Cancer diagnosis and treatment in working-age adults: Implications for employment, health insurance coverage, and financial hardship in the United States.

The rising costs of cancer care and subsequent medical financial hardship for cancer survivors and families are well documented in the United States. Less attention has been paid to employment disruptions and loss of household income after a cancer diagnosis and during treatment, potentially resulting in lasting financial hardship, particularly for working-age adults not yet age-eligible for Medicare coverage and their families. In this article, the authors use a composite patient case to illustrate the adverse consequences of cancer diagnosis and treatment for employment, health insurance coverage, household income, and other aspects of financial hardship. They summarize existing research and provide nationally representative estimates of multiple aspects of financial hardship and health insurance coverage, benefit design, and employee benefits, such as paid sick leave, among working-age adults with a history of cancer and compare them with estimates among working-age adults without a history of cancer from the most recently available years of the National Health Interview Survey (2019-2021). Then, the authors identify opportunities for addressing employment and health insurance coverage challenges at multiple levels, including federal, state, and local policies; employers; cancer care delivery organizations; and nonprofit organizations. These efforts, when informed by research to identify best practices, can potentially help mitigate the financial hardship associated with cancer.

SOD2 promotes the immunosuppressive function of mesenchymal stem cells at the expense of adipocyte differentiation.

The potent immunomodulatory function of mesenchymal stem/stromal cells (MSCs) elicited by proinflammatory cytokines IFN-γ and TNF-α (IT) is critical to resolve inflammation and promote tissue repair. However, little is known about how the immunomodulatory capability of MSCs is related to their differentiation competency in the inflammatory microenvironment. In this study, we demonstrate that the adipocyte differentiation and immunomodulatory function of human adipose tissue-derived MSCs (MSC(AD)s) are mutually exclusive. Mitochondrial reactive oxygen species (mtROS), which promote adipocyte differentiation, were decreased in MSC(AD)s due to IT-induced upregulation of superoxide dismutase 2 (SOD2). Furthermore, knockdown of SOD2 led to enhanced adipogenic differentiation but reduced immunosuppression capability of MSC(AD)s. Interestingly, the adipogenic differentiation was associated with increased mitochondrial biogenesis and upregulation of peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PPARGC1A/PGC-1α) expression. IT inhibited PGC-1α expression and decreased mitochondrial mass but promoted glycolysis in an SOD2-dependent manner. MSC(AD)s lacking SOD2 were compromised in their therapeutic efficacy in DSS-induced colitis in mice. Taken together, these findings indicate that the adipogenic differentiation and immunomodulation of MSC(AD)s may compete for resources in fulfilling the respective biosynthetic needs. Blocking of adipogenic differentiation by mitochondrial antioxidant may represent a novel strategy to enhance the immunosuppressive activity of MSCs in the inflammatory microenvironment.

Employment and workdays lost among spouses of cancer survivors: Intersection with gender across cancer treatment status.

BACKGROUND: Cancer patients and survivors have high care needs, often provided by a spouse or partner. The purpose of this study was to elucidate how employment and work loss patterns differed across cancer history/treatment status and gender. METHODS: Using nationally representative data from the Medical Expenditure Panel Survey (2011, 2016, and 2017), the authors linked data across married participants and categorized them by spouses' cancer treatment status (no cancer history, on treatment for cancer, off treatment for cancer). Multivariable logistic and zero-inflated negative binomial regressions were used to assess the associations among cancer history/treatment status, gender, and employment outcomes (employment status and workdays lost to care for self or others). RESULTS: For men, employment did not differ significantly by cancer history/treatment status (on treatment: odds ratio [OR], 0.58; 95% confidence interval [CI], 0.33-1.02, off treatment: OR, 0.84; 95% CI, 0.62-1.14 vs. no cancer history). For women, employment was not significantly different when the spouse was on treatment for cancer compared to no cancer history (OR, 0.78; 95% CI, 0.33-1.86]) but was significantly increased for women whose spouse was off treatment (OR, 1.39; 95% CI, 1.05-1.84). Among employed participants, women whose spouse was on cancer treatment were nine times more likely to take days off work to provide care (OR, 9.52; 95% CI, 3.94-23.03) and took more than three times as many days off to care for others (OR, 3.21; 95% CI, 2.07-4.97) as men whose spouse had no cancer history. CONCLUSIONS: Wives of cancer survivors are at increased risk of work loss, with implications for their financial and psychological well-being. Employers, policymakers, and clinicians have opportunities to support working caregivers.

