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BACKGROUND: Regular Low-Dose Computed Tomography (LDCT) for lung cancer high-risk population has been proved to improve health outcomes and relieve disease burden efficiently for both individual and society. With geographical impedance becoming the major barrier preventing patients from getting timely healthcare service, this study incorporated health seeking behavior in estimating spatial accessibility of relative scarce LDCT resource in China, thus to provide real-world evidence for future government investment and policy making. METHODS: Taking Sichuan Province in southwest China as the study area, a cross-sectional survey was first carried out to collect actual practice and preferences for seeking LDCT services. Using Computed Tomography (CT) registration data reported by owner institutions representing LDCT services capacity, and grided town-level high-risk population as demand, the Nearest Neighbor Method was then utilized to calculate spatial accessibility of LDCT services. RESULTS: A total of 2,529 valid questionnaires were collected, with only 34.72% of the high-risk populations (746 individuals) followed the recommended annual screening. Participants preferred to travel to municipal-level and above institutions within 60 min for LDCT services. Currently, every thousand high-risk populations own 0.0845 CT scanners in Sichuan Province, with 96.95% able to access LDCT within 60 min and over half within 15 min. Urban areas generally showed better accessibility than rural areas, and the more developed eastern regions were better than the western regions with ethnic minority clusters. CONCLUSIONS: Spatial access to LDCT services is generally convenient in Sichuan Province, but disparity exists between different regions and population groups. Improving LDCT capacity in county-level hospitals as well as promoting health education and policy guidance to the public can optimize efficiency of existing CT resources. Implementing mobile CT services and improving rural public transportation may alleviate emerging disparities in accessing early lung cancer detection.
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Detecção Precoce de Câncer , Neoplasias Pulmonares , Humanos , Estudos Transversais , Detecção Precoce de Câncer/métodos , Etnicidade , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/epidemiologia , Grupos Minoritários , Tomografia Computadorizada por Raios X/métodos , Análise Espacial , China/epidemiologiaRESUMO
BACKGROUND: Sarcopenic obesity (SO) in nursing home residents is rarely studied. We aimed to evaluate and compare the prevalence and consistency of different SO diagnostic methods and to investigate which criterion demonstrated a stronger association with instrumental activities of daily living (IADL) disability. METHODS: We consecutively recruited older adults aged ≥ 60 years, residing in 15 nursing homes in Zigong City, China. Sarcopenia obesity was defined according to the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity criteria (SOESPEN), recommending skeletal muscle mass (SMM) adjusted by body weight (SMM/W) to identify low muscle mass. Further, we adapted ESPEN criteria (SOESPEN-M) by employing SMM adjusted by body mass index (SMM/BMI). RESULTS: We included 832 participants (median age 73.0 years, 296 women). The prevalence of SOESPEN and SOESPEN-M was 43.5% and 45.3%, respectively. SOESPEN showed good consistency with SOESPEN-M (Cohen's kappa = 0.759). More than one-third of participants in the normal weight group were diagnosed with SOESPEN or SOESPEN-M. Even within the underweight group, the prevalence of SOESPEN and SOESPEN-M was 8.9% and 22.2%, respectively. Participants with IADL disability had significantly lower SMM/W and SMM/BMI, but higher fat mass percentage of body weight (FM%) than participants without IADL disability. After full adjustment for potential confounders, SOESPEN-M (OR 1.68, 95% CI 1.21 to 2.32), but not SOESPEN (OR 1.28, 95% CI 0.93 to 1.75), remained significantly associated with IADL disability. CONCLUSIONS: Both SOESPEN and SOESPEN-M showed a high prevalence among nursing home residents, even among individuals with underweight or normal weight. While SOESPEN had a good consistency with SOESPEN-M, only SOESPEN-M was independently associated with IADL disability. Screening and diagnosis of SO should be conducted in nursing home residents irrespective of BMI.
