Publications by authors named "Kexin Sun"

49 Publications

Associations between cancer family history and esophageal cancer and precancerous lesions in high-risk areas of China.

Chin Med J (Engl) 2022 Jan 13. Epub 2022 Jan 13.

Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Background: Family clustering of esophageal cancer (EC) has been found in high-risk areas of China. However, the relationships between cancer family history and esophageal cancer and precancerous lesions (ECPL) have not been comprehensively reported in recent years. This study aimed to provide evidence for identification of high-risk populations.

Methods: This study was conducted in five high-risk areas in China from 2017 to 2019, based on the National Cohort of Esophageal Cancer. The permanent residents aged 40 to 69 years were examined by endoscopy, and pathological examination was performed for suspicious lesions. Information on demographic characteristics, environmental factors, and cancer family history was collected. Unconditional logistic regression was applied to evaluate odds ratios between family history related factors and ECPL.

Results: Among 33,008 participants, 6143 (18.61%) reported positive family history of EC. The proportion of positive family history varied significantly among high-risk areas. After adjusting for risk factors, participants with a family history of positive cancer, gastric and esophageal cancer or EC had 1.49-fold (95% confidence interval [CI]: 1.36-1.62), 1.52-fold (95% CI: 1.38-1.67), or 1.66-fold (95% CI: 1.50-1.84) higher risks of ECPL, respectively. Participants with single or multiple first-degree relatives (FDR) of positive EC history had 1.65-fold (95% CI: 1.47-1.84) or 1.93-fold (95% CI: 1.46-2.54) higher risks of ECPL. Participants with FDRs who developed EC before 35, 45, and 50 years of age had 4.05-fold (95% CI: 1.30-12.65), 2.11-fold (95% CI: 1.37-3.25), and 1.91-fold (95% CI: 1.44-2.54) higher risks of ECPL, respectively.

Conclusions: Participants with positive family history of EC had significantly higher risk of ECPL. This risk increased with the number of EC positive FDRs and EC family history of early onset. Distinctive genetic risk factors of the population in high-risk areas of China require further investigation.

Trial Registration: http://www.chictr.org.cn/, ChiCTR-EOC-17010553.
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http://dx.doi.org/10.1097/CM9.0000000000001939DOI Listing
January 2022

Prediction models for gastric cancer risk in the general population: a systematic review.

Cancer Prev Res (Phila) 2022 Jan 11. Epub 2022 Jan 11.

National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Risk prediction models for gastric cancer (GC) could identify high-risk individuals in the general population. The objective of this study was to systematically review the available evidence about the construction and verification of GC predictive models. We searched PubMed, Embase, and Cochrane Library databases for articles that developed or validated GC risk prediction models up to November 2021. Data extracted included study characteristics, predictor selection, missing data, and evaluation metrics. Risk of bias (ROB) was assessed using the Prediction model study Risk Of Bias Assessment Tool (PROBAST). We identified a total of 12 original risk prediction models that fulfilled the criteria for analysis. The area under the receiver operating characteristic curve ranged from 0.73 to 0.93 in derivation sets (n=6), 0.68 to 0.90 in internal validation sets (n=5), 0.71 to 0.92 in external validation sets (n=7). The higher-performing models usually include age, salt preference, Helicobacter pylori, smoking, BMI, family history, pepsinogen and sex. According to PROBAST, at least one domain with a high ROB was present in all studies mainly due to methodologic limitations in the analysis domain. In conclusion, although some risk prediction models including similar predictors have displayed sufficient discriminative abilities, many have a high ROB due to methodological limitations and are not externally validated efficiently. Future prediction models should adherence to well-established standards and guidelines to benefit GC screening.
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http://dx.doi.org/10.1158/1940-6207.CAPR-21-0426DOI Listing
January 2022

Cadherin-11 promotes the mechanical strength of engineered elastic cartilage by enhancing extracellular matrix synthesis and microstructure.

J Tissue Eng Regen Med 2021 Nov 26. Epub 2021 Nov 26.

Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

Limitations of current treatments for auricular cartilage defects have prompted the field of auricular cartilage tissue engineering. To date, inducing the formation of cartilaginous constructs with biochemical and biomechanical properties of native tissue is the final aim. Through hematoxylin-eosin and immunohistochemistry staining, Cadherin-11(CDH11) was confirmed highly expressed in the auricular cartilage tissue and chondrocytes. In vitro, by knockdown and overexpression of CDH11 in chondrocytes, CDH11 was demonstrated to promote the expression of collagen type II (COL2A), elastin (ELN), aggrecan (ACAN), and cartilage oligomeric matrix protein (COMP). In addition, the CDH11 overexpressed chondrocytes promoted neo-cartilage formation and its biomechanical property by increasing the key transcription factor of chondrogenesis SOX9 expression and cartilage extracellular matrix (ECM) production. The young's modulus and yield stress of the neo-cartilage in CDH11 overexpression group were about 1.7 times (p = 0.0152) and 2 times (p = 0.0428) higher than those in control group, respectively. Then, the immunohistochemistry staining, qRT-PCR and western blot examination results showed that the expression of COL2A and ELN were significantly increased. Notably, the electron microscopy results showed that the collagen and elastic fibers of the neo-cartilage in CDH11-OV group arranged in bunches and were more uniform and compact compared to the control group. Furthermore, CDH11 promoted elastic fiber assembly by increasing lysyl oxidase (LOX), fibrillin-1 (FBN1) expression. Taken together, our results demonstrated that CDH11 improves the mechanical strength of tissue-engineered elastic cartilage by promoting ECM synthesis and elastic fiber assembly.
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http://dx.doi.org/10.1002/term.3271DOI Listing
November 2021

A new method based on guanine rich aptamer structural change for carcinoembryonic antigen detection.

Talanta 2022 Jan 9;236:122867. Epub 2021 Sep 9.

Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address:

Carcinoembryonic antigen (CEA) is one of the most widely used tumor marker around the world, it mainly used for gastrointestinal cancers, especially in colorectal malignancy. At present, the detection methods of CEA are mostly based on antigen-antibody binding, whereas these methods were limited by the high costs and long waiting times in massive population tumor screening. During the experiments, we interestingly found that the fluorescence signal would be dramatically altered when the secondary structure of fluorescent modified guanine-rich DNA changed. Then we explored the reasons and established a new method for CEA detection, this method brings a simple, fast and cheap sensing platform for detection of biomarkers. It has great potential in screening of tumors among the group and is expected to provide prospective effects for tumor treatment.
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http://dx.doi.org/10.1016/j.talanta.2021.122867DOI Listing
January 2022

Monoaminergic Multilocus Genetic Variants Interact with Stressful Life Events in Predicting Changes in Adolescent Anxiety Symptoms: A One-year Longitudinal Study.