Health-related social needs, medical financial hardship, and mortality risk among cancer survivors.

BACKGROUND: Cancer survivors may face challenges affording food, housing, and other living necessities, which are known as health-related social needs (HRSNs). However, little is known about the associations of HRSNs and mortality risk among adult cancer survivors. METHODS: Adult cancer survivors were identified from the 2013-2018 National Health Interview Survey (NHIS) and linked with the NHIS Mortality File with vital status through December 31, 2019. HRSNs, measured by food insecurity, and nonmedical financial worries (e.g., housing costs), was categorized as severe, moderate, and minor/none. Medical financial hardship, including material, psychological, and behavioral domains, was categorized as 2-3, 1, or 0 domains. Using age as the time scale, the associations of HRSNs and medical financial hardship and mortality risk were assessed with weighted adjusted Cox proportional hazards models. RESULTS: Among cancer survivors 18-64 years old (n = 5855), 25.5% and 18.3% reported moderate and severe levels of HRSNs, respectively; among survivors 65-79 years old (n = 5918), 15.6% and 6.6% reported moderate and severe levels of HRSNs, respectively. Among cancer survivors 18-64 years old, severe HRSNs was associated with increased mortality risk (hazards ratio [HR], 2.00; 95% confidence interval [CI], 1.36-2.93, p < .001; reference = minor/none) in adjusted analyses. Among cancer survivors 65-79 years old, 2-3 domains of medical financial hardship was associated with increased mortality risk (HR, 1.58; 95% CI, 1.13-2.20, p = .007; reference = 0 domain). CONCLUSIONS: HSRNs and financial hardship are associated with increased mortality risk among cancer survivors; comprehensive assessment of HRSN and financial hardship connecting patients with relevant services can inform efforts to mitigate adverse consequences of cancer.

Financial hardship among siblings of long-term survivors of childhood cancer: A Childhood Cancer Survivor Study report.

BACKGROUND: Siblings of children with cancer may experience adverse household economic consequences, but their financial outcomes in adulthood are unknown. METHODS: A total of 880 siblings (aged 18-64 years) of adult-aged childhood cancer survivors were surveyed to estimate the prevalence of financial hardship by three established domains (behavioral, material, and psychological). For individual financial hardship items matching the contemporaneous National Health Interview Survey or Behavioral Risk Factor Surveillance System, siblings were compared with the general population by calculating adjusted prevalence odds ratios (ORs) to sample-weighted responses. Multivariable logistic regression models examined associations between sibling characteristics and each hardship domain and between sibling hardship and survivors' cancer/treatment characteristics. RESULTS: Behavioral, material, and psychological hardship was reported by 24%, 35%, and 28%, respectively. Compared with national survey respondents, siblings were more likely to report worries about medical bills (OR, 1.14; 95% confidence interval [CI], 1.06-1.22), difficulty affording nutritious foods (OR, 1.79; 95% CI, 1.54-2.07), and forgoing needed medical care (OR, 1.38; 95% CI, 1.10-1.73), prescription medications (OR, 2.52; 95% CI, 1.99-3.20), and dental care (OR, 1.34; 95% CI, 1.15-1.57) because of cost. Sibling characteristics associated with reporting financial hardship in one or more domains included female sex, older age, chronic health conditions, lower income, not having health insurance, high out-of-pocket medical expenditures, and nonmedical/nonhome debt. No survivor cancer/treatment characteristics were associated with sibling financial hardship. CONCLUSIONS: Adult siblings of childhood cancer survivors were more likely to experience financial hardship compared with the general population. Childhood cancer may adversely affect entire households, with potentially lasting implications.

Intelligent Identification of Cerebrospinal Fluid for the Diagnosis of Parkinson's Disease.

Cerebrospinal fluid (CSF) biomarkers are more sensitive than the Movement Disorder Society (MDS) criteria for detecting prodromal Parkinson's disease (PD). Early detection of PD provides the best chance for successful implementation of disease-modifying treatments, making it crucial to effectively identify CSF extracted from PD patients or normal individuals. In this study, an intelligent sensor array was built by using three metal-organic frameworks (MOFs) that exhibited varying catalytic kinetics after reacting with potential protein markers. Machine learning algorithms were used to process fingerprint response patterns, allowing for qualitative and quantitative assessment of the proteins. The results were robust and capable of discriminating between PD and non-PD patients via CSF detection. The k-nearest neighbor regression algorithm was used to predict MDS scores with a minimum mean square error of 38.88. The intelligent MOF sensor array is expected to promote the detection of CSF biomarkers due to its ability to identify multiple targets and could be used in conjunction with MDS criteria and other techniques to diagnose PD more sensitively and selectively.

