RESILIENT Part 2: A Randomized, Open-Label Phase III Study of Liposomal Irinotecan Versus Topotecan in Adults With Relapsed Small Cell Lung Cancer.

PURPOSE: The phase III RESILIENT trial compared second-line liposomal irinotecan with topotecan in patients with small cell lung cancer (SCLC). PATIENTS AND METHODS: Patients with SCLC and progression on or after first-line platinum-based chemotherapy were randomly assigned (1:1) to intravenous (IV) liposomal irinotecan (70 mg/m2 every 2 weeks in a 6-week cycle) or IV topotecan (1.5 mg/m2 daily for 5 consecutive days, every 3 weeks in a 6-week cycle). The primary end point was overall survival (OS). Key secondary end points included progression-free survival (PFS) and objective response rate (ORR). RESULTS: Among 461 randomly assigned patients, 229 received liposomal irinotecan and 232 received topotecan. The median follow-up was 18.4 months. The median OS was 7.9 months with liposomal irinotecan versus 8.3 months with topotecan (hazard ratio [HR], 1.11 [95% CI, 0.90 to 1.37]; P = .31). The median PFS per blinded independent central review (BICR) was 4.0 months with liposomal irinotecan and 3.3 months with topotecan (HR, 0.96 [95% CI, 0.77 to 1.20]; nominal P = .71); ORR per BICR was 44.1% (95% CI, 37.6 to 50.8) and 21.6% (16.4 to 27.4), respectively. Overall, 42.0% and 83.4% of patients receiving liposomal irinotecan and topotecan, respectively, experienced grade ≥3 related treatment-emergent adverse events (TEAEs). The most common grade ≥3 related TEAEs were diarrhea (13.7%), neutropenia (8.0%), and decreased neutrophil count (4.4%) with liposomal irinotecan and neutropenia (51.6%), anemia (30.9%), and leukopenia (29.1%) with topotecan. CONCLUSION: Liposomal irinotecan and topotecan demonstrated similar median OS and PFS in patients with relapsed SCLC. Although the primary end point of OS was not met, liposomal irinotecan demonstrated a higher ORR than topotecan. The safety profile of liposomal irinotecan was consistent with its known safety profile; no new safety concerns emerged.

Surface reconstructed Fe@C1000 for enhanced Fenton-like catalysis: Sustainable ciprofloxacin degradation and toxicity reduction.

The Fe-based catalysts typically undergo severe problems such as deactivation and Fe sludge emission during the peroxymonosulfate (PMS) activation, which commonly leads to poor operation and secondary pollution. Herein, an S-doped Fe-based catalyst with a core-shell structure (Fe@CT, T = 1000°C) was synthesized, which can solve the above issues via the dynamic surface evolution during the reaction process. Specifically, the Fe0 on the surface of Fe@C1000 could be consumed rapidly, leaving numerous pores; the Fe3C from the core would subsequently migrate to the surface of Fe@C1000, replenishing the consumed active Fe species. The X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS) analyses demonstrated that the reaction surface reconstructed during the PMS activation, which involved the FeIII in-situ reduction by S species as well as the depletion/replenishment of effective Fe species. The reconstructed Fe@C1000 achieved near-zero Fe sludge emission (from 0.59 to 0.08-0.23 mg L-1) during 5 cycles and enabled the dynamic evolution of dominant reactive oxygen species (ROS) from SO4·- to FeIVO, sustainably improving the oxidation capacity (80.0-92.5% in following four cycles) to ciprofloxacin (CIP) and reducing the toxicity of its intermediates. Additionally, the reconstructed Fe@C1000/PMS system exhibited robust resistance to complex water matrix. This study provides a theoretical guideline for exploring surface reconstruction on catalytic activity and broadens the application of Fe-based catalysts in the contaminants elimination.

Evolution of Grain Boundaries Promoted Hydrogen Production for Industrial-Grade Current Density.

