Distinct time trends in colorectal cancer incidence in countries with SDI levels from 1990 to 2019: an age-period-cohort analysis for the Global Burden of Disease 2019 study.

Introduction: The burden of colorectal cancer (CRC) plays a pivotal role in the global cancer epidemic. Our study reported the incidence trends in CRC and the associated effects of age, period, and birth cohort in 204 countries and territories over the past 30 years. Methods: The incidence data of CRC were extracted from the Global Burden of Disease Study (GBD) 2019. We performed the age-period-cohort (APC) model to estimate the overall annual percentage change (net drift) in the incidence rate, the annual percentage change by age group (local drift), and the relative risk (period and cohort effects) of the period and cohort in CRC during 1990-2019. This approach allows examining and distinguishing age, period, and cohort effects in incidence and potentially distinguishing colorectal cancer gaps in prevention and screening. Results: In 2019, the incidence of CRC was 2.17 (95% UI 2.00-2.34) million, of which China, the United States of America, and Japan had the highest incidence population, accounting for 45.9% of the global population. The age-standardized incidence rate (ASIR) was 26.7 (95% UI 28.9-24.6) per 100,000 people, of which 30 countries had an incidence rate greater than 40.0 per 100,000 people. From 1990 to 2019, the middle SDI region had the largest increase in incidence rate, with a net drift of 2.33% (95% CI 2.2-2.46%, p < 0.001). Globally, the incidence population was concentrated in the age group of 50-69 years, and the age group of 30-34 years had the largest increase in incidence rate (local drift 1.19% (95% CI 1.01-1.37%)). At the same time, the sex and age distributions of CRC incidence had significant heterogeneity across regions and countries. In the past 30 years, the incidence rate in 31 countries has been well controlled (net drift <0), and most of them were concentrated in high-and high-middle-SDI regions, such as Australia, Czechia, and Belgium, and the relative risk of incidence generally improved over time and consecutive young birth cohorts. CRC incidence showed an unfavorable trend (net drift ≥1%) in 89 countries, of which 27 countries were more significant (net drift >2%), mostly concentrated in the middle SDI region, such as China, Mexico, and Brazil, and the risk of period and birth cohort was unfavorable. Conclusion: Globally, the incidence of CRC has shown an overall upward trend over the past 30 years, with the exception of some countries with higher SDI values. Significant age-period-cohort differences were observed in the risk of incidence in CRC worldwide. Effective prevention and control policies need to take into account the age-period-cohort effect characteristics of different regions.

Establishing subdivisions of M1 stage nasopharyngeal carcinoma based on decision tree classification: A multicenter retrospective study.

OBJECTIVES: To meet the demand for personalized treatment, effective stratification of patients with metastatic nasopharyngeal carcinoma (mNPC) is essential. Hence, our study aimed to establish an M1 subdivision for prognostic prediction and treatment planning in patients with mNPC. MATERIALS AND METHODS: This study included 1239 patients with mNPC from three medical centers divided into the synchronous mNPC cohort (smNPC, n = 556) to establish an M1 stage subdivision and the metachronous mNPC cohort (mmNPC, n = 683) to validate this subdivision. The primary endpoint was overall survival. Univariate and multivariate Cox analyses identified covariates for the decision-tree model, proposing an M1 subdivision. Model performance was evaluated using time-dependent receiver operating characteristic curves, Harrell's concordance index, calibration plots, and decision curve analyses. RESULTS: The proposed M1 subdivisions were M1a (≤5 metastatic lesions), M1b (>5 metastatic lesions + absent liver metastases), and M1c (>5 metastatic lesions + existing liver metastases) with median OS of 34, 22, and 13 months, respectively (p < 0.001). This M1 subdivision demonstrated superior discrimination (C-index = 0.698; 3-year AUC = 0.707) and clinical utility over those of existing staging systems. Calibration curves exhibited satisfactory agreement between predictions and actual observations. Internal and mmNPC cohort validation confirmed the robustness. Survival benefits from local metastatic treatment were observed in M1a, while immunotherapy improved survival in patients with M1b and M1c disease. CONCLUSION: This novel M1 staging strategy provides a refined approach for prognostic prediction and treatment planning in patients with mNPC, emphasizing the potential benefits of local and immunotherapeutic interventions based on individualized risk stratification.

