Retroperitoneal schwannoma mimicking metastatic seminoma: case report and literature review

If a testicular cancer pat ient has a mass in the retroperitoneum, a metastasis is often the first suspicion, probably leading to improper diagnosis and overtreatment. Here we report a case of retroperitoneal schwannoma mimicking metastatic seminoma. A 29-year-old man, who had a history of seminoma, presented with a single retroperitoneal mass suspected to be a metastasis. Because the patient refused radiotherapy, 3 cycles of cisplatin, etoposide, and bleomycin were offered. Post-chemotherapy computed tomography scan revealed persistence of the retroperitoneal mass, with no change in tumor size or characteristics. Subsequently, retroperitoneal lymph node dissection was performed. The dissected tissue contained negative lymph nodes but a single mass in the attached fat. Pathology revealed retroperitoneal schwannoma, which was confirmed by immunohistochemistry. Thus, clinicians should be aware of retroperitoneal schwannoma and its distinction from metastatic seminoma to avoid misdiagnosis and ensure proper treatment.

Complications of radical nephrectomy for renal cell carcinoma: a retrospective study comparing transperitoneal and retroperitoneal approaches using a standardized reporting methodology in two Chinese centers

The reporting of complications following transperitoneal and retroperitoneal open radical nephrectomy (RN) is nonstandardized. This study aimed to compare early complications between the two approaches using a standardized reporting methodology in a large contemporary cohort. Between 1996 and 2009, 558 patients underwent open RN for renal cell carcinoma (RCC) in our two centers (424 from Sun Yat-sen University Cancer Center and 134 from the First Affiliated Hospital of Sun Yat-sen University). Records were reviewed for clinicopathologic features and complications. Complications were graded using the Clavien system based on the severity of impact. One hundred and five patients (18.8%) had one or more early complications (168 complications overall). The overall rates of grades I to V complications were 5.6%, 10.8%, 2.2%, 0.4%, and 0.2%, respectively. Patients who underwent transperitoneal RN did not experience more overall or procedure-related complications than those who underwent retroperitoneal RN (P=0.911 and P=0.851, respectively). On subgroup analysis, neither grade I/II nor grades III-V complications were significantly different between the transperitonal RN and retroperitoneal RN groups. Multivariate analysis showed that for any grade of complication, age (P=0.016) and estimated blood loss (P=0.001) were significant predictors. We concluded that open RN is a safe procedure associated with low rates of serious morbidity and mortality. Compared with retroperitoneal RN, transperitoneal RN was not associated with more complications. Older patient and more blood loss at surgery were independent predictors for higher early postoperative complication rates.

Impact of proton-induced alteration of carrier lifetime on single-event transient in SiGe heterojunction bipolar transistor

This paper presents an investigation into the impact of proton-induced alteration of carrier lifetime on the singleevent transient(SET) caused by heavy ions in silicon–germanium heterojunction bipolar transistor(SiGe HBT).The ioninduced current transients and integrated charge collections under different proton fluences are obtained based on technology computer-aided design(TCAD) simulation.The results indicate that the impact of carrier lifetime alteration is determined by the dominating charge collection mechanism at the ion incident position and only the long-time diffusion process is affected.With a proton fluence of 5 × 1013 cm-2, almost no change is found in the transient feature, and the charge collection of events happened in the region enclosed by deep trench isolation(DTI), where prompt funneling collection is the dominating mechanism.Meanwhile, for the events happening outside DTI where diffusion dominates the collection process, the peak value and the duration of the ion-induced current transient both decrease with increasing proton fluence, leading to a great decrease in charge collection.