The development of efficient and durable high-current-density hydrogen production electrocatalysts is crucial for the large-scale production of green hydrogen and the early realization of hydrogen economic blueprint. Herein, the evolution of grain boundaries through Cu-mediated NiMo bimetallic oxides (MCu-BNiMo), which leading to the high efficiency of electrocatalyst for hydrogen evolution process (HER) in industrial-grade current density, is successfully driven. The optimal MCu0.10-BNiMo demonstrates ultrahigh current density (>2 A cm-2) at a smaller overpotential in 1 m KOH (572 mV), than that of BNiMo, which does not have lattice strain. Experimental and theoretical calculations reveal that MCu0.10-BNiMo with optimal lattice strain generated more electrophilic Mo sites with partial oxidation owing to accelerated charge transfer from Cu to Mo, which lowers the energy barriers for H* adsorption. These synergistic effects lead to the enhanced HER performance of MCu0.10-BNiMo. More importantly, industrial application of MCu0.10-BNiMo operated in alkaline electrolytic cell is also determined, with its current density reached 0.5 A cm-2 at 2.12 V and 0.1 A cm-2 at 1.79 V, which is nearly five-fold that of the state-of-the-art HER electrocatalyst Pt/C. The strategy provides valuable insights for achieving industrial-scale hydrogen production through a highly efficient HER electrocatalyst.

Molecular Design of Layered Hybrid Silver Bismuth Bromine Single Crystal for Ultra-Stable X-Ray Detection With Record Sensitivity.

Nowadays, weak interlayer coupling and unclear mechanism in layered hybrid silver bismuth bromine (LH-AgBiBr) are the main reasons for limiting its further enhanced X-ray detection sensitivity and stability. Herein, the design rules for LH-AgBiBr and its influence on X-ray detection performance are reported for the first time. Although shortening amine size can enhance interlayer coupling, its detection performance is severely hampered by its easier defect formation caused by enlarged micro strain. In contrast, an appropriate divalent amine design endows the material with improved interlayer coupling and released micro strain, which benefits crystal stability and mechanical hardness. Another contribution is to increase material density and dielectric constant; thus, enhancing X-ray absorption and carrier transport. Consequently, the optimized parallel device based on BDA2 AgBiBr8 achieves a record sensitivity of 2638 µC Gyair -1 cm-2 and an ultra-low detection limit of 7.4 nGyair s-1 , outperforming other reported LH-AgBiBr X-ray detectors. Moreover, the unencapsulated device displays remarkable anti-moisture, anti-thermal (>150 °C), and anti-radiation (>1000 Gyair ) endurance. Eventually, high-resolution hard X-ray imaging is demonstrated by linear detector arrays under a benign dose rate (1.63 µGyair s-1 ) and low external bias (5 V). Hence, these findings provide guidelines for future materials design and device optimization.

Lung Cancer Prediction Using Electronic Claims Records: A Transformer-Based Approach.

Electronic claims records (ECRs) are large scale and longitudinal collections of individual's medical service seeking actions. Compared to in-hospital medical records (EMRs), ECRs are more standardized and cross-sites. Recently, there has been studies showing promising results on modeling claims data for a wide range of medical applications. However, few of them address the exclusion criteria on cohort selection to extract new incidence without prior signs and also often lack of emphasis on predicting cancer in early stages. In this work, we aim to design a lung cancer prediction framework using ECRs with rigorous exclusion design using state-of-the-art sequence-based transformer. Furthermore, this work presents one of the first results by applying disease prediction model to the entire population in Taiwan. The result shows over 2.1 predictive power, 5 average positive predictive value (PPV), and 0.668 area under curve (AUC) in all-stage lung cancer and around 2.0 predictive power, 1 average PPV and 0.645 AUC in early-stage in our dataset. Sub-cohort analysis could funnel high precision selective group into prioritized clinical examination. Onset analysis validates the effect of our exclusion criteria. This work presents comprehensive analyses on lung cancer prediction, and the proposed approach can serve as a state-of-the-art disease risk prediction framework on claims data.

NALIRIFOX versus nab-paclitaxel and gemcitabine in treatment-naive patients with metastatic pancreatic ductal adenocarcinoma (NAPOLI 3): a randomised, open-label, phase 3 trial.

