Cancer Mortality in Chinese Chrysotile Asbestos Miners: Exposure-Response Relationships

Objective: This study was conducted to assess the relationship of mortality from lung cancer and other selected causes to asbestos exposure levels. Methods: A cohort of 1539 male workers from a chrysotile mine in China was followed for 26 years. Data on vital status, occupation and smoking were collected from the mine records and individual contacts. Causes and dates of death were further verified from the local death registry. Individual cumulative fibre exposures (f-yr/ml) were estimated based on converted dust measurements and working years at specific workshops. Standardized mortality ratios (SMRs) for lung cancer, gastrointestinal (GI) cancer, all cancers and nonmalignant respiratory diseases (NMRD) stratified by employment years, estimated cumulative fibre exposures, and smoking, were calculated. Poisson models were fitted to determine exposure-response relationships between estimated fibre exposures and cause-specific mortality, adjusting for age and smoking. Results: SMRs for lung cancer increased with employment years at entry to the study, by 3.5-fold in ≥10 years and 5.3-fold in ≥20 years compared with <10 years. A similar trend was seen for NMRD. Smokers had greater mortality from all causes than nonsmokers, but the latter also had slightly increased SMR for lung cancer. No excess lung cancer mortality was observed in cumulative exposures of <20 f-yrs/ml. However, significantly increased mortality was observed in smokers at the levels of ≥20 f-yrs/ml and above, and in nonsmokers at ≥100 f-yrs/ml and above. A similarly clear gradient was also displayed for NMRD. The exposure-response relationships with lung cancer and NMRD persisted in multivariate analysis. Moreover, a clear gradient was shown in GI cancer mortality when age and smoking were adjusted for. Conclusion: There were clear exposure-response relationships in this cohort, which imply a causal link between chrysotile asbestos exposure and lung cancer and nonmalignant respiratory diseases, and possibly to gastrointestinal cancer, at least for smokers

Predictive value of MRI-detected extramural vascular invasion in stage T3 rectal cancer patients before neoadjuvant chemoradiation

PURPOSE:We set out to explore the probability of MRI-detected extramural vascular invasion (mr-EMVI) before chemoradiation to predict responses to chemoradiation and survival in stage T3 rectal cancer patients. METHODS:A total of 100 patients with T3 rectal cancer who underwent MRI examination and received neoadjuvant chemoradiation and surgery were enrolled. The correlation between mr-EMVI and other clinical factors were analyzed by chi-square. Logistic regression model was performed to select the potential factors influencing tumor responses to neoadjuvant chemoradiation. A Cox proportional hazards regression model was performed to explore potential predictors of survival.RESULTS:The positive mr-EMVI result was more likely to be present in patients with a higher T3 subgroup (T3a+b = 7.1% vs. T3c+d = 90.1%, P < 0.001) and more likely in patients with mesorectal fascia involvement than in those without MRF (65% vs. 38.8%, P = 0.034). Compared with mr-EMVI (+) patients, more mr-EMVI (-) patients showed a good response (staged ≤ ypT2N0) (odds ratio [OR], 3.020; 95% confidence interval [CI], 1.071–8.517; P = 0.037). In univariate analysis, mr-EMVI (+) (hazard ratio [HR], 5.374; 95% CI, 1.210–23.872; P = 0.027) and lower rectal cancers (HR, 3.326; 95% CI, 1.135–9.743; P = 0.028) were significantly associated with decreased disease-free survival. A positive mr-EMVI status (HR, 5.727; 95% CI, 1.286–25.594; P = 0.022) and lower rectal cancers (HR, 3.137; 95% CI, 1.127–8.729; P = 0.029) also served as prognostic factors related to decreased disease-free survival in multivariate analysis.CONCLUSION:The mr-EMVI status before chemoradiation is a significant prognostic factor and could be used for identifying T3 rectal cancer patients who might benefit from neoadjuvant chemoradiation

Hand, foot and mouth disease in China: Evaluating an automated system for the detection of outbreaks

