Application of dose-gradient function in reducing radiation induced lung injury in breast cancer radiotherapy.

OBJECTIVE: Try to create a dose gradient function (DGF) and test its effectiveness in reducing radiation induced lung injury in breast cancer radiotherapy. MATERIALS AND METHODS: Radiotherapy plans of 30 patients after breast-conserving surgery were included in the study. The dose gradient function was defined as DGH=VDVp3, then the area under the DGF curve of each plan was calculated in rectangular coordinate system, and the minimum area was used as the trigger factor, and other plans were triggered to optimize for area reduction. The dosimetric parameters of target area and organs at risk in 30 cases before and after re-optimization were compared. RESULTS: On the premise of ensuring that the target dose met the clinical requirements, the trigger factor obtained based on DGF could further reduce the V5, V10, V20, V30 and mean lung dose (MLD) of the ipsilateral lung in breast cancer radiotherapy, P < 0.01. And the D2cc and mean heart dose (MHD) of the heart were also reduced, P < 0.01. Besides, the NTCPs of the ipsilateral lung and the heart were also reduced, P < 0.01. CONCLUSION: The trigger factor obtained based on DGF is efficient in reducing radiation induced lung injury in breast cancer radiotherapy.

The long-term efficacy and safety of combining ablation and left atrial appendage closure: A systematic review and meta-analysis.

BACKGROUND: Combined ablation and left atrial appendage closure (LAAC) is an alternative for atrial fibrillation patients with a high risk of stroke. However, the long-term outcomes of this combined procedure remain elusive. METHODS: PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from the establishment of databases to 1 January 2021. Studies on the long-term (defined as a mean follow-up of approximately 12 months or longer) efficacy and safety outcomes of combined ablation and LAAC were included. RESULTS: A total of 16 studies comprising 1428 patients were enrolled. The pooled long-term freedom rate from atrial arrhythmia was 0.66 (95% confidence interval [CI]: 0.59-0.71), long-term successful rate sealing of LAAC was 1.00 (95% CI: 1.00-1.00), and ischemic stroke/transient ischemic attack/systemic embolism during follow-up was 0.01 (95% CI: 0.00-0.02). Meanwhile, of the periprocedural adverse events, phrenic nerve palsy, intracoronary air embolus, device embolization, and periprocedural death had a rate of 0.00 (95% CI: 0.00-0.00), procedure-related bleeding events of 0.03 (95% CI: 0.02-0.04), and pericardial effusion requiring or not requiring intervention of 0.00 (95% CI: 0.00-0.01). Moreover, for the long-term adverse events, device dislocation, intracranial bleeding, pericardial effusion requiring or not requiring intervention, and all-cause mortality had a rate of 0.00 (95% CI: 0.00-0.00), device embolization of 0.01 (95% CI: 0.00-0.01), and other bleeding events of 0.01 (95% CI: 0.00-0.03). CONCLUSION: This meta-analysis suggests that the combined atrial ablation and LAAC is an effective and safe strategy with long-term benefits.

Exercise mitigates age-related metabolic diseases by improving mitochondrial dysfunction.

The benefits of regular physical activity are related to delaying and reversing the onset of ageing and age-related disorders, including cardiomyopathy, neurodegenerative diseases, cancer, obesity, diabetes, and fatty liver diseases. However, the molecular mechanisms of the benefits of exercise or physical activity on ageing and age-related disorders remain poorly understood. Mitochondrial dysfunction is implicated in the pathogenesis of ageing and age-related metabolic diseases. Mitochondrial health is an important mediator of cellular function. Therefore, exercise alleviates metabolic diseases in individuals with advancing ageing and age-related diseases by the remarkable promotion of mitochondrial biogenesis and function. Exerkines are identified as signaling moieties released in response to exercise. Exerkines released by exercise have potential roles in improving mitochondrial dysfunction in response to age-related disorders. This review comprehensive summarizes the benefits of exercise in metabolic diseases, linking mitochondrial dysfunction to the onset of age-related diseases. Using relevant examples utilizing this approach, the possibility of designing therapeutic interventions based on these molecular mechanisms is addressed.

A Novel Management Platform Based on Personalized Home Care Pathways for Medicine Management and Rehabilitation of Persons With Parkinson's Disease-Requirements and Implementation Plan of the Care-PD Program.