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Atividades Cotidianas , Casas de Saúde , Obesidade , Sarcopenia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Massa Corporal , China/epidemiologia , Estudos Transversais , Avaliação Geriátrica/métodos , Obesidade/epidemiologia , Obesidade/diagnóstico , Prevalência , Sarcopenia/epidemiologia , Sarcopenia/diagnósticoRESUMO
Introduction: Lung cancer is a leading cause of cancer deaths globally. Despite favorable recommendations, low-dose computed tomography (LDCT) lung screening adoption remains low in China. Barriers such as limited infrastructure, costs, distance, and personnel shortages restrict screening access in disadvantaged regions. We initiated a telemedicine-enabled lung cancer screening (LCS) program in a medical consortium to serve people at risk in underserved communities. The objective of this study was to describe the implementation and initial results of the program. Methods: From 2020 to 2021, individuals aged 40-80 years were invited to take LCS by mobile computed tomography (CT) units in three underserved areas in Western China. Numerous CT scans were remotely reported by radiologists aided by artificial intelligence (AI) diagnostic systems. Abnormal cases were tracked through an integrated hospital network for follow-up. A retrospective cohort study documented participant demographics, health history, LDCT results, and outcomes. Descriptive analysis was conducted to report baseline characteristics and first-year follow-up results. Results: Of the 28,728 individuals registered in the program, 19,517 (67.94%) participated in the screening. The study identified 2.68% of participants with high-risk pulmonary nodules and diagnosed 0.55% with lung cancer after a 1-year follow-up. The majority of high-risk participants received timely treatment in hospitals. Conclusions: This study demonstrated mobile CT units with remote AI assistance improved access to LCS in underserved areas, with high participation and early detection rates. Our implementation supports the feasibility of deploying telemedicine-enabled LCS to increase access to a large scale of basic radiology and diagnostic services in resource-limited settings. Clinical Trial Registration Number: ChiCTR1900024623.
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Inteligência Artificial , Detecção Precoce de Câncer , Neoplasias Pulmonares , Área Carente de Assistência Médica , Telemedicina , Tomografia Computadorizada por Raios X , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico , Pessoa de Meia-Idade , Feminino , Tomografia Computadorizada por Raios X/métodos , Idoso , Masculino , Detecção Precoce de Câncer/métodos , China/epidemiologia , Adulto , Telemedicina/organização & administração , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Unidades Móveis de Saúde/organização & administração , Populações VulneráveisRESUMO
BACKGROUND: This study aimed to screen prognosis-related S100 protein family members in human paxpillomaviruses (HPV)-negative oral squamous cell carcinoma (OSCC) and their molecular regulations. METHODS: Bioinformatic screening was conducted based on single-cell RNA-seq data from Puram 2017 dataset and bulk-seq data from the Cancer Genome Atlas (TCGA). HPV-negative OSCC cell lines CAL-27 and SCC-4 were used as in vitro cell models. RESULTS: Among 21 S100 protein family member genes, S100A13 upregulation was associated with unfavorable progression-free survival and disease-specific survival of OSCC patients. Gene Set Enrichment Analysis showed that the higher S100A13 expression group had elevated genes enriched in DNA repair and oxidative phosphorylation. S100A13 knockdown increased cisplatin sensitivity, while its overexpression decreased the sensitivity of CAL-27 and SCC-4 cells. S100A13 gene had complex alternative transcription patterns. ENST00000440685 is one of the major protein-coding transcripts and was the only transcript elevated in the tumor group. TEAD4 could bind to the promoter of ENST00000440685 and increase its transcription. TEAD4 overexpression alleviated the tumor-suppressive effect of cisplatin in terms of colony formation, the expression of apoptotic proteins, and DNA damage. However, S100A13 knockdown partly abrogated the protective effects of TEAD4 overexpression. CONCLUSION: This study revealed a novel TEAD4-S100A13 axis that might modulate cisplatin sensitivity of OSCC tumor cells.
