Screening for pancreatic cancer in familial high-risk individuals: A systematic review

AIM:To analyze the benefits and harms of pancreatic cancer screening in familial high-risk individuals(HRIs).METHODS:Studies were identified by searching PubMed,EBSCO,ClinicalTrials.gov and the Cochrane database from database inception to June 2014.We also obtained papers from the reference lists of pertinent studies and systematic reviews.Englishlanguage trials and observational studies were searched.The key words used as search terms were "screening" and "surveillance".Cost-effectiveness,diagnostic rate,survival rate,mortality and adverse events were the outcomes of interest.Age,sex,lifestyle and other confounding factors were also considered.However,anticipating only a few of these studies,we also included observational studies with or without control groups.We also included studies concerning the anxiety associated with pancreatic cancer risk and other psychological changes in familial HRIs.We extracted details on study design,objectives,population characteristics,inclusion criteria,year of enrollment,method of screening,adjusted and unadjusted mortality,cost-effectiveness and adverse events from the included studies.Studies were assessed using the Reporting of Observational studies in Epidemiology(STROBE) checklist.RESULTS:Sixteen studies on pancreatic cancer screening were included.Five studies included control groups,nine were observational studies without control groups,and the other two studies investigated the worry associated with pancreatic cancer risk.We found that pancreatic cancer screening resulted in a high curative resection rate(60%vs 25%,P = 0.011),longer median survival time(14.5 mo vs 4 mo,P < 0.001),and higher 3-year survival rate(20%vs 15.0%,P =0.624).We also found that familial HRIs had a higher diagnostic rate of pancreatic tumors than controls(34%vs 7.2%,P< 0.001).In patients who underwent regular physical examinations,more stage I pancreatic cancers were observed(19%vs 2.6%,P= 0.001).In addition,endoscopic ultrasonography,which was the main means of detection,diagnosed 64.3%of pancreatic cancers.In comparison,endoscopic retrograde cannulation of the pancreas,magnetic resonance imaging,and computed tomography diagnosed 28.6%,42.9%,and21.4%,respectively.For mass lesions,instant surgery was recommended because of the beneficial effects of post-operative chemotherapy.However,in patients with intraductal papillary mucinous neoplasms,we did not find a significant difference in outcome between surgery and follow-up without treatment.Moreover,pancreatic cancer screening in familial HRIs had a greater perceived risk of pancreatic cancer(P< 0.0001),higher levels of anxiety regarding pancreatic cancer(P< 0.0001),and increased economic burden.CONCLUSION:Pancreatic cancer screening in familial HRIs is associated with a higher detection rate and longer survival,although screening may influence psychological function and increase the economic burden.

Methods and outcomes of screening for pancreatic adenocarcinoma in high-risk individuals

Pancreatic ductal adenocarcinoma(PDAC) is a lethal neoplasia, for which secondary prevention(i.e., screening) is advisable for high-risk individuals with "familiar pancreatic cancer" and with other specific genetic syndromes(Peutz-Jeghers, p16, BRCA2, PALB and mismatch repair gene mutation carriers). There is limited evidence regarding the accuracy of screening tests, their acceptability, costs and availability, and agreement on whom to treat. Successful target of screening are small resectable PDAC, intraductal papillary mucinous neoplasms with high-grade dysplasia and advanced pancreatic intraepithelial neoplasia. Both magnetic resonance imaging(MRI) and endoscopic ultrasound(EUS) are employed for screening, and the overall yield for pre-malignant or malignant pancreatic lesions is of about 20% with EUS and 14% with MRI/magnetic resonance colangiopancreatography. EUS performs better for solid and MRI for cystic lesions. However, only 2% of these detected lesions can be considered a successful target, and there are insufficient data demonstrating that resection of benign or low grade lesions improves survival. Many patients in the published studies therefore seemed to have received an overtreatment by undergoing surgery. It is crucial to better stratify the risk of malignancy individually, and to better define optimal screening intervals and methods either with computerized tools or molecular biomarkers, possibly in large multicentre studies. At the moment, screening should be carefully performed within research protocols at experienced centres, offering involved individuals medical and psychological advice.

