, in China, the incidence and mortality rates of stomach cancer presented a declining trend owing to the change of individual life styles and the persistent efforts to prevent stomach cancer from the governments at all levels. Helicobacter pylori(H. pylori)infection, poor eating habits, smoking, history of gastrointestinal disorders, and family history of stomach cancer are the main risk factors for stomach cancer in China. As a result, by taking risk factors for stomach cancer into account, specific preventive measures, such as eradicating H. pylori and implementing stomach cancer screening projects, should be taken to better prevent and decrease the burden of stomach cancer.
基金supported by the National Natural Science Foundation of China(No.81974492)the National Natural Science Foundation of China(No.82273721)the Sanming project of Medicine in Shenzhen(No.SZSM201911015)。
文摘In this review,we offer a concise overview of liver cancer epidemiology in China and worldwide from the official databases of GLOBOCAN 2020 and the National Cancer Registry in China.We also summarized the evidence for the main risk factors associated with liver cancer risk and discuss strategies implemented in China to control the liver cancer burden.Overall,liver cancer was the sixth most commonly diagnosed cancer and the third leading cause of cancer-related death worldwide in 2020.Although China contributed to nearly half of cases across the world alone,the incidence and mortality rates of liver cancer presented a declining trend owing to the persistent efforts from the governments at all levels.The current liver cancer burden in China still faces an arduous challenge due to the relatively large population base as well as the substantially low survival rate(12.1%).To better control the liver cancer burden with the lowest cost,specific measures should be conducted by reducing exposure to established risk factors such as hepatitis B infection and aflatoxin.The promotion of surveillance is also an important method to prolong the survival of liver cancer.This review will provide basic information for future direction on the control of liver cancer burden.
基金funded by the National Natural Science Foundation of China(Grant No.82273721)Capital’s Funds for Health Improvement and Research(Grant No.2024-1G-4023)。
文摘Objective:This study aimed to provide a comprehensive overview of the global burden of esophageal cancer(EC)and determine the temporal trends and factors influencing changes in the global burden.Methods:The latest incidence and mortality data for EC worldwide were obtained from GLOBALCAN 2022.The mortality and disability-adjusted life years(DALYs)rates for EC from 1990±2019 were sourced from the 2019 Global Burden of Diseases.Trends in EC mortality and DALYs attributable to 11 risk factors or clusters of risk were analyzed using the joinpoint regression model.The trends in age-related EC burden were assessed using a decomposition approach.Results:An estimated 511,054 new cases of EC were diagnosed in 2022 with 445,391 deaths worldwide.Approximately 75%of cases and deaths occurred in Asia.Nearly 50%of global EC deaths and DALYs were attributed to tobacco use in men in 2019,while 20%were attributed to high body mass index(BMI)in women.From 1990±2019,EC deaths and DALYs attributable to almost all risk factors had declining trends,while EC deaths and DALYs attributed to high BMI in men had upward trends.The age-related EC burden exhibited an upward trend driven by population growth and aging,which contributed to 307.4 thousand deaths and 7.2 million DALYs due to EC.Conclusions:The EC burden remains substantial worldwide.Effective tobacco and obesity control measures are critical for addressing the risk-attributable burden of EC.Population growth and aging pose challenges for EC prevention and control efforts.
