Application of the 'online assessment + FOBT at home' to improve participation and the efficacy of opportunistic screening for colorectal cancer: a retrospective cohort study.

BACKGROUND: Colorectal cancer (CRC) screening faces two major challenges: insufficient screening coverage and poor adherence. A smartphone applet named "Early Screening Assistant (ESA)" was developed to create an online risk-assessment and fecal occult blood test (FOBT) at home. This retrospective study was designed to evaluate whether the new CRC screening strategy can improve the colonoscopy participation rate (PR) and lesion detection rate (DR). METHODS: In total, 6194 individuals who accepted normal health examinations and CRC screening based on the ESA from June 2020 to May 2022 were assigned to the ESA group. Accordingly, 7923 inhabitants who only accepted normal health examinations were assigned to the control group. The colonoscopy PR and neoplastic lesion DR were then compared between the two groups. RESULTS: Overall, a higher proportion of subjects in the ESA group (285 of 6194 [4.6%]) completed colonoscopy than in the control group (126 of 7923, [1.6%]), p < 0.01). The neoplastic lesion DR also significantly increased in the ESA group (76 of 6194 [1.22%]) compared with the control group (15 of 7923 [0.19%]) (p < 0.01). The adjusted diagnostic sensitivity and specificity of the "Online assessment + FOBT at home" were 41.5% and 62.6% for neoplastic lesions, respectively. CONCLUSIONS: This retrospective cohort study confirmed that the new CRC screening strategy based on the "Online assessment + FOBT at home" can improve colonoscopy participation and the neoplastic lesion detection rate and may represent a promising screening strategy for CRC. TRIAL REGISTRATION: This study was registered in China Clinical Trial Registry ( https://www.chictr.org.cn ) on 29/09/2022. REGISTRATION NUMBER: ChiCTR2200064186.

Association between hospital characteristics and 30-day mortality of patients hospitalized for acute myocardial infarction in Sichuan, China.

OBJECTIVE: Because acute myocardial infarction (AMI) is a major cause of death, China faces the challenge of improving its quality of care. This study provides context-specific evidence of association between 30-day mortality and hospital characteristics in China to extend the understanding of hospitalized AMI patients. METHODS: We conducted a retrospective cohort study of 67,619 hospitalized AMI patients at 372 tertiary and secondary hospitals in Sichuan, China, between January 1, 2018 and December 31, 2020. Using a hierarchical logistic regression model to control risk factors, we explored relationships among 30-day mortality, hospital level, AMI volume, and percutaneous coronary intervention (PCI) timeliness. Locally weighted scatterplot smoothing was used to observe the trends of 30-day mortality with increased AMI volume and PCI timeliness. RESULTS: After risk factor adjustment, the 30-day mortality model demonstrated that a lower hospital level and smaller AMI volume were associated with higher 30-day mortality (medium-volume: OR = 1.511, 95% CI (1.195, 1.910); small-volume: OR = 1.636, 95% CI (1.277, 2.096); other tertiary: OR = 1.190, 95% CI (1.037, 1.365); secondary: OR = 1.524, 95% CI (1.289, 1.800)). Similarly, 30-day mortality was higher for patients at hospitals with a low PCI timeliness (low timeliness: OR = 1.318, 95% CI (1.079, 1.610)). Scatterplot smoothing showed hospital 30-day mortality first reduced quickly and gradually stabilized with increased AMI volume and PCI timeliness. CONCLUSION: Patients admitted to tertiary grade A hospitals, large-volume hospitals, and high- or medium-timeliness hospitals were more likely to survive at 30 days. Policymakers should focus on improving the outcomes at hospitals without these characteristics.

A PCA-EEMD-CNN-Attention-GRU-Encoder-Decoder Accurate Prediction Model for Key Parameters of Seawater Quality in Zhanjiang Bay.

