Unravelling immune microenvironment features underlying tumor progression in the single-cell era.

The relationship between the immune cell and tumor occurrence and progression remains unclear. Profiling alterations in the tumor immune microenvironment (TIME) at high resolution is crucial to identify factors influencing cancer progression and enhance the effectiveness of immunotherapy. However, traditional sequencing methods, including bulk RNA sequencing, exhibit varying degrees of masking the cellular heterogeneity and immunophenotypic changes observed in early and late-stage tumors. Single-cell RNA sequencing (scRNA-seq) has provided significant and precise TIME landscapes. Consequently, this review has highlighted TIME cellular and molecular changes in tumorigenesis and progression elucidated through recent scRNA-seq studies. Specifically, we have summarized the cellular heterogeneity of TIME at different stages, including early, late, and metastatic stages. Moreover, we have outlined the related variations that may promote tumor occurrence and metastasis in the single-cell era. The widespread applications of scRNA-seq in TIME will comprehensively redefine the understanding of tumor biology and furnish more effective immunotherapy strategies.

T-cell infiltration and its regulatory mechanisms in cancers: insights at single-cell resolution.

Tumor-infiltrating T cells recognize, attack, and clear tumor cells, playing a central role in antitumor immune response. However, certain immune cells can impair this response and help tumor immune escape. Therefore, exploring the factors that influence T-cell infiltration is crucial to understand tumor immunity and improve therapeutic effect of cancer immunotherapy. The use of single-cell RNA sequencing (scRNA-seq) allows the high-resolution analysis of the precise composition of immune cells with different phenotypes and other microenvironmental factors, including non-immune stromal cells and the related molecules in the tumor microenvironment of various cancer types. In this review, we summarized the research progress on T-cell infiltration and the crosstalk of other stromal cells and cytokines during T-cell infiltration using scRNA-seq to provide insights into the mechanisms regulating T-cell infiltration and contribute new perspectives on tumor immunotherapy.

Ovarian cancer disease burden decreased in the United States from 1975 to 2018: A joinpoint and age-period-cohort analysis.

Ovarian cancer (OC) is the leading cause of gynecological cancer-related deaths in the United States. The purpose of this study was to evaluate long-term trends in OC incidence and incidence-based mortality rates (IBM) in the U.S. from 1975 to 2018 and to assess the effects of age, period, and cohort factors on OC incidence and mortality using an age-period-cohort model. We obtained data from the U.S. OC incidence/mortality data from the Surveillance, Epidemiology, and End Results database from 1975 to 2018. Joinpoint regression analysis was used to determine long-term trends and transitions, and an age-period-cohort model was used to quantify the effects of age, period, and cohort parameters on incidence and mortality. In addition, 1990 to 2019 U.S. OC data obtained from the Global Burden of Disease study served as a potential validation set. Between 1975 and 2018, 80,622 new cases of OC and 60,218 deaths from OC were reported in the U.S. The average annual percent change for OC incidence was -1.33 (95% CI: -1.64 to -1.02, P < .001), with a significant decrease in incidence at a rate of 7.80% (95% CI: -11.52 to -3.92) per year from to 2015-2018. IBM reached its peak for the U.S. population in 1994, with an age-standardized mortality rate of 6.38 (per 100,000 people). IBM rose first, peaked in 1986, and then declined at a rate of 0.39% (95% CI: -0.66 to -0.12) and 2.48% (95% CI: -3.09 to -1.85) per year from to 1986-2007 and 2007-2018, respectively. In addition, age-period-cohort model analysis showed the highest risk of OC incidence in 1980 to 1984 and the highest risk of OC death in 1985-1989. This study reported a significant decline in OC morbidity and mortality in the U.S. since 1986. In addition, this study analyzed the changes in trends in OC incidence and mortality by race/ethnicity in the U.S. Monitoring trends in OC incidence and mortality by race/ethnicity can help in the development of targeted prevention and treatment measures.

Understanding cervical cancer at single-cell resolution.

