Trends in liver cancer mortality in China from 1990 to 2019: a systematic analysis based on the Global Burden of Disease Study 2019.

OBJECTIVE: We aimed to examine trends in overall mortality rates for liver cancer and those within subgroups according to sex, age, aetiological factors and modifiable risk factors in China from 1990 to 2019. DESIGN: The design of this study involved analysing liver cancer mortality rates in China from 1990 to 2019 using joinpoint regression analysis to identify significant changes in mortality rates. Annual percentage changes (APCs) and 95% CIs were used to quantify the magnitude of changes in mortality rates. The study also conducted subgroup analyses based on sex, age, aetiological factors and risk factors to better understand trends in liver cancer mortality rates. RESULTS: The age-standardised mortality from liver cancer in China first increased from 28.12 to 31.54 deaths per 100 000 population in 1990-1996 (APC=2.1%, 95% CI: 1.5% to 2.6%), then dropped at varying rates (1996-2000, APC=-3.7%, 95% CI: -5.2% to -2.1%; 2000-2004, APC=-17.4%, 95% CI: -18.7% to -16.1%; 2004-2007, APC=-5.4%, 95% CI: -8.3% to -2.3%; and 2007-2012, APC=-1.4%, 95% CI: -2.3% to -0.4%), and began to increase again after 2012 (APC=1.3%, 95% CI: 0.9% to 1.7%). Hepatitis B and C virus infections accounted for 63% and 18% of liver cancer-related deaths, respectively, in China from 1990 to 2019. Smoking, drug use, alcohol use and elevated body mass index were the four leading risk factors for liver cancer mortality in China during the study period. Notable variations in both liver cancer mortality rates and changes in mortality rates were observed across sexes and age groups. CONCLUSIONS: The age-standardised liver cancer mortality rate in China significantly decreased from 1996 to 2019. The major differences in liver cancer mortality rates and inconsistent changes in mortality rates between 1990 and 2019 merit the attention of researchers and policymakers.

Analysis of coronary computed tomography angiography-derived pericoronary fat attenuation index characteristics in the diagnostic assessment of patients with Takayasu arteritis.

Background: The clinical value of pericoronary adipose tissue in assessing Takayasu arteritis (TAK) with coronary artery involvement (CAI) is yet to be determined. The purpose of this study was to investigate the characteristics of pericoronary fat attenuation index (FAI) derived from coronary computed tomography angiography (CTA) in patients with TAK. Methods: This is a retrospective study involving enrollment of 111 consecutive patients (mean age, 33.92±12.48 years) who were diagnosed as TAK, of which 52 patients had coronary artery involvement (TAK-CAI) and 59 patients without coronary artery involvement (TAK-nonCAI). Based on the extent of coronary artery lesion, the TAK-CAI group was further classified into localized group (n=25) and diffused group (n=27). Furthermore, patients with TAK were divided into active group (n=33) and inactive group (n=78). Meanwhile, 51 gender-matched individuals with normal appearance in coronary CTA examination were enrolled as the control group. The pericoronary FAI was quantitatively evaluated on each coronary CTA examination groups. The diagnostic value of pericoronary FAI was determined using the area under the curve (AUC) of the receiver operating characteristic. Results: A higher pericoronary FAI was found in TAK-nonCAI group than control group with normal coronary arteries (P<0.001). Multivariate analysis showed that the FAI is an independent risk factor for coronary involvement in TAK patients [odds ratio (OR): 1.23, 95% confidence interval (CI): 1.13-1.35, P<0.001]. With the best cut-off value of -86.50, the pericoronary FAI identified coronary involvement with 67.8% sensitivity and 74.5% specificity (AUC: 0.794, 95% CI: 0.713-0.875, P<0.001). Multivariate analysis showed that the pericoronary FAI is an independent risk factor for determination of active TAK patients (OR: 1.57, 95% CI: 1.25-1.97, P<0.001). With the best cut-off value of -79.50, the pericoronary FAI identified active inflammation with 93.9% sensitivity and 74.4% specificity (AUC: 0.911, 95% CI: 0.860-0.962, P<0.001). Conclusions: Coronary CTA-derived FAI is significantly increased in patients with TAK and can be used as a reliable biomarker to distinguish TAK patients from those with normal coronary arteries, and determine the extent of TAK inflammation.

Advances on resource utilization of semi-dry desulfurization ash by thermal decomposition: a high-efficiency and low-temperature method for large-scale processing.

