Survival analysis of early-onset locally advanced rectal cancer: a retrospective study based on the Surveillance, Epidemiology, and End Results (SEER) database / 中华胃肠外科杂志

Objective: To investigate the factors influencing tumor-specific survival of early-onset locally advanced rectal cancer. Methods: All-age patients with primary locally advanced rectal cancer from the Surveillance, Epidemiology, and End Results (SEER) database (2010 to 2019) were included in this study. Early- and late-onset locally advanced rectal cancer was defined according to age of 50 years at diagnosis. Early-onset locally advanced rectal cancer was divided into five age groups for subgroup analyses. Age, sex, tumor-specific survival time and survival status of patients at diagnosis, pathological grade, TNM stage, perineural invasion, tumor deposits, tumor size, pretreatment CEA , radiotherapy, chemotherapy, and number of lymph node dissections were included. Progression-free survival (PFS) was analyzed and compared between patients with early- and late-onset rectal cancer. Results: A total of 5,048 patients with locally advanced rectal cancer were included in the study (aged 27-70 years): 1,290 (25.55%) patients with early-onset rectal cancer and 3,758 (74.45%) patients with late-onset rectal cancer. Patients with early-onset rectal cancer had a higher rate of perineural invasion (P<0.001), more positive lymph nodes dissected (P<0.001), higher positive lymph node ratios (P<0.001), and a higher proportion receiving preoperative radiotherapy (P=0.002). Patients with early-onset rectal cancer had slightly better short-term survival than those with late-onset rectal cancer (median (IQR ): 54 (33-83) vs 50 (31-79) months, χ2=5.192, P=0.023). Multivariate Cox regression for all patients with locally advanced rectal cancer showed that age (P=0.008), grade of tumor differentiation (P=0.002), pretreatment CEA (P=0.008), perineural invasion (P=0.021), positive number (P=0.004) and positive ratio (P=0.001) of dissected lymph nodes, and sequence of surgery and radiotherapy (P=0.005) influenced PFS. This suggests that the Cox regression results for all patients may not be applicable to patients with early-onset cancer. Cox analysis showed tumor differentiation grade (patients with low differentiation had a higher risk of death, P=0.027), TNM stage (stage III patients had a higher risk of death, P=0.025), T stage (higher risk of death in stage T4, P<0.001), pretreatment CEA (P=0.002), perineural invasion (P<0.001), tumor deposits (P=0.005), number of dissected lymph nodes (patients with removal of 12-20 lymph nodes had a lower risk of death, P<0.001), and positive number of dissected lymph nodes (P<0.001) were independent factors influencing PFS of patients with early-onset locally advanced rectal cancer. Conclusion: Patients with early-onset locally advanced rectal cancer were more likely to have adverse prognostic factors, but an adequate number of lymph node dissections (12-20) resulted in better survival outcomes.

Development and validation of a prognostic prediction model for patients with stage Ⅰ to Ⅲ colon cancer incorporating high-risk pathological features / 中华外科杂志