基金Sanming Project of Medicine in Shenzhen(No.SZSM201911015)。
文摘Objective:China and the United States(the U.S.)have the heaviest colorectal cancer(CRC)burden with considerable variations in temporal trends.This study aims to analyze the temporal patterns of CRC burden and its risk factors in China and the U.S.across the past three decades.Methods:Data were extracted from the Global Burden of Disease(GBD)Study in 2019,including cases,deaths,disability-adjusted life-years(DALYs),age-standardized rate(ASR),and summary exposure value(SEV)of CRC in China and the U.S.between 1990 and 2019.Annual average percentage changes(AAPCs)of CRC burden were calculated using the Joinpoint regression model.The mortality in CRC attributable to potential risk factors was characterized by countries,gender,and age groups.Results:In 2019,there were 607,900 and 227,241 CRC cases,and 261,777 and 84,026 CRC deaths in China and the U.S.,respectively.The age-standardized incidence rate(ASIR)was 30.55 per 100,000 in China and 41.86 per100,000 in the U.S.,and the age-standardized mortality rate(ASMR)was 13.86 per 100,000 in China and 14.77 per100,000 in the U.S.CRC incidence,mortality,and DALY rate in the U.S.showed downward trends in the past three decades(AAPC=-0.47,-1.06,and-0.88,respectively),while upward trends were observed in China(AAPC=3.11,1.05,and 0.91,respectively).Among the cause of CRC,the leading risk factor contributing to CRC death was low milk in China and smoking in the U.S.,respectively.Conclusions:From 1990 to 2019,the burden of CRC in China increased dramatically,particularly for males and middle-aged and elderly people.The management of the major risk factors associated with the high burden of CRC should be enhanced.
基金supported by the National Key R&D Program of China(No.2017YFC0907900,No.2017YFC0907901,No.2017YFC1308700 and No.2017YFC1308705)National Natural Science Foundation of China(No.81773521)。
文摘Objective:Population-level economic burden is essential for prioritizing healthcare resources and healthcare budget making in the future.However,little is known about the economic burden of lung cancer in China.Methods:A prevalence-based approach was adopted to estimate the economic burden of lung cancer,including direct expenditure(medical and non-medical)and indirect cost(disability and premature death).Data on direct expenditure and work-loss days per patient in each year post-diagnosis were obtained from two primary surveys.Other parameters were obtained from literatures and official reports.Projections were conducted based on varying parameters.All expenditure data were reported in United States dollars(USD)using 2017 value(exchange rate:1 USD=6.760 CNY),with the discount rate of 3%.Results:The total economic burden of lung cancer was estimated to be 25,069 million USD in China in 2017(0.121%of gross domestic productivity,GDP).The estimated direct expenditure was 11,098 million USD,up to1.43%of total healthcare expenditure for China,covering 10,303 million USD and 795 million USD for medical and non-medical expenditure,respectively.The estimated indirect cost was 13,971 million,including 1,517 million USD due to disability and 12,454 million USD due to premature death.Under current assumptions,the projected total economic burden would increase to 30.1 billion USD,40.4 billion USD,and 53.4 billion USD in 2020,2025,and 2030,accounting for 0.121%,0.131%,and 0.146%of China's GDP,respectively.However,if China meets the United Nation sustainable development goal of reducing premature death from non-communicable diseases by one-third by 2030,the total economic burden in 2030 would be 31.9 billion USD,0.087%of China's GDP.Conclusions:The economic burden of lung cancer in China in 2017 is substantial and more likely to increase significantly in the future.Policy makers need to take urgent actions in budget making for health systems.The economic burden could be alleviated by reducing the disease burden of lung cancer via effective control and prevention actions.
基金funded by the Jing-jin-ji Special Projects for Basic Research Cooperation (No. J200017)the Sanming Project of the Medicine in Shenzhen (No. SZSM2019 11015)the National Natural Science Foundation of China (No. 82273721)。
文摘Objective: This study aims to provide an analysis of the current status and trends of lung cancer incidence and mortality rates in China, comparing trends with those in the United States(U.S.).Methods: Data on lung cancer incidence and mortality rates spanning 2000 to 2018 were extracted from the China Cancer Registry Annual Report and the Surveillance, Epidemiology, and End Results database for China and the U.S., respectively. Crude incidence and mortality rates were calculated by sex and age, with age-standardized incidence rates(ASIR) and mortality rates(ASMR) calculated using the Segi-Doll world standard population.Trend analyses employed Joinpoint regression models to determine average annual percentage change(AAPC).The study also assessed the proportion of new cases and deaths by sex and age.Results: In 2018, the ASIR of lung cancer for males in China was 50.72 per 100,000 and the ASMR was 39.69 per 100,000, the ASIR for females was 26.25 per 100,000 and the ASMR was 15.24 per 100,000. Both ASIR and ASMR were higher in males and the highest in the population aged 65 years and older, with the lowest among those aged 20-49 years. In China, female ASIR demonstrated an increasing trend(AAPC: 1.16%), while ASMR decreased in both sexes(AAPCs:-0.48% for males,-1.00% for females). The U.S. exhibited decreasing trends in both ASIR and ASMR across sexes and age groups.Conclusions: The study identified an increasing trend in lung cancer incidence among females and a decreasing mortality trend in both sexes in China. These trends are likely linked to factors such as smoking prevalence,advancements in cancer screening, and improved medical care. The findings underscore the need for tailored lung cancer prevention measures in China, particularly the reinforcement of anti-smoking policies.