Cervical cancer is now the fourth most prevalent malignancy in women worldwide, representing a tremendous burden of cancer. The heterogeneity of complex tumor ecosystem impacts tumorigenesis, malignant progression, and response to treatment; thus, a thorough understanding of the tumor ecosystem is vital for enhancing the prognosis of patients with cervical cancer. The rapid development and widespread use of single-cell sequencing have generated a new paradigm of cancer research, providing a comprehensive and in-depth understanding of cancers. In this review, we give an overview of the recent advances made by leveraging single-cell sequencing studies in the dissection of cervical cancer ecosystem heterogeneity. We highlight the evolution of the cervical cancer ecosystem during tumor initiation, progression, and treatment. High-resolution dissection of cervical cancer at the single-cell level has the potential to drive the development of targeted therapies and enable the realization of personalized medicine.

SETD2-H3K36ME3: an important bridge between the environment and tumors.

Epigenetic regulation plays an important role in the occurrence, development and treatment of tumors. The histone methyltransferase SET-domain-containing 2 (SETD2) plays a key role in mammalian epigenetic regulation by catalyzing histone methylation and interacting with RNA polymerase II to mediate transcription elongation and mismatch repair. As an important bridge between the environment and tumors, SETD2-H3K36me3 plays an important role in the occurrence and development of tumors. Many tumors, including renal cancer, gastric cancer, lung cancer, are closely related to SETD2 gene mutations. As a key component of common tumor suppressor mechanisms, SETD2-H3K36me3is an important target for clinical disease diagnosis and treatment. Here, we reviewed the structure and function of the SETD2 and how SETD2-H3K36me3 functions as a bridge between the environment and tumors to provide an in-depth understanding of its role in the occurrence and development of various tumors, which is of great significance for future disease diagnosis and treatment.

Progress in the clinical application of immune checkpoint inhibitors in small cell lung cancer.

Small cell lung cancer (SCLC) is a refractory cancer with poor prognosis due to its aggressive malignancy and high rates of metastasis, recurrence and drug resistance. These characteristics have also greatly impeded the identification of new treatment methods and drugs. The traditional model of SCLC treatment that has been reliant on platinum combined with etoposide for decades has been superseded by the emergence of immune checkpoint inhibitors (ICIs), which have shown significant therapeutic effects and broad application prospects as a monotherapy. This has led to the evaluation of ICIs with different mechanisms of action and their use in combination with radiotherapy or a variety of molecular targeted drugs to achieve synergy, complementary advantages, and reduce adverse reactions. Here, we review the progress in the use of ICIs as a monotherapy or in combination therapy for SCLC and consider the current limitations of these approaches as well as prospects for future developments.

Riskscore Model Based on Oxidative Stress-Related Genes May Facilitate the Prognosis Evaluation for Patients With Colon Cancer.

INTRODUCTION: This study aims to identify the oxidative stress-related genes (OSRGs) with prognostic value and develop a riskscore model for prognosis evaluation in colon cancer. METHODS: The transcriptome data and corresponding clinical information about colon cancer were extracted from The Cancer Genome Atlas database. Differentially expressed OSRGs and transcription factors (TFs) were identified between the normal and tumor samples. A riskscore model was established with OSRGs filtered from Cox regression analysis. This riskscore model was appraised by Kaplan-Meier plot, receiver operating characteristic curve, and Cox regression analysis. The clinical relevance of riskscore and its association with immune cell infiltration were also evaluated. RESULTS: A total of 307 differentially expressed OSRGs and 64 differential TFs were identified. A TF-OSRG regulatory network was constructed in Cytoscape software. A riskscore model was established based on 17 OSRGs with independent prognostic value. This riskscore model could separate the patients into low-risk and high-risk groups. It also had good predictive ability, with an area under the curve = 0.8. In multivariate Cox regression analysis, age, T stage, and riskscore were identified as independent risk factors in colon cancer. Riskscore was significantly correlated with T stage, N stage, and immune cell infiltration. DISCUSSION: We established a useful riskscore model with 17 OSRGs for prognosticating the overall survival in patients with colon cancer. This study provides a new insight into the clinical utility of OSRG-based riskscore model, which will hopefully facilitate the prognosis evaluation of patients with colon cancer.

Immune landscape of viral cancers: Insights from single-cell sequencing.