Oncological outcome of surgical treatment in 336 patients with renal cell carcinoma

Background and Objective: The most effective therapy against renal cell carcinoma (RCC) is surgical treatment; however, there have been few large-scale studies that focused on the oncological outcome of this disease in China. The aim of the current study was to report the clinicopathological results and cancer-specific survival (CSS) rate in RCC patients after surgical treatment in our center. Methods: We retrospectively analyzed the clinicopathological data of 336 RCC patients who underwent radical or partial nephrectomy between 1999 and 2006. Of the 336 patients, 226 were male and 110 were female; the median age was 51 years. Univariate and multivariate analyses were conducted to identify the independent prognostic predictors for this cohort of RCC patients. Results: During follow-up, the overall 5-year CSS rate was 81.4%. The 5-year CSS rates for patients with stage-I, -II, -III, and -IV RCC were 94.7%, 88.9%, 68.8%, and 19.3%, respectively. The patients with T1N0M0 (T1) and T2N0M0 (T2) tumors had similar survival curves. For patients with T1 category tumor, the survival rate did not differ significantly between the radical nephrectomy and nephron-sparing surgery groups. For the 21 patients with metastasis confined to the local lymph nodes, the 5-year survival rate was 31.6% after radical nephrectomy and lymph node dissection. For the 15 patients with vena caval tumor thrombus, the 5-year survival rate was 52.5% after radical nephrectomy and tumor thrombus extirpation. Multivariate Cox regression showed that stage was an independent predictor for CSS (hazard ratio, 3.359; P < 0.001). Conclusions: For localized RCC, the oncological outcome of this cohort is comparable to that reported in the Western literature. For some patients with locally advanced RCC, aggressive surgical treatment can lead to better long-term survival. However, the prognosis of the patients with metastasis still needs to be improved.

Microstructure and mechanical properties of Al−Mg−Si alloy U-shaped profile

To get a full understanding of hot extrusion,solid solution treatment and aging process on the Al−0.56Mg−0.63Si alloy,the microstructure and mechanical properties of a U-shaped profile were studied through optical microscopy,scanning electrical microscopy,transmission electrical microscopy,hardness,and tensile tests.The coarse equiaxed grains existed near the profile edge as a result of the dynamic recrystallization nucleation and exceeding growth during hot extrusion.The fibrous deformed and sub-structured grains located between the two coarse grain layers,due to the occurrence of work-hardening and dynamic recovery.Perpendicular needle β′′precipitates were distributed inside the grain,and obvious precipitates-free zone appeared after aging treatment.The tensile strength,yield strength and elongation of the aged Al−Mg−Si alloy U-shaped profile were no less than 279.4 MPa,258.6 MPa,and 21.6%,respectively.The fracture morphology showed dimple rupture characteristics.The precipitates and grain boundaries played key role in the strengthening contribution.

Single-event-effect propagation investigation on nanoscale system on chip by applying heavy-ion microbeam and event tree analysis

The propagation of single-event effects(SEEs)on a Xilinx Zynq-7000 system on chip(SoC)was inves-tigated using heavy-ion microbeam radiation.The irradia-tion results reveal several functional blocks’sensitivity locations and cross sections,for instance,the arithmetic logic unit,register,D-cache,and peripheral,while irradi-ating the on-chip memory(OCM)region.Moreover,event tree analysis was executed based on the obtained microbeam irradiation results.This study quantitatively assesses the probabilities of SEE propagation from the OCM to other blocks in the SoC.

Single-event effects induced by medium-energy protons in 28 nm system-on-chip

Single-event effects(SEEs)induced by mediumenergy protons in a 28 nm system-on-chip(SoC)were investigated at the China Institute of Atomic Energy.An on-chip memory block was irradiated with 90 MeV and 70 MeV protons,respectively.Single-bit upset and multicell upset events were observed,and an uppermost number of nine upset cells were discovered in the 90 MeV proton irradiation test.The results indicate that the SEE sensitivities of the 28 nm SoC to the 90 MeV and 70 MeV protons were similar.Cosmic Ray Effects on Micro-Electronics Monte Carlo simulations were analyzed,and it demonstrates that protons can induce effects in a 28 nm SoC if their energies are greater than 1.4 MeV and that the lowest corresponding linear energy transfer was 0.142 MeV cm^2 mg^-1.The similarities and discrepancies of the SEEs induced by the 90 MeV and 70 MeV protons were analyzed.