The semi-dry flue gas desulfurization ash (SFGDA) is an industrial waste generated by the semi-dry desulfurization process, and its resources have been continuously attracted attention. Through the method of heat decomposition, the SFGDA decomposed into CaO and SO2 has emerged as a prominent research topic. This paper summarizes various of research workers, who revealed that the decomposition temperature of CaSO4 in SFGDA is greater than 1678 K and 1603 K in the air atmosphere and N2 atmosphere, respectively, presenting challenges such as high energy consumption and limited economic feasibility. On the one hand, the effects of CO and C regulating the pyrolysis atmosphere on reducing the pyrolysis temperature were reviewed. On the other hand, the impact of additives such as Fe2O3 and FeS2 was considered. Ultimately, the joint effects of regulating atmosphere and additives were discussed, and an efficient and low-temperature decomposition route was obtained; adding solid C source and Fe2O3 for pyrolysis reaction, the decomposition temperature of CaSO4 can be reduced by at least 230 K and desulfurization efficiency exceeds 95% under the condition of micro-oxidizing atmosphere. Moreover, the CaO resulting from SFGDA decomposition can be further synthesized into calcium ferrite, while the enriched SO2 can be utilized for the production of industrial sulfuric acid, which holds promising prospects for large-scale industrial applications.

Comparison of Different Thoracic Aortic Wall Characteristics for Assessment of Disease Activity in Takayasu Arteritis: A Quantitative Study with 3.0 T Magnetic Resonance Imaging.

BACKGROUND: Determination of disease activity in Takayasu arteritis (TAK) is crucial for clinical management but challenging. The value of different magnetic resonance imaging (MRI) characteristics for the assessment of disease activity remains unclear. This study investigated the imaging findings of the thoracic aortic wall and elasticity by using a comprehensive 3.0 T MRI protocol. METHODS: We prospectively enrolled 52 consecutive TAK patients. TAK activity was recorded according to the ITAS2010. All the patients underwent thoracic aortic MRI. The luminal morphology of the thoracic aorta and its main branches were quantitatively evaluated using a contrast-enhanced magnetic resonance angiography (MRA) sequence. The maximum wall thickness of the thoracic aorta, postcontrast enhancement ratio, and aortic wall edema were analyzed in each patient through pre- and post-enhanced T1-weighted and T2-weighted imaging. Pulse-wave velocity (PWV) of the thoracic aorta was calculated using a four-dimensional flow technique. RESULTS: The majority of the 52 patients had type V disease (34.62%, 18/52). Among all the MRI indicators of the thoracic aorta, the area under the curve was the largest for the maximal wall thickness (0.804, 95% confidence interval [CI] = 0.667-0.941). The maximal wall thickness (93.33%, 95% CI = 68.1%-99.8%) exhibited the highest sensitivity with a cutoff value of 3.12 mm. Wall edema (84.00%, 95% CI = 63.9%-95.5%) presented the highest specificity. A positive correlation was noted between PWV and patients' age (r = 0.54, p < 0.001), disease duration (r = 0.52, p < 0.001), and the maximum wall thickness (r = 0.45, p = 0.001). CONCLUSIONS: MRI enabled the comprehensive assessment of aortic wall morphology and functional markers for TAK disease activity. Aortic maximal wall thickness was the most accurate indicator of TAK activity. The early phase was superior to the delay phase for aortic wall enhancement analysis for assessing TAK activity.

Assessment of the efficacy of tuina on treating cervicogenic headache: A protocol for systematic review and meta-analysis.

BACKGROUND: Cervicogenic headache is a secondary headache characterized by unilateral headache, symptoms, and signs of neck involvement. It is often worsened by neck movement, sustained awkward head position, or external pressure over the upper cervical or occipital region on the symptomatic side. In this systematic review, we aimed to evaluate the efficacy and safety of massage therapy for the treatment of cervicogenic headache. METHODS: We searched the China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Database, China Doctoral Dissertations Full-Text Database, China Master's Theses Full-Text Database, Cochrane Central Register of Controlled Trials, PubMed, and Embase. We will select all eligible studies published on or before April 1, 2021. We will use Review Manager 5.4, provided by the Cochrane Collaborative Network for statistical analysis. We then assessed the quality and risk of the included studies and observed the outcome measures. RESULTS: This meta-analysis further confirmed the benefits of tuina in the treatment of cervicogenic headache. CONCLUSION: The purpose of this meta-analysis was to explore the effect of tuina on patients with cervicogenic headache and to provide more options for clinicians and patients to treat cervicogenic headache. ETHICS AND DISSEMINATION: This systematic review will evaluate the efficacy and safety of tuina in the treatment of cervicogenic headache. Since all the data included were published, the systematic review did not require ethical approval. REGISTRATION NUMBER: INPLASY202150053.