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Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Bucais , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/genética , Linhagem Celular Tumoral , Cisplatino/farmacologia , Proteínas de Ligação a DNA/genética , Proteínas de Ligação a DNA/metabolismo , Humanos , Neoplasias Bucais/tratamento farmacológico , Neoplasias Bucais/genética , Proteínas Musculares/metabolismo , Proteínas S100 , Carcinoma de Células Escamosas de Cabeça e Pescoço , Fatores de Transcrição de Domínio TEA , Fatores de Transcrição/genéticaRESUMO
BACKGROUND: Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is an efficient method that can reduce lung cancer mortality in high-risk individuals. However, few studies have attempted to measure the preferences for LDCT LCS service delivery. This study aimed to generate quantitative information on the Chinese population's preferences for LDCT LCS service delivery. METHODS: The general population aged 40 to 74 in the Sichuan province of China was invited to complete an online discrete choice experiment (DCE). The DCE required participants to answer 14 discrete choice questions comprising five attributes: facility levels, facility ownership, travel mode, travel time, and out-of-pocket cost. Choice data were analyzed using mixed logit and latent class logit (LCL) models. RESULTS: The study included 2529 respondents, with 746 (29.5%) identified as being at risk for lung cancer. Mixed logit model (MLM) analysis revealed that all five attributes significantly influenced respondents' choices. Facility levels had the highest relative importance (44.4%), followed by facility ownership (28.1%), while out-of-pocket cost had the lowest importance (6.4%). The at-risk group placed relatively more importance on price and facility ownership compared to the non-risk group. LCL model identified five distinct classes with varying preferences. CONCLUSION: This study revealed significant heterogeneity in preferences for LCS service attributes among the Chinese population, with facility level and facility ownership being the most important factors. The findings underscore the need for tailored strategies targeting different subgroup preferences to increase screening participation rates and improve early detection outcomes.
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Comportamento de Escolha , Detecção Precoce de Câncer , Neoplasias Pulmonares , Preferência do Paciente , Tomografia Computadorizada por Raios X , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico , Pessoa de Meia-Idade , China , Masculino , Feminino , Idoso , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Tomografia Computadorizada por Raios X/métodos , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Adulto , Inquéritos e QuestionáriosRESUMO
To compare the LDCT screening results between eligible and ineligible screening candidates in preventive health check-ups population. Using a real-world LDCT screening results among people who took yearly health check-up in health management center of West China Hospital between 2006 and 2017. Objects were classified according to the China National Lung Cancer Screening Guideline with Low-dose Computed Tomography (2018 version) eligibility criteria. Descriptive analysis were performed between eligible and ineligible screening candidates. The proportion of ineligible screening candidates was 64.13% (10,259), and among them there were 4005 (39.04%) subjects with positive screenings, 80 cases had a surgical lung biopsy. Pathology results from lung biopsy revealed 154 cancers (true-positive) and 26 benign results (false-positive), the surgical false-positive biopsy rate was 4.17%, and ineligible group (7.69%) was higher than eligible group (2.47%), P < 0.05. Further, in ineligible screening candidates, the proportion of current smokers was higher among males compared to females (53.85% vs. 4.88%, P < 0.05). Of the 69 lung cancer patients detected in ineligible screening candidates, lung adenocarcinoma accounts for a high proportion of lung cancers both in male (75.00%) and female (85.00%). The proportion of ineligible screening candidates and the surgical false-positive biopsy rate in ineligible candidates were both high in health check-ups population.
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Adenocarcinoma de Pulmão , Neoplasias Pulmonares , Humanos , Masculino , Feminino , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/epidemiologia , Detecção Precoce de Câncer/métodos , Programas de Rastreamento/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVES: Lung cancer is one of the most common malignant tumors threatening human life and health. At present, low-dose computed tomography (LDCT) screening for the high-risk population to achieve early diagnosis and treatment of lung cancer has become the first choice recommended by many authoritative international medical organizations. To further optimize the lung cancer screening method, we conducted a real-world study of LDCT lung cancer screening in a large sample of a healthy physical examination population, comparing differences in lung nodules and lung cancer detection between thin and thick-slice LDCT scanning. METHODS: A total of 29 296 subjects who underwent low-dose thick-slice CT scanning (5 mm thickness) from January 2015 to December 2015 and 28 058 subjects who underwent low-dose thin-slice CT scanning (1 mm thickness) from January 2018 to December 2018 in West China Hospital were included. The positive detection rate, detection rate of lung cancer, pathological stage of lung cancer, and mortality rate of lung cancer were analyzed and compared between the two groups. RESULTS: The positive rate of LDCT screening in the thin-slice scanning group was significantly higher than that in the thick-slice scanning group (20.1% vs. 14.4%, p < 0.001). In addition, the lung cancer detection rate in the thin-slice LDCT screening positive group was significantly higher than that in the thick-slice scanning group (78.0% vs. 52.9%, p < 0.001). CONCLUSIONS: The screening positive rate of low-dose thin-slice CT scanning is higher and more early-stage lung cancer (IA1 stage) can be detected in the screen-positive group.