J Youth Adolesc 2021 Nov 13;50(11):2194-2207. Epub 2021 Sep 13.

Student Counseling Center, Shandong Medical Technician College, Tai'an, China.

Research suggests that genetic variants linked to monoaminergic neurotransmitter function moderate the association between stress and anxiety symptoms, but examining gene-environment (G × E) interactions with individual genes limits power. As one of polygenetic approaches, the multilocus genetic profile score is derived theoretically from combining the effects of multiple candidate genes based on the "biological plausibility". Using this approach, the current study examined the interaction between monoaminergic multilocus genetic variants and stressful life events on the changes in adolescent anxiety symptoms across a one-year timespan. In a Chinese Han adolescent sample which was derived from three vocational high schools (N = 587; T1: M = 16.47 ± 1.53 years; 50.8%, girls), the monoaminergic multilocus genetic profile score was calculated using 5-HTR2C rs6318, TPH2 rs4570625 and DRD2 rs1800497 polymorphisms. Results showed that this monoaminergic multilocus genetic profile score interacted with stressful life events in predicting changes in anxiety symptoms. Consistent with the G×E hypothesis of differential susceptibility, adolescents with more monoaminergic plasticity alleles not only suffered more from high levels of stressful life events, which increased the risk for anxiety symptoms, but also benefited more from low levels of stressful life events, which decreased the risk for anxiety symptoms. There were no significant G × E interactions when individual polymorphisms were examined in isolation. The results highlight the importance of examining aggregated influences of multiple genes in G × E interactions underlying the longitudinal development of adolescent anxiety symptoms.
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http://dx.doi.org/10.1007/s10964-021-01496-yDOI Listing
November 2021

Global patterns of breast cancer incidence and mortality: A population-based cancer registry data analysis from 2000 to 2020.

Cancer Commun (Lond) 2021 11 16;41(11):1183-1194. Epub 2021 Aug 16.

Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China.

Background: Breast cancer is the most commonly diagnosed cancer and leading cause of cancer death among women worldwide but has patterns and trends which vary in different countries. This study aimed to evaluate the global patterns of breast cancer incidence and mortality and analyze its temporal trends for breast cancer prevention and control.

Methods: Breast cancer incidence and mortality data in 2020 were obtained from the GLOBOCAN online database. Continued data from the Cancer Incidence in Five Continents Time Trends, the International Agency for Research on cancer mortality and China National Central Cancer Registry were used to analyze the time trends from 2000 to 2015 through Joinpoint regression, and annual average percent changes of breast cancer incidence and mortality were calculated. Association between Human Development Index and breast cancer incidence and mortality were estimated by linear regression.

Results: There were approximately 2.3 million new breast cancer cases and 685,000 breast cancer deaths worldwide in 2020. Its incidence and mortality varied among countries, with the age-standardized incidence ranging from the highest of 112.3 per 100,000 population in Belgium to the lowest of 35.8 per 100,000 population in Iran, and the age-standardized mortality from the highest of 41.0 per 100,000 population in Fiji to the lowest of 6.4 per 100,000 population in South Korea. The peak age of breast cancer in some Asian and African countries were over 10 years earlier than in European or American countries. As for the trends of breast cancer, the age-standardized incidence rates significantly increased in China and South Korea but decreased in the United States of America (USA) during 2000-2012. Meanwhile, the age-standardized mortality rates significantly increased in China and South Korea but decreased in the United Kingdom, the USA, and Australia during 2000 and 2015.

Conclusions: The global burden of breast cancer is rising fast and varies greatly among countries. The incidence and mortality rates of breast cancer increased rapidly in China and South Korea but decreased in the USA. Increased health awareness, effective prevention strategies, and improved access to medical treatment are extremely important to curb the snowballing breast cancer burden, especially in the most affected countries.
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http://dx.doi.org/10.1002/cac2.12207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8626596PMC
November 2021

Sorption of organochlorine pesticides on polyethylene microplastics in soil suspension.

Ecotoxicol Environ Saf 2021 Oct 5;223:112591. Epub 2021 Aug 5.

Department of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China. Electronic address:

As a new type of environmental pollutant, microplastics (MPs) can adsorb residual organochlorine pesticides (OCPs) in the soil and pose a severe threat to the soil ecosystems. To understand the interaction between soil MPs and OCPs, the sorption of two kinds of OCPs, including hexachlorocyclohexanes (HCHs) and dichlorodiphenyltrichloroethanes (DDTs), on polyethylene (PE) microplastics in soil suspension was studied through sorption kinetics and isotherm models. The effects of solution/soil ratio and MPs diameter on sorption were examined. The kinetic experiment results show that the sorption equilibrium was 12 h, and the sorption process of OCPs on MPs can be well described by a pseudo-second-order model. The Freundlich model (R = 0.942-0.997) provides a better fit to the sorption isotherm data than the Langmuir model (R = 0.062-0.634), indicating that the sorption process takes place on the nonuniform surface of MPs. The MPs had a good sorption effect on OCPs when the solution/soil ratio was from 75:1 to 100:1. As the diameter of MPs increases, the sorption capacity decreases. These results provide support for further research on microplastic pollution in soil.
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http://dx.doi.org/10.1016/j.ecoenv.2021.112591DOI Listing
October 2021

Label-free imaging for quality control of cardiomyocyte differentiation.

Nat Commun 2021 07 28;12(1):4580. Epub 2021 Jul 28.

Morgridge Institute for Research, Madison, WI, USA.

Human pluripotent stem cell (hPSC)-derived cardiomyocytes provide a promising regenerative cell therapy for cardiovascular patients and an important model system to accelerate drug discovery. However, cost-effective and time-efficient platforms must be developed to evaluate the quality of hPSC-derived cardiomyocytes during biomanufacturing. Here, we develop a non-invasive label-free live cell imaging platform to predict the efficiency of hPSC differentiation into cardiomyocytes. Autofluorescence imaging of metabolic co-enzymes is performed under varying differentiation conditions (cell density, concentration of Wnt signaling activator) across five hPSC lines. Live cell autofluorescence imaging and multivariate classification models provide high accuracy to separate low (< 50%) and high (≥ 50%) differentiation efficiency groups (quantified by cTnT expression on day 12) within 1 day after initiating differentiation (area under the receiver operating characteristic curve, 0.91). This non-invasive and label-free method could be used to avoid batch-to-batch and line-to-line variability in cell manufacturing from hPSCs.
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http://dx.doi.org/10.1038/s41467-021-24868-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319125PMC
July 2021

The establishment of an immunosensor for the detection of SPOP.

Sci Rep 2021 06 15;11(1):12571. Epub 2021 Jun 15.