Discussion on Improvement of the Incidence of Complications After the Application of Self-Management and Continuous Nursing in Children with Primary Nephrotic Syndrome.

Objective: To analyze the effects of self-management and continuous nursing on improving the incidence of complications in children with primary nephrotic syndrome. Methods: A retrospective analysis of 80 cases of children with primary nephrotic syndrome treated in our hospital from January 2019 to October 2022 was conducted. The patients were divided into a control group and an observation group, with 40 cases in each group. The control group received routine nursing, while the observation group received self-management and continuous nursing. After different nursing measures were taken in the two groups, the incidence of complications, the total satisfaction rate of patients' parents, quality of life scores, and the urinary albumin excretion rate before and after nursing between the two groups were analyzed. Results: (1) In comparison to the control group, the observation group had a lower incidence of complications (gastrointestinal discomfort, hypoglycemia, and abnormal liver function) (P < .05). (2) In comparison to the control group, the observation group had a higher total satisfaction rate of the patients' parents after nursing (P < .05). (3) Compared to the control group, the observation group reported higher quality of life scores (psychological function, spiritual vitality, and somatic function) after nursing (P < .05). (4) Compared to the control group, the observation group revealed higher self-management ability scores after nursing (P < .05). (5) After nursing, the urinary albumin excretion rate in the observation group was lower than that in the control group (P < .05). (6) In terms of disease recurrence rate after 1 month and 2 months of nursing, the observation group reported was lower rate of disease recurrence compared to the control group (P < .05). Conclusion: The application values of self-management and continuous nursing in children with primary nephrotic syndrome are significant.

Comprehensive assessment of base excision repair (BER)-related lncRNAs as prognostic and functional biomarkers in lung adenocarcinoma: implications for personalized therapeutics and immunomodulation.

BACKGROUND: Lung adenocarcinoma (LUAD) is the most prevalent subtype of lung cancer, and comprehending its molecular mechanisms is pivotal for advancing treatment efficacy. This study aims to explore the prognostic and functional significance of base excision repair (BER)-related long non-coding RNAs (BERLncs) in LUAD. METHODS: A risk score model for BERLncs was developed using the least absolute shrinkage and selection operator regression and Cox regression analysis. Model validation and prognostic evaluation were performed using Kaplan-Meier and receiver-operating characteristic curve analyses. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were conducted to elucidate the potential biological functions of BERLncs. Comparative analyses were carried out to investigate disparities in tumor mutation burden (TMB), immune infiltration, tumor immune dysfunction and exclusion (TIDE) score, chemosensitivity, and immune checkpoint gene expression between the two risk groups. RESULTS: A predictive risk score model comprising 19 BERLncs was successfully developed. Patients were divided into high-risk and low-risk groups according to the median risk score. The high-risk subgroup exhibited significantly inferior overall survival. Functional enrichment analysis revealed pathways associated with lung cancer development, notably the neuroactive ligand-receptor interaction pathway. High-risk patients demonstrated elevated TMB, diminished TIDE scores, and an immunosuppressive tumor microenvironment, while low-risk patients displayed potential benefits from immunotherapy. Additionally, the risk model identified potential anticancer agents. CONCLUSION: The risk score model based on BERLncs shows promise as a prognostic biomarker for LUAD patients, providing valuable insights for clinical decision-making, therapeutic strategies, and understanding of underlying biological mechanisms.

Reporting quality and risk of bias assessment of animal research on Chaihu-Shugan-San for depression: A systematic review.