Evaluation of interfacial properties in SiC composites using an improved cohesive element method

A two-dimensional axisymmetric finite element model based on an improved cohesive element method was developed to simulate interfacial debonding, sliding friction, and residual thermal stresses in SiC composites during single-fiber push-out tests to extract the interfacial bond strength and frictional stress. The numerical load–displacement curves agree well with experimental curves,indicating that this cohesive element method can be used for calculating the interfacial properties of SiC composites.The simulation results show that cracks are most likely to occur at the ends of the experimental sample, where the maximum shear stress is observed and that the interfacial shear strength and constant sliding friction stress decrease with an increase in temperature. Moreover, the load required to cause complete interfacial failure increases with the increase in critical shear strength, and the composite materials with higher fiber volume fractions have higher bearing capacities. In addition, the initial failure load increases with an increase in interphase thickness.

Stage T1N0M0 renal cell carcinoma: the prognosis in Asian patients

The prognostic features of T1N0M0 renal cell carcinoma (RCC) in Asian patients have not been well explored in large sample studies. In this study, we retrospectively analyzed the records of 713 patients undergoing nephrectomy for T1N0M0 RCC between 1991 and 2009 in three Asian hospitals. Univariate and multivariate analysis were performed to identify the independent predictive factors for T1N0M0 RCC prognosis among a series of clinicopathological parameters, including age, gender, tumor size, Fuhrman grade, and histological classification. Our results showed that 388 of 713 patients had tumors 4.0 cm or smaller (stage T1a) and 325 of 713 patients had tumors 4.0-7.0 cm in size (stage T1b). Five-year cancer-specific survival (CSS) and recurrence-free survival (RFS) rates for this group of patients were 96.0% and 93.5%, respectively. The patients with T1b RCC had a significantly lower 5-year CSS and RFS rates than did those with T1a RCC (CSS, 93.1% vs. 98.6%, P = 0.026; RFS, 90.0% vs. 96.5%, P < 0.001). Patients with low grade (grades I-II) tumors had a higher 5-year CSS (97.8% vs. 91.2%, P = 0.001) and RFS (95.5% vs. 85.5%, P < 0.001) rate than did those with high grade (grades I-II) tumors. More interestingly, when stratifying patients to T1a and T1b groups, the role of grade in distinguishing prognosis could be only observed in patients with T1b disease. Cox regression showed tumor size and Fuhrman grade were significant in predicting CSS and RFS. Our study suggests that the prognosis of patients with T1N0M0 RCC is excellent, and these results are comparable to previously reported studies in Western patients. Furthermore, our data indicates that patients with T1b disease and high Fuhrman grade have high risk of tumor recurrence and death, thus requiring more frequent follow-up.

Radical cystectomy for bladder cancer: oncologic outcome in 271 Chinese patients

Few large scale studies have reported the oncologic outcome of radical cystectomy for treating bladder cancer in China; hence, we lack long-term prognostic information. The aim of the current study was to determine the survival rate and prognostic factors of patients who underwent radical cystectomy for bladder cancer in a Chinese medical center. We retrospectively analyzed clinicopathologic data from 271 bladder cancer patients who underwent radical cystectomy between 2000 and 2011. Univariate and multivariate analyses were conducted to identify independent prognostic predictors for this cohort. Median follow-up was 31.7 months(range, 0.2–139.1 months). Thirty-day mortality was(1.4%). The 5-year recurrence-free survival, cancer-specific survival(CSS), and overall survival rates were 61.6%, 72.9%, and 68.0%, respectively. The 5-year CSS rates of patients with T1–T4 disease were 90.7%, 85.0%, 51.0%, and 18.0%, respectively. Patients with organ-confined disease had a higher 5-year CSS rate than those with extravesical disease(81.4% vs. 34.9%, P < 0.001). For the 38 patients(14%) with lymph node involvement, the 5-year CSS rate was 27.7%—significantly lower than that of patients without lymph node metastasis(P < 0.001). The 5-year CSS rate was much higher in patients with low grade tumor than in those with high grade tumor(98.1% vs. 68.1%, P < 0.001). Multivariate Cox regression showed that patient age(hazard ratio, 2.045; P = 0.013) and T category(hazard ratio, 2.213; P < 0.001) were independent predictors for CSS. These results suggest that radical cystectomy is a safe and effective method for treating bladder cancer in Chinese patients. Old age and high T category were associated with poor prognosis in bladder cancer patients who underwent radical cystectomy.