Objective: To examine a predictive model that incorporating high risk pathological factors for the prognosis of stage Ⅰ to Ⅲ colon cancer. Methods: This study retrospectively collected clinicopathological information and survival outcomes of stage Ⅰ~Ⅲ colon cancer patients who underwent curative surgery in 7 tertiary hospitals in China from January 1, 2016 to December 31, 2017. A total of 1 650 patients were enrolled, aged (M(IQR)) 62 (18) years (range: 14 to 100). There were 963 males and 687 females. The median follow-up period was 51 months. The Cox proportional hazardous regression model was utilized to select high-risk pathological factors, establish the nomogram and scoring system. The Bootstrap resampling method was utilized for internal validation of the model, the concordance index (C-index) was used to assess discrimination and calibration curves were presented to assess model calibration. The Kaplan-Meier method was used to plot survival curves after risk grouping, and Cox regression was used to compare disease-free survival between subgroups. Results: Age (HR=1.020, 95%CI: 1.008 to 1.033, P=0.001), T stage (T3:HR=1.995,95%CI:1.062 to 3.750,P=0.032;T4:HR=4.196, 95%CI: 2.188 to 8.045, P<0.01), N stage (N1: HR=1.834, 95%CI: 1.307 to 2.574, P<0.01; N2: HR=3.970, 95%CI: 2.724 to 5.787, P<0.01) and number of lymph nodes examined (≥36: HR=0.438, 95%CI: 0.242 to 0.790, P=0.006) were independently associated with disease-free survival. The C-index of the scoring model (model 1) based on age, T stage, N stage, and dichotomous variables of the lymph nodes examined (<12 and ≥12) was 0.723, and the C-index of the scoring model (model 2) based on age, T stage, N stage, and multi-categorical variables of the lymph nodes examined (<12, 12 to <24, 24 to <36, and ≥36) was 0.726. A scoring system was established based on age, T stage, N stage, and multi-categorical variables of lymph nodes examined, the 3-year DFS of the low-risk (≤1), middle-risk (2 to 4) and high-risk (≥5) group were 96.3% (n=711), 89.0% (n=626) and 71.4% (n=313), respectively. Statistically significant difference was observed among groups (P<0.01). Conclusions: The number of lymph nodes examined was an independent prognostic factor for disease-free survival after curative surgery in patients with stage Ⅰ to Ⅲ colon cancer. Incorporating the number of lymph nodes examined as a multi-categorical variable into the T and N staging system could improve prognostic predictive validity.

Epidemiology of pathogenic tick-borne viruses in China: a review / 中国血吸虫病防治杂志

Ticks are obligate, haematophagous arthropods that are distributed across the world, which may transmit more than 200 pathogens, including viruses, bacteria and parasites. A large number of tick species are widespread in China, and their transmitting tick-borne viral diseases pose a great threat to human health in endemic foci. This review describes the epidemiology of common, emerging and potentially pathogenic tick-borne viruses in China, and recommends the assessment of public health significance and pathogenicity of emerging tick-borne viruses using reverse microbial etiology, so as to provide insights into the management of emerging tick-borne diseases in China.

Evidence-based surgical management for early colon cancer / 中华胃肠外科杂志

In recent years, the incidence of early colon cancer (ECC) in China showed a rising trend. Accurate definition of ECC is of great significance for disease assessment, treatment decision-making and prognosis judgment. Although endoscopic resection has become an option in the treatment of ECC, surgical intervention is still needed for tumor residue and high risk pT1 tumors in order to prevent recurrence and metastasis. There is no consensus on indication, timing, radical resection range and tumor location of ECC surgery. The innovation of laparoscopic surgical techniques strongly promoted the progress of ECC minimally invasive surgery. Postoperative follow-up should be systematic, standardized and individualized, based on the stratification of ECC recurrence risk factors.

Association between maternal body height and risk of preterm birth / 中华流行病学杂志

Objective: To investigate the association between maternal body height and risk of preterm birth. Methods: A total of 11 311 pregnant women who gave birth of live singletons were recruited from the Healthy Baby Cohort Study in Hubei province, China from September 2012 to October 2014. Finally 11 070 pregnant women were selected as study subjects. Data were collected by using questionnaires, their prenatal care records and medical records. The women were divided into 4 groups according to the quartiles distribution (<158 cm, 158- cm, 160- cm, and >164 cm). Gestational age was estimated according to maternal last menstrual time. Preterm birth was defined as delivering a live singleton infant at 28-37 weeks' gestational age. Logistic regression was used to calculate the odds ratios (OR) and 95% confidence intervals (CI) for the association between body height and preterm birth. Results: Among the 11 070 pregnant women, the incidence of preterm birth was 5.9%. Logistic regression analysis indicated that women in group with body height <158 cm had 46% (OR=1.46, 95%CI: 1.16-1.83) higher risk of giving preterm birth than those in group with body height >164 cm after adjustment for potential confounders. Every 1- cm increase in body height was associated with 3% lower risk of preterm birth (OR=0.97, 95%CI: 0.95-0.99). Conclusion: Shorter body height was a risk factor for preterm birth. It is necessary to strengthen the monitoring in pregnant women with short body height to reduce the risk of preterm birth.