Objective: Chaihu-Shugan-San (CSS) is a traditional Chinese medicine formula employed to treat depression. We aim to conduct a reporting quality assessment and risk of bias evaluation of animal research on CSS for depression. Methods: To acquire eligible studies, two reviewers searched plentiful databases from inception to October 23rd, 2021. Reporting quality assessment and risk of bias assessment of the included animal studies were evaluated by using Animal Research: Reporting In Vivo Experiments (ARRIVE) guidelines and the SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) risk of bias tool, respectively. Results: The initial search identified 720 records, while only 30 studies were included. The result of the reporting quality assessment was inferior, items 17 and 19 were not reported at all. The details of five items (items 3, 6, 7, 10, and 18) were not reported. The outcome of the risk of bias assessment suggested that half of the entries (5/10) displayed an unclear risk of bias and a high risk of bias. Blinding with regard to performance bias and detection bias revealed an unclear risk of bias (100%), followed by baseline characteristics (76.67%) and sequence generation (60%). Random outcome assessment showed a high risk of bias (100%). Conclusion: The included animal studies exhibited methodological defects and imprecise reporting. Hence, the ARRIVE guidelines and SYRCLE's RoB tool should be disseminated among basic medical researchers examining CSS for depression to publish studies with low risk of bias and sufficient reporting so that the animal research can promptly be transformed into clinical research.

Endoscopic grading of gastric atrophy and histological gastritis staging on risk assessment for early gastric cancer: A case-control study.

OBJECTIVES: To assess the predictive value of endoscopic grading of gastric atrophy using Kimura-Takemoto classification, histological grading systems of operative link on gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia (OLGIM) on risk stratification for early gastric cancer (EGC) and other potential risk factors of EGC. METHODS: A single-center, case-control study was retrospectively conducted including 68 patients with EGC treated with endoscopic submucosal dissection and 68 age- and sex-matched control subjects. Kimura-Takemoto classification, OLGA and OLGIM systems, and other potential risk factors were evaluated between the two groups. RESULTS: Of the 68 EGC lesions, 22 (32.4%) were well differentiated, 38 (55.9%) were moderately differentiated, and 8 (11.8%) were poorly differentiated, respectively. Multivariate analysis revealed O-type Kimura-Takemoto classification (adjusted odds ratio [AOR] 3.282, 95% confidence interval [CI] 1.106-9.744, P = 0.032) and OLGIM stage III/IV (AOR 17.939, 95% CI 1.874-171.722, P = 0.012) were significantly related to a higher risk of EGC. Especially, O-type Kimura-Takemoto classification within 6-12 months before EGC diagnosis (AOR 4.780, 95% CI 1.650-13.845, P = 0.004) was independently associated with EGC risk. Areas under the receiver operating characteristic curve of the three systems for EGC were comparable. CONCLUSIONS: Endoscopic Kimura-Takemoto classification and histological OLGIM stage III/IV are independent risk factors for EGC, which may reduce the need for biopsies in risk stratification of EGC. Further multicenter prospective studies of large sizes are needed.

Construction and optimization of ecological security network in the Shule River Basin, China.

Construction and optimization of ecological security network is an efficient way to ensure regional ecological security and achieve sustainable development. Based on the morphological spatial pattern analysis method, circuit theory and other methods, we constructed the ecological security network of the Shule River Basin. The PLUS model was used to predict the land use change in 2030, with the aim to explore the current ecological protection direction and propose reasonable optimization strategies. The results showed that there were 20 ecological sources in the Shule River Basin, with a total area of 15774.08 km2, accounting for 12.3% of the total area of study area. The ecological sources were mainly distributed in the south part of the study area. A total of 37 potential ecological corridors were extracted, including 22 important ecological corridors, which showed the overall spatial characteristics of vertical distribution. Meanwhile, 19 ecological pinch points and 17 ecological obstacle points were identified. We predicted that the expansion of construction land would continue to squeeze the ecological space by 2030, and identified 6 warning areas of ecological protection space to effectively avoid conflicts between ecological protection and economic development. After optimization, 14 new ecological sources and 17 stepping stones were added, and the circuitry, ratio of line to node and connectivity index of the ecological security network increased by 18.3%, 15.5%, and 8.2% respectively compared with those before optimization, forming a structurally stable ecological security network. The results could provide scientific basis for ecological security network optimization and ecological restoration.