Analysis of Risks in the Individual Housing Mortgage Loan with Game Theory

Through using game theory,a game model of lendingand borrowing money between banks and individuals isestablished to explain how the risks come into being and are transferred in the dynamic point of view.Some sug-gestions about how to avoid the risks are proposed.

Quantitative Structural Models to Assess Credit Risk on Individuals

Default Probabilities quantitatively measures the credit risk that a borrower will be unable or unwilling to repay its debt. An accurate model to estimate, as a function of time, these default probabilities is of crucial importance in the credit derivatives market. In this work, we adapt Merton’s [1] original works on credit risk, consumption and portfolio rules to model an individual wealth scenario, and apply it to compute this individual default probabilities. Using our model, we also compute the time depending individual default intensities, recovery rates, hazard rate and risk premiums. Hence, as a straight-forward application, our model can be used as novel way to measure the credit risk of individuals.

Differences in individual susceptibility affect the development of trigeminal neuralgia

Trigeminal neuralgia is a syndrome due to dysfunctional hyperactivity of the trigeminal nerve, and is characterized by a sudden, usually unilateral, recurrent lancinating pain arising from one or more divisions of the nerve. The most accepted pathogenetic mechanism for trigeminal neuralgia is compression of the nerve at its dorsal root entry zone or in its distal course. In this paper, we report four cases with trigeminal neuralgia due to an unknown mechanism after an intracranial intervention The onset of trigeminal neuralgia after surgical interventions that are unrelated to the trigeminal nerve suggests that in patients with greater individual susceptibility, nerve contact with the vascular structure due to postoperative pressure and changes in cerebrospinal fluid flow may cause the onset of pain.

Risk of Hearing Loss Caused by Multiple Acoustic Impulses in the Framework of Biovariability

We consider the hearing loss injury among subjects in a crowd with a wide spectrum of individual intrinsic injury probabilities due to biovariability. For multiple acoustic impulses, the observed injury risk of a crowd vs the effective combined dose follows the logistic dose-response relation. The injury risk of a crowd is the average fraction of injured. The injury risk was measured in experiments as follows: each subject is individually exposed to a sequence of acoustic impulses of a given intensity and the injury is recorded;results of multiple individual subjects were assembled into data sets to mimic the response of a crowd. The effective combined dose was adjusted by varying the number of impulses in the sequence. The most prominent feature observed in experiments is that the injury risk of the crowd caused by multiple impulses is significantly less than the value predicted based on assumption that all impulses act independently in causing injury and all subjects in the crowd are statistically identical. Previously, in the case where all subjects are statistically identical (i.e., no biovariability), we interpreted the observed injury risk caused by multiple impulses in terms of the immunity effects of preceding impulses on subsequent impulses. In this study, we focus on the case where all sound exposure events act independently in causing injury regardless of whether one is preceded by another (i.e., no immunity effect). Instead, we explore the possibility of interpreting the observed logistic dose-response relation in the framework of biovariability of the crowd. Here biovariability means that subjects in the crowd have their own individual injury probabilities. That is, some subjects are biologically less or more susceptible to hearing loss injury than others. We derive analytically the distribution of individual injury probability that produces the observed logistic dose-response relation. For several parameter values, we prove that the derived distribution is mathematically a proper density function. We further study the asymptotic approximations for the density function and discuss their significance in practical numerical computation with finite precision arithmetic. Our mathematical analysis implies that the observed logistic dose-response relation can be theoretically explained in the framework of biovariability in the absence of immunity effect.

Minimum MSE Weights of Adjusted Summary Estimator of Risk Difference in Multi-Center Studies

The simple adjusted estimator of risk difference in each center is easy constructed by adding a value c on the number of successes and on the number of failures in each arm of the proportion estimator. Assessing a treatment effect in multi-center studies, we propose minimum MSE (mean square error) weights of an adjusted summary estimate of risk difference under the assumption of a constant of common risk difference over all centers. To evaluate the performance of the proposed weights, we compare not only in terms of estimation based on bias, variance, and MSE with two other conventional weights, such as the Cochran-Mantel-Haenszel weights and the inverse variance (weighted least square) weights, but also we compare the potential tests based on the type I error probability and the power of test in a variety of situations. The results illustrate that the proposed weights in terms of point estimation and hypothesis testing perform well and should be recommended to use as an alternative choice. Finally, two applications are illustrated for the practical use.

