Green credit policy, government subsidy, and enterprises "shifting from virtual to real".

Taking the green credit policy in 2012 as a quasi-natural experiment, this paper uses the difference-in-differences method to explore the impact of green credit policy on enterprises' financial asset allocation and the moderating effect of government subsidy. We find that green credit policy significantly promotes the financial asset allocation of heavy-polluting enterprises, which is mainly reflected in short-term liquid financial investment, thus supporting the precautionary motivation of holding financial assets. The mechanism analysis shows that green credit policy promotes the financial asset allocation of heavy-polluting enterprises by reducing the scale of debt financing and increasing the financing cost. Government subsidy can significantly weaken the promoting effect of green credit policy on enterprises' financial asset allocation, and there is heterogeneity due to the regional environmental regulation intensity and financial development level. Further analysis shows that the negative moderating effect of government subsidy on green credit policy and enterprises' financial asset allocation significantly promotes the "shifting form virtual to real" of heavy polluting enterprises by reducing financial asset allocation. This paper discusses the impact of green credit policy on financial asset allocation of heavy-polluting enterprises in China and further clarifies the significant role of government subsidy in the process, so as to provide suggestions for government to control the "shifting from real to virtual" of enterprises. The results also provide an important reference for countries, especially developing countries, to implement green credit policy and government subsidy to achieve sustainable economic development.

Development and evaluation of a risk assessment tool for the personalized screening of breast cancer in Chinese populations: A prospective cohort study.

INTRODUCTION: Breast cancer is a significant contributor to female mortality, exerting a public health burden worldwide, especially in China, where risk-prediction models with good discriminating accuracy for breast cancer are still scarce. METHODS: A multicenter screening cohort study was conducted as part of the Cancer Screening Program in Urban China. Dwellers aged 40-74 years were recruited between 2014 and 2019 and prospectively followed up until June 30, 2021. The entire data set was divided by year of enrollment to develop a prediction model and validate it internally. Multivariate Cox regression was used to ascertain predictors and develop a risk-prediction model. Model performance at 1, 3, and 5 years was evaluated using the area under the curve, nomogram, and calibration curves and subsequently validated internally. The prediction model incorporates selected factors that are assigned appropriate weights to establish a risk-scoring algorithm. Guided by the risk score, participants were categorized into low-, medium-, and high-risk groups for breast cancer. The cutoff values were chosen using X-tile plots. Sensitivity analysis was conducted by categorizing breast cancer risk into the low- and high-risk groups. A decision curve analysis was used to assess the clinical utility of the model. RESULTS: Of the 70,520 women enrolled, 447 were diagnosed with breast cancer (median follow-up, 6.43 [interquartile range, 3.99-7.12] years). The final prediction model included age and education level (high, hazard ratio [HR], 2.01 [95% CI, 1.31-3.09]), menopausal age (≥50 years, 1.34 [1.03-1.75]), previous benign breast disease (1.42 [1.09-1.83]), and reproductive surgery (1.28 [0.97-1.69]). The 1-year area under the curve was 0.607 in the development set and 0.643 in the validation set. Moderate predictive discrimination and satisfactory calibration were observed for the validation set. The risk predictions demonstrated statistically significant differences between the low-, medium-, and high-risk groups (p < .001). Compared with the low-risk group, women in the high- and medium-risk groups posed a 2.17-fold and 1.62-fold elevated risk of breast cancer, respectively. Similar results were obtained in the sensitivity analyses. A web-based calculator was developed to estimate risk stratification for women. CONCLUSIONS: This study developed and internally validated a risk-adapted and user-friendly risk-prediction model by incorporating easily accessible variables and female factors. The personalized model demonstrated reliable calibration and moderate discriminative ability. Risk-stratified screening strategies contribute to precisely distinguishing high-risk individuals from asymptomatic individuals and prioritizing breast cancer screening. PLAIN LANGUAGE SUMMARY: Breast cancer remains a burden in China. To enhance breast cancer screening, we need to incorporate population stratification in screening. Accurate risk-prediction models for breast cancer remain scarce in China. We established and validated a risk-adapted and user-friendly risk-prediction model by incorporating routinely available variables along with female factors. Using this risk-stratified model helps accurately identify high-risk individuals, which is of significant importance when considering integrating individual risk assessments into mass screening programs for breast cancer. Current clinical breast cancer screening lacks a constructive clinical pathway and guiding recommendations. Our findings can better guide clinicians and health care providers.