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Detecção Precoce de Câncer , Neoplasias Pulmonares , Tomografia Computadorizada por Raios X , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Feminino , Tomografia Computadorizada por Raios X/métodos , China/epidemiologia , Pessoa de Meia-Idade , Detecção Precoce de Câncer/métodos , Idoso , Doses de Radiação , Adulto , Programas de Rastreamento/métodosRESUMO
BACKGROUND: For some common thyroid-related conditions with high prevalence and long follow-up times, ChatGPT can be used to respond to common thyroid-related questions. In this cross-sectional study, we assessed the ability of ChatGPT (version GPT-4.0) to provide accurate, comprehensive, compassionate, and satisfactory responses to common thyroid-related questions. STUDY DESIGN: First, we obtained 28 thyroid-related questions from the Huayitong app, which together with the two interfering questions eventually formed 30 questions. Then, these questions were responded to by ChatGPT (on July 19, 2023), junior specialist and senior specialist (on July 20, 2023) separately. Finally, 26 patients and 11 thyroid surgeons evaluated those responses on four dimensions: accuracy, comprehensiveness, compassion, and satisfaction. RESULTS: Among the 30 questions and responses, ChatGPT's speed of response was faster than that of the junior specialist (8.69 [7.53-9.48] vs. 4.33 [4.05-4.60], P <.001) and senior specialist (8.69 [7.53-9.48] vs. 4.22 [3.36-4.76], P <.001). The word count of the ChatGPT's responses was greater than that of both junior specialist (341.50 [301.00-384.25] vs. 74.50 [51.75-84.75], P <0.001) and senior specialist (341.50 [301.00-384.25] vs. 104.00 [63.75-177.75], P <0.001). ChatGPT received higher scores than junior specialist and senior specialist in terms of accuracy, comprehensiveness, compassion and satisfaction in responding to common thyroid-related questions. CONCLUSIONS: ChatGPT performed better than junior specialist and senior specialist in answering common thyroid-related questions, but further research is needed to validate the logical ability of the ChatGPT for complex thyroid questions.
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γδ T cells are evolutionarily conserved T lymphocytes that manifest unique antitumor efficacy independent of tumor mutation burden (TMB) and conventional human leukocyte antigen (HLA) recognition. However, the dynamic changes in their T cell receptor (TCR) repertoire during cancer progression and treatment courses remain unclear. Here, a comprehensive characterization of γδTCR repertoires are performed in thyroid cancers with divergent differentiation states through cross-sectional studies. The findings revealed a significant correlation between the differentiation states and TCR repertoire diversity. Notably, highly expanded clones are prominently enriched in γδ T cell compartment of dedifferentiated patients. Moreover, by longitudinal investigations of the γδ T cell response to various antitumor therapies, it is found that the emergence and expansion of the Vδ2neg subset may be potentially associated with favorable clinical outcomes after post-radiotherapeutic immunotherapy. These findings are further validated at single-cell resolution in both advanced thyroid cancer patients and a murine model, underlining the importance of further investigations into the role of γδTCR in cancer immunity and therapeutic strategies.