As the percentage of the aging population increases, the incidence of Parkinson's disease (PD) in China is increasing year by year. PD is both a public health and social problem facing the government and society as a whole. Persons with PD need reasonable medication management and rehabilitation strategies after a clear diagnosis. A proper home care plan can effectively slow the progression of PD. However, people with PD lack an effective way to manage their illnesses and cannot achieve the recommended clinical path in a family environment. Medication management, condition monitoring, and rehabilitation training are important components of the home care plan for PD. Persons with PD require strategies that delay the development of the disease and to adhere to treatment, which would contribute to improving their quality of life. Thus, we developed a small program called Care-PD to build a medicine management and service platform for PD. The development of Care-PD is a multi-dimensional model designed for PD, which is funded by the National Key R&D Program of China (No. 2018YFC1314700), and includes services such as medication management, symptom monitoring, professional counseling, home life, and community communication. Care-PD can become a key technology that increases the compliance of persons with PD with home care plans and improve measures to control the disease. In this article, we describe the medication management and services for PD based on the Care-PD program and its structure. The small program will improve the adverse conditions faced by persons with PD by combining the latest technology and clinical approaches. Meanwhile, we describe a verification strategy to evaluate the effectiveness of the Care-PD program as a comprehensive management strategy for PD.

Seventy years' achievements of international cooperation by the National Institute of Parasitic Diseases at the Chinese Center for Disease Control and Prevention.

BACKGROUND: With the promotion of national control programs on parasitic and tropical diseases in China, the National Institute of Parasitic Diseases (NIPD), Chinese Center for Disease Control and Prevention has gained significant experience in the global health arena through international cooperation over the last seven decades allowing a multilateral impact in the elimination of major endemic diseases. METHODS: The achievements of NIPD since 1950 has been analyzed with emphasis on the various stages that started with research and control of the endemic parasitic and other tropical diseases at the national level and progressed via international cooperation into a global presence. RESULTS: The major achievements contributed by NIPD consist of (i) improving technical capability; (ii) promoting control and elimination of parasitic and tropical diseases; (iii) participating in global health governance and cooperation; and (iv) developing a cooperation model for technical assistance and global public health development. It is expected that NIPD's experience of international cooperation will be essential for the dissemination of China's successful experience in global health governance, emergency response and development, with focus on malaria and neglected tropical diseases such as schistosomiasis, soil-borne and food-borne helminthiases and echinococcosis. CONCLUSIONS: NIPD's new tasks will not only continue to promote national control of endemic parasitic infections and disease elimination programs in China, but also play a leading role in global health and disease elimination programs in the future.

From parasitic disease control to global health: New orientation of the National Institute of Parasitic Diseases, China CDC.

As the only specialized institution for research and control of parasitic diseases at the national level in China for almost 70 years, the National Institute of Parasitic Diseases (NIPD) at the Chinese Center for Disease Control and Prevention (China CDC) has been instrumental in supporting the remarkable progress from high prevalence to transmission interruption or low endemicity of several diseases, lymphatic filariasis, malaria and schistosomiasis in particular. This has taken place through technical guidance, emergency response and scientific research as well as providing technical service, education, training, health promotion and international cooperation. With China's increasing involvement in international cooperation and the increased risk for (re)emerging tropical diseases in mind, the Chinese Government designated in 2017 a new Chinese Center for Tropical Disease Research to NIPD. Responding to the expanded responsibilities, the institute is scaling up its activities in several ways: from parasitic diseases to the wider area of tropical diseases; from disease control to disease elimination; from biological research to policy evidences accumulation; and from public health to global health. Based on this new vision and China's previous accomplishments in the areas mentioned, the institute is in a position to move forward with respect to global health and equitable development according to the central principles of the United Nations' Sustainable Development Goals.

Management of corrosive esophageal burns in 149 cases.