Water resource sustainable use assessment methodology and an impact factor analysis framework for SDG 6-oriented river basins: evidence from the Yellow River basin (Shaanxi section) in China.

The rapid growth of developing countries has placed unprecedented pressure on water resources, severely hindering the realization of sustainable development goal 6 (SDG 6) in river basins. In this study, sustainable water resource utilization (SWRU) in the Yellow River basin (Shaanxi section) from 2005 to 2019 is evaluated through an analysis of water resource overload combined with the water footprint (WF) and the water planetary boundary (WPB) and an analysis of water resource utilization quality combined with the WF and city development index (CDI) based on the coupled coordination model. Then, the results are incorporated into the drive-pressure-state-impact-response framework to analyze the impacts of the socioeconomic system on SWRU and the feedback effect of related policies. The results show that there were obvious differences in the spatiotemporal evolution characteristics of the WF in different geographical units. The WF of Guanzhong first increased and then decreased, and the WF of Northern Shaanxi grew continuously. The water deficit state is increasing. Although the coordination level between the WF and CDI in the basin increased by 500.31%, it was characterized by nonequilibrium and volatility. Compared to water resource endowment, socioeconomic development and government policies have greater impacts on SWRU; furthermore, the influencing factors demonstrate spatial variability, revealing the complexity of achieving SDG 6 in the basin. As policy implications, adaptive water resource policies should be formulated on the basis of strengthening the overall basin management. This study provides a scientific basis for promoting the realization of SDG 6 through watershed water management.

FT3/FT4 Enhances Risk Assessment in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Based on GRACE 2.0 Score.

Little is known about the association between the free triiodothyronine/free thyroxine (FT3/FT4) ratio and clinical outcomes in euthyroid patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI). A total of 1448 euthyroid patients with NSTE-ACS who underwent PCI were included in this prospective study. Multivariate Cox regression analysis revealed that there was a significantly increased risk of stroke (hazard ratio [HR] 11.380, 95% confidence interval [CI]: 1.386-93.410, P = .024) and major adverse cardiovascular and cerebrovascular events (MACCEs) (HR 3.364, 95% CI: 1.595-7.098, P = .001) in patients in lower FT3/FT4 tertiles. The combined model of FT3/FT4 ratio and the Global Registry of Acute Coronary Events (GRACE) score provided the added value of risk assessment by improving C-statistics, integrated discrimination improvement (IDI), and the net reclassification index (NRI) (all P < .05). Thus, in euthyroid patients with NSTE-ACS undergoing PCI, the FT3/FT4 ratio was not only an independent prognostic indicator of long-term MACCE but also enhanced risk discrimination when combined with the GRACE risk score, which suggests that the calculation of FT3/FT4 before and after PCI may contribute to risk stratification in this particular patient group.

Combination of GWAS and FST-based approaches identified loci associated with economic traits in sugarcane.

Sugarcane is a globally important plant for both sugar and biofuel production. Although conventional breeding has played an important role in increasing the productivity of sugarcane, it takes a long time to achieve breeding goals such as high yield and resistant to diseases. Molecular breeding, including marker-assisted breeding and genomic selection, can accelerate genetic improvement by selecting elites at the seedling stage with DNA markers. However, only a few DNA markers associated with important traits were identified in sugarcane. The purpose of this study was to identify DNA markers associated with sugar content, stalk diameter, and sugarcane top borer resistance. The sugarcane samples with trait records were genotyped using the restriction site-associated DNA sequencing (RADseq) technology. Using FST analysis and genome-wide association study (GWAS), a total of 9, 23 and 9 DNA variants (single nucleotide polymorphisms (SNPs)/insertions and deletions (indels)) were associated with sugar content, stalk diameter, and sugarcane top borer resistance, respectively. The identified genetic variants were on different chromosomes, suggesting that these traits are complex and determined by multiple genetic factors. These DNA markers identified by both approaches have the potential to be used in selecting elite clones at the seeding stage in our sugarcane breeding program to accelerate genetic improvement. Certainly, it is essential to verify the reliability of the identified DNA markers associated with traits before they are used in molecular breeding in other populations.