Negatively Charged Hydrophobic Carbon Nano-Onion Interfacial Layer Enabling High-Rate and Ultralong-Life Zn-Based Energy Storage.

Zn-based electrochemical energy storage (EES) systems are attracting more attention, whereas their large-scale application is restricted by the dendrite and parasitic reaction-caused unstable Zn anodes. Herein, a negatively charged hydrophobic carbon nano-onion (CNO) interfacial layer is proposed to realize ultrastable and high-rate Zn anodes, enabling high-performance Zn-based EES. For the CNO interfacial layer, its hydrophobicity not only blocks active water but also reduces the Zn2+ desolvation barrier, and meanwhile, the negatively-charged CNO nanoparticles adsorb Zn2+ and repel SO4 2- to homogenize Zn2+ flux, accelerate Zn2+ desolvation and suppress the self-corrosion of Zn anodes. Besides, the conductive CNO interfacial layer increases the surface area for the Zn deposition to reduce local current density. Consequently, under the modulation of the CNO interfacial layer, Zn plating/stripping exhibits impressive reversibility with an average Coulombic efficiency of 99.4% over 800 cycles, and Zn anodes present significantly enhanced electrochemical stability and rate performance, whose operation lifetime exceeds 2000 h at 1 mA cm-2 and 350 h even at 10 mA cm-2 . Moreover, high-rate and ultralong-life Zn-ion hybrid supercapacitors are achieved with the CNO interfacial layer-modulated Zn anode and activated CNO cathode. This work provides new thinking in regulating the Zn deposition interface to realize high-performance Zn-based EES.

Effect of crystal-water on the optical and dielectric characteristics of calcium sulfate in the THz band.

The effect of crystal-water contents on the optical properties and dielectric characteristics of calcium sulfate in the THz band is investigated. The complex dielectric constant and conductivity are analyzed using the Drude-Smith model. The refractive index and absorption coefficient are linearly increased with the content of crystal-water, and the corresponding linear fitting lines of R2 over 0.97 are obtained. The dielectric properties of calcium sulfate are significantly affected by the crystal-water content. These results indicate that a new method to quantitative measurement of the crystal-water content in hydrous minerals is provided.

Photoelectrochemical properties of self-powered corundum-structured Ga2O3nanorod array/fluorine-doped SnO2photodetectors modulated by precursor concentrations.

Herein, corundum-structured Ga2O3(α-Ga2O3) nanorod array/fluorine-doped SnO2(FTO) structures have been fabricated by hydrothermal and thermal annealing processes with different precursor concentrations from 0.01 to 0.06 M. The diameter and length of the nanorod arrays are much larger with increasing precursor concentrations due to more nucleation sites and precursor ions participating in the reaction procedures. The optical bandgap decreases from 4.75 to 4.47 eV because of the tensile stress relieving with increasing the precursor concentrations. Based on self-powered photoelectrochemical (PEC) photodetectors, the peak responsivity is improved from ∼0.33 mA W-1for 0.06 M to ∼1.51 mA W-1for 0.02 M. Schottky junctions can be formed in PEC cells. More photogenerated carriers can be produced in wider depletion region. From Mott-Schottky plots, the depletion regions become much wider with decreasing the precursor concentrations. Therefore, the enhance responsivity is owing to the wider depletion regions. Due to the reduced possibility of photogenerated holes captured by traps ascribed from fewer green and yellow luminescence defects, smaller charge transfer resistance, and shorter transportation route, the decay time becomes much faster through decreasing the precursor concentrations. Compared with the other self-poweredα-Ga2O3-nanorod-array-based PEC photodetectors, it shows the fastest response time (decay time of 0.005 s/0.026 s) simply modulated by precursor concentrations for the first time without employing complex precursors, seed layers or special device designs. Compared with other high-responsivity monoclinic Ga2O3(ß-Ga2O3) self-powered photodetectors, our devices also show comparable response speed with simple control and design. This work provides the realization of fast-speed self-powered Ga2O3based solar-blind ultraviolet photodetectors by simple modulation processes and design, which is a significant guidance for their applications in warnings, imaging, computing, communication and logic circuit, in the future.