OBJECTIVES: We sought to present our experience in the management of esophageal burns. METHODS: From April 1976 through October 2003, 149 patients with corrosive esophageal burns were included in this study. Treatment modalities consisted of modified intraluminal stenting in 28, colon interposition in 71, gastric transposition in 25, repair of cervical stricture with platysma myocutaneous flap in 17, and miscellaneous operations in 12 patients. Eleven of these patients underwent the above procedures twice at our institute. The remaining 7 patients were treated with conservative therapy. RESULTS: Twenty-three patients recovered from intraluminal stenting, and 5 experienced stricture after stent removal. One of the 5 patients with failed stents responded to bougienage, and the remaining 4 patients required esophageal reconstruction later. Of the 71 colon interpositions, 5 patients died postoperatively, and complications consisted of proximal anastomotic fistula in 17, anastomotic stenosis in 6, and abdominal incision dehiscence in 2 patients. Postoperative complications in the 25 patients with gastric transpositions comprised anastomotic stricture in 2 patients and empyema in 1 patient. There was a cervical leak in 1 of the 17 patients undergoing the repair of cervical esophageal or anastomotic stricture with a platysma myocutaneous flap. One of the patients in the group undergoing 12 miscellaneous procedures died 8 months after surgical intervention. All the survivors currently eat regular diets. CONCLUSIONS: Intraluminal stenting can prevent the formation of caustic esophageal stricture. The location of the cicatricial esophagus dictates whether to perform concomitant esophagectomy during esophageal reconstruction. Platysma myocutaneous flap repair is an excellent method for the treatment of severe cervical esophageal or anastomotic stricture.

[Study on the protective effect of green tea on gastric, liver and esophageal cancers].

OBJECTIVE: To assess the protective effect of drinking green tea on the development of gastric, liver and esophageal cancers. METHODS: A population based study was conducted in Taixing, Jiangsu province, including 206, 204, 218 cases, respectively, and 415 population controls. RESULTS: Green tea decreased the development of gastric cancer risk by 40%. Dose-response relationships were observed between the length of time, concentration and quantity of green tea drinking and its protective effects on gastric cancer. For individuals who drink green tea for more than 250 g per month, the risk of gastric cancer reduced about 60%. Green tea might have protective effect on liver cancer. However, no protective effect of green tea was observed on esophageal cancer. CONCLUSION: Green tea drinking might be a protective factor for gastric cancer. However, the protective effects of green tea on liver and esophageal cancer were not obvious.

[Diagnosis and surgical treatment of middle lobe disease of lung: report of 163 cases].

OBJECTIVE: To discuss the principle of diagnosis and surgical treatment of middle lobe diseases of right lung. METHODS: We analysed the clinical data and prognosis of 163 patients who suffered from middle lobe diseases of right lung and received surgical treatment. RESULTS: There were 97 men and 66 women in the group with the ratio 1.5:1, whose age arranged from 13 to 74 years. The shortest course was one week, and the longest 25 years. The average course was 30.3 months. 78 of 163 patients with tumors were malignant (47.9%) and 85 benign (52.1%). The number of the patients below 50 years old was 91 and 81.3% of them were benign, which was very markedly higher than that of the patients with malignant tumors (P < 0.01). The number of the patients above 50 years old was 72 and 84.7% were malignant, which was very markedly higher than that of the patients with benign tumors (P < 0.01); 8 of 11 patients (72.7%, 8/11) who suffered from tuberculosis combined with bronchoactesis. One of this group died from respiratory failure after operation, packed accumulation of fluid between lobes happened in seven cases (4.3%). The survival rate of 1, 3, 5 years of malignant patients at stages I, II were 88.4%, 62.8%, 51.2%, for that at stages III, IV were 76.5%, 41.2%, 14.7%. All of the four patients who received vage-resection, their malignant tumors recurred in one year after operation. No benign lesion recurred in 10 years. CONCLUSION: (1) It should be noticed that nearly half of middle lobe disease were malignant, especially to those whose ages were above 50 years old. (2) When the diagnosis is hard to be confirmed, open-thoracic exploration should be performed in order not to delay the treatment or enlarge the range of lung resection. (3) Most of middle lobe tuberculosis may be combined with bronchoactesis. (4) Setting drainage tube may be useful to decrease the risk of interlobe accumulation of fluid. (5) Vage resection is not suitable for carcinoma of middle lobe of lung.

[Determination of key interventions for the transition from control to elimination of malaria in China].