Multi-Sequence and Multi-Regional MRI-Based Radiomics Nomogram for the Preoperative Assessment of Muscle Invasion in Bladder Cancer.

BACKGROUND: Whether bladder cancer (BCa) invades muscle is a determinant of management. However, the accuracy of preoperative diagnosis of muscle invasion is not satisfactory. PURPOSE: To investigate the value of multi-sequence and multi-regional magnetic resonance imaging (MRI)-based radiomics nomogram for assessing muscle invasion of BCa. STUDY TYPE: Retrospective. POPULATION: 342 BCa patients, divided into a training set (239 cases), a validation set (68 cases), and a test set (35 cases). FIELD STRENGTH/SEQUENCE: 3.0 T/T2 -weighted image, diffusion-weighted imaging, and dynamic contrast-enhanced imaging. ASSESSMENT: Patients were divided into muscle-invasive (79 cases) and non-muscle-invasive (263 cases). Two radiologists delineated the whole tumor, tumor body, and muscle layer of BCa, respectively, and extracted radiomic features. STATISTICAL TESTS: Recursive feature elimination, Pearson correlation coefficient, logistic regression, least absolute shrinkage and selection operator (Lasso) regression analysis, and 5-fold cross-validation were used to screen features and build a radiomics model. The clinical data were collected to construct a clinical model and a radiomics-clinical nomogram. RESULTS: 23,688 features were extracted. After screening, the radiomics scoring model was constructed using nine radiomics features with area under curve (AUC) values of 0.933, 0.913, and 0.931 in the training, validation, and test sets, respectively. The clinical model was constructed using five clinical independent risk factors; the AUC values in the training, validation, and test set were 0.876, 0.859, and 0.824, respectively. After logistic regression analysis, the AUC values of the radiomics-clinical nomogram were made up of four clinical independent risk factors and radiomics scores were 0.955, 0.922, and 0.935 for the training, validation, and test sets, respectively. The DeLong test between clinical model and radiomics-clinical nomogram shows P < 0.001. CONCLUSION: Multi-sequence and multi-regional MRI-based radiomics models could effectively assess the state of BCa muscular invasion. The radiomics-clinical nomogram is superior to clinical model for assessing BCa muscular invasion. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 2.

The paradoxical effects of social class on career adaptability: The role of intolerance of uncertainty.

Introduction: As a growth background factor, family social class has far-reaching effects on youth career development. However, we have limited understanding of the role and functional mechanisms of social class in career adaptability. Based on the social cognitive theory of social class, we examine the mediating role of intolerance of uncertainty in the relationship between youths' subjective social class and career adaptability. We also explore the moderating influences of self-esteem. Methods: Data were collected from a sample consisting of 712 undergraduates (63.2% female) in China. Results: Results show that subjective social class positively impacts career adaptability via prospective anxiety, and negatively impacts career adaptability via inhibitory anxiety. The intensity of these indirect relationships is contingent on youths' self-esteem. Discussion: Our study illustrates the complex and paradoxical effects of social class on career adaptability and has important theoretical and practical implications. This study expands the theoretical perspective by bringing in the social cognitive theory of social class, provides novel insight into the complex interaction between individuals and the environment in youth career development, and should provide inspiration for the design of career intervention programs.

Correction: Cost-Effectiveness of Lung Cancer Screening Using Low-Dose Computed Tomography Based on Start Age and Interval in China: Modeling Study.

[This corrects the article DOI: 10.2196/36425.].