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Linfócitos Intraepiteliais , Neoplasias da Glândula Tireoide , Humanos , Camundongos , Animais , Receptores de Antígenos de Linfócitos T gama-delta/genética , Estudos Transversais , Imunoterapia , Neoplasias da Glândula Tireoide/terapiaRESUMO
Background: To investigate the association between metabolic syndrome (MetS) and its components and prostate cancer (PCa). Methods: This study enrolled 482 943 consecutive men who underwent routine health checkups at the Health Management Center of West China Hospital Between 2010 and 2017. For patients with elevated prostate-specific antigen (PSA) levels or color Doppler ultrasound indicating abnormal prostates, we recommended prostate puncture and follow-up. We used the chi-square test and independent t-test for categorical variables and continuous variables, respectively. We used logistic regression analysis to evaluate the effects of MetS and its components on prostate cancer risk. Results: We found that the incidence of PCa in Chinese men over 40 years of age was 0.1%. Among the 85882 participants, 31.5% (27016/85882) of the patients were diagnosed with MetS. PCa was associated with older age, higher PSA levels, lighter weight and shorter height, hypertension, elevated fasting blood glucose (FBG) and HDL cholesterol level, lower triglycerides. After excluded the interference of other factors in multivariate logistic analysis, we found that MetS, hypertension, hyperlipidemia, hyperglycemia, and obesity were not related to the risk of PCa. High age and PSA levels were risk factors for prostate cancer. Conclusions: High age and PSA levels were risk factors for prostate cancer. MetS, hypertension, hyperlipidemia, hyperglycemia, and obesity were not related to the risk of PCa.
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Hiperglicemia , Hipertensão , Síndrome Metabólica , Neoplasias da Próstata , Adulto , Humanos , Hiperglicemia/complicações , Hipertensão/epidemiologia , Masculino , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Obesidade/complicações , Antígeno Prostático Específico , Neoplasias da Próstata/epidemiologiaRESUMO
The study aimed to investigate the influencing factors of physicians in recommending low-dose computed tomography (LDCT) for lung cancer screening to high-risk groups. A total of 1767 participants with good knowledge of LDCT were included in a cross-sectional study. Data about physicians' demographics, perception of barriers on LDCT screening, medical conditions for practicing medicine and the behavior of recommending LDCT were collected by a questionnaire. Physicians who care about the transportation convenience of patients were less likely to recommend LDCT (OR 0.568, 95% CI (0.423 to 0.763), p < 0.05). The physicians who considered LDCT expensive, recommended LDCT less than others (OR 0.308, 95% CI (0.186 to 0.510), p < 0.05). The false positive rate of LDCT can decrease the possibility of physicians' recommending (OR 0.542, 95% CI (0.387 to 0.758), p < 0.05). The physicians in oncology department and health management center were more likely to recommend LDCT (OR 2.282, 95% CI (1.557 to 3.345); OR 2.476, 95% CI (1.618 to 3.791)). The convenience of transportation, the price, and the\ false positive rate may be the main concerns among physicians on recommending LDCT to high-risk groups. The influencing factors of physicians' recommending on LDCT was various. Information technology, government support in price and self-improvement of LDCT should be gathered together to break the barriers on physicians' recommending on LDCT.
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Background: Several studies have found a strong association between cardiovascular diseases and myeloperoxidase (MPO) as a marker of oxidative stress. Although the anti-inflammatory effects of vitamin D in adults have been validated, evidence about the relationship between MPO and 25(OH)D is lacking. This study aimed to investigate the relationship between MPO and 25(OH)D in the general Chinese population. Methods: From November 2018 to August 2019, a total of 6414 subjects were enrolled in a tertiary referral hospital in China, which included 3,122 women and 3,292 men. The dependent and independent variables were MPO and 25(OH)D, respectively. The confounders included age, sex, body mass index, waist-hip ratio, smoking status, alcohol drinking status, calcium, and parathyroid hormone concentration. Results: In the fully adjusted model, we found that MPO decreased by 0.12 (95% CI -0.16, -0.08), ng/mL for each unit (1 nmol/L) increase in 25(OH)D. When 25(OH) D was divided into quartiles, compared with Q1 (< 41.4 nmol/L), the adjusted beta coefficients (ß) of MPO in Q2-Q4 were -2.29 (95% CI, -4.31 to -0.27), -4.76 (95% CI, -6.83 to -2.69), and -6.07 (95% CI, -8.23 to -3.92), respectively (P for the trend < 0.0001). When 25(OH) D was divided according to clinical severity, compared with the severely deficient (< 30 nmol/L) s≥ 30, < 50 nmol/L) and sufficient groups (≥ 50 nmol/L) were -2.59 (95% CI, -5.87 to 0.69) and -5.87 (95% CI, -9.17 to -2.57), respectively (P for the trend < 0.0001). Conclusion: After adjusting for age, sex, BMI, waist-hip ratio, smoking status, alcohol status, calcium, and PTH, circulating 25(OH)D was negatively associated with MPO.