Institute of Life Science, Chongqing Medical University, 1 Yi Xue Yuan Road, Chongqing, 400016, People's Republic of China.

In this paper, we first synthesis three-dimensional jasmine-like [email protected] acid(L-ASP) inorganic-organic hybrid nanoflowers to load palladium-platinum nanoparticles (Pd-Pt NPs) as the signal enhancer in order to quantify intracellular speckle-type POZ domain protein. Scanning electron microscope, fourier transform infrared, energy dispersive spectrometer, X-ray photoelectron spectroscopy analysis was used to characterize the newly synthesized materials. The newly formed [email protected]/Pd-PtNPs can catalyze the decomposition of hydrogen peroxide and exhibit excellent catalytic performance. When different concentration of speckle-type POZ domain protein is captured by speckle-type POZ domain protein antibody linked to the surface of [email protected]/Pd-Pt NPs, the current signal decreases with the increase concentration of speckle-type POZ domain protein. After optimization, the speckle-type POZ domain protein immunosensor exhibited a good linear response over a concentration range from 0.1-1 ng mL with a low detection limit of 19 fg mL. The proposed sensor demonstrates good stability within 28 days, acceptable reproducibility (RSD = 0.52%) and selectivity to the speckle-type POZ domain protein in the presence of possible interfering substances and has potential application for detecting other intracellular macromolecular substances.
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http://dx.doi.org/10.1038/s41598-021-91944-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206368PMC
June 2021

Patterns and trends of cancer incidence in children and adolescents in China, 2011-2015: A population-based cancer registry study.

Cancer Med 2021 07 2;10(13):4575-4586. Epub 2021 Jun 2.

Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Background: Cancer is a major concern for children and adolescents worldwide. This study aims to report on cancer incidence patterns at age 0-19 years in 2011-2015 and their trends in 2000-2015.

Methods: We collected data on malignancies in population of 0-19 years submitted by high-quality population-based cancer registries in China. Age-standardized rates by world standard population (WSR) and annual percent change (APC) were calculated.

Results: In total, 215 cancer registries from 30 provinces contributed datasets during 2011-2015. Twenty-two registries provided continuous data for trend analysis from 2000 to 2015. In total 16,954 malignancies occurred in 177,416,582 person-years. WSRs were 93.32 and 96.03 per million person-years in children aged 0-14 and 0-19 years. Incidence rates were higher in boys than in girls and were higher in urban area than in rural area. In children aged 0-14 years, the top three common diagnostic groups were leukemia, central nervous system (CNS) tumors, and lymphomas in both sexes. In adolescents aged 15-19 years, the top three common diagnostic groups were leukemia, epithelial tumors and melanoma, and CNS tumors in boys and epithelial tumors and melanoma, leukemia, and germ cell and gonadal tumors in girls. WSRs for cancers in 0-19 years of age increased significantly in boys from 2000 to 2005 (APC = 5.3%, 95% CI: 2.3%-8.3%) and in girls from 2000 to 2015 (APC = 1.2%, 95% CI: 0.1%-2.4%).

Conclusions: Cancer incidence in children and adolescents is on the rise in China. The observed age, sex, and geographical variations in cancer incidence should be used to inform targeted prevention and control policies.
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http://dx.doi.org/10.1002/cam4.4014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267116PMC
July 2021

Breast cancer incidence and mortality in women in China: temporal trends and projections to 2030.

Cancer Biol Med 2021 May 18. Epub 2021 May 18.

Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China.

Objective: Breast cancer was the most common cancer and the fifth cause of cancer deaths among women in China in 2015. The evaluation of the long-term incidence and mortality trends and the prediction of the future burden of breast cancer could provide valuable information for developing prevention and control strategies.

Methods: The burden of breast cancer in China in 2015 was estimated by using qualified data from 368 cancer registries from the National Central Cancer Registry. Incident cases and deaths in 22 cancer registries were used to assess the time trends from 2000 to 2015. A Bayesian age-period-cohort model was used to project the burden of breast cancer to 2030.

Results: Approximately 303,600 new cases of breast cancer (205,100 from urban areas and 98,500 from rural areas) and 70,400 breast cancer deaths (45,100 from urban areas and 24,500 from rural areas) occurred in China in 2015. Urban regions of China had the highest incidence and mortality rates. The most common histological subtype of breast cancer was invasive ductal carcinoma, followed by invasive lobular carcinoma. The age-standardized incidence and mortality rates increased by 3.3% and 1.0% per year during 2000-2015, and were projected to increase by more than 11% until 2030. Changes in risk and demographic factors between 2015 and 2030 in cases are predicted to increase by approximately 13.3% and 22.9%, whereas deaths are predicted to increase by 13.1% and 40.9%, respectively.

Conclusions: The incidence and mortality of breast cancer continue to increase in China. There are no signs that this trend will stop by 2030, particularly in rural areas. Effective breast cancer prevention strategies are therefore urgently needed in China.
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http://dx.doi.org/10.20892/j.issn.2095-3941.2020.0523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330522PMC
May 2021

Colorectal cancer burden and trends: Comparison between China and major burden countries in the world.

Chin J Cancer Res 2021 Feb;33(1):1-10

National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Objective: To summarize the colorectal cancer (CRC) burden and trend in the world, and compare the difference of CRC burden between other countries and China.

Methods: Incidence and mortality data were extracted from the GLOBOCAN2018 and Cancer Incidence in Five Continents. Age-specific incidence trend was conducted by Joinpoint analysis and average annual percent changes were calculated.

Results: About 1.85 million new cases and 0.88 million deaths were expected in 2018 worldwide, including 0.52 million (28.20%) new cases and 0.25 million (28.11%) deaths in China. Hungary had the highest age-standardized incidence and mortality rates in the world, while for China, the incidence and mortality rates were only half of that. CRC incidence and mortality were highly correlated with human development index (HDI). Unlike the rapid increase in Republic of Korea and the downward trend in Canada and Australia, the age-standardized incidence rates by world standard population in China and Norway were rising gradually. The age-specific incidence rate in the age group of 50-59 years in China was increasing rapidly, while in Republic of Korea and Canada, the fastest growing age group was 30-39 years.

Conclusions: The variations of CRC burden reflect the difference of risk factors, as well as levels of HDI and screening (early detection activities). The burden of CRC in China is high, and the incidence of CRC continues to increase, which may lead to a sustained increase in the burden of CRC in China in the future. Screening should be expanded to control CRC, and focused on young people in China.
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http://dx.doi.org/10.21147/j.issn.1000-9604.2021.01.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941684PMC
February 2021

Preparation and Characterization of Tacrolimus-Loaded SLNs in situ Gel for Ocular Drug Delivery for the Treatment of Immune Conjunctivitis.