Cost-Effectiveness of Lung Cancer Screening Using Low-Dose Computed Tomography Based on Start Age and Interval in China: Modeling Study.

BACKGROUND: Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death in China. The effectiveness of screening for lung cancer has been reported to reduce lung cancer-specific and overall mortality, although the cost-effectiveness, optimal start age, and screening interval remain unclear. OBJECTIVE: This study aimed to assess the cost-effectiveness of lung cancer screening among heavy smokers in China by incorporating start age and screening interval. METHODS: A Markov state-transition model was used to assess the cost-effectiveness of a lung cancer screening program in China. The evaluated screening strategies were based on a screening start age of 50-74 years and a screening interval of once or annually. Transition probabilities were obtained from the literature and validated, while cost parameters were derived from databases of local medical insurance bureaus. A societal perspective was adopted. The outputs of the model included costs, quality-adjusted life years (QALYs), and lung cancer-specific mortality, with future costs and outcomes discounted by 5%. A currency exchange rate of 1 CNY=0.1557 USD is applicable. The incremental cost-effectiveness ratio (ICER) was calculated for different screening strategies relative to nonscreening. RESULTS: The proposed model suggested that screening led to a gain of 0.001-0.042 QALYs per person as compared with the findings in the nonscreening cohort. Meanwhile, one-time and annual screenings were associated with reductions in lung cancer-related mortality of 0.004%-1.171% and 6.189%-15.819%, respectively. The ICER ranged from 119,974.08 to 614,167.75 CNY per QALY gained relative to nonscreening. Using the World Health Organization threshold of 212,676 CNY per QALY gained, annual screening from a start age of 55 years and one-time screening from the age of 65 years can be considered as cost-effective in China. Deterministic and probabilistic sensitivity analyses were conducted. CONCLUSIONS: This economic evaluation revealed that a population-based lung cancer screening program in China for heavy smokers using low-dose computed tomography was cost-effective for annual screening of smokers aged 55-74 years and one-time screening of those aged 65-74 years. Moreover, annual lung cancer screening should be promoted in China to realize the benefits of a guideline-recommended screening program.

Epidemic Risk Assessment by a Novel Communication Station Based Method.

The COVID-19 pandemic has caused serious consequences in the last few months and trying to control it has been the most important objective. With effective prevention and control methods, the epidemic has been gradually under control in some countries and it is essential to ensure safe work resumption in the future. Although some approaches are proposed to measure people's healthy conditions, such as filling health information forms or evaluating people's travel records, they cannot provide a fine-grained assessment of the epidemic risk. In this paper, we propose a novel epidemic risk assessment method based on the granular data collected by the communication stations. We first compute the epidemic risk of these stations in different intervals by combining the number of infected persons and the way they pass through the station. Then, we calculate the personnel risk in different intervals according to the station trajectory of the queried person. This method could assess people's epidemic risk accurately and efficiently. We also conduct extensive simulations and the results verify the effectiveness of the proposed method.

Cost-effectiveness of risk-tailored screening strategy for colorectal cancer: A systematic review.

BACKGROUND AND AIM: Though one-size-fits-all age-based screening for colorectal cancer (CRC) is effective in reducing the incidence and mortality, the evidence regarding on personized screening based on individual risk factors has been growing. The study aimed to perform a systematic review to synthesize economic evidence of risk-tailored CRC screening strategies. METHODS: This systematic review was conducted in EMBASE, Web of Science, PubMed, Cochrane Library, Econlit, and National Institute for Health Research Economic Evaluation Database from inception to June 30, 2021. We calculated the incremental cost-effectiveness ratio (ICER) of cost per life year or quality-adjusted life year gained for the risk-tailored screening compared with no screening or uniform screening. A strategy was cost-effective with less cost and equal or more effectiveness than the comparator along with lower ICER than the willingness-to-pay threshold. RESULTS: Our review finally comprised seven studies. Five studies reported the results of comparisons of risk-tailored CRC screening with no screening, and supported that risk-tailored screening was cost-effective. All of seven studies reported the ICERs of risk-tailored screening and age-based screening. Disparities in the discrimination of risk-prediction tool, accuracy of adopted techniques, uptake rate of screening and cost estimation impacted the cost-effectiveness. CONCLUSIONS: Studies on the economic evaluation of risk-tailored CRC screening are limited, and current evidence is not sufficient to support the replacement of risk-tailored screening for traditional age-based screening.