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OBJECTIVES: Low-dose CT (LDCT) can help determine the early stage of lung cancer and reduce mortality. However, knowledge of lung cancer and lung cancer screening among community residents and medical workers, and potential factors that may affect medical institutions to set up LDCT are limited. DESIGN: A cross-sectional study was conducted in Sichuan province, China, in 2021. Community residents, medical workers and medical institutions were randomly selected, and participants responded to related questionnaires. Knowledge of lung cancer and LDCT lung cancer screening was evaluated. Data analyses were performed using SAS V.9.4. RESULTS: A total of 35 692 residents, 6350 medical workers and 81 medical institutions were recruited; 4.05% of the residents were very familiar with lung cancer and 37.89% were (completely) unfamiliar. Characteristics, such as age and level of education, were significantly related to residents who were very familiar with lung cancer. Furthermore, 22.87% of the residents knew that LDCT can effectively screen for early-stage lung cancer, which was correlated with smoking (OR 1.1300; 95% CI 1.0540 to 1.2110; p=0.006) and family history of cancer (OR 1.2210; 95% CI 1.1400 to 1.3080; p<0.0001); 66.06% of medical workers believed that LDCT can detect early-stage lung cancer. Technicians and nurses were less knowledgeable than doctors about whether LDCT can effectively screen for early-stage lung cancer (OR 0.6976; 95% CI 0.5399 to 0.9015; p=0.0059 and OR 0.6970; 95% CI 0.5718 to 0.8496; p=0.0004, respectively). Setting up LDCT in medical institutions was related to grade, administrative rank, number of hospital beds that opened and total number of medical workers. CONCLUSIONS: The knowledge of lung cancer in residents is relatively low, and the knowledge of LDCT in screening (early-stage) lung cancer needs to be improved both in residents and medical workers. Possible factors that affect medical institutions to set up LDCT may need to be incorporated.
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Detecção Precoce de Câncer , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias Pulmonares , China/epidemiologia , Estudos Transversais , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/prevenção & controle , Programas de Rastreamento , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: This population-based cross-sectional study aimed to identify the best predictor of the 10-year cardiovascular (CV) high risk among old and new anthropometric indices. METHODS: We investigated 76,915 adults older than 18 years of age living in southwest China. Ten obesity indices were calculated. The 10-year cardiovascular disease (CVD) risk was estimated using the Framingham risk score. Receiver operating characteristic curve analysis was performed to assess the ability of the anthropometric index to predict the 10-year high risk of CVD events. RESULTS: The waist-to-hip ratio (WHR) had the highest area under the curve (AUC) value (0.711; sensitivity: 62.22%, specificity: 42.73%) in men, while the body fat index (BAI) had the lowest AUC value (0.624, sensitivity: 49.07%, specificity: 54.84%). The waist-to-height ratio (WHtR) and the body roundness index (BRI) showed the highest AUC value (0.751, sensitivity: 39.24%, 39.83%, specificity: 75.68%, 68.59%) in women, while the BAI showed the lowest AUC value (0.671, sensitivity: 53.15%, specificity: 57.14%). CONCLUSIONS: The WHR was the best anthropometric measure for assessing the 10-year high risk of CVD in men, while the WHtR and BRI were the best measures for women. In men, the WHR should be < 0.88, and in women, the WHtR should be < 0.502 or the BRI should be < 3.41.