Authors:
Kexin Sun Ke Hu

Drug Des Devel Ther 2021 12;15:141-150. Epub 2021 Jan 12.

Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, People's Republic of China.

Background: The aim of this study is to develop a novel in situ gel of tacrolimus-loaded SLNs (solid lipid nanoparticles) for ocular drug delivery.

Methods: The optimal formulation was characterized by surface morphology, particle size, zeta potential, entrapment efficiency, drug loading and in vitro release behavior. In vivo studies were also conducted to evaluate the pharmacokinetic and pharmacodynamic results.

Results: In this study, TAC-SLNs ISG were prepared using homogenization followed by probe sonication method. The average particle size of TAC-SLNs ISG was observed to be 122.3±4.3 nm. Compared with TAC-SLNs, in situ gel did not increase particle size, and there was no significant difference between them. The results of viscosity measurement showed that TAC SLNs-ISG were typical of pseudo plastic systems and showed a marked increase in viscosity as temperature increased and ultimately formed a rigid gel (32°C). In vitro and in vivo studies illustrated the sustained release model of the drug from TAC-SLNs ISG. Animal model showed that TAC-SLNs ISG had good pharmacodynamics when compared with eye drops and SLNs.

Conclusion: Our results demonstrated that TAC SLNs-ISG had the potential for being an ideal ocular drug delivery system.
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http://dx.doi.org/10.2147/DDDT.S287721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811375PMC
September 2021

Initial results from a multi-center population-based cluster randomized trial of esophageal and gastric cancer screening in China.

BMC Gastroenterol 2020 Nov 24;20(1):398. Epub 2020 Nov 24.

Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Background: We initiated the first multi-center cluster randomized trial of endoscopic screening for esophageal cancer and gastric cancer in China. The objective of the study was to report the baseline screening findings in this trial.

Methods: We recruited a total of 345 eligible clusters from seven screening centers. In the intervention group, participants from high-risk areas were screened by endoscopy; in non-high-risk areas, high-risk individuals were identified using a questionnaire and advised for endoscopy. Lugol's iodine staining in esophagus and indigo carmine dye in stomach were performed to aid in the diagnosis of suspicious lesions. The primary outcomes of this study were the detection rate (proportion of positive cases among individuals who underwent endoscopic screening) and early detection rate (the proportion of positive cases with stage 0/I among all positive cases).

Results: A total of 149,956 eligible subjects were included. The detection rate was 0.7% in esophagus and 0.8% in stomach, respectively. Compared with non-high-risk areas, the detection rates in high-risk areas were higher, both in esophagus (0.9% vs. 0.1%) and in stomach (0.9% vs. 0.3%). The same difference was found for early-detection rate (esophagus: 92.9% vs. 53.3%; stomach: 81.5% vs. 33.3%).

Conclusions: The diagnostic yield of both esophagus and stomach were higher in high-risk areas than in non-high-risk areas, even though in non-high-risk areas, only high-risk individuals were screened. Our study may provide important clues for evaluating and improving the effectiveness of upper-endoscopic screening in China.

Trial Registration: Protocol Registration System in Chinese Clinical Trial Registry, ChiCTR-EOR-16008577. Registered 01 June 2016-Retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=14372.
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http://dx.doi.org/10.1186/s12876-020-01517-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686770PMC
November 2020

Cancer registration in China and its role in cancer prevention and control.

Lancet Oncol 2020 07;21(7):e342-e349

National Cancer Center/National Clinical Research Center for Cancer /Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address:

Cancer has become a leading cause of death in China, with an increasing burden of cancer incidence and mortality observed over the past half century. Population-based cancer registries have been operating in China for about 60 years, and, in 2018, their role has expanded to include the formulation and evaluation of national cancer control programmes and the care of patients with cancer. The purpose of this Review is to provide an overview of the key milestones in the development of cancer registration in China, the current status of registry coverage and quality, and a description of the changing cancer profile in China from 1973 to 2015. This Review is a comprehensive and updated review on the development of population-based cancer registries in China over a 60-year time span. We highlight some aspects of cancer control plans that illustrate how cancer registration data have become central to the identification of health priorities for China and provide a means to track progress in cancer control for the country.
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http://dx.doi.org/10.1016/S1470-2045(20)30073-5DOI Listing
July 2020

An Improved Real-Coded Genetic Algorithm Using the Heuristical Normal Distribution and Direction-Based Crossover.

Comput Intell Neurosci 2019 14;2019:4243853. Epub 2019 Nov 14.

College of Engineering, Northeast Agricultural University, Harbin, Heilongjiang 150030, China.

A multi-offspring improved real-coded genetic algorithm (MOIRCGA) using the heuristical normal distribution and direction-based crossover (HNDDBX) is proposed to solve constrained optimization problems. Firstly, a HNDDBX operator is proposed. It guarantees the cross-generated offsprings are located near the better individuals in the population. In this way, the HNDDBX operator ensures that there is a great chance of generating better offsprings. Secondly, as iterations increase, the same individuals are likely to appear in the population. Therefore, it is possible that the two parents of participation crossover are the same. Under these circumstances, the crossover operation does not generate new individuals, and therefore does not work. To avoid this problem, the substitution operation is added after the crossover so that there is no duplication of the same individuals in the population. This improves the computational efficiency of MOIRCGA by leading it to quickly converge to the global optimal solution. Finally, aiming at the shortcoming of a single mutation operator which cannot simultaneously take into account local search and global search, a Combinational Mutation method is proposed with both local search and global search. The experimental results with sixteen examples show that the multi-offspring improved real-coded genetic algorithm (MOIRCGA) has fast convergence speed. As an example, the optimization model of the cantilevered beam structure is formulated, and the proposed MOIRCGA is compared to the RCGA in optimizing the parameters of the cantilevered beam structure. The optimization results show that the function value obtained with the proposed MOIRCGA is superior to that of RCGA.
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http://dx.doi.org/10.1155/2019/4243853DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925694PMC
May 2020

sp. nov., an actinobacterium isolated from the rhizosphere soil of wheat ( L.).

Int J Syst Evol Microbiol 2019 Oct 29;69(10):3268-3275. Epub 2019 Jul 29.

Key Laboratory of Agricultural Microbiology of Heilongjiang Province, Northeast Agricultural University, No. 59 Mucai Street, Xiangfang District, Harbin 150030, PR China.