Viral infections trigger a wide range of immune responses thought to drive tumorigenesis and malignant progression. Dissecting virus-induced changes in the tumor immune microenvironment (TIME) is therefore crucial to identify key leukocyte populations that may represent novel targets for cancer therapy. Single-cell sequencing approaches have now been widely applied to the analysis of various tumors, thus enabling multiomics characterization of the highly heterogeneous TIME that bulk-sequencing cannot fully elucidate. In this review, we summarized key recent findings from sequencing studies of the immune infiltrate and antitumor response in virus-associated cancers at single cell resolution. Additionally, we also reviewed recent developments in immunotherapy for virus-associated cancers. We anticipate that the strategic use of single-cell sequencing will advance our understanding of the TIME of viral cancers, leading to the development of more potent novel treatments.

Analysis of prognostic factors and establishment of prediction model of lung adenocarcinoma based on SEER database.

Background: Few models have been developed to predict survival outcomes for lung adenocarcinoma (LUAD). In this study, we aimed to establish a nomogram for the prediction of cancer-specific survival (CSS) in LUAD patients which can be further developed as a convenient web-based calculator. Methods: We performed a retrospective analysis of 50,007 LUAD patients selected from the Surveillance, Epidemiology, and End Result (SEER) 18 registry database. To enhance the reliability of the analysis, the patients' data were further randomly divided into the training cohort (70%) and validation cohort (30%). The optimal age cut-off points were determined using X-tile software, and patients were divided into three age groups: 10-72, 73-79, and 80-99 years. We selected independent prognostic factors from 17 variables by Cox regression, and plotted a visual nomogram to predict the 1-, 3-, and 5-year CSS. The predictive performance of the nomogram was evaluated through the concordance index (C-index), calibration curve and receiver operating characteristic (ROC) curve. To facilitate CSS forecast, a web-based calculator has subsequently been developed. Results: We selected sex, age, race, marital status, N stage, tumor size, surgery, radiotherapy, chemotherapy, and metastasis (bone, brain, liver, and lung) as independent prognostic factors. The C-index was 0.779 [95% confidence interval (CI): 0.775-0.783] in the training set prediction model, and 0.782 (95% CI: 0.778-0.786) in the validation set. ROC analysis showed that area under the curve (AUC) values were 0.700, 0.733 and 0.669 for the 1-, 3- and 5-year CSS in the training set and 0.700, 0.744 and 0.669 in the validation set, respectively. In the nomogram calibration curve, there was strong correlation between the observed and predictive values. A web-based calculator can be accessed at: https://hjhlovelfb.shinyapps.io/DynNomapp/. Conclusions: This nomogram model has good predictive power and can help clinicians identify LUAD patients at high risk of cancer-related death. This nomogram is expected to be a precise and personalized tool for predicting the prognosis of patients with LUAD.

The role transition of radiotherapy for the treatment of liver cancer in the COVID-19 era.

The uncontrollable COVID-19 crises in the SARS-CoV-2 high-prevalence areas have greatly disrupted the routine treatment of liver cancer and triggered a role transformation of radiotherapy for liver cancer. The weight of radiotherapy in the treatment algorithm for liver cancer has been enlarged by the COVID-19 pandemic, which is helpful for the optimal risk-benefit profile.

The Incidence-Based Mortality and Survival Trends in Patients with Gastric Signet Ring Cell Carcinoma.

Materials and Methods: The patients from the Surveillance, Epidemiology, and End Results (SEER) database were recruited to explore the incidence-based mortality and survival trends from 2000 to 2017. We further analyzed the differences in mortality and survival trends in these patients by sex and stage. We also used joinpoint software to evaluate the trends in annual percentage change (APC) for statistical significance. Results: 14916 patients were collected, including 7801 (52.3%) male and 7115 (47.7%) female. We identified a single joinpoint at 2002. The overall incidence-based mortality of gastric SRC declined in America after 2002 (APC = -1.21, P < 0.05). In stratified analysis by sex and stage, the incidence-based mortality rate was higher in males than females. After 2002, the mortality rate decreased significantly in male (APC = -1.68, P < 0.05) and M0-stage patients (APC = -1.75, P < 0.05). In survival trend analysis, the 2-year relative survival improved in M0-stage gastric SRC, especially for males (APC = 1.14, P < 0.05). As for M1-stage patients, the 2-year relative survival significantly elevated in both male (APC = 3.87, P < 0.05) and female (APC = 5.63, P < 0.05) patients. Conclusions: The incidence-based mortality of gastric SRC has declined, and survival has improved in America over time. These optimistic trends may be attributed to cancer screening implementation and advances in novel treatments in the past decades.