Quantitative assessment whole-rock iron content in magnetite protolith based on terahertz time-domain spectroscopy.

Terahertz time-domain spectroscopy was first used to establish a correlation with the whole-rock iron (TFe) content in different depths of the Bayan Obo protolith. Compared with element content obtained by the traditional method of X-ray fluorescence spectroscopy (XRF), a similar tendency of the absorption coefficient and refractive index is presented. Furthermore, three machine learning algorithms, namely, partial least squares regression (PLSR), random forest (RF), and multi-layer perceptron (MLP), were used to develop a quantitative analytical model for TFe content of the protolith minerals. Among the three algorithms, MLP has the highest detection accuracy, with a model coefficient of determination R 2 reaching up to 0.945. These findings demonstrate that terahertz time-domain spectroscopy can be used to rapidly quantify the TFe elemental content of protolith, providing a method of detecting the content of mineral components.

Quantitative assessment whole-rock iron content in magnetite protolith based on terahertz time-domain spectroscopy: publisher's note.

This publisher's note serves to correct errors in Appl. Opt.63, 2528 (2024)APOPAI0003-693510.1364/AO.517400.

Effects of Acupuncture Combined with Yi Qi Yang Yin and Blood Activating Formula on Blood Glucose and Renal Function in Early Diabetic Nephropathy: A Randomized Controlled Trial.

Objective: To study the effects of acupuncture combined with the formula of Yi Qi Yang Yin and blood activating (A-YBF) on blood glucose levels and renal function in patients with early diabetic nephropathy. Methods: 96 patients with early diabetic nephropathy treated in our hospital from April 2021 to April 2022 were included in the study and divided into the control group (conventional medical treatment) and the study group (A-YBF), with 48 cases in each group. The efficacy and adverse effects were recorded by comparing the Chinese medicine symptom points, blood glucose level, renal function, and inflammatory factor level between the two groups before and after the treatment. Results: The clinical efficacy of the study group was significantly higher than that of the control group (P < .05). Before treatment, no difference was found between the primary and secondary symptom scores of the two groups (P > .05); after treatment, the primary and secondary symptom scores of the study group were lower than those of the control group (P < .05). Before treatment, there was no difference in fasting blood glucose (FPG) and 2h postprandial glucose (2hPG) levels; 24h urine protein quantification, cystatin C (Cys-C), urinary albumin excretion rate (UAER), and estimated glomerular filtration rate (eGFR) levels; and growth differentiation factor-15 (GDF-15), interleukin-1ß (IL-1ß), interleukin-17 (IL-17), and serum amyloid A (SAA) levels between the two groups (P > .05). After treatment, FPG and 2hPG levels; 24h urine protein quantification, Cys-C and UAER levels; and GDF-15, IL-1ß, IL-17, and SAA levels were lower in the study group than in the control group, while eGFR levels were higher than those in the control group (P < .05). Conclusion: A-YBF can effectively reduce blood glucose levels and improve renal function in patients with early diabetic nephropathy and can be promoted in clinical application.

Hydrogen-Bonded Organic Frameworks Chelated Manganese for Precise Magnetic Resonance Imaging Diagnosis of Cancers.

Magnetic resonance imaging (MRI) is an important tool in the diagnosis of many cancers. However, clinical gadolinium (Gd)-based MRI contrast agents have limitations, such as large doses and potential side effects. To address these issues, we developed a hydrogen-bonded organic framework-based MRI contrast agent (PFC-73-Mn). Due to the hydrogen-bonded interaction of water molecules and the restricted rotation of manganese ions, PFC-73-Mn exhibits high longitudinal relaxation r1 (5.03 mM-1 s-1) under a 3.0 T clinical MRI scanner. A smaller intravenous dose (8 µmol of Mn/kg) of PFC-73-Mn can provide strong contrast and accurate diagnosis in multiple kinds of cancers, including breast tumor and ultrasmall orthotopic glioma. PFC-73-Mn represents a prospective new approach in tumor imaging, especially in early-stage cancer.

Terahertz Time-Domain Spectroscopic Characteristics of Typical Metallic Minerals.