Objective To evaluate the performance of China's infectious disease automated alert and response system in the detection of outbreaks of hand, foot and mouth (HFM) disease. Methods We estimated size, duration and delay in reporting HFM disease outbreaks from cases notified between 1 May 2008 and 30 April 2010 and between 1 May 2010 and 30 April 2012, before and after automatic alert and response included HFM disease. Sensitivity, specificity and timeliness of detection of aberrations in the incidence of HFM disease outbreaks were estimated by comparing automated detections to observations of public health staff. Findings The alert and response system recorded 106 005 aberrations in the incidence of HFM disease between 1 May 2010 and 30 April 2012 - a mean of 5.6 aberrations per 100 days in each county that reported HFM disease. The response system had a sensitivity of 92.7% and a specificity of 95.0%. The mean delay between the reporting of the first case of an outbreak and detection of that outbreak by the response system was 2.1 days. Between the first and second study periods, the mean size of an HFM disease outbreak decreased from 19.4 to 15.8 cases and the mean interval between the onset and initial reporting of such an outbreak to the public health emergency reporting system decreased from 10.0 to 9.1 days. Conclusion The automated alert and response system shows good sensitivity in the detection of HFM disease outbreaks and appears to be relatively rapid. Continued use of this system should allow more effective prevention and limitation of such outbreaks in China

Development of multifunctional unmanned aerial vehicles versus ground seeding and outplanting: What is more effective for improving the growth and quality of rice culture?

The agronomic processes are complex in rice production. The mechanization efficiency is low in seeding, fertilization, and pesticide application, which is labor-intensive and time-consuming. Currently, many kinds of research focus on the single operation of UAVs on rice, but there is a paucity of comprehensive applications for the whole process of seeding, fertilization, and pesticide application. Based on the previous research synthetically, a multifunctional unmanned aerial vehicle (mUAV) was designed for rice planting management based on the intelligent operation platform, which realized three functions of seeding, fertilizer spreading, and pesticide application on the same flight platform. Computational fluid dynamics (CFD) simulations were used for machine design. Field trials were used to measure operating parameters. Finally, a comparative experimental analysis of the whole process was conducted by comparing the cultivation patterns of mUAV seeding (T1) with mechanical rice direct seeder (T2), and mechanical rice transplanter (T3). The comprehensive benefit of different rice management processes was evaluated. The results showed that the downwash wind field of the mUAV fluctuated widely from 0 to 1.5 m, with the spreading height of 2.5 m, and the pesticide application height of 3 m, which meet the operational requirements. There was no significant difference in yield between T1, T2, and T3 test areas, while the differences in operational efficiency and input labor costs were large. In the sowing stage, T1 had obvious advantages since the working efficiency was 2.2 times higher than T2, and the labor cost was reduced by 68.5%. The advantages were more obvious compared to T3, the working efficiency was 4 times higher than in T3, and the labor cost was reduced by 82.5%. During the pesticide application, T1 still had an advantage, but it was not a significant increase in advantage relative to the seeding stage, in which operating efficiency increased by 1.3 times and labor costs were reduced by 25%. However, the fertilization of T1 was not advantageous due to load and other limitations. Compared to T2 and T3, operational efficiency was reduced by 80% and labor costs increased by 14.3%. It is hoped that this research will provide new equipment for rice cultivation patterns in different environments, while improving rice mechanization, reducing labor inputs, and lowering costs

Heterologous expression of the Haynaldia villosa pattern-recognition receptor CERK1-V in wheat increases resistance to three fungal diseases

Wheat production is under continuous threat by various fungal pathogens. Identification of multiple-disease resistance genes may lead to effective disease control via the development of cultivars with broad-spectrum resistance. Plant Lysin-motif (LysM)-type pattern-recognition receptors, which elicit innate immunity by recognizing fungal pathogen associated molecular patterns such as chitin, are potential candidates for such resistance. In this study, we cloned a LysM receptor-like kinase gene, CERK1-V, from the diploid wheat relative Haynaldia villosa. CERK1-V expression was induced by chitin and Blumeria graminis f. sp. tritici, the causal agent of wheat powdery mildew. Heterologous overexpression of CERK1-V in wheat inhibited the development of three fungal pathogens, thereby increased resistance to powdery mildew, yellow rust, and Fusarium head blight. CERK1-V physically interacted with the wheat LysM protein TaCEBiPs. CERK1-V/TaCEBiPs interaction promoted chitin recognition and activated chitin signal transduction in wheat. Transgenic plants with excessively high CERK1-V expression showed high resistance but abnormal plant growth, whereas plants with moderate expression level showed adequate resistance level with no marked impairment of plant growth. In transgenic lines, RNA-seq showed that gene expression involved in plant innate immunity was activated. Expression of genes involved in photosynthesis, ER stress and multiple phytohormone pathways was also activated. Optimized expression of CERK1-V in wheat can confer disease resistance without compromising growth or defense fitness