Investigation of single event effect in 28-nm system-on-chip with multi patterns

Single event effects (SEEs) in a 28-nm system-on-chip (SoC) were assessed using heavy ion irradiations, and susceptibilities in different processor configurations with data accessing patterns were investigated. The patterns included the sole processor (SP) and asymmetric multiprocessing (AMP) patterns with static and dynamic data accessing. Single event upset (SEU) cross sections in static accessing can be more than twice as high as those of the dynamic accessing, and processor configuration pattern is not a critical factor for the SEU cross sections. Cross section interval of upset events was evaluated and the soft error rates in aerospace environment were predicted for the SoC. The tests also indicated that ultra-high linear energy transfer (LET) particle can cause exception currents in the 28-nm SoC, and some even are lower than the normal case.

Intraarterial chemotherapy with gemcitabine and cisplatin in locally advanced or recurrent penile squamous cell carcinoma

The prognosis of locally advanced or recurrent squamous cell carcinoma(SCC) of the penis after conventional treatment is dismal. This study aimed to evaluate the therapeutic effects of intraarterial chemotherapy with gemcitabine and cisplatin on locally advanced or recurrent SCC of the penis. Between April 1999 and May 2011, we treated 5 patients with locally advanced penile SCC and 7 patients with recurrent disease with intraarterial chemotherapy. The response rate and toxicity data were analyzed, and survival rates were calculated. After 2 to 6 cycles of intraarterial chemotherapy with gemcitabine and cisplatin, 1 patients with locoregionally advanced disease achieved a complete response, and 4 achieved partial response. Of the 7 patients with recurrent disease, 2 achieved complete response, 3 achieved partial response, 3 had stable disease, and 1 developed progressive disease. An objective tumor response was therefore achieved in 10 of the 12 patients. The median overall survival for the patients was 24 months(range, 10-50 months). Three out of 10 patients who responded were long-term survivors after intraarterial chemotherapy. Intraarterial chemotherapy with gemcitabine and cisplatin may be effective and potentially curative in locoregionally advanced or recurrent penile SCC. The contribution of this therapy in the primary management of advanced or recurrent penile SCC should be prospectively investigated.

Research on SEE mitigation techniques using back junction and p^+ buffer layer in domestic non-DTI SiGe HBTs by TCAD

In this paper we investigate two techniques for single event effect(SEE) mitigation by using back junction and p^+buffer layer in non-deep trench isolation(DTI) domestic silicon–germanium heterojunction bipolar transistors(SiGe HBTs)based on technology computer aided design(TCAD) simulation. The effectiveness of the two mitigation techniques and the influence of various structure parameters are investigated. Simulation results indicate that the two techniques are more effective in reducing collector charge collection induced by heavy ions striking at positions outside the collector–substrate(C–S) junction where charge collection is dominated by diffusion. By properly adjusting the parameters, charge collection of events outside the C–S junction can be reduced by more than an order of magnitude, while charge collection of events in the device center is halved without affecting the direct current(DC) and alternating current(AC) characteristics of the SiGe HBTs.

Total and cause-specific mortality attributable to cold spells in China:A multicity and multicounty study

Climate change has resulted in an increase in the frequency and intensity of extreme cold weather events,but few multicity or multicounty researches have explored the association between cold spells and mortality risk and burden.We collected daily data on climate,sociodemo-graphic factors and mortality in 18 cities/counties across 11 geographical regions for the period of November to March 2014-2018.A distributed lag nonlinear model was used to examine the association between cold spells and mortality after adjustment for confounding factors.Twelve definitions of cold spells were used.Multi-meta regression analysis was applied to pool the impacts over different regions.Cold spells were significantly associated with all-cause mortality at lag 0-21(CRR:1.38,95%CI:1.21,1.57).In addition to respiratory diseases and cir-culatory system diseases,digestive,endocrine and nervous system diseases and injury were also affected by cold spells.The magnitude of the impacts of cold spells on mortality varied among the diseases investigated,with the highest risk estimate found for influenza and pneumonia(CRR:2.00,95%CI:1.45,2.76)and the lowest estimate found for injury(CRR:1.26,95%CI:1.09,1.46).The fraction of all-cause mortality attributable to cold spells was 2.31%(95%CI:0.90%,3.46%).Among the regional differences,the attributable burden of all-cause mortality was higher in rural areas and subtropical monsoon climate zone,with attributable fractions of 2.85%(95%CI:1.23%,4.11%)and 3.36%(95%CI:0.55%,5.35%),respectively.Cold spells increased mortality from a range of diseases.Women,older adults and residents of rural areas and subtropical monsoon climate zone were more vulnerable to cold spells impacts.The findings may help to formulate preventive strategies and early warning response plans to reduce mortality burden of extreme cold events.