Neoadjuvant Chemoradiotherapy Changes the Landscape of Soluble Immune Checkpoint Molecules in Patients With Locally Advanced Rectal Cancer.

Background: We aimed to investigate clinical implications of specific soluble immune checkpoint molecules (sICMs) in locally advanced rectal cancer (LARC) patients treated with neoadjuvant chemoradiotherapy (nCRT). Methods: We prospectively enrolled 30 LARC patients treated with nCRT and collected blood samples from them before, during, and after nCRT for prospective studies. Immune checkpoints often refer to T cell surface molecules influencing the immune response. Immune checkpoints, in the form of a soluble monomeric form, is widely present in blood. In the study, eight immune checkpoint-related plasma proteins, including programmed death-ligand 1 (PD-L1), CD80, CD86, CD28, CD27, glucocorticoid-induced tumor necrosis factor receptor (GITR), GITR ligand (GITRL), and inducible T-cell costimulator (ICOS), were measured using the Luminex platform. Two independent pathologists categorized patients as the good responders and the poor responders according to Dworak tumor regression grade (TRG). Results: Of the 30 patients, the levels of sPD-L1, sCD80, sCD86, sCD28, sGITR, sGITRL, sCD27, and sICOS decreased during nCRT (Pre-nCRT vs. During-nCRT, all p<0.05) but were restored after nCRT treatment (Pre-nCRT vs. Post-nCRT, all p>0.05). In the 14 good responders, the levels of sICMs, other than sGITR (p=0.081) and sGITRL (p=0.071), decreased significantly during nCRT (Pre-nCRT vs. During-nCRT, p<0.05), but they were all significantly increased after nCRT (During-nCRT vs. Post-nCRT, all p<0.05). In the 16 poor responders, only sCD80 was significantly reduced during nCRT (Pre-nCRT vs. During-nCRT, p<0.05), and none was significantly increased after nCRT (During-nCRT vs. Post-nCRT, all p<0.05). High levels of sICMs before nCRT were associated with poor response (all OR≥1). The Pre-model that incorporated the 8 sICMs before nCRT yielded a good predictive value (AUC, 0.848) and was identified as an independent predictor of treatment response (OR, 2.62; 95% CI, 1.11-6.18; p=0.027). Conclusion: Our results suggest chemoradiotherapy could influence the change of sPD-L1, sCD80, sCD86, sCD28, sGITR, sGITRL, sCD27, and sICOS in patients with LARC. The levels of the majority of soluble immune checkpoint molecules were reduced during nCRT and then restored at the end of nCRT, particularly in patients who responded well to nCRT. Combined baseline sICMs can be developed to predict treatment response.

STK25 enhances hepatocellular carcinoma progression through the STRN/AMPK/ACC1 pathway.

BACKGROUND: Serine/threonine protein kinase 25 (STK25) plays an important role in regulating glucose and insulin homeostasis and in ectopic lipid accumulation. It directly affects the progression and prognosis of nonalcoholic fatty liver disease (NAFLD). However, the effects of STK25 on lipid metabolism in hepatocellular carcinoma (HCC) remain unexplored. The aim of this study was to investigate the role of STK25 in HCC and to elucidate the underlying mechanisms. METHODS: Immunohistochemistry was used to measure the expression of STK25 in hepatic tissues of HCC patients, and public datasets were used as supplementary material for predicting the expression of STK25 and the prognosis of patients with HCC. The interaction between STK25 and striatin (STRN) was determined by the STRING database, immunohistochemistry and western blot analyses. The involved signaling pathway was detected by the KEGG database and western blot. Moreover, the biological behaviors of the HCC cells were detected by wound healing assays, Transwell invasion assays and oil red O staining. Finally, it was verified again by xenograft model. RESULTS: STK25 is highly expressed in HCC patients and is associated with poor prognosis. STK25 knockdown inhibited the HCC cell invasion and proliferation, promotes apoptosis. Consistently, STK25 knockdown inhibited tumor growth in xenograft mouse model. Besides, STK25 deficiency decreased lipid synthesis, energy reserve, epithelial-mesenchymal transition (EMT) by down-regulating lipid metabolism signaling pathway. STRN could reverse the change of lipid metabolism. CONCLUSIONS: Our results demonstrated that STK25 interacted with STRN to regulates the energy reserve and EMT via lipid metabolism reprogramming. Accordingly, high expression of STK25 may be associated with HCC patients and poor prognosis, which implicates STK25 could be a potential target for lipid metabolism in cancer therapy.