Limitations in activities of daily living increase the risk of stroke in older Chinese adults:a population-based longitudinal study

It remains unclear whether limitations in activities of daily living(ADL) increase the risk of stroke in older Chinese adults.This longitudinal study used data from the Chinese Longitudinal Healthy Longevity Survey to investigate the effects of limitations in ADL on the incidence of stroke in older adults.Between 2002 and 2011,46,728 participants from 22 provinces in China were included in this study.Of participants,11,241 developed limitations in ADL at baseline.A 3-year follow-up was performed to determine the incidence of stroke.During the 3-year follow-up,929 participants(8.26%) and 2434 participants(6.86%) experienced stroke in the ADL limitations group and non-ADL limitations group,respectively.Logistic regression was used to analyze the effect of ADL limitations on the risk of stroke.The results showed that after adjusting for the confounding factors gender,age,weight,hypertension,diabetes,heart disease,natural teeth,hearing impairment,visual impairment,smoking,alcohol abuse,exercise,ethnicity,literacy,residential area,and poverty,the ADL limitations group had a 77% higher risk of developing stroke than the non-ADL limitations group.After propensity score matching,the ADL limitations group still had a 33% higher risk of developing stroke than the non-ADL limitations group(OR = 1.326,95% CI:1.174–1.497).These findings suggest that limitations in ADL are a stroke risk factor.

Probabilistic Fuzzy Regression Approach from the Point of View Risk

Fuzzy regression analysis is an important regression analysis method to predict uncertain information in the real world. In this paper, the input data are crisp with randomness;the output data are trapezoid fuzzy number, and three different risk preferences and chaos optimization algorithm are introduced to establish fuzzy regression model. On the basis of the principle of the minimum total spread between the observed and the estimated values, risk-neutral, risk-averse, and risk-seeking fuzzy regression model are developed to obtain the parameters of fuzzy linear regression model. Chaos optimization algorithm is used to determine the digital characteristic of random variables. The mean absolute percentage error and variance of errors are adopted to compare the modeling results. A stock rating case is used to evaluate the fuzzy regression models. The comparisons with five existing methods show that our proposed method has satisfactory performance.

Risk-analysis-based research and application of land use planning

The establishments which produce,store and use kinds of inflammable,explosive or toxic materials may induce accident,such as fire,explosion or poisonous gas dispersion,etc. Therefore,there is a need to locate these establishments appropriately and conduct land use planning in the vicinity of these establishments based on risk analysis. Consulting advanced experience which obtained from land-use planning in European countries,this paper studied on locating hazardous establishment based on risk index,land-use planning based on consequence-probability,and land-use planning based on individual risk. Frameworks and procedures of the three approaches above were determined and applied to a proposed LNG station. The results show three methods are feasible when major projects' location and their surrounding buildings or establishments' layout are considered.

Role of National Culture of Foreign Investors in the Area of Credit Risk Management： Case Study of Polish Banking Industry

Among the researches dedicated to the risk management in banks, there are not many analyses made from cultural point of view. The author attempts to assess the attitude to credit risk in the Polish banking system, in terms of cultural factors influencing the approach to this issue. The purpose of this paper is focused on testing the hypothesis that foreign owners of banks （headquarters） transfer elements of their national culture to its subsidiaries operating in Poland. It is done by analysis of statistical correlations between the indexes defining the main characteristics of national cultures and the actual financial performance indicators reached by selected banks in the period from 2004 to 2010 in Poland. The study objectives are the following： Firstly, whether the owners from different countries transfer their cultural attitude to risk to subordinate daughter-banks in Poland. The second question concerns the relevance of uncertainty avoidance and individualism/collectivism concepts of two, to some extent, competing approaches. The findings say that the regularity of the transfer of the cultural attitude to credit risk from the parent banks to their subsidiaries is confirmed by interviews with senior managers, but it is only partially reflected in the statistics. Main outcomes of the study propose that the cultural factors of bank risk management policy shouldn＇t be ignored and developed in other cross-cultural research areas, e.g. ethnocentrism. Generally, these studies are present lessons for companies, investors, and policymakers, but the usefulness of these implications varies.