In order to effectively solve the problem of low accuracy of seawater water quality prediction, an optimized water quality parameter prediction model is constructed in this paper. The model first screened the key factors of water quality data with the principal component analysis (PCA) algorithm, then realized the de-noising of the key factors of water quality data with an ensemble empirical mode decomposition (EEMD) algorithm, and the data were input into the two-dimensional convolutional neural network (2D-CNN) module to extract features, which were used for training and learning by attention, gated recurrent unit, and an encoder-decoder (attention-GRU-encoder-decoder, attention-GED) integrated module. The trained prediction model was used to predict the content of key parameters of water quality. In this paper, the water quality data of six typical online monitoring stations from 2017 to 2021 were used to verify the proposed model. The experimental results show that, based on short-term series prediction, the root mean square error (RMSE), mean absolute percentage error (MAPE), and decision coefficient (R2) were 0.246, 0.307, and 97.80%, respectively. Based on the long-term series prediction, RMSE, MAPE, and R2 were 0.878, 0.594, and 92.23%, respectively, which were all better than the prediction model based on an enhanced clustering algorithm and adam with a radial basis function neural network (ECA-Adam-RBFNN), a prediction model based on a softplus extreme learning machine method with partial least squares and particle swarm optimization (PSO-SELM-PLS), and a wavelet transform-depth Bi-S-SRU (Bi-directional Stacked Simple Recurrent Unit) prediction model. The PCA-EEMD-CNN-attention-GED prediction model not only has high prediction accuracy but can also provide a decision-making basis for the water quality control and management of aquaculture in the waters around Zhanjiang Bay.

A Novel Prognostic Model Based on Seven Necroptosis-Related miRNAs for Predicting the Overall Survival of Patients with Lung Adenocarcinoma.

Lung adenocarcinoma (LUAD) remains one of the leading causes of cancer-related deaths worldwide. This study is aimed at constructing a risk scoring model based on necroptosis-related miRNAs to predict prognosis of LUAD. Expression profile of miRNA in LUAD was downloaded from The Cancer Genome Atlas (TCGA) database. We screened the differentially expressed necroptosis-related miRNAs between LUAD patients and normal samples, thus constructed a seven miRNA-based risk stratification on the basis of the TGCA cohort. This risk stratification was prove to be effective in predicting the overall survival (OS) of patients with LUAD. Furthermore, we constructed a nomogram model based on the combination of risk characteristics and clinicopathological features, which was also prove to be accurate and efficient in predicting OS of LUAD patients. Functional enrichment analyses on the targeted genes of these miRNAs with prognostic value were carried out. Results indicated that these targeted genes were closely related to the development and metastasis of tumors. In summary, our research has developed a prognostic model based on the expression of miRNAs related to necroptosis. This model might be used to predict the prognosis of LUAD accurately, which might be helpful in improving treatment efficacy of LUAD.

BuFeiXiaoJiYin ameliorates the NLRP3 inflammation response and gut microbiota in mice with lung cancer companied with Qi-yin deficiency.

INTRODUCTION: NLRP3 inflammasome responses and gut microbiota have been shown an important role in lung cancer, however, the relationship between gut microbiota and NLRP3 inflammasome responses in lung cancer with Qi-yin deficiency remains elusive. METHODS: To investigate the effect of the traditional Chinese medicine BuFeiXiaoJiYin (BFXJY) on NLRP3 inflammasome responses and dysbiosis in lung cancer with Qi-yin deficiency, the female BALB/cA-nu mice were treated with LPS and ATP to induce inflammation, and were intragastrically treated with warm Chinese medicine and smoked with shavings to induce Qi-yin deficiency, as well as were injected with 1 × 107/ml A549 cells to simulate lung cancer. Then the three different doses of BuFeiXiaoJiYin (BFXJY) and positive control (CRID3) were used for intervention in mice for 27 consecutive days. Then, we estimated the protection effect of BFXJY on lung cancer mice with Qi-yin deficiency, through deterring tumor growth, NLRP3 inflammasome, PKC signaling, and homeostasis of gut microbiota. RESULTS: In this study, we found that BFXJY could inhibit the tumor growth in lung cancer with Qi-yin deficiency by reducing the production of IL-1ß and IL-18 and inhibiting NLRP3 inflammasome activation, which might be associated with the inhibition of PKC signaling. Furthermore, BFXJY could promote microbial diversity and balance the microbial composition changes induced by inflammation and Qi-yin deficiency in lung cancer. CONCLUSION: BuFeiXiaoJiYin ameliorates the NLRP3 inflammation response and gut microbiota in mice with lung cancer companied with Qi-yin deficiency. Our study provides a theoretical basis for the clinical development of therapeutic drugs targeting to treat lung cancer.

Prognostic value of EGFR and p-EGFR in nasopharyngeal carcinoma: A systematic review and meta-analysis.