基金funded by the National Natural Science Foundation of China (Grant No. 82273721)the National Natural Science Foundation of China (Grant No. 81974492)+1 种基金the Capital’s Funds for Health Improvement and Research Conflict of interest statement (Grant No. 2024-1G-4023)CAMS Innovation Fund for Medical Sciences (CIFMS)(Grant No. 2021-I2M-C&T-B-049)。
文摘Objective: The burden of gastric cancer(GC) across different age groups needs updating. We determined the GC global, regional, and national burden profiles and changes in incidence for 3 sequential 5-year intervals from 2003 to 2017.Methods: The latest incidence and mortality estimates of GC from 185 countries and regions were extracted from the GLOBOCAN 2022 database. The 5-year interval age-standardised incidence rates(ASIRs) were evaluated using cancer registry data from volumes X±XII of the Cancer Incidence in Five Continents(CI5). Correlation analysis was used to evaluate the relationship between ASIR or the age-standardised mortality rate(ASMR) and the Human Development Index(HDI).Results: There was an estimated global 968,000 new GC cases and 660,000 deaths in 2022, with male predominance. GC ASIRs and ASMRs were 9.2 and 6.1 per 100,000 persons, respectively. East Asia had the highest burden, with 53.8% of cases and 48.2% of deaths among all geographic regions. There was a significant correlation between ASIR and HDI. Over three 5-year intervals from 2003 to 2017, the incidence of GC notably decreased in most countries but peaked at 2008±2012 in New Zealand, Turkey, and South Africa. Several countries in Europe, Oceania, and America suggest an increasingly concerning trend among younger individuals, especially females.Conclusions: GC is a significant health issue, especially among males and in geographic regions with an HDI, such as eastern Asia. While the incidence of GC is decreasing in many countries due to prevention efforts and improved treatments, a rising trend persists among younger individuals. Comprehensive prevention strategies tailored to different age patterns are clearly needed.
基金supported by the Capital’s Funds for Health Improvement and Research (Grant No. 2024-1G-4023)。
文摘Objective: Liver cancer is a major health concern globally and in China. This analysis investigated deaths and disability-adjusted life years(DALYs) with respect to etiologies and risk factors for liver cancer in China and worldwide.Methods: Global and China-specific data were collected on liver cancer deaths, DALYs, and age-standardized rates(ASRs) from the Global Burden of Disease Study 2019 database. Liver cancer etiologies were classified into five groups and risk factors were categorized into three levels. Each proportion of liver cancer burden was calculated in different geographic regions. The joinpoint regression model were used to assess the trends from 1990±2019.Results: Liver cancer accounted for 484,577 deaths worldwide in 2019 with an ASR of 5.9 per 100,000 population. China had an elevated liver cancer death ASR in 2019 and males had an ASR 1.7 times the global rate. The global ASR for DALYs peaked at 75±79 years of age but peaked earlier in China. Hepatitis B virus was the prominent etiology globally(39.5%) and in China(62.5%), followed by hepatitis C virus and alcohol consumption. In high sociodemographic index countries, non-alcoholic steatohepatitis has gained an increasing contribution as an etiologic factor. The liver cancer burden due to various etiologies has decreased globally in both genders. However, metabolic risk factors, particularly obesity, have had a growing contribution to the liver cancer burden, especially among males.Conclusions: Despite an overall decreasing trend in the liver cancer burden in China and worldwide, there has been a rising contribution from metabolic risk factors, highlighting the importance of implementing targeted prevention and control strategies that address regional and gender disparities.