A Gram-stain-positive, aerobic, heterotrophic, non-spore-forming and rod-shaped strain, designated SJ-23, was isolated from rhizosphere soil of wheat ( L.) collected from Langfang, Hebei Province, central PR China and characterized using a polyphasic approach. Morphological and chemotaxonomic characteristics were consistent with those of members of the genus . The polar lipids consisted of diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylglycerol, glycolipid and three unidentified lipids. The predominant menaquinones detected were MK-12, MK-11 and MK-10. Major fatty acids were identified as anteiso-C, anteiso-C and iso-C. The 16S rRNA gene sequence analysis showed that strain SJ-23 belongs to the genus with high sequence similarities to DSM 43045 (99.2 %), subsp. DSM 8595 (98.8 %) and subsp. DSM 8596 (98.6 %). Results of phylogenetic analysis based on 16S rRNA gene sequences indicated that the strain formed a separate branch in the genus . Furthermore, the combination of DNA-DNA hybridization results and some phenotypic characteristics demonstrated that strain SJ-23 could be distinguished from its closest relatives. Therefore, it is proposed that strain SJ-23 represents a novel species of the genus , for which the name sp. nov. is proposed. The type strain is SJ-23 (=CGMCC 4.7419=DSM 105049).
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http://dx.doi.org/10.1099/ijsem.0.003621DOI Listing
October 2019

Identification of Novel Genetic Polymorphisms Associated with Type 2 Diabetes Mellitus: A Chinese Sib-Pair Study.

Genet Test Mol Biomarkers 2019 Jul;23(7):435-441

1 Department of Epidemiology and Biostatistics, School of Public Public Health, Peking University, Beijing, China.

To discover possible relationships between single nucleotide polymorphisms (SNPs) and type 2 diabetes mellitus (T2DM) and its risk factors. The present sib-pair study was conducted in a rural community of Beijing, China. SNPs rs2297630, rs1746048, and rs1801157 located within or nearby the gene were genotyped using the allele-specific polymerase chain reaction method. Haseman-Elston regression was used to investigate linkages between these SNPs and T2DM. A generalized estimating equation logistic regression model was used to discover associations between the SNPs, T2DM, and its risk factors. A total of 3171 participants were recruited, comprising 2277 sib pairs. After Bonferroni correction ( = 0.016), rs2297630 was found to be significantly linked to ( = 0.003) and associated with T2DM (AA vs. GG/GA: OR = 2.26, 95% CI: 1.31-3.88,  = 0.003). There were interactions between rs2297630 and dyslipidemia ( < 0.001) and between rs1746048 and hypertension ( = 0.011). Compared to dyslipidemia-free subjects with rs2297630 GG/GA genotypes, dyslipidemia patients with rs2297630 AA had a higher risk of T2DM (OR = 4.15, 95% CI: 2.24-7.67,  < 0.001). Compared to hypertension-free subjects with rs1746048 CC genotypes, hypertension-free subjects with rs1746048 CT/TT had a decreased risk of T2DM (OR = 0.77, 95% CI: 0.60-0.99,  = 0.045). A novel linkage and association was found between rs2297630 and T2DM. Moreover, novel interactions were found between rs2297630 and dyslipidemia as well as rs1746048 and hypertension. These findings will help identify individuals at higher risk of developing T2DM.
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http://dx.doi.org/10.1089/gtmb.2018.0149DOI Listing
July 2019

Higher TGF-β2 Level in the Aqueous Humor of the Second Eye Versus the First Eye in the Course of Sequential Cataract Surgery.

Ocul Immunol Inflamm 2020 Apr 11;28(3):439-445. Epub 2019 Apr 11.

Department of Ophthalmology, First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China.

: To assess the differences in cytokine levels in the aqueous humor (AH) of bilateral eyes receiving sequential phacoemulsification and intraocular lens implantation.: The levels of 33 cytokines in AH samples collected from separate single-eye operations of 26 age-related cataract patients who experiencing sequential cataract surgery were compared between the first-eye and second-eye groups.: The AH level of transforming growth factor beta 2 (TGF-β2), an immunosuppression regulator, in the second-eye group was significantly higher than that in the first-eye group (p = 0.002). No differences in the concentrations or detection rates of other cytokines were observed between the first- and second-eye groups.: During bilateral sequential cataract surgery, the AH of the second eye had a higher level of TGF-β2 but not of proinflammatory cytokines or chemokines compared with those in the first eye, implying a protective mechanism preventing the sympathetic immune reaction induced by the first-eye cataract surgery.
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http://dx.doi.org/10.1080/09273948.2019.1578888DOI Listing
April 2020

Oxidized ATM-mediated glycolysis enhancement in breast cancer-associated fibroblasts contributes to tumor invasion through lactate as metabolic coupling.

EBioMedicine 2019 Mar 22;41:370-383. Epub 2019 Feb 22.

Key Laboratory of Laboratory Medical Diagnostics, Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China. Electronic address:

Background: Cancer-associated fibroblasts (CAFs) are the predominant residents in the breast tumor microenvironment. In our work, we found activation of DNA damage-independent ATM (oxidized ATM), enhanced glycolysis and aberrant metabolism-associated gene expressions in breast CAFs. Nevertheless, whether and how oxidized ATM regulates the glycolytic activity of CAFs keep in unveil. Recently, a reverse Warburg effect was observed in tumor tissues, in which host cells (such as CAFs, PSCs) in the tumor microenvironment have been found to "fuel" the cancer cells via metabolites transfer. However, the molecular mechanisms of the metabolites from stromal cells playing a role to the progression of cancer cells remain to be determined.

Methods: Oxidized ATM activation in stromal CAFs was assessed by western blotting and immunofluorescence. The increased glycolytic ability of CAFs was validated by measurements of OCR and ECAR and detections of glucose consumption and lactate production. Kinase assay and western blotting were performed to confirm the phosphorylation of GLUT1. The membrane location of phosphorylated GLUT1 was determined by biotin pull-down assay and immunofluorescence staining. The regulation of PKM2 through oxidized ATM was evaluated by western blots. In addition, the impact of lactate derived from hypoxic CAFs on cancer cell invasion was investigated both in vitro (transwell assays, western blots) and in vivo (orthotopic xenografts).

Findings: Hypoxia-induced oxidized ATM promotes glycolytic activity of CAFs by phosphorylating GLUT1 at S490 and increasing PKM2 expression. Moreover, lactate derived from hypoxic CAFs, acting as a metabolic coupling between CAFs and breast cancer cells, promotes breast cancer cell invasion by activating the TGFβ1/p38 MAPK/MMP2/9 signaling axis and fueling the mitochondrial activity in cancer cells.

Interpretation: Our work shows that oxidized ATM-mediated glycolysis enhancement in hypoxic stromal fibroblasts plays an essential role in cancer cell invasion and metastasis and may implicate oxidized ATM as a target for breast tumor treatment. FUND: This research was supported by National Natural Science Foundation of China.
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http://dx.doi.org/10.1016/j.ebiom.2019.02.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442874PMC
March 2019

Liver cancer incidence and mortality in China: Temporal trends and projections to 2030.