Cytokine release syndrome in COVID-19: a major mechanism of morbidity and mortality.

The coronavirus disease 2019 (COVID-19) triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) erupted in Hubei Province of China in December 2019 and has become a pandemic. Severe COVID-19 patients who suffer from acute respiratory distress syndrome (ARDS) and multi-organ dysfunction have high mortality. Several studies have shown that this is closely related to the cytokine release syndrome (CRS), often loosely referred to as cytokine storm. IL-6 is one of the key factors and its level is positively correlated with the severity of the disease. The molecular mechanisms for CRS in COVID-19 are related to the effects of the S-protein and N-protein of the virus and its ability to trigger NF-κB activation by disabling the inhibitory component IκB. This leads to activation of immune cells and the secretion of proinflammatory cytokines such as IL-6 and TNF-α. Other mechanisms related to IL-6 include its interaction with GM-CSF and interferon responses. The pivotal role of IL-6 makes it a target for therapeutic agents and studies on tocilizumab are already ongoing. Other possible targets of treating CRS in COVID-19 include IL-1ß and TNF-α. Recently, reports of a CRS like illness called multisystem inflammatory syndrome in children (MIS-C) in children have surfaced, with a variable presentation which in some cases resembles Kawasaki disease. It is likely that the immunological derangement and cytokine release occurring in COVID-19 cases is variable, or on a spectrum, that can potentially be governed by genetic factors. Currently, there are no approved biological modulators for the treatment of COVID-19, but the urgency of the pandemic has led to numerous clinical trials worldwide. Ultimately, there is great promise that an anti-inflammatory modulator targeting a cytokine storm effect may prove to be very beneficial in reducing morbidity and mortality in COVID-19 patients.

The Clinicopathological Features and Overall Survival of Patients With Gastric Neuroendocrine Carcinoma.

OBJECTIVES: Gastric neuroendocrine carcinoma (GNEC) is a class of rare histological subtypes in gastric cancer (GC). This retrospective case-control study aimed to explore the clinicopathological features and overall survival (OS) of patients with GNEC. METHODS: A large population of GNEC and intestinal-type GC (IGC) patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The 1:1 propensity score matching (PSM) analysis was initiated to adjust the confounders between GNEC and IGC cohorts. Kaplan-Meier (KM) plots with log-rank tests were used to compare the survival differences in GNEC versus IGC. Additionally, Cox proportional hazard regression models were adopted to characterize the prognostic factors relevant to OS of the GNEC patients. RESULTS: An entity of 4596 patients were collected, including 3943 (85.8%) IGC patients and 653 (14.2%) GNEC patients. The PSM analysis well-balanced all confounders in GNEC versus IGC (all P > .05). The KM plots showed that GNEC had significantly superior OS to IGC both before and after PSM analysis. Before PSM, the median OS was 52 (33.6-70.4) months in GNEC versus 32 (29.3-34.7) months in IGC (P = .0015). After PSM, the median OS was 26 (18.3-33.7) months in GNEC versus 21 (17.7-24.3) months in IGC (P = .0039). Stratified analysis indicated that GNEC had superior survivals to IGC in early stage patients and those who received surgery. In Cox regression analysis, age ≥ 60, tumor size > 50 mm, stage II-IV, T2, and N3 were independent risk factors for the GNEC patients (hazard ratio [HR]>1, P < .05). By contrast, year 2010 to 2015, female, and surgery were independent protective factors for these patients (HR < 1, P < .05). CONCLUSIONS: GNEC has unique clinicopathological features quite different from IGC and may have a superior survival to IGC in early stage patients. The prognostic factors identified here may assist the clinicians to more individually treat these patients.

Prognostic Value of Inflammatory Markers in Nasopharyngeal Carcinoma Patients in the Intensity-Modulated Radiotherapy Era.