Using "Age and Total-PSA" as the Main Indicators: The Results of Taizhou Integrated Prostate Screening (No 2).

The aim of the study was to analyze population-based prostate cancer (PCa) screening and the incidence of PCa among males ≥50 years of age residing in the Luqiao district of Taizhou, China. From October to December 2020, male residents ≥50 years of age were screened for serum total prostate-specific antigen (total-PSA). If t-PSA re-test levels persisted above 4 µg/L, subjects underwent further noninvasive examinations, including digital rectal examination or multiparameter magnetic resonance imaging (mpMRI) of the prostate. Subjects underwent prostate biopsy of pathological tissue based on t-PSA and mpMRI results. A total of 3524 (49.1%) residents participated in this PCa screening study. In total, 285 (8.1%) subjects exhibited t-PSA levels ≥4.0 µg/L and 112 (3.2%) underwent noninvasive examinations. Forty-two (1.2%) residents underwent prostate biopsy, of which 16 (0.45%) were diagnosed with PCa. Of those diagnosed with PCa, three (19%) had localized PCa (cT1-cT2N0M0), six (37%) had locally advanced PCa (cT3a- cT4N0-1M0), and seven (44%) had advanced metastatic PCa (M1). Unfortunately, 3477 (48.5%) residents did not participate in the study, mainly due to lack of awareness of PCa based on feedback from local health centers. Age and t-PSA were used as primary screening indicators and, when further combined with mpMRI and prostate biopsy, confirmed the diagnosis of PCa among participating residents. Although this was a relatively economical and convenient screening method, education and knowledge should be further enhanced to increase the participation rate in PCa screening programs.

[Assessment of the local blood supply when femoral neck fracture occurs:advances in the anatomy research and its clinical application].

The stability of internal fixation of femoral neck fractures can be obtained through surgical techniques, the configuration of screws and bone grafting, etc. However, the blood supply injury caused by fractures could not be completely reversed by the current medical management. Hence, the comprehensive evaluation of the residual blood supply of the femoral neck, to perioperatively avoid further iatrogenic injury, has become a hotspot. The anatomy of the extraosseous blood supply of the femoral neck has been widely reported, while its clinical application mostly involved the assessment of the medial circumflex femoral artery and retinacular arteries. However, further studies are needed to explore the prognosis of patients with these artery injuries, with different degrees, caused by femoral neck fractures. Direct observations of nutrient foramina in vivo are not possible with current clinical technologies, but it is possible to make reasonable preoperative planning to avoid subsequent femoral head necrosis based on the distribution features of nutrient foramina. The anatomy and clinical application studies of the intraosseous blood supply focused on the junction area of the femoral head and neck to probe the mechanism of femoral head necrosis. Thus, the intraosseous blood supply of other regions in the femoral neck remains to be further investigated. In addition, a blood supply evaluation system based on a three-level structure, extraosseous blood vessels, nutrient foramina, and intraosseous vascular network, could be explored to assist in the treatment of femoral neck fractures.

Predicting Breast Reduction Resection Weights and Attainment of Insurance-Mandated Minimums.

BACKGROUND: Despite evidence that reduction mammaplasty alleviates macromastia symptoms independent of resection weights, resection minimums are commonly used to grant insurance coverage. Multiple formulas have been published to predict resection weights, but very few have evaluated predictive performance relative to attaining common insurance minimums. METHODS: This was a retrospective single-center review of 268 patients from 2007 to 2020. Multiple linear regression and exponential models were created to predict resection weights and attainment of the Schnur, 350-g, and 500-g minimums. Accuracy was compared against published Appel, Descamps, and Galveston equations. Body mass index subgroup analyses were performed. RESULTS: The exponential model possessed the lowest resection weight prediction error overall (172.8 ± 211.5 g). All equations performed significantly better than surgeons in predicting attainment of the 500-g minimum. None performed better than the surgeons' predictive accuracy in attaining a 350-g minimum. Multiple linear regression and exponential models performed significantly better than surgeons in predicting attainment of the Schnur minimum. Only the exponential model performed significantly better than surgeons for both the Schnur (82% versus 71%; P < 0.01) and the 500-g minimums (89% versus 68%; P < 0.01). On body mass index subgroup analyses, all three minimums were biased in favor of obese women-the least egregious of these was the 350-g minimum. CONCLUSIONS: All minimums were biased against nonobese women. Our exponential model equation based on preoperative sternal notch-to-nipple and nipple-to-inframammary fold distances accurately predicts resection weights and improves on our surgeons' predictive accuracy in attaining the Schnur or 500-g minimums. This may prove useful in the preoperative setting to better counsel patients.