Chin J Cancer Res 2018 Dec;30(6):571-579

Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China.

Objective: Liver cancer is one of the most common cancers and major cause of cancer deaths in China, which accounts for over 50% of new cases and deaths worldwide. The systematic liver cancer statistics including of projection through 2030 could provide valuable information for prevention and control strategies in China, and experience for other countries.

Methods: The burden of liver cancer in China in 2014 was estimated using 339 cancer registries' data selected from Chinese National Cancer Center (NCC). Incident cases of 22 cancer registries were applied for temporal trends from 2000 to 2014. The burden of liver cancer through 2030 was projected using age-period-cohort model.

Results: About 364,800 new cases of liver cancer (268,900 males and 95,900 females) occurred in China, and about 318,800 liver cancer deaths (233,500 males and 85,300 females) in 2014. Western regions of China had the highest incidence and mortality rates. Incidence and mortality rates decreased by about 2.3% and 2.6% per year during the period of 2000-2014, respectively, and would decrease by more than 44% between 2014 and 2030 in China. The young generation, particularly for those aged under 40 years, showed a faster down trend.

Conclusions: Based on the analysis, incidence and mortality rates of liver cancer are expected to decrease through 2030, but the burden of liver cancer is still serious in China, especially in rural and western areas. Most cases of liver cancer in China can be prevented through vaccination and more prevention efforts should be focused on high risk groups.
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http://dx.doi.org/10.21147/j.issn.1000-9604.2018.06.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6328503PMC
December 2018

Disparities by province, age, and sex in site-specific cancer burden attributable to 23 potentially modifiable risk factors in China: a comparative risk assessment.

Lancet Glob Health 2019 02;7(2):e257-e269

National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address:

Background: Understanding disparities in the burden of cancer attributable to different risk factors is crucial to inform and improve cancer prevention and control. In this report, we estimate the site-specific population-attributable fractions (PAFs) for 23 potentially modifiable risk factors across all provinces in China.

Methods: In this comparative risk assessment study, we used 2014 cancer mortality data for adults from 978 county-level surveillance points in 31 provinces of mainland China. Risk-factor prevalence estimates were obtained from representative surveys. We used summary relative risks obtained from several recent large-scale pooled analyses or high-quality meta-analyses of studies in China. We calculated PAFs using multiple formulae incorporating exposure prevalence and relative risk data stratified by age, sex and province and then combined to create summary PAFs by sex, cancer site, and risk factors.

Findings: About 1 036 004 cancer deaths (45·2% of all cancer deaths [95% CI 44·0-46·4]) in China in 2014 in adults aged 20 years or older were attributable to 23 evaluated risk factors. The PAF was higher in men (51·2% [95% CI 50·0-52·4]) than in women (34·9% [33·6-36·2]), with the leading risk factors being active smoking in men and low fruit intake in women. By province, the PAF in both sexes combined ranged from 35·2% in Shanghai to 52·9% in Heilongjiang, while the PAF varied from 40·9% in Shanghai to 56·4% in Guangdong among men and from 26·9% in Shanghai to 48·0% in Heilongjiang among women. The highest PAF among men was smoking in all 31 provinces, whereas among women it varied among low fruit intake (14 provinces), hepatitis B virus infection (seven provinces), smoking (six provinces), excess bodyweight (three provinces), and human papilloma virus infection (one province).

Interpretation: The PAFs of cancers attributable to potentially modifiable risk factors vary substantially across provinces in China. Regional adoption of effective primary cancer prevention strategies has a vast potential to reduce the burden of cancer and disparities in China. Smoking, poor diet, and infection warrant particular policy attention as they contributed a large proportion to the total cancer burden.

Funding: National Science and Technology Basic Research Special Foundation of China.
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http://dx.doi.org/10.1016/S2214-109X(18)30488-1DOI Listing
February 2019

ATM-Mediated Phosphorylation of Cortactin Involved in Actin Polymerization Promotes Breast Cancer Cells Migration and Invasion.

Cell Physiol Biochem 2018 14;51(6):2972-2988. Epub 2018 Dec 14.

Key Laboratory of Laboratory Medical Diagnostics, Chinese Ministry of Education, Chongqing Medical University, Chongqing,

Background/aims: The ataxia-telangiectasia mutated (ATM) protein kinase is critical for the maintenance of genomic stability and acts as tumor suppressor. Although evidence shows that a DNA damage-independent ATM (oxidized ATM) may be involved in cancer progression, the underlying mechanism is still unclear.

Methods: Immunohistochemistry, immunofluorescence and western blotting were applied to detect the levels of oxidized ATM. Transwell assay was used to detect the cell migration and invasion abilities in different treatments. Quantitative phosphoproteome analysis was performed using hypoxic BT549 cells, in the presence or absence of Ku60019, a specific inhibitor of ATM kinase. The phosphorylated cortactin, the target protein of oxidized ATM, was confirmed by immunoprecipitation-western blots and in vitro kinase assay. The functions of phosphorylated cortactin were studied by specific short hairpin RNA, site-directed mutation, transwell assay, and actin polymerization assay.

Results: Enhanced oxidized ATM proteins were present not only in the advanced and invasive breast tumor tissues but also malignant hypoxic breast cancer cells, in the absence of DNA damage. Loss of ATM expression or inhibiting oxidized ATM kinase activity reduced breast cancer cell migration and invasion. Using quantitative phosphoproteomics approach, 333 oxidized ATM target proteins were identified, some of these proteins govern key signaling associated with gap junction, focal adhesion, actin cytoskeleton rearrangement. Cortactin, one of the biggest changed phospho-protein, is a novel oxidized ATM-dependent target in response to hypoxia. Mechanically, we reveal that hypoxia-activated ATM can enhance the binding affinity of cortactin with Arp2/3 complex by phosphorylating cortactin at serine 113, and as a result, in favor of breast cancer cell migration and invasion.

Conclusion: Oxidized ATM can phosphorylate cortactin at serine 113, playing a critical role in promoting breast tumor cell mobility and invasion via actin polymerization.
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http://dx.doi.org/10.1159/000496048DOI Listing
January 2019

Cancer-associated fibroblast (CAF)-derived IL32 promotes breast cancer cell invasion and metastasis via integrin β3-p38 MAPK signalling.

Cancer Lett 2019 02 27;442:320-332. Epub 2018 Oct 27.