An Evaluation Index System of Basic Elderly Care Services Based on the Perspective of Accessibility.

Population aging has become more and more severe in many countries. As a result, the demand for basic elderly care services has risen. The establishment of an evaluation index system for basic elderly care services can provide guidelines for governments to improve the quality of such services. Based on the "5A" theoretical analysis framework of Penchansky and Thomas, this paper introduces the concept of "accessibility" into evaluation. The "accessibility" model of services, through a literature review, field research, and three rounds of expert correspondence, consists of three first-level indicators, including the accessibility of home-based community elderly care services, the accessibility of institutional elderly care services, and the accessibility of administrative services. The evaluation index system of 15 s-level indicators and 70 third-level indicators, using AHP to determine the weight value of each indicator, provides a quantitative basis for the quality evaluation and improvement of basic elderly care services. Based on our quantitative results, policy recommendations are put forward: strengthen the support for the human and financial resources of community home-based elderly care services; improve the affordability of basic elderly care services; increase the types and numbers of institutional elderly care service projects; improve the availability and adaptability of institutional elderly care services; improve the accessibility of administrative services so that elderly care service institutions and elderly care administrative agencies can establish an effective communication and feedback mechanism.

Fluorescence spectrometry based chromaticity mapping, characterization, and quantitative assessment of dental caries.

PURPOSE: Dental caries detection, especially the accurate detection of early caries, facilitates prompt interventions. It is reasonably common to use fluorescence imaging for classification and evaluation of caries, but lacks a quantitative, precise and easy-to-use characterization for practical applications. In this study a quantitative approach for caries stage detection by correlating caries spectral and chromatic features was examined. METHODS: A 405 nm LED light source was used as the excitation source. A hyperspectral imaging camera is employed to collect 336 spectral data of different caries stages. Four critical intervals for different stages of caries were extracted by fluorescence spectral features. The mapping relationship between caries spectral and chromatic features was established by Fast Formula Fitting (FFF) and Neural Network Fitting (NNF) methods. RESULTS: The 470-780 nm spectral power distribution was proved to be the best matching color waveband guiding the selection of filters in future instrument development. The correlation coefficients for the two fitting methods were 0.990 and 0.999, respectively. Both methods achieved caries stage prediction at the pixel level with high accuracy using color information. The visualization region in the chromaticity diagram was created. CONCLUSIONS: This quantitative method enables accurate prediction of caries on the entire tooth surface and facilitates the development of portable and low-cost caries detection instruments.

Budget-constraint admissible output consensus tracking for intermittent-interaction singular multiagent networks.

Budget-constraint admissible output consensus tracking design and analysis for the intermittent-interaction singular multiagent networks with given cost budgets are addressed in this paper. Two critical characteristics of many practical multiagent networks are focused. The first one is that the dynamics of each agent contains dynamical modes, as well as impulsive modes and static modes, and interactions among agents are intermittent. The second one is that the network is constrained by the cost budget, and the weighted design between tracking performances and energy consumptions should be guaranteed under budget constraints. Firstly, in virtue of the decomposition of observability, a new singular consensus tracking protocol with the dynamic output feedback is proposed by intermittent protocol states. Meanwhile, a cost index is constructed by considering both the tracking performance and the energy consumption. Then, criteria of budget-constraint admissible output consensus tracking analysis and design are given. By designing the gain matrices of consensus tracking protocols, not only multiagent networks with dynamical modes and static modes reach output consensus tracking while eliminating impulsive modes, but also the upper bound of the cost index can be kept within the cost budget; that is, the weighted design with the budget constraint is achieved. Finally, theoretical results are demonstrated by numerical simulations.