Water quality criteria and ecological risk assessment for copper in Liaodong Bay, China.

The establishment of water quality criteria (WQC) for copper (Cu) was used as the basis for an ecological risk assessment of marine Cu pollution in Liaodong Bay, China. Published ecotoxicity data for Cu were obtained and supplemented with the results of acute Cu toxicity tests. The marine WQC for Cu in Liaodong Bay was developed using a species sensitivity distribution method with a safety factor of 2.0 and the USEPA acute-to-chronic ratio method. The ecological risk of Cu in Liaodong Bay was assessed by comparing the seawater Cu concentrations with the developed WQC. The results of this study showed that the acute and chronic Cu concentrations in Liaodong Bay were 3.31 and 2.18 µg/L, respectively. Comparison of the WQC to Cu concentrations in the bay resulted in risk quotients slightly >1.0 and typically ≤2.0. These data suggest that certain organisms in Liaodong Bay are at risk. These results can assist in the development of a pollution control management approach for the bay.

A Very Fast Image Stitching Algorithm for PET Bottle Caps.

In the beverage, food and drug industry, more and more machine vision systems are being used for the defect detection of Polyethylene Terephthalate (PET) bottle caps. In this paper, in order to address the result of cylindrical distortions that influence the subsequent defect detection in the imaging process, a very fast image stitching algorithm is proposed to generate a panorama planar image of the surface of PET bottle caps. Firstly, the three-dimensional model of the bottle cap is established. Secondly, the relative poses among the four cameras and the bottle cap in the three-dimensional space are calculated to obtain the mapping relationship between three-dimensional points on the side surface of the bottle cap and image pixels taken by the camera. Finally, the side images of the bottle cap are unfolded and stitched to generate a planar image. The experimental results demonstrate that the proposed algorithm unfolds the side images of the bottle cap correctly and very fast. The average unfolding and stitching time for 1.6-megapixel color caps image can reach almost 123.6 ms.

Impact of Hospital Characteristics and Governance Structure on the Adoption of Tracking Technologies for Clinical and Supply Chain Use: Longitudinal Study of US Hospitals.

BACKGROUND: Despite the increasing adoption rate of tracking technologies in hospitals in the United States, few empirical studies have examined the factors involved in such adoption within different use contexts (eg, clinical and supply chain use contexts). To date, no study has systematically examined how governance structures impact technology adoption in different use contexts in hospitals. Given that the hospital governance structure fundamentally governs health care workflows and operations, understanding its critical role provides a solid foundation from which to explore factors involved in the adoption of tracking technologies in hospitals. OBJECTIVE: This study aims to compare critical factors associated with the adoption of tracking technologies for clinical and supply chain uses and examine how governance structure types affect the adoption of tracking technologies in hospitals. METHODS: This study was conducted based on a comprehensive and longitudinal national census data set comprising 3623 unique hospitals across 50 states in the United States from 2012 to 2015. Using mixed effects population logistic regression models to account for the effects within and between hospitals, we captured and examined the effects of hospital characteristics, locations, and governance structure on adjustments to the innate development of tracking technology over time. RESULTS: From 2012 to 2015, we discovered that the proportion of hospitals in which tracking technologies were fully implemented for clinical use increased from 36.34% (782/2152) to 54.63% (1316/2409), and that for supply chain use increased from 28.58% (615/2152) to 41.3% (995/2409). We also discovered that adoption factors impact the clinical and supply chain use contexts differently. In the clinical use context, compared with hospitals located in urban areas, hospitals in rural areas (odds ratio [OR] 0.68, 95% CI 0.56-0.80) are less likely to fully adopt tracking technologies. In the context of supply chain use, the type of governance structure influences tracking technology adoption. Compared with hospitals not affiliated with a health system, implementation rates increased as hospitals affiliated with a more centralized health system-1.9-fold increase (OR 1.87, 95% CI 1.60-2.13) for decentralized or independent hospitals, 2.4-fold increase (OR 2.40, 95% CI 2.07-2.80) for moderately centralized health systems, and 3.1-fold increase for centralized health systems (OR 3.07, 95% CI 2.67-3.53). CONCLUSIONS: As the first of such type of studies, we provided a longitudinal overview of how hospital characteristics and governance structure jointly affect adoption rates of tracking technology in both clinical and supply chain use contexts, which is essential for developing intelligent infrastructure for smart hospital systems. This study informs researchers, health care providers, and policy makers that hospital characteristics, locations, and governance structures have different impacts on the adoption of tracking technologies for clinical and supply chain use and on health resource disparities among hospitals of different sizes, locations, and governance structures.