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Doenças Cardiovasculares , Adulto , Índice de Massa Corporal , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Curva ROC , Fatores de Risco , Circunferência da Cintura , Razão Cintura-EstaturaRESUMO
Background: Accumulating evidence has suggested that cystatin C is associated with cognitive impairment in patients with neurodegenerative diseases. However, the association between cystatin C and cognitive decline in patients with multiple system atrophy (MSA) remains largely unknown. Objectives: The objective was to determine whether cystatin C was independently associated with cognitive decline in patients with early-stage MSA. Methods: Patients with MSA underwent evaluation at baseline and the 1-year follow-up. Cognitive function was evaluated with Montreal cognitive assessment (MoCA). Changes in the MoCA score and the absolute MoCA score at the 1-year assessment were considered the main cognitive outcome. The cystatin C concentrations in patients with MSA and age, sex, and body mass index matched-healthy controls (HCs) were measured. A multiple linear regression model was used to test the association between cystatin C and cognitive decline. Results: A total of 117 patients with MSA and 416 HCs were enrolled in the study. The cystatin C levels were significantly higher in patients with MSA than in HCs (p < 0.001). Cystatin C levels were negatively correlated with MoCA score at baseline and at 1-year follow-up. Multiple linear regression model adjusted for potential confounders showed that baseline cystatin C levels were significantly associated with the MoCA score (p = 0.004) or change in the MoCA score (p = 0.008) at 1-year follow-up. Conclusion: Our results suggested that cystatin C may serve as a potential biomarker of cognitive decline in patients with early-stage MSA.
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BACKGROUND: The thresholds of alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (PIVKA-II) when detecting hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients with antiviral nucleoside analog (NA) remain controversial. A relevant integrated nomogram needs to be developed. METHODS: We enrolled a consecutive series of 5666 cases diagnosed with CHB either with or without antiviral agents and randomly allocated them to the training set (n=3966, 70.00%) and the validation set (n=1700, 30.00%). RESULTS: In the training set, the levels of AFP and PIVKA-II of NA-treated patients were significantly lower than those of untreated patients. The most appropriate cut-off values of AFP and PIVKA-II were 151.40 ng/mL (a sensitivity of 39.77% and a specificity of 92.17%) and 35.50 mAU/mL (a sensitivity of 84.85% and a specificity of 69.43%) for NA-treated patients. As for BCLC-0/A HCC, the most appropriate cut-off values of AFP and PIVKA-II were 151.40 ng/mL and 32.50 mAU/mL for NA-treated patients, respectively. A logistic regression model composed of AFP, PIVKA-II and other clinical parameters to predict the risk of HBV-related HCC for NA-treated patients was established and verified to have an AUROC of 0.868 (95% CI, 0.827-0.909) for all-stage HCC and an AUROC of 0.856 (95% CI, 0.809-0.903) for BCLC-0/A HCC. CONCLUSION: The new detection thresholds of AFP and PIVKA-II might lead to the ability to perform early detection for hepatoma in NA-treated patients and the innovative risk prediction model is a valuable tool for identifying high-risk CHB patients.
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CONTEXT: Many controversies exist regarding screening and treatment of thyroid cancer (TC), especially papillary thyroid microcarcinoma (PTMC). OBJECTIVE: The aim of this study was to evaluate patients' psychological distress and sleep disturbance throughout thyroid nodule (TN) screening, diagnosis, and treatment. METHODS: A total of 2834 participants (1153 participants with TNs) were enrolled during the screening phase, and 1105 individuals with TNs (87 individuals with TC) were enrolled during the diagnosis phase. Of the 87 TC patients, 66 underwent immediate operation (OP), and 21 patients with PTMC opted for active surveillance (AS). Four validated scales were applied to quantify the outcome indicators at prescreening, postscreening, postdiagnosis, and posttreatment. RESULTS: Higher psychological distress and sleep disturbance were found postscreening than prescreening in subjects with TNs, but no differences in those without nodules. Compared with postscreening, higher scores of psychological distress and sleep disturbance were identified in patients with suspicious TC treated with fine needle aspiration (FNA) or with AS. Lower psychological distress and sleep disturbance were noted for patients with benign nodules than for TC patients. OP for TC, especially PTMC, did not alleviate psychological distress or sleep disturbance compared with the same parameters in patients who underwent AS. CONCLUSION: Based on the findings of impaired psychological health and sleep quality, screening for TNs in adults who show no symptoms should be performed with caution. Psychological distress and sleep disturbance should also be taken into consideration when FNA is performed for suspected TC or OP for papillary thyroid cancer, especially PTMC.