Effects of rosuvastatin on expression of angiotensin-converting enzyme 2 after vascular balloon injury in rats

Objective To investigate the effects and mechanisms of rosuvastatin on angiotensin -converting enzyme 2 (ACE2) in the process of neointimal formation after vascular balloon injury in rats, and to explore the effects of ACE2 and rosuvastatin in restenosis. Methods Thirty-six Wistar rats were randomly allocated into three groups: control group (n = 12), surgery group (n = 12), and statin group (n = 12). Aortic endothelial denudation of rats was performed using 2F balloon catheters. At days 14 and 28 after injury, aortic arteries were harvested to examine the following. Intimal thickening was examined by hematoxylin and eosin staining. We measured angiotensin II (Ang II) and angiotensin 1-7 (Ang-[1–7]) levels by a radioimmunological method or enzyme-linked immunosorbent assay. Protein andmRNAexpression of ACE2 and Ang II type 1 receptor (AT1) were investigated by immunohistochemistry, Western blots, and Reverse transcriptase- polymerase chain reaction (RT-PCR). We measured changes in proliferating cell nuclear antigen (PCNA) by immunohistochemistry. The level of phosphorylated extracellular signal regulated kinase 1/2 (P-ERK1/2) was evaluated byWestern blotting. Results Proliferation of vascular smooth muscle cells (VSMC) and intimal thickening were higher at day 14 after vascular balloon injury in the surgery group compared with the control group. Proliferation of VSMC was decreased by day 28 after injury, while intimal thickening continued. With rosuvastatin treatment, the extent of VSMC proliferation and intimal thickening was reduced at day 14 and 28 after injury. Ang II and P-ERK levels were significantly increased, Ang-(1–7) levels were significantly decreased, mRNA and protein expressions of ACE2 were significantly decreased, and AT1 expression was significantly increased at days 14 and 28 after vascular balloon injury in the surgery group compared with the control group. PCNAexpression was higher in the surgery group than in the control group, and it was significantly decreased after being given rosuvastatin. Expression of ACE2 mRNA and protein, and Ang-(1–7) levels were significantly increased, while AT1 expression and levels of Ang II and P-ERK were significantly decreased in the statin group compared with the surgery group. Conclusions Expression of ACE2 mRNA and protein is decreased in the process of intimal thickening after balloon injury. The inhibitory effect of rosuvastatin on intimal thickening is related to upregulation of ACE2, an increase in Ang-(1–7), downregulation of AT1, and activation of the P-ERK pathway.