Prognostic Significance of Preprocedural N-Terminal Pro-B-Type Natriuretic Peptide Assessment in Diabetic Patients With Multivessel Coronary Disease Undergoing Revascularization.

Background and Aims: The N-terminal pro-B-type natriuretic peptide (NT-proBNP) may predict adverse cardiovascular outcomes in patients with diabetes. However, its prognostic value in patients with multivessel disease (MVD) undergoing coronary revascularization remains unclear. This study aimed to evaluate the prognostic significance of preprocedural NT-proBNP levels in diabetic patients with MVD undergoing coronary revascularization. Methods: A total of 886 consecutive diabetic patients with MVD who underwent coronary revascularization were enrolled in this study. Patients were divided into quartiles according to their pre-procedural NT-proBNP levels. Kaplan-Meier curves and Cox regression analyses were performed to evaluate the risk of cardiovascular events, including all-cause death, cardiovascular death, myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACE), according to the NT-proBNP quartiles. Results: During a median follow-up period of 4.2 years, 111 patients died (with 82 being caused by cardiovascular disease), 133 had MI, 55 suffered from stroke, and 250 experienced MACE. Kaplan-Meier curves demonstrated that NT-proBNP levels were significantly associated with higher incidences of all-cause death, cardiovascular death, MI, and MACE (log-rank test, P < 0.001, respectively). Multivariate Cox regression analysis revealed that NT-proBNP level was an independent predictor of adverse outcomes, including all-cause death (HR, 1.968; 95% CI, 1.377-2.812; P < 0.001), cardiovascular death (HR, 1.940; 95% CI, 1.278-2.945; P = 0.002), MI (HR, 1.722; 95% CI, 1.247-2.380; P = 0.001), and MACE (HR, 1.356; 95% CI, 1.066-1.725; P = 0.013). The role of NT-proBNP in predicting adverse outcomes was similar in patients with stable angina pectoris and acute coronary syndrome. Moreover, preprocedural NT-proBNP alone discriminated against the SYNTAX II score for predicting all-cause death [area under the curve (AUC), 0.662 vs. 0.626, P = 0.269], cardiovascular death (AUC, 0.680 vs. 0.622, P = 0.130), MI (AUC, 0.641 vs. 0.579, P = 0.050), and MACE (AUC, 0.593 vs. 0.559, P = 0.171). The addition of NT-proBNP to the SYNTAX II score showed a significant net reclassification improvement, integrated discrimination improvement, and improved C-statistic (all P < 0.05). Conclusion: NT-proBNP levels were an independent prognostic marker for adverse outcomes in diabetic patients with MVD undergoing coronary revascularization, suggesting that preprocedural NT-proBNP measurement might help in the risk stratification of high-risk patients.

Comparative yield and efficiency of strategies based on risk assessment and fecal immunochemical test in colorectal cancer screening: A cross-sectional population-based analysis.

OBJECTIVE: Integration of risk stratification into fecal immunochemical test (FIT) might aid in the suboptimal detection of advanced neoplasms by FIT in colorectal cancer (CRC) screening. A comparative study was conducted to evaluate the participation and diagnostic yield of the parallel combination of questionnaire-based risk assessment (QRA) and FIT, FIT-only and QRA-only strategies in a CRC screening program in China. METHODS: The study included 29,626 individuals aged 40-74 years and invited to participate in a CRC screening program in China. Participants were first invited to undertake QRA and one-time FIT (OC-sensor). Participants with positive QRA or FIT were deemed to be high-risk individuals who were recommended for subsequent colonoscopy. Participation, detection rate, and resource demand for colonoscopy were calculated and compared. RESULTS: Of the 29,626 invitees, 20,203 completed the parallel combination, 8,592 completed the QRA-only, and 11 completed the FIT-only strategy. For the parallel combination, FIT-only, and QRA-only strategies, the overall positivity rates were 10.2% (2,928/28,806), 5.4% (1,096/20,214), and 6.8% (1,944/28,795), respectively; the yield of advanced neoplasm per 10,000 invitees were 46.9 [95% confidence interval (95% CI): 39.8-55.4], 36.8 (95% CI: 30.5-44.4), and 12.2 (95% CI: 8.8-16.8), respectively; the positive predictive values for detecting advanced neoplasms among participants who completed colonoscopy were 4.7% (95% CI: 4.0%-5.6%), 9.9% (95% CI: 8.3%-11.9%), and 1.9% (95% CI: 1.3%-2.6%), respectively; the number of colonoscopies required to detect one advanced neoplasm was 11.4 (95% CI: 9.8-13.4), 5.7 (95% CI: 4.8-6.7), and 28.4 (95% CI: 20.7-39.2), respectively. CONCLUSIONS: The parallel combination of QRA and FIT did not show superior efficacy for detecting advanced neoplasm compared with FIT alone in this CRC screening program.