基金This work was supported by the Science Challenge Project(Grant No.TZ2016005)NSAF(Grant No.U1730449)+2 种基金the National Natural Science Foundation of China(Grant Nos.11975055 and 11905015)the National Key Program for S&T Research andDevelopment in China(GrantNo.2016YFA0401100)The PIC simulations were performed on the Tianhe-2 supercomputer(China).
文摘Interfacial magnetic field structures induced by transverse electron-scale shear instability(mushroom instability)are found to be strongly associated with electron and ion dynamics,which in turn will influence the development of the instability itself.We find that high-frequency electron oscillations are excited normal to the shear interface.Also,on a larger time scale,the bulk of the ions are gradually separated under the influence of local magnetic fields,eventually reaching an equilibrium related to the initial shear conditions.Wepresent a theoretical model of this behavior.Such separation on the scale of the electron skin depth will prevent different ions from mixing and will thereafter restrain the growth of higher-order instabilities.We also analyze the role of electron thermal motion in the generation of the magnetic field,and we find an increase in the instability growth rate with increasing plasma temperature.These results have potential for providing a more realistic description of relativistic plasma flows.
基金supported by the National Natural Science Foundation of China(Nos.52071346,52111530193,and 52274387)the Natural Science Foundation of Hunan Province for Distinguished Young Scholars(No.2023JJ10075)+3 种基金the Hunan Provincial Natural Science Foundation of China(No.2021JJ30846)the Central South University Research Program of Advanced Interdisciplinary Studies(No.2023QYJC038)the Funding for the Medical Engineering Cross Disciplinary Project at Shanghai Jiao Tong University,and the Fundamental Research Funds for the Central Universities of Central South University(No.2022ZZTS0402)The authors would also thank Sinoma Institute of Materials Research(Guangzhou)Co.,Ltd.for the assistance with the TEM characterization.
文摘A good Ti-based joint implant should prevent stress shielding and achieve good bioactivity and anti-infection performance.To meet these requirements,the low-elastic-modulus alloy—Ti–35Nb–2Ta–3Zr—was used as the substrate,and functional coatings that contained bioceramics and Ag ions were prepared for coating on TiO_(2)nanotubes(diameter:(80±20)nm and(150±40)nm)using anodization,deposition,and spin-coating methods.The effects of the bioceramics(nano-β-tricalcium phosphate,microhydroxyapatite(micro-HA),and meso-CaSiO_(3))and Ag nanoparticles(size:(50±20)nm)on the antibacterial activity and the tribocorrosion,corrosion,and early in vitro osteogenic behaviors of the nanotubes were investigated.The tribocorrosion and corrosion results showed that the wear rate and corrosive rate were highly dependent on the features of the nanotube surface.Micro-HA showed great wear resistance with a wear rate of(1.26±0.06)×10^(−3)mm^(3)/(N·m)due to adhesive and abrasivewear.Meso-CaSiO_(3)showed enhanced cell adhesion,proliferation,and alkaline phosphatase activity.The coatings that contained nano-Ag exhibited good antibacterial activity with an antibacterial rate of≥89.5%against Escherichia coli.These findings indicate that hybrid coatings may have the potential to accelerate osteogenesis.
基金supported by the Foundation of Aerospace Center Hospital(No.YN202107)the Foundation of Aerospace Medical Health Technology Group(No.2021YK02)。
文摘With the continuous development of science and technology,artificial intelligence(AI)is coming into our lives and changing our lives.Since China entered the aging society in 2000,the degree of population aging has deepened.Comprehensive geriatric assessment(CGA)is now the accepted gold standard for the care of older people in hospitals.However,some problems limit the clinical application,such as complexity and time consuming.Therefore,by analyzing previous studies,we summarize some existing AI tools in order to find a more optimized assessment tool to complete the entire CGA process.