阴茎癌改良临床病理肿瘤分期预后意义分析

背景与目的第8版美国癌症联合会-TNM(American Joint Committee on Cancer tumor–node–metastasis,AJCC-TNM)分期基于的是一些回顾性单中心研究。本研究旨在分析分期的预后价值,并探讨加入脉管癌栓的改良的临床病理肿瘤分期能否提高对T2–3期阴茎癌患者预后预测的准确性。方法根据第8版AJCC-TNM分期对2000年至2015年在中国和巴西2个中心接受治疗的411例患者所组成的训练队列进行分期。采用C-indexes一致性系数进行预测模型的评估,Bbootstrap再抽样法(1000次)进行模型验证。采用来自4个大洲15个中心接受治疗的436例患者的数据进行外部验证。结果根据第8版AJCC-TNM分期的T2和T3期患者有存活率重叠(P=0.587)。脉管癌栓是转移和生存的重要预后因素(均P <0.001)。多因素分析显示,仅脉管癌栓对癌症特异性生存(cancer-specific survival,CSS)有显著影响(风险比=1.587,95%置信区间=1.253–2.011;P=0.001)。发生脉管癌栓的T2和T3期患者的CSS显著短于无脉管癌栓的患者(P <0.001)。因此,我们提出一种改良的临床病理分期,将第8版AJCC-TNM分期的T2和T3期细分为如下2个新类别:T2期肿瘤侵犯尿道海绵体和/或阴茎海绵体和/或尿道且无淋巴管侵犯;T3期肿瘤侵犯尿道海绵体和/或阴茎海绵体和/或尿道并有淋巴管侵犯。加入脉管癌栓的改良的分期显示出预后分层改善,各组间CSS差异显著(均P <0.005),患者预后预测的准确性高于第8版AJCC-TNM分期(C-index,0.739 vs. 0.696)。以上结果在外部验证队列中得到了确认。结论 T2–3期阴茎癌是异质性的,加入脉管癌栓的改良临床病理分期比第8版AJCC-TNM分期对阴茎癌患者的预后预测能力更强。

Expression of AIF-1 and RANTES in Unexplained Spontaneous Abortion and Possible Association with Alloimmune Abortion

Objective To investigate the effects of allograft inflammatory factor-1 （AIF-1） and （RANTES） in sera and deciduas on unexplained early spontaneous abortion. Methods AIF-1 and RANTES were examined in sera and deciduas/endometria of 43 unexplained early spontaneous abortion women （group A）, 40 healthy women with early pregnancy（group B） and 20 healthy women with no pregnancy （group C）. Immunohistochemistry and enzyme linked immunosorbent assay （ELISA） were used in this study. Results AIF-1 protein was expressed both in deciduas of group A and in endometria of group C. In group A, H scores in the recurrent abortion deciduas specimens were significantly greater than those in the first abortion;in endometrium, expression of AIF-1 was greater in the secretory than in proliferative phase of group C. In group B, concentrations of RANTES in sera were higher in 7th-8th week of pregnancy than in 6th-7th and 〉8th week of pregnancy; expression of AIF-1 protein showed a negative correlation with RASNTES concentration; a significant increase of the RANTES levels in sera and tissue was observed in group B. Conclusion These results demonstrate, for the first time, that AIF-1 are expressed in deciduas of unexplained spontaneous abortion suggesting that AIF-1 involve in alloimmune abortion; RANTES might act as a novel blocking antibody;AIF-1 and RANTES might act as reliable markers for diagnosis of early alloimmune abortion.

A modified clinicopathological tumor staging system for survival prediction of patients with penile cancer

Background:The 8th American Joint Committee on Cancer tumor-node-metastasis(AJCC-TNM)staging system is based on a few retrospective single-center studies.We aimed to test the prognostic validity of the staging system and to determine whether a modified clinicopathological tumor staging system that includes lymphovascular emboliza-tion could increase the accuracy of prognostic prediction for patients with stage T2-3 penile cancer.Methods:A training cohort of 411 patients who were treated at 2 centers in China and Brazil between 2000 and 2015 were staged according to the 8th AJCC-TNM staging system.The internal validation was analyzed by bootstrap-corrected C-indexes(resampled 1000 times).Data from 436 patients who were treated at 15 centers over four conti-nents were used for external validation.Results:A survivorship overlap was observed between T2 and T3 patients(P=0.587)classified according to the 8th AJCC-TNM staging system.Lymphovascular embolization was a significant prognostic factor for metastasis and survival(all P<0.001).Based on the multivariate analysis,only lymphovascular embolization showed a significant influ-ence on cancer-specific survival(CSS)(hazard ratio=1.587,95%confidence interval=1.253-2.011;P=0.001).T2 and T3 patients with lymphovascular embolization showed significantly shorter CSS than did those without lymphovascu-lar embolization(P<0.001).Therefore,a modified clinicopathological staging system was proposed,with the T2 and T3 categories of the 8th AJCC-TNM staging system being subdivided into two new categories as follows:t2 tumors invade the corpus spongiosum and/or corpora cavernosa and/or urethra without lymphovascular invasion,and t3 tumors invade the corpus spongiosum and/or corpora cavernosa and/or urethra with lymphovascular invasion.The modified staging system involving lymphovascular embolization showed improved prognostic stratification with significant differences in CSS among all categories(all P<0.005)and exhibited higher accuracy in predicting patient prognoses than did the 8th AJCC-TNM staging system(C-index,0.739 vs.0.696).These results were confirmed in the external validation cohort.Conclusions:T2-3 penile cancers are heterogeneous,and a modified clinicopathological staging system that incorporates lymphovascular embolization may better predict the prognosis of patients with penile cancer than does the 8th AJCC-TNM staging system.