PURPOSE: Inflammatory markers have been widely used in various cancers, but rarely in nasopharyngeal carcinoma (NPC). Here, we evaluated the prognostic value of pretreatment neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte-ratio (PLR), systemic immune index (SII), and systemic inflammation response index (SIRI) on NPC in the intensity-modulated radiotherapy (IMRT) era. METHODS: We retrospectively analyzed data from NPC patients from the Renmin Hospital of Wuhan University, between January 2012 and July 2020. We used Chi-square test or Fisher's exact test to compare the baseline characteristics, then applied Kaplan-Meier (K-M) survival analysis to compare the overall survival (OS) and progression-free survival (PFS) rates. Multivariate Cox proportional risk models were applied to identify independent prognostic factors. RESULTS: We enrolled a total of 342 NPC patients and found optimal cut-off values of 2.65, 184.91, 804.08, and 1.34 for NLR, PLR, SII, and SIRI, respectively. K-M survival analysis revealed that high NLR, PLR, SII, and SIRI were significantly associated with worse OS and PFS relative to those in the low groups. Results from univariate Cox analysis showed that clinical, T, and M stages, as well as NLR, PLR, SII, and SIRI were associated with OS, whereas age, alongside the aforementioned parameters, was associated with PFS. Moreover, multivariate Cox analysis showed that age ≥49 years (HR=2.48, 95% CI=1.21-5.05, P=0.013) and M1 stage (HR=3.84, 95% CI=1.52-9.73, P=0.013) were independent prognostic factors for OS, whereas SIRI ≥1.34 (HR=1.91, 95% CI=1.05-3.47, P=0.034) and M1 stage (HR=2.91, 95% CI=1.44-5.86, P=0.003) were independent prognostic factors for PFS. CONCLUSION: Overall, our findings indicated that high NLR, PLR, SII, and SIRI were significantly associated with poor OS and PFS in NPC patients. High SIRI may be an independent risk factor for PFS of NPC patients in the IMRT era.

Postoperative Radiotherapy for Patients With Resectable Stage III-N2 Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis.

PURPOSE: For resectable cases of stage III-N2 non-small cell lung cancer (NSCLC), the best treatment after surgery is still uncertain. The effect of postoperative radiotherapy (PORT) is controversial. Thus, we performed this updated meta-analysis to reassess the data of PORT in stage III-N2 NSCLC patients, to figure out whether these patients can benefit from PORT. METHODS: We conducted searches of the published literature in EMBASE, PubMed, and the Cochrane Library for relevant randomized control trials (RCTs) comparing PORT group with the non-PORT group in NSCLC patients at stage III-N2. These studies allowed the prior chemotherapy in the treatment. We extracted the data from these articles and used the hazard ratios (HRs) and their 95% confidence intervals (CIs) as summary statistics for estimating the effect of PORT on overall survival (OS), disease-free survival (DFS), local-regional recurrence-free survival (LRFS). RESULT: The analyses of seven randomized controlled trials (1,318 participants) show no benefit of PORT on survival (HR, 0.87; 95% CI, 0.71 to 1.07; p = 0.18) but a significantly different effect of PORT on DFS (HR, 0.83; 95% CI, 0.71 to 0.97; p = 0.02) and LRFS (HR, 0.64; 95% CI, 0.50 to 0.81; p = 0.0003). There is not enough evidence of a difference in the effect on survival by the utility of chemotherapy along with PORT though subgroup analysis of no chemotherapy group, concurrent chemoradiotherapy and sequential chemoradiotherapy group. Even in trials with 3D-CRT radiation technique, the pooled analysis shows no benefit of PORT on survival in patients with stage III-N2 NSCLC (data is not shown). CONCLUSION: Our findings illustrate that in the postoperative treatment for patients with stage III-N2 NSCLC, PORT contributes to a significantly increased DFS and LR and may not associate with an improved OS, indicating a cautious selection.

Regional Differences in Epidemiological and Clinical Characteristics, Treatment, and Clinical Outcomes of COVID-19 in Wuhan and Remote Areas of Hubei Province.