基金This work was funded by the Foundation(No.LJ2020030)from the Project of the Education Department of Liaoning Province,China.
文摘Oil dispersible suspension concentrates are safe,green,and environmentally friendly formulations.Problems such as layering,pasting,and bottoming are frequently encountered during the production,storage,and transportation process.Polyisobutylene succinimide functions as a dispersant and exhibits great potential to improve the physical stability of the oil dispersible suspension concentrate.From a microscopic perspective,the sorption characteristics of the polyisobutylene succinimide dispersant T151 on penoxsulam particle surfaces were comprehensively evaluated with XPS,FTIR,and SEM.The T151 adsorption procedure complied with a pseudo-second-order kinetic adsorption model,and it was a kind of physical sorption with an Ea of 22.57 kJ⋅mol^(−1).The T151 sorption model was consistent with the Langmuir isotherm.The adsorption process was spontaneous and followed by an entropy increase.TheΔH^(θ)of dispersant T151 on the surface of penoxsulam particles was 31.59 kJ⋅mol^(−1).The adsorption procedure was endothermic,and the primary force was hydrogen bonding.The XPS results showed that the F and S electronic peaks at the penoxsulam interface decreased,and that the C electronic peak increased significantly after the adsorption of dispersant T151,indicating the adsorption on the surface of penoxsulam particles.The results of this study provide a vital theoretical basis for the application of polyisobutylene succinimide dispersants in oil dispersible suspension systems.
基金supported by the Twelfth Five-Year Planning Project of the Scientific and Technological Department of China(No.2011BAI11B02)the CAMS Innovation Fund for Medical Sciences(CIFMS)(Nos.2020-I2M-C&T-B-050 and 2016-I2M-1-009).
文摘To the Editor:Contemporary guidelines recommend primary percutaneous coronary intervention(PPCI)as the gold-standard reperfusion modality in patients with ST-segment elevation myocardial infarction(STEMI)within 12 h of symptom onset.However,in realworld clinical practice,the implementation of PPCI faces substantial operational challenges,particularly in resource-limited settings,such as inadequate availability of specialized cardiac catheterization teams with requisite procedural expertise or the complete absence of coronary intervention capabilities in numerous rural healthcare facilities across China.Consequently,fibrinolytic therapy remains the predominant reperfusion strategy for STEMI management in county-level hospitals,with particularly high utilization rates observed in geographically remote regions.[3,4]Furthermore,our previous study revealed that 42.5%of STEMI patients fail to receive any form of evidence-based reperfusion therapy,representing a critical gap in optimal care delivery.To elucidate the prognostic implications of these treatment pathways within China’s unique healthcare system,this study aimed to compare the long-term outcomes among STEMI patients receiving PPCI,fibrinolysis,and no reperfusion therapy using data from the China Acute Myocardial Infarction Registry(CAMI Registry,clinicaltrials.gov,NCT01874691).
基金supported by grants from the National Natural Science Foundation of China(No.82273721)the Cooperation Project in Beijing,Tianjin,and Hebei of China(No.J200017)+1 种基金the Sanming Project of Medicine in Shenzhen(No.SZSM201911015)National Key Research&Development Program of China(No.2016YFC1302502).