Nitrogen emission and deposition budget in an agricultural catchment in subtropical central China.

The study of emissions and depositions of atmospheric reactive nitrogen species (Nrs) in a region is important to uncover the sources and sinks of atmospheric Nrs in the region. In this study, atmospheric total Nrs depositions including both wet-only and dry deposition were monitored simultaneously across major land-use types in a 105 km2 catchment called Jinjing River Catchment (JRC) in subtropical central China from 2015 to 2016. Based on activity data and emission factors for the main Nrs emission sources, ammonia (NH3) and nitrogen oxides (NOx) emission inventories for the catchment were also compiled. The estimated total Nrs deposition in JRC was 35.9 kg N ha-1 yr-1, with approximately 49.7 % attributed to reduced compounds (NHx), and 40.5 % attributed to oxidized (NOy). The total Nrs emission rate in JRC was 80.4 kg N ha-1 yr-1, with 61.5 and 18.9 kg N ha-1 yr-1 from NH3 and NOx emissions, respectively. Livestock excretion and fertilization were the two main contributing emission sources for NH3, while vehicle sources contributed the bulk of NOx emissions. The net atmospheric budgets of Nrs in paddy field, forest, and tea field were +3.7, -36.1, and +23.8 kg N ha-1 yr-1, respectively. At the catchment scale, the net atmospheric budget of Nrs was +47.7 kg N ha-1 yr-1, with +43.7 kg N ha-1 yr-1 of NHx and +4.0 kg N ha-1 yr-1 of NOy, indicating that the subtropical catchment was net sources of atmospheric Nrs. Considering that excessive atmospheric Nr emissions and deposition may cause adverse effects on the environment, effects should be conducted to mitigate the Nrs emissions from agriculture and transportation, and increasing the area of forest is good for reducing the net positive budget of atmospheric Nrs in the subtropical catchments in China.

Noninvasive assessment of myocardial energy metabolism and dynamics using in vivo deuterium MRS imaging.

PURPOSE: The assessment of cellular energy metabolism is crucial for understanding myocardial physiopathology. Here, we conducted a pilot study to develop an alternative imaging approach for the assessment of myocardial energy metabolism. METHODS: We developed a deuterium MRSI method to noninvasively monitor the accumulation of deuterated downstream metabolites and deuterated water in rat hearts infused with deuterated glucose or acetate substrate on a 16.4 Tesla animal scanner. RESULTS: We found that the deuterated water accumulation rate and isotopic turnover rate of deuterated glutamate/glutamine via the tricarboxylic acid cycle and exchange in rat hearts were much higher when infused with acetate compared to that with glucose, demonstrating the myocardium substrate preference for acetate over glucose. CONCLUSION: We demonstrated the feasibility of deuterium MRSI for noninvasive imaging and assessment of myocardial energy metabolism in vivo. Although the strong signal and large dynamics of myocardial deuterated water may provide a sensitive imaging biomarker, quantifying the metabolic rates still poses a challenge due to the confounding effects of blood recirculation, perfusion, and multiple deuterated water production pathways. In contrast, the deuterated glutamate/glutamine signal and change should directly reflect the metabolic activity of the myocardial tricarboxylic acid cycle, which can be used to study the metabolic shift in substance preference between acetate and glucose in the diseased state. Deuterium MRSI is noninvasive and robust and may have the potential to assess myocardial energy metabolism in human patients.