Background: The Coronavirus disease 2019 (COVID-19) pandemic has been a major threat to global health. Regional differences in epidemiological and clinical characteristics, treatment and outcomes of patients have not yet been investigated. This study was conducted to investigate these differences amongCOVID-19 patients in Hubei Province, China. Methods: This retrospective cross-sectional study analyzed data on 289 COVID-19 patients from designated hospitals in three regions:Urban (Wuhan Union West Hospital), Suburban areas of Wuhan (Hannan Hospital) and Enshi city, between February 8 and 20, 2020. The final date of follow-up was December 14th, 2020. The outcomes were case fatality rate and epidemiological and clinical data. Results: Urban Wuhan experienced a significantly higher case fatality rate (21.5%) than suburban Wuhan (5.23%) and rural area of Enshi (3.51%). Urban Wuhan had a higher proportion of patients on mechanical ventilation (24.05%) than suburban Wuhan (0%) and rural Enshi (3.57%). Treatment with glucocorticoids was equivalent in urban and suburban Wuhan (46.84 and 45.75%, respectively) and higher than Enshi (25.00%). Urban Wuhan had a higher proportion of patients with abnormal tests including liver function and serum electrolytes and a higher rate of pneumonia (p < 0.01 for all). Urban Wuhan also had a higher incidence of respiratory failure, heart disease, liver disease and shock, compared with the other two regions (all p < 0.05). Conclusions: Our findings revealed that there are regional differences in COVID-19. These findings provide novel insights into the distribution of appropriate resources for the prevention, control and treatment of COVID-19 for the global community.

Primary tumor resection benefited the survival of patients with distant metastatic gastric cancer.

BACKGROUND: The role of surgery in the treatment of patients with distant metastatic (M1) gastric cancer (GC) remains controversial currently. This study aimed to clarify the impact of primary tumor resection (PTR) on the survival of such patients. MATERIALS AND METHODS: The surveillance, epidemiology, and end results database was adopted to extract eligible patients. We designed a retrospective case-control study. The patients were divided into two groups according to whether they received PTR. The 1:1 propensity score matching (PSM) analysis was performed to balance the confounding factors between no-surgery and surgery groups. The categorical variables were described with Chi-square tests. Cancer-specific survival (CSS) and overall survival (OS) were evaluated by Kaplan-Meier method with log-rank test. Cox proportional hazard models were utilized to identify prognostic factors of CSS. RESULTS: A total of 1716 patients were included, including 1108 (64.6%) patients without surgery and 608 (35.4%) patients with surgery. After PSM, most confounders were well balanced between the two comparison groups. Survival analysis in matched cohorts indicated that surgery exerted significant survival advantages in both CSS and OS curves. The median CSS was 11.0 (9.8-12.2) months in the surgery group versus 9.0 (8.0-10.0) months in the no-surgery group (P < 0.001). Multivariable Cox regression analysis identified surgery as an independent prognostic factor for favorable prognosis (hazard ratio: 0.689, 95% confidence interval: 0.538-0.881, P = 0.003). CONCLUSION: Surgery showed significant survival benefits for the patients with M1 stage GC. Our study has provided additional evidence to support PTR for these patients.

Psychological Responses of the Patients in Cabin Hospital to the COVID-19 Outbreak: A Comparative Epidemiologic Analysis.

The building of cabin hospitals in Wuhan has been proven to be clinically successful in curing mild-symptom COVID-19 patients shortly after the outbreak of COVID-19 in late 2019. At the same time, the psychological effect of patients being treated in cabin hospitals and the features of the psychological status of the whole society remained ambiguous. This study adopted a self-administrated questionnaire to investigate the stress, depression, and anxiety status of patients in cabin hospitals (n = 212) and healthy participants outside of Hubei province (n = 221) in a population level from February 29 to March 01, 2020. The research measured participants' stress response, depression level, and anxiety level as well as their social support system and their resilience level. Results indicated that in this sudden outbreak of an unknown pandemic, all people (whether or not infected) showed a generally high level of stress, depression, and anxiety, regardless of age, gender, education level, and employment. It also showed that people with a lower level of psychological resilience and social support reported more severe symptoms of depression, anxiety, and stress. Moreover, the research also found a positive effect of cabin hospitals on the psychological recovery of COVID-19 patients. Stress response of patients increased after entering into cabin hospitals, while after 3-4 weeks' treatment, patients showed a decrease in their depression and anxiety levels. This research advances the understanding of COVID-19 and gives suggestions to optimize the design and the allocation of resources in cabin hospitals and better deal with the unknown pandemics in the future.