BACKGROUND: Pancreatic ductal adenocarcinoma remains one of the most lethal malignancies, with few treatment options. NAPOLI 3 aimed to compare the efficacy and safety of NALIRIFOX versus nab-paclitaxel and gemcitabine as first-line therapy for metastatic pancreatic ductal adenocarcinoma (mPDAC). METHODS: NAPOLI 3 was a randomised, open-label, phase 3 study conducted at 187 community and academic sites in 18 countries worldwide across Europe, North America, South America, Asia, and Australia. Patients with mPDAC and Eastern Cooperative Oncology Group performance status score 0 or 1 were randomly assigned (1:1) to receive NALIRIFOX (liposomal irinotecan 50 mg/m2, oxaliplatin 60 mg/m2, leucovorin 400 mg/m2, and fluorouracil 2400 mg/m2, administered sequentially as a continuous intravenous infusion over 46 h) on days 1 and 15 of a 28-day cycle or nab-paclitaxel 125 mg/m2 and gemcitabine 1000 mg/m2, administered intravenously, on days 1, 8, and 15 of a 28-day cycle. Balanced block randomisation was stratified by geographical region, performance status, and liver metastases, managed through an interactive web response system. The primary endpoint was overall survival in the intention-to-treat population, evaluated when at least 543 events were observed across the two treatment groups. Safety was evaluated in all patients who received at least one dose of study treatment. This completed trial is registered with ClinicalTrials.gov, NCT04083235. FINDINGS: Between Feb 19, 2020 and Aug 17, 2021, 770 patients were randomly assigned (NALIRIFOX, 383; nab-paclitaxel-gemcitabine, 387; median follow-up 16·1 months [IQR 13·4-19·1]). Median overall survival was 11·1 months (95% CI 10·0-12·1) with NALIRIFOX versus 9·2 months (8·3-10·6) with nab-paclitaxel-gemcitabine (hazard ratio 0·83; 95% CI 0·70-0·99; p=0·036). Grade 3 or higher treatment-emergent adverse events occurred in 322 (87%) of 370 patients receiving NALIRIFOX and 326 (86%) of 379 patients receiving nab-paclitaxel-gemcitabine; treatment-related deaths occurred in six (2%) patients in the NALIRIFOX group and eight (2%) patients in the nab-paclitaxel-gemcitabine group. INTERPRETATION: Our findings support use of the NALIRIFOX regimen as a possible reference regimen for first-line treatment of mPDAC. FUNDING: Ipsen. TRANSLATION: For the plain language summary see Supplementary Materials section.

Absence of Lugol staining indicates initiation of esophageal squamous cell carcinoma: A combined genomic and epidemiologic study.

The genomic characteristics during the carcinogenic process of esophageal squamous cell carcinoma (ESCC) remain largely unknown. We report here the genomic characteristics of 106 esophageal tissues of various stages from a population-based screening cohort in China ("Endoscopic Screening for Esophageal Cancer in China" trial) and 57 ESCC tissues from a local hospital. A significant increase in somatic mutation and copy number alterations is observed in the non-dysplastic Lugol unstaining lesions (ND-LULs). Extensive clonal expansion has emerged in the ND-LULs to an extent similar to that in higher-stage lesions. The burden of genomic alterations correlates with the size of LULs in the ND-LULs. 8-year follow-up shows that ND-LULs harbor an increased risk of progression to ESCC (adjusted IRR6-10 mm vs. none = 4.66, adjusted IRR>10 mm vs. none = 40.70), and the risk is correlated with LUL size for both non-dysplastic and dysplastic lesions. Lugol unstaining can be the initial stage in the carcinogenic process of ESCC.

Predictive value of intratumoral-metabolic heterogeneity derived from 18F-FDG PET/CT in distinguishing microsatellite instability status of colorectal carcinoma.