Analysis of COVID-19 Guideline Quality and Change of Recommendations: A Systematic Review.

Background Hundreds of coronavirus disease 2019 (COVID-19) clinical practice guidelines (CPGs) and expert consensus statements have been developed and published since the outbreak of the epidemic. However, these CPGs are of widely variable quality. So, this review is aimed at systematically evaluating the methodological and reporting qualities of COVID-19 CPGs, exploring factors that may influence their quality, and analyzing the change of recommendations in CPGs with evidence published. Methods We searched five electronic databases and five websites from 1 January to 31 December 2020 to retrieve all COVID-19 CPGs. The assessment of the methodological and reporting qualities of CPGs was performed using the AGREE II instrument and RIGHT checklist. Recommendations and evidence used to make recommendations in the CPGs regarding some treatments for COVID-19 (remdesivir, glucocorticoids, hydroxychloroquine/chloroquine, interferon, and lopinavir-ritonavir) were also systematically assessed. And the statistical inference was performed to identify factors associated with the quality of CPGs. Results We included a total of 92 COVID-19 CPGs developed by 19 countries. Overall, the RIGHT checklist reporting rate of COVID-19 CPGs was 33.0%, and the AGREE II domain score was 30.4%. The overall methodological and reporting qualities of COVID-19 CPGs gradually improved during the year 2020. Factors associated with high methodological and reporting qualities included the evidence-based development process, management of conflicts of interest, and use of established rating systems to assess the quality of evidence and strength of recommendations. The recommendations of only seven (7.6%) CPGs were informed by a systematic review of evidence, and these seven CPGs have relatively high methodological and reporting qualities, in which six of them fully meet the Institute of Medicine (IOM) criteria of guidelines. Besides, a rapid advice CPG developed by the World Health Organization (WHO) of the seven CPGs got the highest overall scores in methodological (72.8%) and reporting qualities (83.8%). Many CPGs covered the same clinical questions (it refers to the clinical questions on the effectiveness of treatments of remdesivir, glucocorticoids, hydroxychloroquine/chloroquine, interferon, and lopinavir-ritonavir in COVID-19 patients) and were published by different countries or organizations. Although randomized controlled trials and systematic reviews on the effectiveness of treatments of remdesivir, glucocorticoids, hydroxychloroquine/chloroquine, interferon, and lopinavir-ritonavir for patients with COVID-19 have been published, the recommendations on those treatments still varied greatly across COVID-19 CPGs published in different countries or regions, which may suggest that the CPGs do not make sufficient use of the latest evidence. Conclusions Both the methodological and reporting qualities of COVID-19 CPGs increased over time, but there is still room for further improvement. The lack of effective use of available evidence and management of conflicts of interest were the main reasons for the low quality of the CPGs. The use of formal rating systems for the quality of evidence and strength of recommendations may help to improve the quality of CPGs in the context of the COVID-19 pandemic. During the pandemic, we suggest developing a living guideline of which recommendations are supported by a systematic review for it can facilitate the timely translation of the latest research findings to clinical practice. We also suggest that CPG developers should register the guidelines in a registration platform at the beginning for it can reduce duplication development of guidelines on the same clinical question, increase the transparency of the development process, and promote cooperation among guideline developers all over the world. Since the International Practice Guideline Registry Platform has been created, developers could register guidelines prospectively and internationally on this platform

Internal mammary lymph node recurrence: rare but characteristic metastasis site in breast cancer