文摘Family history(FH)of cancer is an established risk factor for early onset of cancer.However,reliable estimates on the difference in onset age between familial and sporadic cancers remain scarce in the Chinese population.;This multicenter,hospital-based,cross-sectional study included 23 hospitals across 12 provinces in China.Patients diagnosed with cancers of the lung,stomach,esophagus,or colorectum between January 1,2016 and December 31,2017 were identified.Detailed information on sociodemographic characteristics,lifestyle factors,stage at diagnosis,and onset age was collected.We analyzed the association between FH and onset age across different cancer types using quantile regressions.;Among 41,072 eligible patients,3054(7.44%)reported a first-degree FH of cancer,and they were diagnosed at younger ages than those without FH(median difference:-1.19,95%confidence interval[CI]:-1.59 to-0.79).Stratified by cancer type,the most pronounced difference was observed in colorectal cancer(median difference:-2.25,95%CI:-3.31 to-1.19).Failure to account for lead time bias resulted in an overestimation of the FH effect,ranging from 3.4%to 15.4%across cancer types.Quantile regression analysis revealed that the impact of FH on age at diagnosis was more pronounced at the upper tail of the age distribution for all cancers combined and for each cancer type individually.;Our findings suggest that FH of cancer is associated with the early onset of lung,stomach,esophageal,and colorectal cancers in China.Cancer screening at earlier ages is needed for individuals with an FH.
基金supported by grants from the National Natural Science Foundation of China(No.81773521)an Open Competition Grant,Health Policy and System Sciences from the China Medical Board(No.19-340)a Talent Incentive Plan sponsored by the Cancer Hospital,Chinese Academy of Medical Sciences.
文摘Background:Most studies have evaluated disability-adjusted life years(DALYs)of colorectal cancer(CRC)patients based on a set of generic disability weights(DWs).This study aimed to apply local CRC-stage-specific DWs to estimate the burden of DALYs for CRC(CRC-DALYs)in populations in China and consider the influence of local screening coverage of CRC.Methods:A prevalence-based model was constructed using data from various sources.Years lived with disability(YLDs)were estimated mainly via cumulative prevalence data(based on CRC incidence rates,population numbers,and survival rates),stage-specific proportions of CRC,and DWs of the local population.Years of life lost(YLLs)were calculated based on the CRC mortality rates and standard life expectancies.CRC incidence and mortality rates for the years 2020,2025,and 2030 were estimated by joinpoint regression,and the corresponding DALYs were predicted.The main assumption was made for CRC screening coverage.Sensitivity analyses were used to assess the impact of population,DWs,and coverage.Results:In 2017,among the Chinese population,the estimated number of CRC-DALYs was 4,303,314(11.9%for YLDs).If CRC screening coverage rate in China(2.3%)remains unchanged,the overall DALYs in 2030 are predicted to increase by 37.2%(45.1%of those aged≥65 years).More optimistically,the DALYs would then decrease by 0.7%in 2030(from 5,902,454 to 5,860,200)if the coverage could be increased to 25.0%.A sensitivity analysis revealed that using local DWs would change the base-case values by 5.7%.Conclusions:The estimated CRC-DALYs in China using population-specific DWs were considerably lower(with a higher percentage of YLDs)than the global burden of disease(GBD)estimates(5,865,004,of 4.6%for YLDs),suggesting the impact extent of applying local parameters.Sustainable scale-up CRC screening needs to be in place to moderate the growth trend of CRC-DALYs in China.
文摘To the Editor,A 26-year-old woman with congenital heart disease,postatrial septal defect repair,postarterial catheter ligation,hypoxia-associated pulmonary hypertension,and reduced right heart function,which manifested as a severe decrease in activity tolerance,chest tightness and shortness of breath,and easy fatigue of breathing,was treated with oxygen,targeting medications such as anisentan,tadalafil,remodulin,and diuretic potassium supplementation to enhance cardiac function,and then her symptoms were slightly improved compared with the previous ones.She was guided with in-hospital respiratory training to the extent that the patient could tolerate it and then was discharged from the hospital to have a home-based respiratory rehabilitation for a period of 3 months.The training plan was as follows:(i)Respiratory muscle function test:the patient's resting maximal inspiratory pressure(MIP)and maximal expiratory pressure(MEPw)ere assessed by the respiratory trainer equipment,and the respiratory muscle weakness/invulnerability was defined as a measured maximal pressure value less than 80 cmH_(2)0 according to the ERS guidelines.
基金supported by the National Natural Science Foundation of China(82273721)Special Project of Beijing-Tianjin-Hebei Basic Research Cooperation(J200017)Sanming Project of Medicine in Shenzhen(SZSM201911015).