Ambulatory Human Gait Phase Detection Using Wearable Inertial Sensors and Hidden Markov Model.

Gait analysis, as a common inspection method for human gait, can provide a series of kinematics, dynamics and other parameters through instrumental measurement. In recent years, gait analysis has been gradually applied to the diagnosis of diseases, the evaluation of orthopedic surgery and rehabilitation progress, especially, gait phase abnormality can be used as a clinical diagnostic indicator of Alzheimer Disease and Parkinson Disease, which usually show varying degrees of gait phase abnormality. This research proposed an inertial sensor based gait analysis method. Smoothed and filtered angular velocity signal was chosen as the input data of the 15-dimensional temporal characteristic feature. Hidden Markov Model and parameter adaptive model are used to segment gait phases. Experimental results show that the proposed model based on HMM and parameter adaptation achieves good recognition rate in gait phases segmentation compared to other classification models, and the recognition results of gait phase are consistent with ground truth. The proposed wearable device used for data collection can be embedded on the shoe, which can not only collect patients' gait data stably and reliably, ensuring the integrity and objectivity of gait data, but also collect data in daily scene and ambulatory outdoor environment.

Deep learning analysis in coronary computed tomographic angiography imaging for the assessment of patients with coronary artery stenosis.

BACKGROUND AND OBJECTIVE: Recently, deep convolutional neural network has significantly improved image classification and image segmentation. If coronary artery disease (CAD) can be diagnosed through machine learning and deep learning, it will significantly reduce the burdens of the doctors and accelerate the critical patient diagnoses. The purpose of the study is to assess the practicability of utilizing deep learning approaches to process coronary computed tomographic angiography (CCTA) imaging (termed CCTA-artificial intelligence, CCTA-AI) in coronary artery stenosis. MATERIALS AND METHODS: A CCTA reconstruction pipeline was built by utilizing deep learning and transfer learning approaches to generate auto-reconstructed CCTA images based on a series of two-dimensional (2D) CT images. 150 patients who underwent successively CCTA and digital subtraction angiography (DSA) from June 2017 to December 2017 were retrospectively analyzed. The dataset was divided into two parts comprising training dataset and testing dataset. The training dataset included the CCTA images of 100 patients which are trained using convolutional neural networks (CNN) in order to further identify various plaque classifications and coronary stenosis. The other 50 CAD patients acted as testing dataset that is evaluated by comparing the auto-reconstructed CCTA images with traditional CCTA images on the condition that DSA images are regarded as the reference method. Receiver operating characteristic (ROC) analysis was used for statistical analysis to compare CCTA-AI with DSA and traditional CCTA in the aspect of detecting coronary stenosis and plaque features. RESULTS: AI significantly reduces time for post-processing and diagnosis comparing to the traditional methods. In identifying various degrees of coronary stenosis, the diagnostic accuracy of CCTA-AI is better than traditional CCTA (AUCAI = 0.870, AUCCCTA = 0.781, P < 0.001). In identifying ≥ 50% stenotic vessels, the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of CCTA-AI and traditional method are 86% and 83%, 88% and 59%, 85% and 94%, 73% and 84%, 94% and 83%, respectively. In the aspect of identifying plaque classification, accuracy of CCTA-AI is moderate compared to traditional CCTA (AUC = 0.750, P < 0.001). CONCLUSION: The proposed CCTA-AI allows the generation of auto-reconstructed CCTA images from a series of 2D CT images. This approach is relatively accurate for detecting ≥50% stenosis and analyzing plaque features compared to traditional CCTA.

Liver assessment using Gd-EOB-DTPA-enhanced magnetic resonance imaging in primary biliary cholangitis patients.

PURPOSE: To evaluate the feasibility of utilizing gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for the assessment of Child-Pugh class and for differentiating between patients with primary biliary cholangitis (PBC) and posthepatitic cirrhosis. MATERIALS AND METHODS: 45 PBC patients and 45 posthepatitic cirrhosis patients were enrolled and Gd-EOB-DTPA-enhanced MRI was applied. The average relative signal enhancement (RE) of the liver and average contrast to noise ratio (CNR) of common bile duct at 4, 20, and 50 min between different Child-Pugh classes of PBC patients were compared. The RE and CNR in all timepoints in patients with the same Child-Pugh class were compared between PBC patients and posthepatitic cirrhosis patients. RESULTS: The RE of liver and CNR of common bile duct at 4, 20, and 50 min was significantly different between all Child-Pugh classes of PBC patients. There were also no significant differences in the RE of liver and CNR of common bile duct in all timepoints between patients with PBC and posthepatitic cirrhosis in the same Child-Pugh class. CONCLUSION: Gd-EOB-DTPA-enhanced MRI is feasible for liver function assessment in PBC patients. However, the ability of this modality in differentiating liver cirrhosis of different etiologies requires further investigation.