Purpose/background: Microsatellite instability (MSI) status is a significant biomarker for the response to immune checkpoint inhibitors, response to 5-fluorouracil-based adjuvant chemotherapy, and prognosis in colorectal carcinoma (CRC). This study investigated the predictive value of intratumoral-metabolic heterogeneity (IMH) and conventional metabolic parameters derived from 18F-FDG PET/CT for MSI in patients with stage I-III CRC. Methods: This study was a retrospective analysis of 152 CRC patients with pathologically proven MSI who underwent 18F-FDG PET/CT examination from January 2016 to May 2022. Intratumoral-metabolic heterogeneity (including heterogeneity index [HI] and heterogeneity factor [HF]) and conventional metabolic parameters (standardized uptake value [SUV], metabolic tumor volume [MTV], and total lesion glycolysis [TLG]) of the primary lesions were determined. MTV and SUVmean were calculated on the basis of the percentage threshold of SUVs at 30%-70%. TLG, HI, and HF were obtained on the basis of the above corresponding thresholds. MSI was determined by immunohistochemical evaluation. Differences in clinicopathologic and various metabolic parameters between MSI-High (MSI-H) and microsatellite stability (MSS) groups were assessed. Potential risk factors for MSI were assessed by logistic regression analyses and used for construction of the mathematical model. Area under the curve (AUC) were used to evaluate the predictive ability of factors for MSI. Results: This study included 88 patients with CRC in stages I-III, including 19 (21.6%) patients with MSI-H and 69 (78.4%) patients with MSS. Poor differentiation, mucinous component, and various metabolic parameters including MTV30%, MTV40%, MTV50%, and MTV60%, as well as HI50%, HI60%, HI70%, and HF in the MSI-H group were significantly higher than those in the MSS group (all P < 0.05). In multivariate logistic regression analyses, post-standardized HI60% by Z-score (P = 0.037, OR: 2.107) and mucinous component (P < 0.001, OR:11.394) were independently correlated with MSI. AUC of HI60% and our model of the HI60% + mucinous component was 0.685 and 0.850, respectively (P = 0.019), and the AUC of HI30% in predicting the mucinous component was 0.663. Conclusions: Intratumoral-metabolic heterogeneity derived from 18F-FDG PET/CT was higher in MSI-H CRC and predicted MSI in stage I-III CRC patients preoperatively. HI60% and mucinous component were independent risk factors for MSI. These findings provide new methods to predict the MSI and mucinous component for patients with CRC.

Quantitative assessment of renal functions using 68Ga-EDTA dynamic PET imaging in renal injury in mice of different origins.

Background: Early detection of kidney diseases can be challenging as conventional methods such as blood tests or imaging techniques (computed tomography (CT), magnetic resonance imaging (MRI), or ultrasonography) may be insufficient to assess renal function. A single-photon emission CT (SPECT) renal scan provides a means of measuring glomerular filtration rates (GFRs), but its diagnostic accuracy is limited due to its planar imaging modality and semi-quantification property. In this study, we aimed to improve the accuracy of GFR measurement by preparing a positron emission tonometry (PET) tracer 68Ga-Ethylenediaminetetraacetic acid (68Ga-EDTA) and comprehensively evaluating its performance in healthy mice and murine models of renal dysfunction. Methods: Dynamic PET scans were performed in healthy C57BL/6 mice and in models of renal injury, including acute kidney injury (AKI) and unilateral ureter obstruction (UUO) using 68Ga-EDTA. In a 30-min dynamic scan, PET images and time-activity curves (TACs) were acquired. Renal function and GFR values were measured using renograms and validated through serum renal function parameters, biodistribution results, and pathological staining. Results: 68Ga-EDTA dynamic PET imaging quantitatively captured the tracer elimination process. The calculated GFR values were 0.25 ± 0.02 ml/min in healthy mice, 0.01 ± 0.00 ml/min in AKI mice, and 0.25 ± 0.04, 0.29 ± 0.03 and 0.24 ± 0.01 ml/min in UUO mice, respectively. Furthermore, 68Ga-EDTA dynamic PET imaging and GFRPET were able to differentiate mild renal impairment before serum parameters indicated any changes. Conclusions: Our findings demonstrate that 68Ga-EDTA dynamic PET provides a reliable and precise means of evaluating renal function in two murine models of renal injury. These results hold promise for the widespread clinical application of 68Ga-EDTA dynamic PET in the near future.

Enhanced Desulfurization by Tannin Extract Absorption Assisted by Binuclear Sulfonated Phthalocyanine Cobalt Polymer: Performance and Mechanism.