Optimizing Positivity Thresholds for a Risk-Adapted Screening Strategy in Colorectal Cancer Screening.

INTRODUCTION: Risk-adapted screening combining the Asia-Pacific Colorectal Screening score, fecal immunochemical test (FIT), and colonoscopy improved the yield of colorectal cancer screening than FIT. However, the optimal positivity thresholds of risk scoring and FIT of such a strategy warrant further investigation. METHODS: We included 3,407 participants aged 50-74 years undergoing colonoscopy from a colorectal cancer screening trial. For the risk-adapted screening strategy, subjects were referred for subsequent colonoscopy or FIT according to their risk scores. Diagnostic performance was evaluated for FIT and the risk-adapted screening method with various positivity thresholds. Furthermore, a modeled screening cohort was established to compare the yield and cost using colonoscopy, FIT, and the risk-adapted screening method in a single round of screening. RESULTS: Risk-adapted screening method had higher sensitivity for advanced neoplasm (AN) (27.6%-76.3% vs 13.8%-17.3%) but lower specificity (46.6%-90.8% vs 97.4%-98.8%) than FIT did. In a modeled screening cohort, FIT-based screening would be slightly affected because the threshold varied with a reduction of 76.0%-80.9% in AN detection and 82.0%-84.4% in cost when compared with colonoscopy. By contrast, adjusting the threshold of Asia-Pacific Colorectal Screening score from 3 to 5 points for risk-adapted screening varied from an increase of 12.6%-14.1% to a decrease of 55.6%-60.1% in AN detection, with the reduction of cost from 4.2%-5.3% rising to 66.4%-68.5%. DISCUSSION: With an appropriate positivity threshold tailored to clinical practice, the risk-adapted screening could save colonoscopy resources and cost compared with the colonoscopy-only and FIT-only strategies.

Clinical assessment of the results of one-stage circular incision techniques for limb ring constriction due to amniotic band syndrome.

BACKGROUND: Amniotic band syndrome (ABS) is a congenital malformation that results in abnormalities in many parts of the body. Most surgical treatments for ABS used multi-stage Z-plasties. The purpose of this study was to assess the clinical results of one-stage circular incision techniques for limb ring constriction due to amniotic band syndrome. METHODS: We reviewed 27 patients with limb ring constriction in ABS from 2010 to 2020. The mean ages of the patients were 11.7 months (range, 0-72 months). The complete circular incision release the ABS. All patients' operations were used one-stage circular incision surgical techniques, including patients with multiple bands. All the patients were followed up with a period ranges from 2 years to 10 years. Patient-reported visual analog scale (VAS) scar ranking on a scale of 0 (minimum satisfaction) to 10 (maximum satisfaction) were used to evaluate esthetic outcomes. RESULTS: After our surgery, all the limbs, toes, and fingers were rescued, and the lymphedema reduced remarkably. The VAS scores (mean ±â€ŠSD) for patient satisfaction were 7.55 ±â€Š1.89. The surgical treatment of amniotic band syndrome in a one-stage circular incision is safe and effective. CONCLUSION: The one-stage circular incision surgical techniques have many advantages, including reduced surgical invasiveness, scar formation, and the cost of treatment. LEVEL OF EVIDENCE: Level IV-retrospective case series.