Prevalence and distribution of hypertension in population aged 15 years and over in Guizhou province / 中华流行病学杂志

Objective: To understand the prevalence and distribution of hypertension in population aged 15 years and over in Guizhou province and provide evidence for the prevention and management of hypertension. Methods: Face to face interviews using national standard questionnaire were conducted among the study subjects selected in Guizhou through multi-stage random sampling. Blood pressure measurement for them was done with Omron HEM-1300 professional portable blood pressure monitor. SPSS 19.0 software was used for statistical analysis. The ratio was compared by the χ(2) test. The influencing factors of hypertension was analyzed by multivariate logistic regression analysis. Results: A total of 13 480 participants were investigated, including 5 509 (40.8%) men and 7 971 (59.2%) women; 6 558 (48.6%) urban residents and 6 922 (51.4%) rural residents. Among the subjects surveyed, 3 232 (23.9%) were smokers, 2 412 (17.9%) were alcoholic and 4 859 (36.0%) were obese or overweight. A total of 3 937 (29.2%) hypertension patients were found. The prevalence of hypertension was 29.2%. The standardized prevalence of hypertension were 18.97% (compared with national population composition) and 21.16% (compared with Guizhou province population composition), respectively. The hypertension prevalence in men and women were 29.8% and 28.8%, respectively. The hypertension prevalence in rural population (35.8%) was higher than that in urban population (22.2%). The difference was statistically significant (P<0.001). The hypertension prevalence in people aged 65 years and over was 56.2%. The prevalence of hypertension were 34.3% and 27.6% in smokers and non-smokers, 39.2% and 27.0% in alcoholic and non-alcoholic and 40.7% and 22.7% in obese or overweight group and normal or less weight group, respectively. There were significant statistical differences in prevalence of hypertension among the population in urban area and rural area, with different age, education levels, smoking status, drinking status and BMI (P<0.001). Conclusions: The prevalence of hypertension in Guizhou was at a high level. The hypertension prevalence in rural area was higher than that in urban area. Hypertension prevalence increased significantly with age. The prevalence of hypertension was negatively associated with the education level of the people. Older age, living in rural area, smoking, drinking, obesity were the risk factors for hypertension.

A novel prognostic index for oral cancer in Fujian province / 中华流行病学杂志

Objective: To explore the survival factors and construct a prognostic index (PI) for oral squamous cell carcinoma (OSCC). Methods: From January 2004 to June 2016, a total of 634 patients with pathologically confirmed OSCC were recruited in a hospital of Fujian. The clinical and follow-up data of all the patients with pathologically confirmed OSCC were collected to identify the factors influencing the prognosis of OSCC. All the patients were randomly divided into two groups: modeling group (modeling dataset, n=318) and validation group (validation dataset, n=316). Randomization was carried out by using computer-generated random numbers. In the modeling dataset, survival rates were calculated using Kaplan-Meier method and compared using the log-rank test. Cox regression model was used to estimate the hazard ratio (HRs) and 95% confidence intervals (CIs) of prognosis factors. An PI for OSCC patients prognostic prediction model was developed based on β value of each significant variable obtained from the multivariate Cox regression model. Using the tertile analysis, patients were divided into high-risk group, moderate-risk group, and low-risk group according to the PI, the Akaike information criterion (AIC) and Harrell's c-statistic (C index) were used to evaluated the model's predictability. Results: Results from the multivariate Cox regression model indicated that aged ≥55 years (HR=2.22, 95%CI: 1.45-3.39), poor oral hygiene (HR=2.12, 95%CI: 1.27-3.54), first diagnosis of lymph node metastasis (HR=5.78, 95%CI: 3.60-9.27), TNM stage Ⅲ-Ⅳ (stage Ⅰ as reference) (HR=2.43, 95%CI: 1.10-5.37) and poor differentiation (well differentiation as reference) (HR=2.53, 95%CI: 1.60-4.01) were the risk factors influencing the prognosis of OSCC. The PI model had a high predictability in modeling group and validation group (AIC and C index were 1 205.80, 0.700 2 and 1 150.47, 0.737 3). Conclusion: Age, poor oral hygiene, first diagnosis of lymph node metastasis, TNM stage and histological grade were factors associated with the prognosis of OSCC, and the PI model has a certain significance in the clinical treatment of OSCC.