Removal of hydrogen sulfide (H2S) from coke oven gas has attracted increasing attention due to economic and environmental concerns. In this study, tannin extract (TE) absorption combined with binuclear sulfonated phthalocyanine cobalt organic polymer (OTS) and binuclear sulfonated phthalocyanine cobalt (PDS) with a fixed bed reactor is used for removal of H2S. The effect of gas flow rate, concentration of H2S, co-existence of organic sulfide compounds and O2 were investigated. Then, the effect of total alkalinity content of TE, NaVO3, OTS and PDS was studied in detail. The experimental results demonstrated that 100% H2S conversion could maintain for 13 h at a total alkalinity of 5.0 g/L, TE concentration of 4.0 g/L, NaVO3 concentration of 5 g/L, and OTS and PDS concentration of 0.2 g/L and 0.2 g/L, respectively. The OTS and PDS showed synergistic effect on boosting TE desulfurization efficiency. The results provide a new route for the investigation of liquid catalyzed oxidation desulfurization in an efficient and low-cost way.

Minimally Invasive or Open Esophagectomy for Treatment of Resectable Esophageal Squamous Cell Carcinoma? Answer From a Real-world Multicenter Study.

OBJECTIVE: To evaluate the long-term and short-term outcomes of MIE compared with OE in localized ESCC patients in real-world settings. BACKGROUND: MIE is an alternative to OE, despite the limited evidence regarding its effect on long-term survival. METHODS: We recruited 5822 consecutive patients with resectable ESCC in 2 typical high-volume centers in southern and northern China, 1453 of whom underwent MIE. Propensity score-based overlap weighted regression adjusted for multifaceted confounding factors was used to compare outcomes in the MIE and OE groups. RESULTS: Five-year OS was 62.7% in the MIE group and 57.7% in the OE group. The overlap weighted Cox regression showed slightly better OS in the MIE group (hazard ratio 0.93, 95% confidence interval: 0.82-1.06). Although duration of surgery was longer and treatment cost higher in the MIE group than in the OE group, the number of lymph nodes harvested was larger, the proportion of intraoperative blood transfusions lower, and postoperative complications less in the MIE group. 30-day (risk ratio [RR] 0.77, 0.381.55) and 90-day (RR 0.79, 0.46-1.35) mortality were lower in the MIE group versus the OE group, although not statistically significant. These findings were consistent across different analytic approaches and subgroups, notably in the subset of ESCC patients with large tumors. CONCLUSIONS: MIE can be performed safely with OS comparable to OE for patients with localized ESCC, indicating MIE may be recommended as the primary surgical approach for resectable ESCC in health facilities with requisite technical capacity.

Is Adjuvant Therapy a Better Option for Esophageal Squamous Cell Carcinoma Patients Treated With Esophagectomy? A Prognosis Prediction Model Based on Multicenter Real-World Data.

OBJECTIVE: To construct a prediction model for more precise evaluation of prognosis which will allow personalized treatment recommendations for adjuvant therapy in patients following resection of ESCC. BACKGROUND: Marked heterogeneity of patient prognosis and limited evidence regarding survival benefit of various adjuvant therapy regimens pose challenges in the clinical treatment of ESCC. METHODS: Based on comprehensive clinical data obtained from 4129 consecutive patients with resected ESCC in a high-risk region in China, we identified predictors for overall survival through a 2-phase selection based on Cox proportional hazard regression and minimization of Akaike information criterion. The model was internally validated using bootstrapping and externally validated in 1815 patients from a non-high-risk region in China. RESULTS: The final model incorporates 9 variables: age, sex, primary site, T stage, N stage, number of lymph nodes harvested, tumor size, adjuvant treatment, and hemoglobin level. A significant interaction was also observed between N stage and adjuvant treatment. N1+ stage patients were likely to benefit from addition of adjuvant therapy as opposed to surgery alone, but adjuvant therapy did not improve overall survival for N0 stage patients. The C -index of the model was 0.729 in the training cohort, 0.723 after bootstrapping, and 0.695 in the external validation cohort. This model outperformed the seventh edition American Joint Committee on Cancer staging system in prognostic prediction and risk stratification. CONCLUSIONS: The prediction model constructed in this study may facilitate precise prediction of survival and inform decision-making about adjuvant therapy according to N stage.

Factor decomposition for ecological pressure of the whole industrial energy carbon footprint: a case study of China.