Accurate identification and understanding of various metallic minerals are crucial for deciphering geological formations, structures, and ages. Giving their pivotal role as essential natural resources, a microscopic exploration of metallic minerals becomes imperative. Traditional analytical methods, while helpful, exhibit certain limitations. However, terahertz time-domain spectroscopy, distinguished by its high signal-to-noise ratio, expansive frequency band, and low incident wave energy, is a promising complement to conventional techniques in characterizing metallic minerals. This study employs terahertz time-domain spectroscopy to examine samples of Stibnite, Sphalerite, Galena, and Pyrite originating from diverse geological conditions. The vibrations of molecules within these metallic minerals induce discernible changes in the terahertz spectra. Our findings untiate the extensive potential of terahertz time-domain spectroscopy in the characterization of metallic minerals, affirming its considerable practical value in mineral resource exploration.

The cost burden of metastatic prostate cancer in the US populations covered by employer-sponsored health insurance.

BACKGROUND: Recent advancements in the clinical management of metastatic prostate cancer include several costly therapies and diagnostic tests. The objective of this study was to provide updated information on the cost to payers attributable to metastatic prostate cancer among men aged 18 to 64 years with employer-sponsored health plans and men aged 18 years or older covered by employer-sponsored Medicare supplement insurance. METHODS: By using Merative MarketScan commercial and Medicare supplemental data for 2009-2019, the authors calculated differences in spending between men with metastatic prostate cancer and their matched, prostate cancer-free controls, adjusting for age, enrollment length, comorbidities, and inflation to 2019 US dollars. RESULTS: The authors compared 9011 patients who had metastatic prostate cancer and were covered by commercial insurance plans with a group of 44,934 matched controls and also compared 17,899 patients who had metastatic prostate cancer and were covered by employer-sponsored Medicare supplement plans with a group of 87,884 matched controls. The mean age of patients with metastatic prostate cancer was 58.5 years in the commercial samples and 77.8 years in the Medicare supplement samples. Annual spending attributable to metastatic prostate cancer was $55,949 per person-year (95% confidence interval [CI], $54,074-$57,825 per person-year) in the commercial population and $43,682 per person-year (95% CI, $42,022-$45,342 per person-year) in the population covered by Medicare supplement plans, both in 2019 US dollars. CONCLUSIONS: The cost burden attributable to metastatic prostate cancer exceeds $55,000 per person-year among men with employer-sponsored health insurance and $43,000 among those covered by employer-sponsored Medicare supplement plans. These estimates can improve the precision of value assessments of clinical and policy approaches to the prevention, screening, and treatment of prostate cancer in the United States.

Magnetic Resonance Diagnosis of Early Triple-Negative Breast Cancer Based on the Ionic Covalent Organic Framework with High Relaxivity and Long Retention Time.

Patients with triple-negative breast cancer (TNBC) have dismal prognoses due to the lack of therapeutic targets and susceptibility to lymph node (LN) metastasis. Therefore, it is essential to develop more effective approaches to identify early TNBC tissues and LNs. In this work, a magnetic resonance imaging (MRI) contrast agent (Mn-iCOF) was constructed based on the Mn(II)-chelated ionic covalent organic framework (iCOF). Because of the porous structure and hydrophilicity, the Mn-iCOF has a high longitudinal relaxivity (r1) of 8.02 mM-1 s-1 at 3.0 T. For the tumor-bearing mice, a lower dose (0.02 mmol [Mn]/kg) of Mn-iCOF demonstrated a higher signal-to-noise ratio (SNR) value (1.8) and longer retention time (2 h) compared to a 10-fold dose of commercial Gd-DOTA (0.2 mmol [Gd]/kg). Moreover, the Mn-iCOF can provide continuous and significant MR contrast for the popliteal LNs within 24 h, allowing for accurate evaluation and dissection of LNs. These excellent MRI properties of the Mn-iCOF may open new avenues for designing more biocompatible MRI contrast agents with higher resolutions, particularly in the diagnosis of TNBC.

Impact of glucocorticoids on the efficacy of neoadjuvant chemoradiotherapy and survival of patients with locally advanced rectal cancer: a retrospective study.