OBJECTIVE: To determine the key interventions transferring from the control to elimination of malaria in China so as to provide the basic information for achieving malaria elimination. METHODS: Based on the data collected from the document entitled of The National Annual Report on Schistosomiasis, Malaria and Echinococcosis, published by the National Institute of Parasitic Diseases of Chinese Center for Disease Control and Prevention, the malaria incidence and intervention data were selected only in the typical endemic provinces during the period of 2004-2010. The correlation between the incidence and interventions in the target provinces was analyzed based on the Panel Data Regression Model, and the key interventions were determined. RESULTS: Four provinces namely Anhui, Yunnan, Hainan and Henan were targeted with 87.56% of the national malaria figures from 2004 to 2010. When Y was given as vivax malaria incidence, X1 as the log of the number of historical cases receiving radical treatment in the pre-transmission stage (RTPT) (F = 14.53, P < 0.01, R2 = 0.72), X2 as the log of risk population receiving RTPR (F = 15.90, P < 0.01, R2 = 0.71) and X3 as the number of technicians trained in microscopy (F = 11.53, P < 0.01, R2 = 0.61), three space-fixed effect models were established respectively, and X1, X2, as well as X3 had negative effects on Y value. When Y was given as falciparum malaria incidence, X1 as the accumulated technicians trained in microscopy (F = 11.06, P < 0.01, R2 = 0.87), X2 as the log of technicians trained in entomology (F = 15.28, P < 0.01, R2 = 0.89) , two two-way (space and time) fixed effect models were established respectively, and both X1 and X2 had negative effects on Y value. CONCLUSION: RTPT among historical patients and at-risk populations as well as microscopy training influences the variation of vivax malaria incidence, while the significant interventions of microscopy training and vector control training indicate that the integrated measures with strengthened capacity in diagnosis and vector control are of importance in the control of falciparum malaria transmission.

Transition from control to elimination: impact of the 10-year global fund project on malaria control and elimination in China.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) supported a project on the control and elimination of malaria in People's Republic of China which was one of the biggest-scale international cooperation programmes to control malaria in the country during the past 10 years. The project promoted the effective implementation of the Chinese national malaria control programme. On the basis of epidemiologic data, an overview of the project activities and key performance indicators, the overall impact of the GFATM project was evaluated. We also reviewed relevant programme features including technological and management approaches, with a focus on best practice, innovations in implementation and the introduction of international standards. Last, we summarised the multi-stakeholder cooperation mechanism and comments on its sustainability in the post-GFATM period. Recommendations for the future management of the Chinese national malaria elimination programme are put forward after considering the challenges, shortcomings and lessons learnt during the implementation of the GFATM project in China to sustain past achievements and foster the attainment of the ultimate goal of malaria elimination for the country.

China-Africa cooperation initiatives in malaria control and elimination.

Malaria has affected human health globally with a significant burden of disease, and also has impeded social and economic development in the areas where it is present. In Africa, many countries have faced serious challenges in controlling malaria, in part due to major limitations in public health systems and primary health care infrastructure. Although China is a developing country, a set of control strategies and measures in different local settings have been implemented successfully by the National Malaria Control Programme over the last 60 years, with a low cost of investment. It is expected that Chinese experience may benefit malaria control in Africa. This review will address the importance and possibility of China-Africa collaboration in control of malaria in targeted African countries, as well as how to proceed toward the goal of elimination where this is technically feasible.

Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy.

BACKGROUND: Thymectomy is considered the most effective treatment in patients with myasthenia gravis. This study aimed to explore the predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy. METHODS: Clinical records of 243 patients with myasthenia gravis who underwent thymectomy were reviewed retrospectively. The following factors were analyzed in relation to the occurrence of myasthenic crisis after thymectomy: gender, age, duration of symptoms, Osserman stage, history of myasthenic crisis, concomitant diseases, preoperative pyridostigmine dose, preoperative steroid therapy, operation approach, operation time, presence of thymoma, major postoperative complications. RESULTS: Forty-four patients experienced postoperative myasthenic crisis during the first month after thymectomy. Univariate analysis revealed that Osserman stage (RR = 0.0976, P = 0.000), history of myasthenic crisis (RR = 0.2309, P = 0.012), preoperative pyridostigmine dose (RR = 0.4349, P = 0.016), thymoma (RR = 0.0606, P = 0.000), and major postoperative complications (RR = 0.1094, P = 0.000) were significantly related to postoperative myasthenic crisis. Multivariate Logistic regression analysis showed that Osserman stage (IIb + III + IV) (RR = 0.0953, P = 0.000), thymoma (RR = 0.0294, P = 0.000), and major postoperative complications (RR = 0.0424, P = 0.000) independently predict postoperative myasthenic crisis. CONCLUSION: Osserman stage (IIb + IIIb + IV), thymoma and major postoperative complications are independent predictors of postoperative myasthenic crisis in patients with myasthenia gravis who underwent thymectomy.