Assessment of effective mitigation and prediction of the spread of SARS-CoV-2 in Germany using demographic information and spatial resolution.

Non-pharmaceutical interventions (NPIs) are important to mitigate the spread of infectious diseases as long as no vaccination or outstanding medical treatments are available. We assess the effectiveness of the sets of non-pharmaceutical interventions that were in place during the course of the Coronavirus disease 2019 (Covid-19) pandemic in Germany. Our results are based on hybrid models, combining SIR-type models on local scales with spatial resolution. In order to account for the age-dependence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we include realistic prepandemic and recently recorded contact patterns between age groups. The implementation of non-pharmaceutical interventions will occur on changed contact patterns, improved isolation, or reduced infectiousness when, e.g., wearing masks. In order to account for spatial heterogeneity, we use a graph approach and we include high-quality information on commuting activities combined with traveling information from social networks. The remaining uncertainty will be accounted for by a large number of randomized simulation runs. Based on the derived factors for the effectiveness of different non-pharmaceutical interventions over the past months, we provide different forecast scenarios for the upcoming time.

How to handle the delayed or missed dose of rivaroxaban in patients with non-valvular atrial fibrillation: model-informed remedial dosing.

BACKGROUND: Rivaroxaban is an oral anticoagulant widely used for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). During long-term anticoagulant therapy, delayed or missed doses are common. This study aimed to explore appropriate remedial dosing regimens for non-adherent rivaroxaban-treated patients. METHODS: Monte Carlo simulation based on a previously established rivaroxaban population pharmacokinetic/pharmacodynamic (PK/PD) model for patients with NVAF was employed to design remedial dosing regimens. The proposed regimens were compared with remedial strategies in the European Heart Rhythm Association (EHRA) guide by assessing deviation time in terms of drug concentration, factor Xa activity, and prothrombin time. RESULTS: The proposed remedial dosing regimens were dependent on delay duration. The missed dose should be taken immediately when the delay does not exceed 6 h; a half dose is advisable when the delay is between 6 and 20 h. A missed dose should be skipped if less than 4 h remains before the next dose. The proposed regimens resulted in shorter deviation time than that of the EHRA guide. CONCLUSION: PK/PD modeling and simulation provide valid evidence on the remedial dosing regimen of rivaroxaban, which could help to minimize the risk of bleeding and thromboembolism.

Composition and changes in breast cancer patients' diagnosis and treatment expenses under the influence of medical insurance policy reform-A study on 3 950 patients in Guangxi Medical University Cancer Hospital. / åŒ»ä¿æ”¿ç­–æ”¹é©å½±å“ä¸‹ä¹³è ºç™Œæ‚£è€ è¯Šç–—è´¹ç”¨çš„æž„æˆåŠå˜åŒ–­­åŸºäºŽå¹¿è¥¿åŒ»ç§‘大学附属肿瘤医院3 950ä¾‹æ‚£è€ çš„ç ”ç©¶.