Assuntos
Detecção Precoce de Câncer/psicologia , Angústia Psicológica , Transtornos do Sono-Vigília/psicologia , Neoplasias da Glândula Tireoide/psicologia , Nódulo da Glândula Tireoide/psicologia , Adulto , Biópsia por Agulha Fina/psicologia , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/psicologia , Carcinoma Papilar/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/terapia , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/terapia , Tireoidectomia/psicologia , Conduta ExpectanteRESUMO
Understanding of dedifferentiation, an indicator of poo prognosis for patients with thyroid cancer, has been hampered by imprecise and incomplete characterization of its heterogeneity and its attributes. Using single-cell RNA sequencing, we explored the landscape of thyroid cancer at single-cell resolution with 46,205 cells and delineated its dedifferentiation process and suppressive immune microenvironment. The developmental trajectory indicated that anaplastic thyroid cancer (ATC) cells were derived from a small subset of papillary thyroid cancer (PTC) cells. Moreover, a potential functional role of CREB3L1 on ATC development was revealed by integrated analyses of copy number alteration and transcriptional regulatory network. Multiple genes in differentiation-related pathways (e.g., EMT) were involved as the downstream targets of CREB3L1, increased expression of which can thus predict higher relapse risk of PTC. Collectively, our study provided insights into the heterogeneity and molecular evolution of thyroid cancer and highlighted the potential driver role of CREB3L1 in its dedifferentiation process.
RESUMO
A limited number of studies have investigated the significance of cystatin C, creatinine, uric acid and urea in prostate cancer. The present study aimed to explore the correlation between these molecules and total prostate-specific antigen (tPSA) levels using big data from patients of different Chinese ethnicities. Patients undergoing physical examination at the Medical Examination Center of West China Hospital (Chengdu, China) between January 2010 and May 2019 were retrospectively included. A χ2 test or Fisher's test and Kruskal-Wallis rank-sum test were used to compare categorical and continuous variables. Pearson's correlation coefficients (r) with 95% CI were also determined to assess the correlation between tPSA and cystatin, uric acid, creatinine and urea in the entire patient population and in different ethnicities. A total of 253,281 male patients were included and their mean age was 47.83±14.28 years. The mean tPSA level of these patients was 1.15±1.88 ng/ml. The mean levels of the renal function-associated parameters cystatin C, uric acid, creatinine and urea were 0.91±0.19, 388.02±77.37, 83.94±55.89 and 5.23±1.23 ng/ml, respectively. In the total patient population, urea (r=0.0774, P<0.0001), creatinine (r=0.0219, P<0.0001) and cystatin (r=0.1513, P<0.0001) were slightly positively correlated with tPSA, whereas uric acid was negatively correlated with tPSA (r=-0.0307, P<0.0001). Subgroup analyses generally yielded consistent results; however, a stronger correlation was noted between cystatin C and tPSA for the Mongolian ethnicity (r=0.6572, P<0.0001) and between creatinine and tPSA for the Yi ethnicity (r=0.6125, P<0.0001). In conclusion, the present study used data from a large population to reveal a generally significant and slightly positive correlation between tPSA and cystatin C levels among the 10 most common ethnicities in China. Subgroup analyses indicated that the tPSA level was moderately positively correlated with the creatinine level for the Mongolian and Yi ethnicities and the cystatin C level was moderately positively correlated with tPSA for the Mongolian ethnicity. Future studies are required to confirm and expand the present results.
RESUMO
Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects the joints and other organs for which there is currently no effective treatment. Mesenchymal stem cells (MSCs) have therapeutic potential due to their immunomodulatory and differentiation effects. While extensive experimental studies and clinical trials have demonstrated the effects of MSCs in various diseases, MSCs have been found to cause abnormal differentiation and tumor formation. Therefore, extracellular vesicles derived from MSCs (MSC-EVs) are more effective, less toxic, and more stable than the parental cells. MSC-EVs transfer various nucleic acids, proteins, and lipids from parent cells to recipient cells, and thus participate in chronic inflammatory and immune processes. In this review, we summarize the properties and biological functions of MSCs and MSC-EVs in RA. Improvement in our understanding of the mechanisms underlying MSC and MSC-EVs in RA provides an insight into potential biomarkers and therapeutic strategies for RA.