Key Laboratory of Laboratory Medical Diagnostics, Chinese Ministry of Education, Chongqing Medical University, Chongqing, 400016, China. Electronic address:

Metastasis is the leading cause of breast cancer-related deaths. Cancer-associated fibroblasts (CAFs), the predominant stromal cell type in the breast tumour microenvironment, may contribute to cancer progression through interaction with tumour cells. Nonetheless, little is known about the details of the underlying mechanism. Here we found that interaction of interleukin 32 (IL32) with integrin β3 (encoded by ITGB3; a member of the integrin family) mediating the cross-talk between CAFs and breast cancer cells plays a crucial role in CAF-induced breast tumour invasiveness. IL32, an 'RGD' motif-containing cytokine, was found to be abundantly expressed in CAFs. Integrin β3 turned out to be up-regulated in breast cancer cells during epithelial-mesenchymal transition (EMT). CAF-derived IL32 specifically bound to integrin β3 through the RGD motif, thus activating intracellular downstream p38 MAPK signalling in breast cancer cells. This signalling increased the expression of EMT markers (fibronectin, N-cadherin, and vimentin) and promoted tumour cell invasion. Counteracting IL32 activity, a knockdown of IL32 or integrin β3 led to specific inactivation of p38 MAPK signalling in tumour cells. Blockage of the p38 MAPK pathway also diminished IL32-induced expression of EMT markers and breast cancer cell invasion and metastasis. Thus, our data indicate that CAF-secreted IL32 promotes breast cancer cell invasion and metastasis via integrin β3-p38 MAPK signalling.
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http://dx.doi.org/10.1016/j.canlet.2018.10.015DOI Listing
February 2019

Provincial-level cancer burden attributable to active and second-hand smoking in China.

Tob Control 2019 11 15;28(6):669-675. Epub 2018 Oct 15.

National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Background: Understanding disparities in the burden of cancer attributable to smoking is crucial to inform and improve tobacco control measures. In this report, we estimate the population attributable fraction (PAF) of cancers deaths attributable to smoking at the national and provincial levels in China.

Methods: Using cancer mortality data from 978 counties, smoking data from a nationwide survey and relative risks from a prospective study of 0.5 million adults in China, we calculated the absolute (non-standardised) and standardised numbers and proportions of cancer deaths among adults 30 years and older attributable to active and second-hand smoking in 2014 across all 31 provinces in Mainland China.

Results: The estimated number of cancer deaths attributable to smoking in China in 2014 was 342 854 among men and 40 313 among women, of which second-hand smoking accounted for 1.8% and 50.0%, respectively. Among men, the absolute PAF in China was 23.8%, ranging from 14.6% in Xinjiang to 26.8% in Tianjin; the overall standardised PAF was 22.2%, ranging from 15.7% in Xinjiang to 26.0% in Guizhou. Among women, the overall absolute and standardised PAFs were 4.8% and 4.0%, ranging from 1.8% and 1.6% in Jiangxi to 14.9% and 9.6% in Heilongjiang, respectively. Overall, provinces with the highest standardised PAFs among men were located in Southwest China and among women in the Northeast.

Conclusions: Comprehensive smoke-free policies in China should expand to all provinces, notably those with a higher burden of cancer attributable to smoking, instead of being mostly limited to Beijing and some other metropolitan areas.
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http://dx.doi.org/10.1136/tobaccocontrol-2018-054583DOI Listing
November 2019

Annual cost of illness of stomach and esophageal cancer patients in urban and rural areas in China: A multi-center study.

Chin J Cancer Res 2018 Aug;30(4):439-448

National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Objective: Stomach and esophageal cancer are imposing huge threats to the health of Chinese people whereas there were few studies on the financial burden of the two cancers.

Methods: Costs per hospitalization of all patients with stomach or esophageal cancer discharged between September 2015 and August 2016 in seven cities/counties in China were collected, together with their demographic information and clinical details. Former patients in the same hospitals were sampled to collect information on annual direct non-medical cost, indirect costs and annual number of hospitalization. Annual direct medical cost was obtained by multiplying cost per hospitalization by annual number of hospitalization. Annual cost of illness (ACI) was obtained by adding the average value of annual direct medical cost, direct non-medical cost and indirect cost, stratified by sex, age, clinical stage, therapy and pathologic type in urban and rural areas. Costs per hospitalization were itemized into eight parts to calculate the proportion of each part. All costs were converted to 2016 US dollars (1 USD=6.6423 RMB).

Results: Totally 19,986 cases were included, predominately male. Mean ages of stomach cancer and urban patients were lower than that of esophageal cancer and rural patients. ACI of stomach and esophageal cancer patients were $10,449 and $13,029 in urban areas, and $2,927 and $3,504 in rural areas, respectively. Greater ACI was associated with male, non-elderly patients as well as those who were in stage I and underwent surgeries. Western medicine fee took the largest proportion of cost per hospitalization.

Conclusions: The ACI of stomach and esophageal cancer was tremendous and varied substantially among the population in China. Preferential policies of medical insurance should be designed to tackle with this burden and further reduce the health care inequalities.
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http://dx.doi.org/10.21147/j.issn.1000-9604.2018.04.07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129568PMC
August 2018

[Extra longtime continuous chest compression to rescue cardiopulmonary arrest: a case report and the literature review].

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2018 May;30(5):481-483

Department of Intensive Care Unit, General Hospital of Fushun Mining Bureau, Fushun 113008, Liaoning, China. Corresponding author: Zhang Yan, Email:

Objective: The new cardiopulmonary resuscitation (CPR) guideline emphasize the importance of chest compression, which was considered as the first step to CPR. The duration for CPR is usually limited to 30 minutes. With the development of new technology and evidence-based medicine, the success of extra longtime CPR has become possible, which is of great significance to some patients with cardiac arrest (CA), but the time limit has not been determined. On February 23rd in 2016, a 76-year-old female patient with respiratory and cardiac arrest who was on the third day after transurethral resection of bladder tumor (TUR-BT) was admitted to the intensive care unit of the General Hospital of Fushun Mining Bureau. On the basis of the comprehensive treatment measures such as ventilator support ventilation, physical cooling with ice cap, 1 mg adrenaline for intravenous injection, low molecular heparin of 5 000 U for subcutaneous injection, and the continuous chest compression were carried out in a timely and effective manner for 125 minutes, which make the patient recover to sinus rhythm and her brain function recovered well without any sequelae, and follow-up of the patient in 1 year showed well. The key to success or failure of CPR depend on the patient's condition. If the patients in healthy, single cause, a good response to the resuscitation, the pulsation of the large artery can be seen now and then during the rescue, and the recovery of the spontaneous breathing, CPR should be kept on. In the process of CPR, individualized assessment of the disease progression without the 30-minute time limit, may benefit the patients in maximum. In the future clinical practice, we should actively explore more favorable evidence, so that CA patients can be rescued more.
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http://dx.doi.org/10.3760/cma.j.issn.2095-4352.2018.05.017DOI Listing
May 2018

Comparing the Economic Burden of Type 2 Diabetes Mellitus Patients with and without Medical Insurance: A Cross-Sectional Study in China.