<p>Abstract</p> <p>Background</p> <p>To assess the frequency of IMLN recurrence, its associated risk factors with disease-free interval (DFI) and its predicting factors on overall survival time.</p> <p>Methods</p> <p>133 cases of breast cancer IMLN recurrence were identified via the computerized CT reporting system between February 2003 and June 2008, during which chest CT for patients with breast cancer (n = 8867) were performed consecutively at Cancer Hospital, Fudan University, Shanghai, China. Patients' charts were retrieved and patients' characteristics, disease characteristics, and treatments after recurrence were collected for analysis. The frequency was 1.5% (133/8867).</p> <p>Results</p> <p>IMLN recurrence was presented as the first metastatic site in 121 (91%) patients while 88 (66.2%) had other concurrent metastases. Typical chest CT images included swelling of the IMLN at the ipsilateral side with local lump and sternal erosion located mostly between the second and third intercostal space. The median disease-free interval (DFI) of IMLN recurrence was 38 months. The independent factors that could delay the IMLN recurrence were small tumor size (HR 0.5 95%CI: 0.4 - 0.8; <it>p </it>= 0.002), and positive ER/PR disease (HR 0.6, 95% CI: 0.4 - 0.9; <it>p </it>= 0.006). The median survival time after IMLN recurrence was 42 months, with a 5-year survival rate of 30%. Univariate analysis showed four variables significantly influenced the survival time: DFI of IMLN recurrence (p = 0.001), no concurrent distant metastasis (p = 0.024), endocrine therapy for patients with positive ER/PR (p = 0.000), radiotherapy (p = 0.040). The independent factors that reduced the death risk were no concurrent distant metastases (HR: 0.7, 95% CI: 0.4 - 0.9; <it>p </it>= 0.031), endocrine therapy for patients with positive ER/PR status (HR: 0.2, 95% CI: 0.1 - 0.5; <it>p </it>= 0.001) and palliative radiotherapy (HR: 0.3, 95% CI: 0.1- 0.9; <it>p </it>= 0.026).</p> <p>Conclusions</p> <p>The risk of IMLN recurrence is low and there are certain characteristics features on CT images. ER/PR status is both a risk factor for DFI of IMLN recurrence and a prognostic factor for overall survival after IMLN recurrence. Patients with only IMLN recurrence and/or local lesion have a good prognosis.</p

Feasibility study of dual parametric 2D histogram analysis of breast lesions with dynamic contrast-enhanced and diffusion-weighted MRI

Abstract Background This study aimed to investigate the diagnostic value of a dual-parametric 2D histogram classification method for breast lesions. Methods This study included 116 patients with 72 malignant and 44 benign breast lesions who underwent CAIPIRINHA-Dixon-TWIST-VIBE dynamic contrast-enhanced (CDT-VIBE DCE) and readout-segmented diffusion-weighted magnetic resonance examination. The volume of interest (VOI), which encompassed the entire lesion, was segmented from the last phase of DCE images. For each VOI, a 1D histogram analysis (mean, median, 10th percentile, 90th percentile, kurtosis and skewness) was performed on apparent diffusion coefficient (ADC) and volume transfer constant (Ktrans) maps; a 2D histogram image (Ktrans-ADC) was generated from the pixelwise aligned maps, and its kurtosis and skewness were calculated. Each parameter was correlated with pathological results using the Mann–Whitney test and receiver operating characteristic curve analysis. Results For the Ktrans histogram, the area under the curve (AUC) of the mean, median, 90th percentile and kurtosis had statistically diagnostic values (mean: 0.760; median: 0.661; 90th percentile: 0.781; and kurtosis: 0.620). For the ADC histogram, the AUC of the mean, median, 10th percentile, skewness and kurtosis had statistically diagnostic values (mean: 0.661; median: 0.677; 10th percentile: 0.656; skewness: 0.664; and kurtosis: 0.620). For the 2D Ktrans-ADC histogram, the skewness and kurtosis had statistically higher diagnostic values (skewness: 0.831, kurtosis: 0.828) than those of the 1D histogram (all P < 0.05). Conclusions The dual-parametric 2D histogram analysis revealed better diagnostic accuracy for breast lesions than single parametric histogram analysis of either Ktrans or ADC maps