Abuse of diphenoxylate and related factors of forced drug abstainer in Gansu province / 中华流行病学杂志

Objective: To investigate the prevalence of diphenoxylate abuse and related factors of forced drug abstainer in Gansu province. Methods: By using a self-designed questionnaire, an epidemiologic investigation was carried out among 2 108 forced drug abstainer selected from the compulsory isolation detoxification center of Gansu province. A case-control study was conducted to analyze the factors related with diphenoxylate abuse. Results: The diphenoxylate abuse rate among forced drug abstainer in Gansu was 19.8% (406/2 046), ranking first in medical drug abuse. Multiple logistic regression analysis showed that factors as relieving withdrawal symptoms (OR=2.08, 95%CI: 1.01- 4.32), ways to obtain diphenoxylate (other ways: OR=1.00; regular clinic: OR=27.67, 95%CI: 2.64-289.82; friend: OR=0.01, 95%CI: 0.01-0.03), degree of euphoria (high: OR=1.00; medium: OR =3.36, 95%CI: 1.18-9.55; low: OR=26.16, 95%CI: 10.30-66.42), years of drug abuse (<5 years: OR=1.00; 10-15 years: OR=2.48, 95%CI: 1.02-6.04), abuse at home or in friend's house (OR=3.04, 95%CI: 1.08-8.68), abuse in car (OR=0.05, 95%CI: 0.00-0.68) and detoxification for the first time (OR=0.61, 95%CI: 0.43-0.86) were the possible influencing factors for diphenoxylate abuse. Conclusions: The prevalence of diphenoxylate abuse in forced drug abstainer in Gansu was relatively high. Reasons of abusing, the way to obtain diphenoxylate, whether using drug together with friends, degree of euphoria, years of abuse, abuse place and times for detoxification were related factors influencing the abuse of diphenoxylate.

Correlation between pregnancy-induced hypertension and age in pregnant women from Hebei province, 2016 / 中华流行病学杂志

Objective: To analyze the correlation between age and pregnancy-induced hypertension (PIH) in pregnant women from Hebei province in 2016. Methods: A retrospective analysis was conducted by using the clinical data of 64 909 pregnant women, delivering in 22 hospitals in Hebei in 2016. Descriptive statistics was used to describe the general data and pregnancy outcomes of pregnant women, and χ(2) test was used to compare the incidence of PIH in different age groups, and logistic regression analysis was used to analyze the risk factors for PIH. Results: The incidence of PIH was lowest in 20-29 year old women, and increased obviously in those aged<20 and>35 years (P<0.05), and the incidence was positively correlated with age. Logistic regression analysis showed that age, times of pregnancy, number of previous cesarean section and fetus number of current pregnancy were the risk factors for PIH (OR=1.293, 1.153, 1.307, 3.607), while times of deliver and times of prenatal examination were the protective factors (OR=0.655, 0.951). Conclusion: Advanced age pregnancy and young age pregnancy would significantly increase the incidence of PIH. Prenatal care should be strengthened for pregnant women at risk for PIH.

Progress in research of bacillus calmette-guerin vaccination and repeated vaccination / 中华流行病学杂志

Tuberculosis (TB) is a serious infectious diseases threating human health, bacillus balmette-guerin vaccine (BCG) is the only available TB vaccine now, neonatal vaccination can significantly reduce the incidence and death of tuberculosis. However, due to its limited protection period, one dose vaccination after birth does not have a protective effect for adolescents and adults. Therefore, how to reduce the prevalence of TB in adolescents and adults effectively is essential for TB prevention and control. In this paper, we reviewed the literature from PubMed, CNKI, and Wanfang database to analyze and summarize the characteristics of BCG vaccine, immune effects and immunity endurance, the effects of BCG vaccination and repeated BCG vaccination in adolescents adults and discuse the change of attitude and trends of BCG use in the three documents issued by the World Health Organization on position of BCG.