The purpose of this paper is to study the influencing factors of the ecological pressure of the energy carbon footprint (EPECF) of China's whole industry from 2000 to 2018. First, the EPECF of 48 sub industries is calculated, then divides 48 sub-industries into high-, medium-, and low-pressure industries, and uses the logarithmic mean Divisia index (LMDI) method to analyze and summarize the main driving forces of China's industrial EPECF changes. Finally, policy suggestions for the future industrial decompression are put forward. The main results are as follows: (1) Economic development is the most important factor to promote the growth of EPECF of the three major industries. (2) At present, the population pressure factors of forest and grassland have little effect, and the effect of returning farmland to forest and grassland has not been truly played. (3) The adjustment of industrial structure has gradually become a key factor in reducing EPECF of the three industries. (4) The gradual stability of energy intensity has a certain inhibitory effect on the increase of EPECF in high-pressure industry. (5) The adjustment of energy structure in low-pressure industry has gradually worked. Therefore, the government should establish an economic sustainable development system, vigorously develop clean energy, and realize the green transformation of various industries. This provides an empirical example for other countries in the world to reduce the EPECF.

Decoupling trend and emission reduction potential of CO2 emissions from China's petrochemical industry.

This paper aims to study the decoupling status and emission reduction potential of China's petrochemical industry from 1996 to 2019. Firstly, the IPCC method is used to calculate the CO2 emissions of the petrochemical industry in China, then the logarithmic mean Divisia index (LMDI) method is used to identify the influencing factors of CO2 emissions, then the decoupling index is constructed to analyze the dependence of economic development on CO2 emissions, and finally the emission reduction potential model is established by using the influencing factors to reflect the CO2 emission reduction potential of the petrochemical industry. The results reveal that (1) the CO2 emissions can be divided into two stages of slow decline (1996-2000), (2015-2019), and one stage of rapid growth (2000-2015). (2) The energy intensity effect is the most effective factor to restrain CO2 emission, the economic growth effect is the key factor to promote CO2 emission. (3) From 1996 to 2019, there was a weak decoupling relationship between CO2 emission of petrochemical industry and economic development. Strong decoupling only occurred in 1996-2000 and 2015-2019. The CO2 emissions show only three decoupling score: I, II, and III. (4) CO2 mitigation occurred in four sub periods: 1996-2000, 2005-2010, 2010-2015, and 2015-2019. Therefore, the government should establish an energy-saving and environment-friendly industrial production system, intensify the use of clean energy, and optimize the labor force structure. It not only effectively strengthens the decoupling between the petrochemical industry and economic development, but also provides an empirical example for the carbon emission reduction and economic sustainable development of the petrochemical industry in other countries in the world.

Corrigendum: Predictive value of intratumoral-metabolic heterogeneity derived from 18F-FDG PET/CT in distinguishing microsatellite instability status of colorectal carcinoma.

[This corrects the article DOI: 10.3389/fonc.2023.1065744.].

Vertically Oriented Porous PET as Template to Integrated Metal Halide for High-Performance Large-Area and Ultra-Flexible X-Ray Detector.

High-performance X-ray detectors have immense potential in medical and security inspections. However, the current X-ray detectors are limited in flexible, high-spatial-resolution large-scale detection, and integration for imaging. Here, nuclear track-etched porous polyethylene terephthalate (PET) is developed as the template for preparing uniform, large-area (≥105 cm2 ), and flexible metal halide (MH)-based X-ray detectors. Adjustable high-density vertically oriented porous PET with adjustable thickness can provide proper physical support for flexible thick absorption film, thus improving X-ray absorption ability with excellent bending stability. Moreover, vertical channels can block the ion migration, lateral charge diffusion, and water/oxygen attacks, increasing activation energy for ionic transport, charge collection rate of electrodes, and environmental stability. Hence, the related detectors eventually obtain large sensitivity (6722 µC Gyair -1 cm-2 ), low detection limit (1.87 nGyair s-1 ), and high spatial resolution (5.17 lp mm-1 ) compared to the detectors without porous PET template. Meanwhile, the device shows no degradation after storage or working under various thermal attacks. MH-filled-PET is also monolithically integrated on the bottom circuit with different MHs and it is applied to single-pixel mode and fast linear-array imaging in a broad range of X-rays photon energy (20 to 160 keV).

Metal-Free PAZE-NH4 X3 ⋠H2 O Perovskite for Flexible Transparent X-ray Detection and Imaging.