Predicting lymph node metastasis in colorectal cancer:An analysis of influencing factors to develop a risk model

BACKGROUND Colorectal cancer(CRC)is a significant global health issue,and lymph node metastasis(LNM)is a crucial prognostic factor.Accurate prediction of LNM is essential for developing individualized treatment strategies for patients with CRC.However,the prediction of LNM is challenging and depends on various factors such as tumor histology,clinicopathological features,and molecular characteristics.The most reliable method to detect LNM is the histopathological examination of surgically resected specimens;however,this method is invasive,time-consuming,and subject to sampling errors and interobserver variability.AIM To analyze influencing factors and develop and validate a risk prediction model for LNM in CRC based on a large patient queue.METHODS This study retrospectively analyzed 300 patients who underwent CRC surgery at two Peking University Shenzhen hospitals between January and December 2021.A deep learning approach was used to extract features potentially associated with LNM from primary tumor histological images while a logistic regression model was employed to predict LNM in CRC using machine-learning-derived features and clinicopathological variables as predictors.RESULTS The prediction model constructed for LNM in CRC was based on a logistic regression framework that incorporated machine learning-extracted features and clinicopathological variables.The model achieved high accuracy(0.86),sensitivity(0.81),specificity(0.87),positive predictive value(0.66),negative predictive value(0.94),area under the curve for the receiver operating characteristic(0.91),and a low Brier score(0.10).The model showed good agreement between the observed and predicted probabilities of LNM across a range of risk thresholds,indicating good calibration and clinical utility.CONCLUSION The present study successfully developed and validated a potent and effective risk-prediction model for LNM in patients with CRC.This model utilizes machine-learning-derived features extracted from primary tumor histology and clinicopathological variables,demonstrating superior performance and clinical applicability compared to existing models.The study provides new insights into the potential of deep learning to extract valuable information from tumor histology,in turn,improving the prediction of LNM in CRC and facilitate risk stratification and decision-making in clinical practice.

Blood pressure differences in people with various individual characteristics in Guangdong Province

Objective To study the differences in blood pressure (BP) levels and the main factors raising BP among the population in Guangdong Province. Methods The data analyzed stem from the sampling survey of hypertension in Guangdong Province in 1991, covering 42, 894 subjects over 15 years old. Individual characteristics included age, sex, occupation, education, smoking, alcohol drinking and body mass index (BMI) . Results Systolic and diastolic BP increased with age. The hypertension prevalence rate in male is higher than in female. The age - adjusted prevalence rate in office personnel is the highest (12.9 % ) among all occupations. It was increased with education level and BMI (in people educated at university and over is 13. 1 % ), and higher in smokers and alcohol-drinkers than non-smokers and non -alcohol-drinkers. Conclusions Age, occupation, education, smoking, alcohol drinking and BMI all effect BP. These risk factors should be reduced in the Guangdong population.

免除伦理审查制度适法性与可操作性探讨

结合我国现行法律和基本伦理原则,深入分析了免除伦理审查的前置条件和适用情形在适法性与可操作性上可能存在的问题,并在此基础上提出了可行性的建议:第一,明确监管范围,免除伦理审查是一种特殊的审查方式,而非不进行伦理审查;第二,全面评估风险,对研究的风险判断不仅要考虑因研究给个人带来的生理风险,还应考虑其心理、经济、社会以及法律等方面的风险,尤其是对最小风险应明确界定;第三,界定前置条件中的具体概念,以及在此基础上适用情形的判断,制定具体、合理、合法的实施细则,为免除伦理审查的实施提供参考。

智慧养老的侵权风险与规制革新

新一轮科技革命正以空前力量改变着传统生产生活方式。相较于传统养老,智慧养老依托大数据、人工智能等技术,能够根据老年人的需求实时、快捷地进行服务供给。处于数字弱势地位的老年群体具有风险意识薄弱、心理脆弱、生理脆弱的特点,导致其个人信息容易被泄露,个人隐私权保护受到冲击,智能养老产品侵害权益的现象也时有发生。智慧养老所产生的侵权风险呈现多变性、隐匿性与不可预测性,现有法律规制面临严重适用困境。为促进智慧养老法治化,需重塑智慧养老法律规制的价值抉择,明确智慧养老信息收集、使用的界限,设置大数据时代隐私权保护举证规则,完善智能养老产品责任司法适用标准。