Clinical characteristics, medical service utilization, and expenditure for colorectal cancer in China, 2005 to 2014: Overall design and results from a multicenter retrospective epidemiologic survey.

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in China, however, publicly available, descriptive information on the clinical epidemiology of CRC is limited. METHODS: Patients diagnosed with primary CRC during 2005 through 2014 were sampled from 13 tertiary hospitals in 9 provinces across China. Data related to sociodemographic characteristics, the use of diagnostic technology, treatment adoption, and expenditure were extracted from individual medical records. RESULTS: In the full cohort of 8465 patients, the mean ± SD age at diagnosis was 59.3 ± 12.8 years, 57.2% were men, and 58.7% had rectal cancer. On average, 14.4% of patients were diagnosed with stage IV disease, and this proportion increased from 13.5% in 2005 to 20.5% in 2014 (P value for trend < .05). For diagnostic techniques, along with less use of x-rays (average, 81.6%; decreased from 90.0% to 65.7%), there were increases in the use of computed tomography (average, 70.4%; increased from 4.5% to 90.5%) and magnetic resonance imaging (average, 8.8%; increased from 0.1% to 20.4%) over the study period from 2005 to 2014. With regard to treatment, surgery alone was the most common (average, 50.1%), but its use decreased from 51.3% to 39.8% during 2005 through 2014; and the use of other treatments increased simultaneously, such as chemotherapy alone (average, 4.1%; increased from 4.1% to 11.9%). The average medical expenditure per patient was 66,291 Chinese Yuan (2014 value) and increased from 47,259 to 86,709 Chinese Yuan. CONCLUSIONS: The increasing proportion of late-stage diagnoses presents a challenge for CRC control in China. Changes in diagnostic and treatment options and increased expenditures are clearly illustrated in this study. Coupled with the recent introduction of screening initiatives, these data provide an understanding of changes over time and may form a benchmark for future related evaluations of CRC interventions in China.

Population-level economic burden of lung cancer in China: Provisional prevalence-based estimations, 2017-2030.

OBJECTIVE: Population-level economic burden is essential for prioritizing healthcare resources and healthcare budget making in the future. However, little is known about the economic burden of lung cancer in China. METHODS: A prevalence-based approach was adopted to estimate the economic burden of lung cancer, including direct expenditure (medical and non-medical) and indirect cost (disability and premature death). Data on direct expenditure and work-loss days per patient in each year post-diagnosis were obtained from two primary surveys. Other parameters were obtained from literatures and official reports. Projections were conducted based on varying parameters. All expenditure data were reported in United States dollars (USD) using 2017 value (exchange rate: 1 USD= 6.760 CNY), with the discount rate of 3%. RESULTS: The total economic burden of lung cancer was estimated to be 25,069 million USD in China in 2017 (0.121% of gross domestic productivity, GDP). The estimated direct expenditure was 11,098 million USD, up to 1.43% of total healthcare expenditure for China, covering 10,303 million USD and 795 million USD for medical and non-medical expenditure, respectively. The estimated indirect cost was 13,971 million, including 1,517 million USD due to disability and 12,454 million USD due to premature death. Under current assumptions, the projected total economic burden would increase to 30.1 billion USD, 40.4 billion USD, and 53.4 billion USD in 2020, 2025, and 2030, accounting for 0.121%, 0.131%, and 0.146% of China's GDP, respectively. However, if China meets the United Nation sustainable development goal of reducing premature death from non-communicable diseases by one-third by 2030, the total economic burden in 2030 would be 31.9 billion USD, 0.087% of China's GDP. CONCLUSIONS: The economic burden of lung cancer in China in 2017 is substantial and more likely to increase significantly in the future. Policy makers need to take urgent actions in budget making for health systems. The economic burden could be alleviated by reducing the disease burden of lung cancer via effective control and prevention actions.