[Seasonal Variation Characteristics and Pollution Assessment of Heavy Metals in Water and Sediment of Taipu River].

Taipu River is a river spanning two provinces and one city in a demonstration area in the Yangtze River Delta on an ecologically friendly developmentand an important water source in the upper reaches of the Huangpu River in Shanghai. To understand the multi-media distribution characteristics, pollution status, and ecological risk of heavy metals in the Taipu River, the contents of heavy metals (As, Cd, Co, Cr, Cu, Mn, Ni, Pb, Sb, and Zn) in the sediments of Taipu River were analyzed, and the pollution status and potential ecological risk were evaluated using the Nemerow comprehensive pollution index, geo-accumulation index, and potential ecological risk index methods. In addition, the health risk assessment model was used to assess the health risk of heavy metals in surface water of Taipu River. The results showed that the concentrations of Cd, Cr, Mn, and Ni in the surface water of Taipu River exceeded the class Ⅲ water limit at the upstream point in spring; the concentrations of Sb exceeded the class Ⅲ water limit at all points in winter; the average value of As exceeded the class Ⅲ water limit in overlying water during the wet season; and the average values of As and Cd exceeded the class Ⅲ water limit in pore water during the wet season. The health risk assessment of surface water implied that both adults and children had higher health risk in spring and lower health risk in other seasons. The health risk of children was significantly higher than that of adults, and it mainly came from chemical carcinogenic heavy metal elements As, Cd, and Cr. The average contents of Co, Mn, Sb, and Zn in Taipu River sediments in the four seasons all exceeded the Shanghai soil baseline; the average contents of As, Cr, and Cu in summer, autumn, and winter exceeded the Shanghai soil baseline; and the average contents of Cd, Ni, and Pb in summer and winter exceeded the Shanghai soil baseline. The evaluation results of the Nemerow comprehensive pollution index and geo-accumulation index showed that the pollution degree of the middle reaches of Taipu River was higher than that of the upper and lower reaches, and the Sb pollution was more serious. The potential ecological risk index method revealed that the Taipu River sediment was at a low risk. Cd had a high contribution in both the wet and dry seasons and could be regarded as the main heavy metal of potential ecological risk in the Taipu River sediment.

Contribution of insurance status to the association between marital status and cancer-specific survival: a mediation analysis.

OBJECTIVES: To evaluate the extent to which marriage influences cancer-specific survival (CSS) by influencing the insurance status among patients with common solid cancers and the feasibility of reducing the survival gap caused by marriage by increasing private insurance coverage for unmarried patients. SETTING: A retrospective cohort study with patients retrieved from the Surveillance, Epidemiology and End Results programme. PARTICIPANTS: Patients with nine common solid cancers diagnosed between 2007 and 2016 were included. Patients were excluded if their marital status, insurance status, socioeconomical status, stage or cause of death was unavailable, if survival time was less than 1 month, or if they were younger than 18 years at the time of diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was CSS, which was compared between married and unmarried individuals. Mediation analyses were conducted to determine the contribution of insurance status to the association between marriage and CSS. RESULTS: Married patients had better CSS than those unmarried (time ratio 1.778; 95% CI 1.758 to 1.797). Private health insurance was a key factor mediating the association between marital status and CSS (proportion mediated (PM), 17%; 95% CI 17% to 17.1%). The PM ranges from 10.7% in prostate cancer to 20% in kidney cancer. The contribution of private insurance to the association between marital status and CSS was greater among women than among men (PM 18.5% vs 16.7%). The mediating effect of private insurance was the greatest for the comparison between married and separated individuals (PM 25.6%; 95% CI 25.3% to 25.8%) and smallest for the comparison between married and widowed individuals (PM 11.0%; 95% CI 10.9% to 11.1%). CONCLUSIONS: 17% of the marital disparities in CSS are mediated by private insurance coverage. Increasing private insurance coverage for unmarried patients may reduce the survival gap related to marital status and sex. However, it is unclear whether better publicly funded insurance would have the same effect.

Liquid biopsy posttreatment surveillance in endemic nasopharyngeal carcinoma: a cost-effective strategy to integrate circulating cell-free Epstein-Barr virus DNA.

BACKGROUND: The optimal posttreatment surveillance strategy for nasopharyngeal carcinoma (NPC) remains unclear. Circulating cell-free Epstein-Barr virus (cfEBV) DNA has been recognized as a promising biomarker to facilitate early detection of NPC recurrence. Therefore, we aim to determine whether integrating circulating cfEBV DNA into NPC follow-up is cost-effective. METHODS: For each stage of asymptomatic nonmetastatic NPC patients after complete remission to primary NPC treatment, we developed a Markov model to compare the cost-effectiveness of the following surveillance strategies: routine follow-up strategy, i.e., (1) routine clinical physical examination; routine imaging strategies, including (2) routine magnetic resonance imaging plus computed tomography plus bone scintigraphy (MRI + CT + BS); and (3) routine 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT); cfEBV DNA-guided imaging strategies, including (4) cfEBV DNA-guided MRI + CT + BS and (5) cfEBV DNA-guided PET/CT. Clinical probabilities, utilities, and costs were derived from published studies or databases. Sensitivity analyses were performed. RESULTS: For all disease stages, cfEBV DNA-guided imaging strategies demonstrated similar survival benefits but were considerably more economical than routine imaging strategies. They only required approximately one quarter of the number of imaging studies compared with routine imaging strategies to detect one recurrence. Specifically, cfEBV DNA-guided MRI + CT + BS was most cost-effective for stage II (incremental cost-effectiveness ratio [ICER] $57,308/quality-adjusted life-year [QALY]) and stage III ($46,860/QALY) patients, while cfEBV DNA-guided PET/CT was most cost-effective for stage IV patients ($62,269/QALY). However, routine follow-up was adequate for stage I patients due to their low recurrence risk. CONCLUSIONS: The cfEBV DNA-guided imaging strategies are effective and cost-effective follow-up methods in NPC. These liquid biopsy-based strategies offer evidence-based, stage-specific surveillance modalities for clinicians and reduce disease burden for patients.

An optimal posttreatment surveillance strategy for cancer survivors based on an individualized risk-based approach.

The optimal post-treatment surveillance strategy that can detect early recurrence of a cancer within limited visits remains unexplored. Here we adopt nasopharyngeal carcinoma as the study model to establish an approach to surveillance that balances the effectiveness of disease detection versus costs. A total of 7,043 newly-diagnosed patients are grouped according to a clinic-molecular risk grouping system. We use a random survival forest model to simulate the monthly probability of disease recurrence, and thereby establish risk-based surveillance arrangements that can maximize the efficacy of recurrence detection per visit. Markov decision-analytic models further validate that the risk-based surveillance outperforms the control strategies and is the most cost-effective. These results are confirmed in an external validation cohort. Finally, we recommend the risk-based surveillance arrangement which requires 10, 11, 13 and 14 visits for group I to IV. Our surveillance strategies might pave the way for individualized and economic surveillance for cancer survivors.