[Integrating technologies for urban communities' municipal solid waste minimization].

Municipal solid waste management of urban communities has difficulties of insufficient source separation and food waste's high moisture content, an integrating technology of manual separation, simple compression of food waste, reclaim of food waste and composting leachate was studied. Manual separating rate was 36.8 kg/h, and would increase when the worker became sophisticated. Community separated food waste had high organic matter content of 44.493%, nutrients N, P, K contents of 2.586%, 0.649% and 1.274%, C/N ratio of 17.427, but 0.07-0.82 times lower heavy metals contents compared to centralized separation of mixed municipal solid waste. Moisture content of food waste was still 78.7%, high enough to have negative impacts of composting processes. Composting leachate processing with biological stabilization and dilution showed a fertilizer efficiency, and dry weight of impatiens irrigated with composting leachate was 1.46-2.49 times of tap water irrigation. Integrating technology based on community's manual separation could decrease 52.6% municipal solid waste.

[Bad tourist behaviors and their environmental impacts on Xixi National Wetland Park in Hangzhou].

By the methods of site investigation, data collection and correlation analysis, the bad tourist behaviors and their environmental impacts on Xixi National Wetland Park in 2006 were studied. The occurrence probabilities of three bad tourist behaviors, i.e., picking, trampling, and littering were 6.5%, 10.3% and 12.6%, respectively. Picking probability was primarily related to the vegetation types along walkways, while the scale of heavy trampling was negatively correlated with tour distance from the entrance. Waste production by each tourist was 782 g x d(-1) on average. The waste from littering amounted for 13.6% of the total. Tourist flow fluctuations of daily, weekly, and monthly perspectives for the study area showed high seasonality and successive days of overloaded tourist flows during peak seasons, which caused an increase of bad tourist behaviors. However, the water quality in the Park was not affected because of the improvement of dredging facilities.

Initial experiences of maintaining atrioventricular intrinsic conduction during cardiac resynchronization therapy in non-responders.

BACKGROUND: Cardiac resynchronization therapy (CRT) is a major breakthrough in therapy for advanced heart failure patients; however, a number of key clinical research questions remain, perhaps most importantly the issue of why apparently suitable patients do not respond to CRT. METHODS: Seven patients, six males and one female, aged (56.43 +/- 6.13) years, all diagnosed with dilated cardiomyopathy, were included in this study. They were all non-responders to CRT who underwent routine optimization postoperatively, and received optimal drug therapy. On the basis of biventricular pacing, titrating various atrioventricular (AV) intervals were performed to get the true fusional QRS complexes composed of biventricular pacing and AV intrinsic conduction. Then, the effects of AV intrinsic conduction during CRT were evaluated. RESULTS: On the setting of AV intrinsic conduction during CRT, the true fusional QRS complexes were the narrowest, and all patients showed alleviation of symptoms, improvement of exercise tolerance, life quality and hemodynamic parameters during more than 6 months of follow-up. CONCLUSIONS: Titrating AV intervals to get the true fusional QRS complexes composed of biventricular pacing and AV intrinsic conduction will be beneficial for non-responders to CRT. Maintaining AV intrinsic conduction during CRT may decrease the rates of non-responders to CRT.

[Adaptive optimized technologies for ecological sanitation and their complex ecological benefits].

Aiming at the ecological characters of the cities in central and west China, several ecological sanitary (ecosan) technologies with different adaptability were integrated, and five adaptive optimized technologies were established. The environmental effects, resources recyclable potential, economic benefits, management difficulties, and public acceptance of each of the technologies were studied, with the possible complex eco-benefits of the technical improvement assessed. The results showed that decentralized ecosan technologies had the advantages of conserving water, recycling nutrients and saving cost, but also had the problems in management and public acceptance. Centralized ecosan technologies had the advantages in management and public acceptance, but were short in high cost and low recycling potential. If the sanitary system was improved through applying ecosan technologies, the greenhouse gases emission (CO2 equivalent) and water pollution (calculated as BOD5) could be reduced by 70% and 30%, respectively, while recycled nutrients (the sum of N, P, K) could be increased by 15 times. The optimized system could supply 3% of domestic energy, 10% of domestic water, and 15% of food demand, and the total cost could be reduced by 56% when the resource-recycling benefits were taken into account.