Economic burden of premature deaths attributable to different heatwaves in China: A multi-site study, 2014-2019

It has been well documented that heatwaves are linked to elevated mortality and morbidity.However,the selection of optimal heatwave definitions for subsequent risk assessment has been inconsistent and there is no full picture of the effects of heatwaves with different intensities on economic losses due to mortality,which can provide important insights for public health considerations.Hence,we used a two-stage time series analysis,combined with values of statistical life(VsL)based on the value of a statistical life year to assess the economic burden of deaths associated with heatwaves of different intensities and durations and to identify the vulnerable populations and regions.We further conducted stratified analyses by age,sex,and region.We found 2.9%(95%CI:0.0%,6.5%)-20.0%(95%CI:2.9%,34.2%)of VsL were attributable to heatwaves,corresponding to attributable economic losses(AELs)of 2.20(95%CI:0.32,3.77)-4.77(95%CI:1.53,7.63)billion CNY.The economic burden of death was most sensitive to heatwave H99P_2D(99th percentile,at last 2 consecutive days),while H97.5P_2D(97.5th percentile,at last 2 consecutive days)caused the highest attributable economic losses.Females and elderly people aged≥65 years were more sensitive.The AELs in the temperate zone and northern regions were larger than those in subtropical zone and southern regions during relatively low-intensity heatwaves,respectively.By contrast,the AELs in subtropical zone and southern regions were relatively higher than those in temperate zone and northern regions during relatively high-intensity heatwaves,respectively.The AELs were larger in urban areas than in rural areas.Tailored intervention strategies,primarily focusing on vulnerable populations and regions,should be formulated to reduce the economic loss due to heatwaves in the context of climate change.

Temperature change between neighboring days and hospital admissions in China

The short-term temperature fluctuation caused by global climate change is one of the risk factors affecting public health.Exploring the association between temperature fluctuation and diseases,which has received relatively limited research attention,can contribute to enhancing awareness of health risks and taking timely measures for health risk alert and management.Therefore,this study aims to investigate the relationship between temperature change between neighboring days(TCN)and hospitalizations,identify diseases sensitive to extreme TCN,and evaluate the related disease burden.We collected meteorological and hospitalization data from 2014 to 2019 in 23 sites of China to explore the impact of TCN on hospitalizations.We first quantified site-specific associations between TCN and hospitalizations and then conducted meta-analysis to pool the results,to assess the relative risk of extreme TCN for susceptible diseases,and to estimate the related disease burden attributed to TCN.Stratified analyses were undertaken by age,sex,and disease type.Results showed that all-cause hospital admission was significantly linked to TCN.A negative TCN(below-1.9℃)in the cool season and a positive TCN(above 1.0℃)in the warm season increased the risk of hospitalization.People aged 15-64 years,men,and patients with musculoskeletal system or connective tissue diseases were more sensitive to extremely negative TCN during the cool season.People aged over 65 years,men,and patients with respiratory diseases were more sensitive to extremely positive TCN during the warm season.The attributable fraction to all-cause hospitalization from negative TCN in the cool season was 2.05%(95%CI:-0.90%,4.53%)and from positive TCN in the warm season was 5.79%(95%CI:2.98%,8.31%).Circulatory diseases in the cool season and respiratory diseases in the warm season had the highest disease burden.Our findings indicate that awareness of TCN and its health risks should be promoted and evidence-informed policies are needed to reduce the risk of TCN.