BACKGROUND: Preclinical studies suggest that glucocorticoids (GCs) promote the proliferation and development of colorectal cancer. Because GCs are broadly prescribed for treatment-related adverse events in patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiotherapy (NCRT), it's essential to assess the effect of GCs on clinical outcomes. METHODS: LARC cases treated with NCRT followed by surgery were assessed retrospectively. Evaluation of the relationship between GCs use (GCs vs. non-GCs) and neoadjuvant rectal (NAR) score (as a three-level categorical dependent variable) was performed using multivariable multinomial logistic regression (MLR). We also examined the relationship between the accumulated dose of GCs and NAR using multivariate MLR. Survival analysis of disease-free survival (DFS) and overall survival (OS) was performed using the Kaplan-Meier method. Multivariate Cox regression was used to assess confounding factors that could influence OS and DFS. RESULTS: This retrospective cohort study included 790 patients with newly diagnosed non-metastatic LARC (T3-4/N + M0) who received NCRT followed by surgery between January 2012 and April 2017. The end of the follow-up period was May 11, 2022. Among the 790 patients with LARC, 342 (43.2%) received GCs treatment and 448 (56.8%) did not during the NCRT-to-surgery period. GCs medication was significantly different between mid-NAR (8-16) and low-NAR (< 8) (odds ratio [OR], 0.615; 95% CI, 0.420-0.901; P = 0.013), and the high-NAR (> 16) and low-NAR (0.563; 0.352-0.900; 0.016). Patients exposed to GCs, had a decreased 5-year OS (GCs vs. non-GCs = 80.01% (95% CI, 75.87%-84.37%) vs. 85.30% (82.06%-88.67%), P = 0.023) and poorer 5-year DFS (73.99% (69.45%-78.82%) vs. 78.7% (75.14%-82.78%), P = 0.045). The accumulated dose of GCs was an independent risk factor for OS (hazard ratio [HR], 1.007 [1.001-1.014], 0.036) and DFS (1.010 [1.004-1.017], 0.001). CONCLUSIONS AND RELEVANCE: Our study revealed that GCs were associated with reduced efficacy of NCRT and worse clinical outcomes in patients with LARC during the NCRT-to-surgery period.

Investigation of the Therapeutic Effect and Mechanism of Holographic Meridian Scraping Therapy on Knee Osteoarthritis.

Objective: This study aimed to investigate the efficacy of holographic meridian scraping therapy on patients with knee osteoarthritis (KOA) and its impact on serum IL-1ß and TNF-α levels. Methods: A prospective study was conducted, enrolling seventy KOA patients admitted to the Hebei Provincial Hospital of Traditional Chinese Medicine between August 2021 and April 2022. The patients were divided into two groups using the random number table method: control group (n = 35) and treatment group (n = 35). The control group received oral celecoxib capsules (100 mg, twice daily), while the treatment group received an additional daily holographic meridian scraping session (20 minutes/day). Throughout the two-week study, the researchers continuously monitored the visual analogue scale (VAS) score, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and the changes in serum IL-1ß and TNF-α expression. Results: The treatment group demonstrated significantly better overall efficiency and efficacy compared to the control group (P < .05). Both groups exhibited decreased VAS and WOMAC scores after treatment in comparison to pre-treatment levels (P < .05), with the treatment group showing lower scores than the control group after treatment (P < .05). Furthermore, serum TNF-α and IL-1ß levels in both groups decreased after treatment compared to pre-treatment levels within the same group (P < .05). The treatment group had significantly lower serum TNF-α and IL-1ß levels than the control group after treatment (P < .05). Conclusions: Combining holographic meridian scraping therapy with celecoxib effectively treats KOA and significantly improves patient conditions, along with reductions in serum TNF-α and IL-1ß levels.

First Report of Colletotrichum fructicola Causing Anthracnose on Paeonia lactiflora in China.