OBJECTIVES: To understand the influence of medical insurance policy reforms in Guangxi on the hospitalization expenses of breast cancer patients by analyzing the composition and changing trend in breast cancer diagnosis and treatment expenses in the Guangxi Medical University Cancer Hospital, and to provide the evidence for the improvement of medical insurance policy reform. METHODS: A total of 3 950 breast cancer patients were collected from 2014 to 2017 and analyzed. Kruskal-Wallis test and multiple linear regression model were used to discuss the breast cancer related epidemiology and analyze the composition of hospitalization expenses and its influential factors. RESULTS: The median hospitalization cost of breast cancer patients in our hospital from 2014 to 2017 was 29 266.94 Chinese Yuan. Single factor analysis showed that the impact of year, hospitalization days, age, payment method, tumor stage, and treatment method on hospitalization cost was significant (all P<0.01). Multiple linear regression analysis showed that the power of influential factors of hospitalization costs arranged descending from 2014 to 2017 as follows: hospitalization days, treatment methods, payment method, tumor staging, and age. CONCLUSIONS: Reasonably controlling hospitalization days and actively promoting the integration of urban and rural medical insurance can effectively reduce the economic burden for breast cancer patients.

Exploring the Safety, Effectiveness, and Cost-Effectiveness of a Chinese Patent Medicine (Fufang E'jiao Syrup) for Alleviating Cancer-Related Fatigue: A Protocol for a Randomized, Double-Blinded, Placebo-Controlled, Multicenter Trial.

OBJECTIVE: To provide higher level evidence on the benefits of a Chinese patent medicine (CPM) (Fufang E'jiao Syrup, FFEJS) for alleviating cancer-related fatigue (CRF), this article describes a protocol for a randomized controlled trial. METHODS/DESIGN: We designed a double-blind, placebo-controlled stratified permuted block randomization clinical trial on CRF among 3 types of cancer in China. Participants will be equally allocated to FFEJS group or placebo group according to the randomization sequence and the hospitals they were enrolled at. Each patient will receive 20 ml of either the study formula FFEJS or a placebo formula, 3 times a day for 6 weeks. The follow-up period will be another 4 weeks for safety evaluation. The primary outcome is the difference in improvement of fatigue as measured with the Revised Piper Fatigue Scale-Chinese Version (RPFS-CV). Secondary outcomes include change in fatigue (measured by routine blood panel and hormones in peripheral blood) and QoL (measured by Edmonton symptom assessment scale and Functional Assessment of Cancer Therapy). Patient safety will be measured by liver, renal or cardiac damage, and the risk of FFEJS having a tumor promotion and progression effect will be monitored throughout this study. Cost-effectiveness will also be evaluated mainly by incremental cost per each quality-adjusted life year gained. DISCUSSION: This article describes the study design of a CPM for CRF in patients with advanced cancer through exploring the effectiveness, safety, and cost-effectiveness of FFEJS. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04147312. Registered on 1 Sep 2019.

Quantitative Assessment of Occipital Metabolic and Energetic Changes in Parkinson's Patients, Using In Vivo 31P MRS-Based Metabolic Imaging at 7T.

Abnormal energy metabolism associated with mitochondrial dysfunction is thought to be a major contributor to the progression of neurodegenerative diseases such as Parkinson's disease (PD). Recent advancements in the field of magnetic resonance (MR) based metabolic imaging provide state-of-the-art technologies for non-invasively probing cerebral energy metabolism under various brain conditions. In this proof-of-principle clinical study, we employed quantitative 31P MR spectroscopy (MRS) imaging techniques to determine a constellation of metabolic and bioenergetic parameters, including cerebral adenosine triphosphate (ATP) and other phosphorous metabolite concentrations, intracellular pH and nicotinamide adenine dinucleotide (NAD) redox ratio, and ATP production rates in the occipital lobe of cognitive-normal PD patients, and then we compared them with age-sex matched healthy controls. Small but statistically significant differences in intracellular pH, NAD and ATP contents and ATPase enzyme activity between the two groups were detected, suggesting that subtle defects in energy metabolism and mitochondrial function are quantifiable before regional neurological deficits or pathogenesis begin to occur in these patients. Pilot data aiming to evaluate the bioenergetic effect of mitochondrial-protective bile acid, ursodeoxycholic acid (UDCA) were also obtained. These results collectively demonstrated that in vivo 31P MRS-based neuroimaging can non-invasively and quantitatively assess key metabolic-energetic metrics in the human brain. This provides an exciting opportunity to better understand neurodegenerative diseases, their progression and response to treatment.