文摘Surveillance recommendations for gastric cancer(GC)in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions.We aimed to develop a less endoscopy-related equipment-dependent risk-stratification tool,and assessed whether mild-precursor-lesion patients can be safely exempt from surveillance.In the multicenter communitybased cohort,75,051 participants receiving baseline endoscopy were enrolled during 2015–2017 and followed-up until 2021.Cumulative incidence rates(CIRs)of GC for precancerous-conditions were calculated by Kaplan-Meier method and compared by Log-rank tests.Mixedeffects Cox regression models were used to detect potential factors for progression towards GC.A risk score was calculated as counts of selected factors.An independent cohort,including 26,586 participants was used for external validation.During a median follow-up of 6.25 years,CIRs of GC were 0.302%,0.436%,and 4.756%for normal group,non-neoplastic(atrophic gastritis/intestinal metaplasia)and neoplastic lesions(low-grade/high-grade dysplasia),respectively(Ptrend<0.001).Four predictors,including male,≥60 years,smoking,and limited vegetable consumption,were selected for risk-stratification.High-risk patients(≥3 risk factors)with non-neoplastic lesions showed higher GC risks(adjusted HR=7.73,95%CI:4.29–13.92),and their four-year CIR reached the one-year CIR of neoplastic lesions.Further categorizing non-neoplastic lesions by histological grade,both patients with moderate-to-severe lesions(aHR=3.07,95%CI:1.67–5.64)and high-risk patients with mild lesions(aHR=7.29,95%CI:3.58–14.86)showed higher risks.Consistent trends were observed in validation cohort.High-risk mild-precursor-lesion patients should receive surveillance within 3–5 years after baseline screening.Our study provides evidence on supplementing current guideline recommendations.
基金supported by the Capital’s Funds for Health Improve-ment and Research(grant number:2024-1G-4023)。
文摘Background:Existing hepatocellular carcinoma(HCC)prediction models lack transferability and generalizability when applied to female populations,resulting in diminished performance and inadequate tools for accurate HCC risk stratification among females.This study aims to develop and validate a score-based prediction model for early detection of HCC in female hepatitis B surface antigen(HBsAg)carriers.Methods:Participants were recruited from a multicenter prospective cohort engaged in liver cancer screening across China including seven high-risk rural areas and one additional high-risk rural area.The study involved 7080 females as the derivation cohort and 2069 as the validation cohort,with all participants aged 35-70 years and HBsAg positive.Laboratory tests and epidemiological surveys were conducted.Key predictor variables were identified through LASSO regression analysis,and score-based prediction models were developed based on Cox proportional hazards model.Model performance including discrimination and calibration was evaluated,and compared to existing prediction models and screening strategies.Results:After a median follow-up of 3.69 and 5.42 years,147 and 45 HCC cases were identified in the derivation and validation cohorts,respectively.The female HCC(HCCF)model incorporating five independent variables:age,α-fetoprotein(AFP),albumin,alanine aminotransferase,and platelet,showed excellent performance with an area under the receiver operating characteristic curve(AUC)of 0.82(95%CI:0.78-0.86).The HCCF-Enhanced model which included cirrhosis,achieved an AUC of 0.85(95%CI:0.81-0.89).Both models demonstrated superior predictive performance than existing models,with strong predictive accuracy in the validation cohort:AUCs of 0.83(95%CI:0.77-0.89)and 0.88(95%CI:0.83-0.92),respectively.The HCCF model,at a score threshold of 7,achieved the largest Youden’s index and identified 32.80%of high-risk individuals.When combined with ultrasonography(US),the model detected 37 additional cases,significantly improved screening sensitivity and accuracy compared to the traditional AFP plus US strategy.Conclusions:The developed HCCF models with good performance for HCC prediction in HBsAg-positive females significantly improve screening efficiency and provide an effective tool for surveillance,ultimately helping to optimize prevention and management strategies for HCC.