Paeonia lactiflora Pall is a traditional famous flower with long cultivated history in China, and has important medical and ornamental functions (Duan et al. 2022). In the middle of June 2022, anthracnose disease was observed nearly 25% (n=90) on P. lactiflora in Poyang County, Shangrao City, Jiangxi Province (29.00° N, 116.67° E) (Figure 1 E). The symptoms of the disease were small, round, light brown spots then grew bigger to round or irregular dark brown lesions (5 to 7 mm diameter) progressively on the leaves with disease spread (Figure 1 A). Subsequently, necrotic tissue was formed in the center and caused fade and wilt on the leaves ultimately, which reduced the medicinal and aesthetic value severely. Small pieces of diseased tissue (5 × 5 mm) were cut from the diseased junction, disinfected with 75% ethanol for 30 to 45 seconds, then 1% NaClO for 1 to 2 minutes, rinsed three times with sterile water. To identify the pathogen, tissues were placed on PDA and incubated for 3 days at 28°C. Single spore isolates were cultured on PDA, the colonies of one representative strain (SY4) were originally white with a lot of aerial mycelium after 5 to 7 days at 28°C in the incubator. The center of the colony turned greyish-white, released tiny orange-yellow particles (conidia) (Figure 1 F and 1 G), which were single, colorless, elongated ovals with rounded ends and measured 11.29 to 23.24 × 3.94 to 5.60 µm (av=15.89 µm × 4.74 µm, n=50) (Figure 1 H and 1 I). The isolate SY4 was identified to Colletotrichum fructicola based on morphological characteristics (Yang et al. 2021; Li et al. 2022b). For further molecular identification, the rDNA-ITS, actin gene (ACT), glyceraldehyde-3-phosphatedehydrogenase (GAPDH), chitin synthase (CHS) and calmodulin gene (CAL) genes were amplified and sequenced with primers of ITS1/ITS4 (Gardes et al. 1993), ACT-512F/ACT-783R, GDF/GDR (Templeton et al. 1992), CHS-79F/CHS-345R (Carbone et al. 1999) and CL1C/ CL2C (Weir et al. 2012) respectively. The accession numbers in GenBank were OP523977 (ITS-rDNA), OP547618 (ACT), OP605733 (GAPDH), OP605732 (CHS), and OP605731 (CAL). The BLAST analysis revealed that these sequences were identical more than 99% with those of C. fructicola (GenBank accession Nos. MZ437948.1, MN525803.1, MN525860.1, MZ13360.1 and ON188684.1) (Figure 2). To confirm pathogenicity, the leaves were cleaned with 75% ethanol, rinsed with sterile water. After the leaf surface was dried naturally, 20 leaves were pricked at two symmetrical places on either side of the main veins of the leaf with a sterilized inoculum needle (2.0 mm in diameter), half of the wounded leaves were inoculated with 20 µL spore suspension (1.0 × 106 spores/mL) (Figure 1 C and 1 D), while the other half were inoculated with sterile water as controls (Figure 1 B). Inoculated leaves were grown for 5 days in an incubator at 28 °C and above 90% relative humidity, repeated three times. The results demonstrated that the wounded leaves with C. fructicola showed the same signs of wilting with the original disease leaves, while control leaves remained healthy. The same fungus was reisolated from the diseased leaves which confirmed with Koch's postulates. The same fungus was re-isolated from the diseased leaves while it was not isolated from control leaves, confirmed with Koch's postulates. In China, it had been reported that C. fructicola caused anthracnose on Persea americana (Li et al. 2022a) and Myrica rubra (Li et al. 2022b). To the best of our knowledge, this is the first report of anthracnose on P. lactiflora caused by C. fructicola in China. The results will help to develop effective control strategies for anthracnose on P. lactiflora.

Person-years of life lost and lost earnings from cigarette smoking-attributable cancer deaths, United States, 2019.

State-specific information on lost earnings due to smoking-attributable cancer deaths to inform and advocate for tobacco control policies is lacking. We estimated person-years of life lost (PYLL) and lost earnings due to cigarette smoking-attributable cancer deaths in the United States nationally and by state. Proportions and numbers of cigarette smoking-attributable cancer deaths and associated PYLL among individuals aged 25 to 79 years in 2019 were calculated and combined with annual median earnings to estimate lost earnings attributable to cigarette smoking. In 2019, estimated total PYLL and lost earnings associated with cigarette smoking-attributable cancer deaths in ages 25 to 79 years in the United States were 2 188 195 (95% CI, 2 148 707-2 231 538) PYLL and $20.9 billion ($20.0 billion-$21.7 billion), respectively. States with the highest overall age-standardized PYLL and lost earning rates generally were in the South and Midwest. The estimated rate per 100 000 population ranged from 352 (339-366) in Utah to 1337 (1310-1367) in West Virginia for PYLL and from $4.3 million ($3.5 million-$5.2 million) in Idaho to $14.8 million ($10.6 million-$20.7 million) in Missouri for lost earnings. If age-specific PYLL and lost earning rates in Utah had been achieved by all states, 58.2% (57.0%-59.5%) of the estimated total PYLL (1 274 178; 1 242 218-1 306 685 PYLL) and 50.5% (34.2%-62.4%) of lost earnings ($10.5 billion; $7.1 billion-$13.1 billion) in 2019 nationally would have been avoided. Lost earnings due to smoking-attributable cancer deaths are substantial in the United States and are highest in states with weaker tobacco control policies.