Long-term effect of iodine deficiency on growth and food utilization rate in second filial generation rats / 中华预防医学杂志

To study the effect of iodine deficiency on body weight, food consumption, and food utilization rate of second filial generation Wistar rats.According to the food pattern of a high-iodine deficient population, two types of low-iodine food have been produced using the main crops grown in this area (iodine levels of 50 and 20 μg/kg, respectively). Wistar rats were randomly divided into three groups, normal iodine group (NI group), low-iodine group one (LI group) and low-iodine group two (LII group), using the random number table method and fed diets containing 300, 50, and 20 μg/kg of iodine, respectively. Parental generation rats were fed until they reached reproductive age; first filial generation rats were allocated to the same diet as their mothers. After 3 months of feeding, first filial generation rats gave birth to second filial generation rats; second filial generation rats were allocated to the same diet as their mothers. After feeding for 90, 180, and 270 days, rats were sacrificed. One-way analysis of variance was used to analyze body weight, food intake, and food utilization rate data collected during the time of feeding and blood iodine hormone level, which was determined after sacrifice.The LI and LII groups generally demonstrated decreased activity, slow reaction, and growth retardation compared with the NI group. After 270 days, the urine iodine levels of the LI and LII groups were 1.7 and 0.2 μg/L, respectively, which were significantly lower than the NI group (255.2 μg/L) (0.001). Additionally, the weight of female rats in the LI and LII groups were (288.1±10.5) and (275.7±2.7) g, respectively, which was significantly lower than that of the NI group ((311.0±2.3) g) (0.001). The weight of male rats were (446.0±4.6) and (451.8±19.1) g, respectively, which were significantly lower than that of the NI group ((517.2±7.8) g) (0.001). In the LI and LII groups, food intake of female and male rats after 270 days were (465.0±27.7), (658.4±28.6) and (423.0±13.2), (548.0±18.8) g, respectively, which were significantly lower than that of the NI group ((499.5±21.8), (760.8±33.0) g) (0.001). Moreover, the food utilization rate of female rats in the LI and LII groups was (8.7±0.4)% and (6.0±0.58)%, which was lower than that of the NI group ((11.7±3.5)%) (0.001); similarly, male rats showed rates of (8.9±1.5)% and (6.9±1.31)%, respectively, which were lower than that of the NI group ((13.7±3.0)%) (0.001). After 270 days, the level of T3 in the LI and LII groups were (0.45±0.10) and (0.34±0.15) ng/ml, respectively, which was significantly lower than that of the NI group ((0.91±0.49) ng/ml) (0.01). Moreover, the level of T4 were (69.02±27.87) , (53.18±13.53) ng/ml in LI and LII groups, respectively, which was lower than that of the NI group ((76.69±29.42) ng/ml) (0.05).This study indicated that iodine deficiency induced by a long-term low-iodine diet can cause changes in weight, food intake, and food utilization rate among second filial iodine deficiency rats. More importantly, the iodine content in low-iodine food impacts these parameters.

Ficolin-A enhances inhibition of the C-terminal 19 kDa region ofmerozoite surface protein-1 of plasmodium berghei using test in vivo

Malaria remains a serious public health problem with significant morbidity and mortality. This study was conducted to identify whether ficolin-A could play an active role of against malaria infection. The function of ficolin-A was analyzed in mouse model. The open reading frame of ficolin-A was cloned from the liver of new born C57BL/6 mice by RT-PCR and then inserted into the expression vector of eukaryon to construct p VAX1-ficolin-A plasmid. Meanwhile, the open reading frame of the 19-kDa fragment of merozoite surface protein-1 of Plasmodium berghei [MSP1[19]] was cloned and then the expression vector of eukaryon, p VAX1- MSP1[19] was constructed. Both recombinant vectors were used in the mouse model of infection by Plasmodium berghei. p VAX 1-ficolin-A alone could not significantly suppress parasite density and prolong survival time of infection mice; however, when injected p VAX1-ficolin-A and p VAX1- MSP1[19] together, the percent of invasion by Plasmodium was decreased [from 43.78% to 22.23% at 10 day after infection, compared to vector] and the survival time was prolonged significantly in the infection mouse model [P=0.01]. Ficolin-A can enhance the immunoprotection of MSP1[19], it implies ficolin-A may be used as immunoenhancer in the study of vaccine defending malaria