PURPOSE: To evaluate the prognostic effect and clinical significance of epidermal growth factor receptor and its phosphorlated form (EGFR/p-EGFR) in nasopharyngeal carcinoma. METHODS: A systematic review and meta-analysis was designed. We visited PubMed, Embase, China National Knowledge Infrastructure Database, Database of Chinese sci-tech periodicals, WanFang Database, and China Biology Medicine disc to search for Chinese and English publications of prospective studies and retrospective studies investigating the association of EGFR/p-EGFR and nasopharyngeal carcinoma prognosis from inception to April 2021. The inclusion criteria were that the samples should be pathologically confirmed as nasopharyngeal carcinoma and the expression of EGFR/p-EGFR should be detected via immunohistochemistry; the study should analyze the prognostic significance of EGFR/p-EGFR in nasopharyngeal carcinoma; hazard ratio (HR) and 95% confidence interval (CI) should be reported in the study or could be derived from survival curves; and the outcomes of the study should include overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS). RESULTS: A total of 18 studies evaluating 1451 samples were included. For studies that reported OS as an outcome, EGFR overexpression indicated worse OS of nasopharyngeal carcinoma patients. The heterogeneity between studies was high (I2 = 91%, P < .01), and a random-effect model was used to combine the effect size (HR = 1.71, 95% CI [1.21, 2.41], P < .01). Further sensitivity analysis and prespecified subgroup analysis were performed to detect the source of heterogeneity, and the results showed that the heterogeneity could not be eliminated. Publication bias assessed by funnel plots and Begg test and Egger test was low (Begg test: P = .846 and Egger test: P = .074). p-EGFR was not correlated with the OS of nasopharyngeal carcinoma patients (HR = 1.01, 95% CI [0.88, 1.15], P = .92). For studies that reported DFS, EGFR overexpression was associated with worse DFS in patients with nasopharyngeal carcinoma (HR = 2.53, 95% CI [1.84, 3.47], P < .01). For studies that reported PFS, EGFR overexpression was not correlated with the PFS of nasopharyngeal carcinoma patients (HR = 1.86, 95% CI [0.90, 3.82], P = .09). For studies that reported DMFS, EGFR overexpression was not correlated with the DMFS of nasopharyngeal carcinoma patients, and high heterogeneity between studies was detected (I2 = 97%, P < .01). A random-effect model was used to combine the effect size (HR = 1.80, 95% CI [0.56, 5.76], P = .32). A sensitivity analysis was conducted. Publication bias was detected to be low (Begg test: P = .817 and Egger test: P = .954). There was no correlation between p-EGFR overexpression and DMFS in patients with nasopharyngeal carcinoma (HR = 1.20, 95% CI [0.95, 1.52], P = .12). CONCLUSION: In nasopharyngeal carcinoma patients, EGFR overexpression could be used as a biomarker that predicts poor OS and DFS, but not a prognostic biomarker for PFS and DMFS. The overexpression of p-EGFR was not shown to be associated with the prognosis of nasopharyngeal carcinoma patients and could not be used as a prognostic biomarker. ETHICS AND DISSEMINATION: This study was registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), and reported as stated by the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Neither ethical approval nor informed consent was required since this study was conducted based on previous publications. INPLASY REGISTRATION NUMBER: INPLASY 202150010.

Comprehensive Pulmonary Rehabilitation is an Effective Way for Better Postoperative Outcomes in Surgical Lung Cancer Patients with Risk Factors: A Propensity Score-Matched Retrospective Cohort Study.