Metal-free perovskites are of interest for their chemical diversity and eco-friendly properties, and recently have been used for X-ray detection with superior carrier behavior. However, the size and shape complexity of the organic components results in difficulties in evaluating their stability in high-energy radiation. Herein, we introduce multiple hydrogen-bond metal-free PAZE-NH4 X3 ⋅H2 O perovskite, where H2 O leads to more hydrogen bonds appearing between organic molecules and the perovskite host. As suggested by the theoretical calculations, multiple hydrogen bonds promote stiffness of the lattice, and increase the diffusion barrier to inhibit ionic migration. Then, low trap density, high µτ products and structural flexibility of PAZE-NH4 Br3 ⋅H2 O give a flexible X-ray detector with the highest sensitivity of 3708 µC Gyair -1 cm-2 , ultra-low detection limit of 0.19 µGyair -1 s-1 and superior spatial resolution of 5.0 lp mm-1 .

Economic Burden Conferred by Population-Level Cancer Screening on Resource-Limited Communities: Lessons From the ESECC Trial.

Objectives: Upper gastrointestinal (G.I.) cancer screening has been conducted in China for decades. However, the economic burden for treatment "intensively" occurred in advance due to screening in resource-limited communities remain unclear. Methods: We compared the treatment costs for upper G.I. cancers from the screening and control arms of a population-based randomized trial in a high-risk area for esophageal cancer (EC) in China based on claims data from the health insurance system in the local area which included whole population coverage. Results: The average out-of-pocket cost per treatment of EC in the screening arm was lower than that in the control arm ($5,972 vs. $7,557). This difference was a consequence of down-staging from screening which resulted in lower cost therapy for earlier stage cancers. Moreover, this result is similar for cardial and non-cardial gastric cancer in the two study arms ($7,933 vs. $10,605). However, three times as many (103 vs. 36) families in the screening arm suffered catastrophic health expenditure for all cancer types. The overall treatment cost for all EC patients in the screening arm ($1,045,119) was 2.44 times that in the control arm ($428,292), and the ratio for cardial and non-cardial gastric cancer was 1.12 ($393,261 vs. $351,557). Conclusion: Cancer treatment secondary to screening may triple the likelihood of catastrophic patient medical expenditure, and sharply increase the economic pressure on the local community, particularly for cancer types which are of high prevalence. Financial support for patients and the health insurance system should be taken into consideration when planning budgets for cancer screening programs in communities which are resource-limited.

Update and validation of a diagnostic model to identify prevalent malignant lesions in esophagus in general population.

Background: Previous risk prediction models taking esophageal malignant lesions detected during endoscopy as the primary outcome are not always sufficient to identify prevalent cases which are "overlooked" at screening. We aimed to update and externally validate our previous risk prediction model for malignant esophageal lesions by redefining the predicted outcome. Methods: 15,192 individuals from the Endoscopic Screening for Esophageal Cancer in China randomized controlled trial (ESECC trial, NCT01688908) were included as the training set, and 4576 participants from another population-based esophageal squamous cell carcinoma (ESCC) screening cohort (Anyang Esophageal Cancer Cohort Study, AECCS) served as the external validation set. Lesions with severe dysplasia or worse diagnosed at chromoendoscopy or identified via follow-up within 1 year after screening were defined as main outcome. Logistic regressions were applied to reconstruct the questionnaire-based prediction model using information collected before screening, with Akaike Information Criterion to determine the model structure. Findings: The final prediction model included age and its quadratic term, family history of ESCC, low body mass index (≤22 kg/m2), use of coal or wood as main fuel for cooking, eating rapidly, and ingestion of leftover food. The area under the curve was 0·77 (95% CI: 0·73-0·80) and 0·71 (95% CI: 0·65-0·78) in the training and validation set. When screening the top 50% or 10% of high-risk individuals within population, the detection rates can be increased in both cohorts, as compared to universal screening. Interpretation: The described tool may promote the efficiency of current national screening programs for ESCC and contribute to a precision screening strategy in high-risk regions in China. Funding: This work was supported by the National Natural Science Foundation of China (82073626, 81773501), the National Science & Technology Fundamental Resources Investigation Program of China (2019FY101102), the National Key R&D Program of China (2021YFC2500405), the Beijing-Tianjin-Hebei Basic Research Cooperation Project (J200016), the Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (XXZ0204) and the Beijing Nova Program (Z201100006820093). Sponsors had no role in the study design, data collection, analysis, and interpretation of data.