Med Sci Monit 2018 May 12;24:3098-3102. Epub 2018 May 12.

Medical Informatics Center, Peking University, Beijing, China (mainland).

BACKGROUND The burden of diabetes has become a worldwide public health issue. Previous studies focused on the composition and influencing factors of hospitalization costs for insured patients. The aim of this study was to compare the economic burden of diabetic patients with and without medical insurance (MI) in China, from the aspects of types of medical costs and diabetic comorbidities. MATERIAL AND METHODS We identified 124 701 patients with type 2 diabetes mellitus in 2015 from electronic Hospitalization Summary Reports. The information on demographics, comorbidities, and hospitalization costs were extracted and evaluated. Differences between groups were analyzed by Mann-Whitney U test. RESULTS The mean age of patients was 58.0±13.4 years. Hypertensive diseases (63.5%), ischemic heart diseases (21.3%), and chronic kidney disease (17.5%) were the most common comorbidities. The median hospitalization costs for diabetic patients with and without MI were 9485.0 RMB and 9104.0 RMB, respectively. The insured patients' median out-of-pocket (OOP) cost was 1601.3 RMB, and they incurred more costs for laboratory tests, imaging examinations, and medical services, and less costs for prescribed drugs (p<0.05). Insured patients had higher costs when associated with hypertensive diseases, cerebrovascular diseases, and ischemic heart diseases (p<0.05). CONCLUSIONS Diabetic patients with MI have higher hospitalization costs than those without MI, but uninsured patients carry a heavier OOP burden. The MI system in China needs further improvement to reduce the economic burden of diabetes.
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http://dx.doi.org/10.12659/MSM.907909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5973488PMC
May 2018

Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries.

Lancet Glob Health 2018 05;6(5):e555-e567

Haining Cancer Registry, Haining Institute for Cancer Prevention and Control, Zhejiang, China.

Background: From 2003 to 2005, standardised 5-year cancer survival in China was much lower than in developed countries and varied substantially by geographical area. Monitoring population-level cancer survival is crucial to the understanding of the overall effectiveness of cancer care. We therefore aimed to investigate survival statistics for people with cancer in China between 2003 and 2015.

Methods: We used population-based data from 17 cancer registries in China. Data for the study population was submitted by the end of July 31, 2016, with follow-up data on vital status obtained on Dec 31, 2015. We used anonymised, individual cancer registration records of patients (aged 0-99 years) diagnosed with primary, invasive cancers from 2003 to 2013. Patients eligible for inclusion had data for demographic characteristics, date of diagnosis, anatomical site, morphology, behaviour code, vital status, and last date of contact. We analysed 5-year relative survival by sex, age, and geographical area, for all cancers combined and 26 different cancer types, between 2003 and 2015. We stratified survival estimates by calendar period (2003-05, 2006-08, 2009-11, and 2012-15).

Findings: There were 678 842 records of patients with invasive cancer who were diagnosed between 2003 and 2013. Of these records, 659 732 (97·2%) were eligible for inclusion in the final analyses. From 2003-05 to 2012-15, age-standardised 5-year relative survival increased substantially for all cancers combined, for both male and female patients, from 30·9% (95% CI 30·6-31·2) to 40·5% (40·3-40·7). Age-standardised 5-year relative survival also increased for most cancer types, including cancers of the uterus (average change per calendar period 5·5% [95% CI 2·5-8·5]), thyroid (5·4% [3·2-7·6]), cervix (4·5% [2·9-6·2]), and bone (3·2% [2·1-4·4]). In 2012-15, age-standardised 5-year survival for all patients with cancer was higher in urban areas (46·7%, 95% CI 46·5-47·0) than in rural areas (33·6%, 33·3-33·9), except for patients with oesophageal or cervical cancer; but improvements in survival were greater for patients residing in rural areas than in urban areas. Relative survival decreased with increasing age. The increasing trends in survival were consistent with the upward trends of medical expenditure of the country during the period studied.

Interpretation: There was a marked overall increase in cancer survival from 2003 to 2015 in the population covered by these cancer registries in China, possibly reflecting advances in the quality of cancer care in these areas. The survival gap between urban and rural areas narrowed over time, although geographical differences in cancer survival remained. Insight into these trends will help prioritise areas that need increased cancer care.

Funding: National Key R&D Program of China, PUMC Youth Fund and the Fundamental Research Funds for the Central Universities, and Major State Basic Innovation Program of the Chinese Academy of Medical Sciences.
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http://dx.doi.org/10.1016/S2214-109X(18)30127-XDOI Listing
May 2018

Present and changing trends in surgical modalities and neoadjuvant chemotherapy administration for female breast cancer in Beijing, China: A 10-year (2006-2015) retrospective hospitalization summary report-based study.

Thorac Cancer 2018 06 6;9(6):707-717. Epub 2018 Apr 6.

Medical Informatics Center, Peking University Health Science Center, Beijing, China.

Background: This study was conducted to describe present and changing trends in surgical modalities and neoadjuvant chemotherapy (NACT) in female breast cancer patients in China from 2006 to 2015.

Methods: Data of 44 299 female breast cancer patients from 15 tertiary hospitals in Beijing were extracted from hospitalization summary reports. Surgeries were categorized into five modalities: breast-conserving surgery (BCS), simple mastectomy (SM), modified radical mastectomy (MRM), radical mastectomy (RM), and extensive radical mastectomy (ERM).

Results: In total, 38 471 (86.84%) breast cancer patients underwent surgery: 22.64% BCS, 8.22% SM, 63.97% MRM, 4.24% RM, and 0.93% ERM. Older patients (> 60) underwent surgery more frequently than younger patients (< 60). The proportion of patients who underwent BCS was highest in the age ≥ 80 (39.24%) and < 40 (28.69%) subgroups and in patients with papillary carcinoma (35.48%), and lowest in the age 60- subgroup (18.17%) and in patients with Paget's disease (19.05%). SM was most frequently performed in patients with Paget's disease (29.00%), and MRM for ductal (64.99%), and lobular (63.78%) carcinomas. During the study period, the proportion of patients who underwent MRM dropped by 29.04%, SM and BCS increased from 15.78% and 30.83%, respectively, and NACT increased in all subgroups, particularly in patients with lymph node involvement (26.72%).

Conclusions: Surgical modalities varied significantly by age and histologic group. The use of BCS and SM increased dramatically, while MRM declined significantly. The proportion of patients treated with NACT has increased significantly, especially in patients with lymph node involvement.
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http://dx.doi.org/10.1111/1759-7714.12636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5983198PMC
June 2018
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