BACKGROUND: To investigate the effectiveness and cost minimization of comprehensive pulmonary rehabilitation (CPR) in lung cancer patients who underwent surgery. PATIENTS AND METHODS: A retrospective observational study based on medical records was conducted, with 2410 lung cancer patients who underwent an operation with/without CPR during the peri-operative period. Variables including clinical characteristics, length of stay (LOS), postoperative pulmonary complications (PPCs), and hospitalization expenses were compared between the intervention group (IG) and control group (CG). The CPR regimen consists of inspiratory muscle training (IMT), aerobic endurance training, and pharmacotherapy. RESULTS: Propensity score matching analysis was performed between two groups, and the ratio of matched patients was 1:4. Finally, 205 cases of IG and 820 cases of CG in the matched cohort of our study were identified. The length of postoperative hospital stay [median: 5 interquartile (4-7) vs 7 (4-8) days, P < 0.001] and drug expenses [7146 (5411-8987) vs 8253 (6048-11,483) ¥, P < 0.001] in the IG were lower compared with the CG. Additionally, the overall incidence of PPCs in the IG was reduced compared with the CG (26.8% vs 36.7%, P = 0.008), including pneumonia (10.7% vs 16.8%, P = 0.035) and atelectasis (8.8% vs 14.0%, P = 0.046). Multivariable analysis showed that CPR intervention (OR = 0.655, 95% CI: 0.430-0.865, P = 0.006), age ≥70 yr (OR = 1.919, 95% CI: 1.342-2.744, P < 0.001), smoking (OR = 2.048, 95% CI: 1.552-2.704, P < 0.001) and COPD (OR = 1.158, 95% CI: 1.160-2.152, P = 0.004) were related to PPCs. CONCLUSION: The retrospective cohort study revealed a lower PPC rate and the shorter postoperative length of stay in the patients receiving CPR, demonstrating the clinical value of CRP as an effective strategy for surgical lung cancer patients with risk factors.

Liver regeneration in the first week after living donor liver transplantation: evaluation with sonography.

BACKGROUND/AIMS: Liver regeneration is a crucial issue after adult-to-adult living donor liver transplantation A-ALDLT. Several studies have shown the rapid enlargement of liver size 3 months after surgery but how the liver regenerate in the first postoperative week remains unknown. The purpose of our study was to investigate liver regeneration in the first postoperative week using sonography. METHODOLOGY: Twenty pairs of donors and recipients undergone A-ALDLT were enrolled between March 2007 and January 2008. A linear regression was done to determine the relationship between the preoperative donor liver volumetric measurements by CT and ultrasound. The volume of graft liver was obtained by water bath during surgery and by ultrasound daily in the first postoperative week. RESULTS: Liver volume of the 20 donors measured by CT and ultrasound were 1367.8±193.7cm3 and 1281.1±149.3cm3, respectively. The sonographic measurement correlated well with that of CT (r=0.93, p <0.0001). The mean volume of ex vivo graft livers was 595±193.7cm3. Hepatic volume increased sharply, by 42.31% at postoperative day one and 93.5% at postoperative day seven. CONCLUSIONS: Sonographic measurement of liver volume is accurate. Bedside ultrasound is a useful ancillary test to assess liver regeneration in early postoperative days. Liver regenerated vigorously in A-ALDLT recipients in the first postoperative week.

[Effects of dujieqing oral liquid on the promoter methylation of the MGMT gene in middle-and-late stage tumor patients receiving chemotherapy].

OBJECTIVE: To observe the effects of Dujieqing Oral Liquid (DJQ) on the promoter methylation of the O6-methylguanine-DNA methyltransferase (MGMT) gene in the plasma DNA samples from middle-and-late stage tumor patients receiving chemotherapy. METHODS: Recruited 60 patients were randomly assigned to the treatment group (treated by conventional chemotherapy combined DJQ, 20 mL each time, three times daily) and the control group (treated by chemotherapy alone), 30 in each group. The therapeutic course was 8 weeks. The promoter methylation of the MGMT gene in the plasma DNA samples form middle-and-late stage tumor patients receiving chemotherapy was detected before and after treatment using nested methylation-specific polymerase chain reaction (MSP). Meanwhile, the peripheral hemogram was detected. The clinical efficacy and toxic/adverse reactions were assessed using Karnofsky performance scale (KPS). RESULTS: Results of the promoter methylation of MGMT genes showed that methylation rate was 20.00% in the treatment group and 46.67% in the control group (P<0.05). Compared with before treatment, the KPS was significantly improved in the treatment group after treatment, while it significantly decreased in the control group after treatment (both P<0.05). There was statistical difference in the KPS between the two groups after treatment (P<0.01). The toxic/adverse reactions were milder in the treatment group than in the control group (P<0.01). CONCLUSIONS: DJQ showed efficiency synergism and toxicity reducing effects, but with no effect on the hematopoietic function of the bone marrow. MGMT gene was indicated as DJQ's target point for efficiency synergism and toxicity reducing. The efficiency synergism and toxicity reducing effects were achieved by regulating the activities of MGMT gene.