Image Quality and Stenosis Assessment of Non-Contrast-Enhanced 3-T Magnetic Resonance Angiography in Patients with Peripheral Artery Disease Compared with Contrast-Enhanced Magnetic Resonance Angiography and Digital Subtraction Angiography.

PURPOSE: To evaluate the diagnostic performance of flow-sensitive dephasing (FSD)-prepared steady-state free precession (SSFP) magnetic resonance angiography (MRA) at 3 T for imaging infragenual arteries relative to contrast-enhanced MRA (CE-MRA) and digital subtraction angiography (DSA). MATERIALS AND METHODS: A series of 16 consecutive patients with peripheral arterial disease (PAD) underwent a combined peripheral MRA protocol consisting of FSD-MRA for the calves and large field-of-view CE-MRA. DSA was performed on all patients within 1 week of the MR angiographies. Image quality and degree of stenosis was assessed by two readers with rich experience. Inter-observer agreement was determined using kappa statistics. Receiver operating characteristic (ROC) curve analysis determined the diagnostic value of FSD-MRA, CE-MRA, and CE-MRA combined with FSD-MRA (CE+FSD MRA) in predicting vascular stenosis. RESULTS: At the calf station, no significantly difference of subjective image quality scores was found between FSD-MRA and CE-MRA. Inter-reader agreement was excellent for both FSD-MRA and CE-MRA. Both of FSD-MRA and CE-MRA carry a stenosis overestimation risk relative to DSA standard. With DSA as the reference standard, ROC curve analysis showed that the area under the curve was largest for CE+FSD MRA. The greatest sensitivity and specificity were obtained when a cut-off stenosis score of 2 was used. CONCLUSION: In patients with severe PAD,3 T FSD-MRA provides good-quality diagnostic images without a contrast agent and is a good supplement for CE-MRA. CE+FSD MRA can improve the accuracy of vascular stenosis diagnosis.

Left Ventricular Diastolic Dysfunction Assessment with Dual-Source CT.

PURPOSE: To assess the impact of left ventricular (LV) diastolic dysfunction on left atrial (LA) phasic volume and function using dual-source CT (DSCT) and to find a viable alternative prognostic parameter of CT for LV diastolic dysfunction through quantitative evaluation of LA phasic volume and function in patients with LV diastolic dysfunction. MATERIALS AND METHODS: Seventy-seven patients were examined using DSCT and Doppler echocardiography on the same day. Reservoir, conduit, and contractile function of LA were evaluated by measuring LA volume (LAV) during different cardiac phases and all parameters were normalized to body surface area (BSA). Patients were divided into four groups (normal, impaired relaxation, pseudonormal, and restrictive LV diastolic filling) according to echocardiographic findings. The LA phasic volume and function in different stages of LV diastolic function was compared using one-way ANOVA analysis. The correlations between indexed volume of LA (LAVi) and diastolic function in different stages of LV were evaluated using Spearman correlation analysis. RESULTS: LA ejection fraction (LAEF), LA contraction, reservoir, and conduit function in patients in impaired relaxation group were not different from those in the normal group, but they were lower in patients in the pseudonormal and restrictive LV diastolic dysfunction groups (P < 0.05). For LA conduit function, there were no significant differences between the patients in the pseudonormal group and restrictive filling group (P = 0.195). There was a strong correlation between the indexed maximal left atrial volume (LAVmax, r = 0.85, P < 0.001), minimal left atrial volume (LAVmin, r = 0.91, P < 0.001), left atrial volume at the onset of P wave (LAVp, r = 0.84, P < 0.001), and different stages of LV diastolic function. The LAVi increased as the severity of LV diastolic dysfunction increased. CONCLUSIONS: LA remodeling takes place in patients with LV diastolic dysfunction. At the same time, LA phasic volume and function parameters evaluated by DSCT indicated the severity of the LV diastolic dysfunction. Quantitative analysis of LA phasic volume and function parameters using DSCT could be a viable alternative prognostic parameter of LV diastolic function.