个体化预测脓毒血症患儿并发急性肾损伤列线图模型的建立及验证

目的构建及验证脓毒血症患儿并发急性肾损伤(AKI)的列线图预测模型,并进行验证。方法本研究设计为回顾性研究,收集2019年8月至2021年8月在我院治疗的108例脓毒症患儿的临床资料。通过单因素和多因素Logistic回归分析脓毒血症患儿并发AKI的独立危险因素,利用R软件(R 4.0.3)构建列线图模型,采用Bootstrap法进行内部验证,采用校正曲线、Hosmer-Lemeshow检验和ROC曲线评价模型的预测能力。结果108例脓毒症患儿中,30例(27.78%)并发AKI(AKI组),78例(72.22%)无发生AKI(无AKI组)。AKI组与无AKI组的机械通气时间、急性生理与慢性健康评分(APACHEⅡ评分)、降钙素原(PCT)、C-反应蛋白(CRP)、白蛋白(ALB)、肌酸激酶(CK)等比较,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,机械通气时间(OR=1.245,95%CI:1.004~1.545)、APACHEⅡ评分(OR=1.529,95%CI:1.068~2.187)、PCT(OR=1.597,95%CI:1.237~2.061)、CRP(OR=1.046,95%CI:1.012~1.080)、ALB(OR=0.815,95%CI:0.721~0.979)、CK(OR=0.814,95%CI:0.730~0.942)是脓毒血症患儿并发AKI的独立影响因素(P<0.05)。基于上述影响因素建立列线图预测模型,经内部验证,校准曲线的平均绝对误差(MAE)为0.031,预测值与实际值基本一致;Hosmer-Lemeshow拟合优度检验显示模型拟合度较好(χ2=2.134,P=0.976)。曲线下面积(AUC)为0.965(95%CI:0.932~0.996),灵敏度为0.867,特异度为0.949。结论机械通气时间、APACHEⅡ评分、PCT、CRP、ALB、CK是脓毒血症患儿并发AKI的独立影响因素,基于上述因素建立的脓毒血症患儿并发AKI列线图预测模型具有良好的校准度和区分度,可为临床早期筛查脓毒血症并发AKI的高风险患儿及个体化干预方案的制定提供参考依据。

基于福格行为模型的社区主要不良心脏事件高危者的健康干预

目的探讨基于福格行为模型的健康干预对社区主要不良心脏事件高危者生活方式、用药依从性及院前延迟行为意向的影响。方法将不良心脏事件高危者按照社区分为对照组和干预组各66人。对照组采用常规健康管理,干预组在对照组的基础上依据福格行为模型从动机、能力和提示3个关键要素进行健康干预6个月并随访3个月。在干预前、干预后和随访后对两组健康促进生活方式、院前延迟行为意向、用药依从性进行评价。结果对照组60人、干预组57人完成干预及随访。干预及随访后,干预组健康促进生活方式、用药依从性评分显著高于对照组,院前延迟行为意向评分显著低于对照组(均P<0.05)。结论基于福格行为模型的健康干预有利于提高社区不良心脏事件高危者的健康促进生活方式和用药依从性,降低院前延迟行为意向。

考虑消费者双重行为的农产品绿色供应链数字化策略

为探究消费者风险规避和绿色偏好行为对绿色供应链数字化发展的双重影响,构建产品绿色度和安全水平函数,运用Stackelberg博弈模型,构建农户和农产品零售商组成的两级绿色供应链博弈模型,分析两种行为对绿色供应链数字化策略的影响,对集中决策和分散决策下供应链成员决策进行对比分析,并设计考虑奖惩的供应链契约。最后对模型进行数值仿真,验证该契约的可行性。研究发现:无论是集中决策还是分散决策,消费者规避心理总不利于绿色供应链发展,绿色偏好与之相反;相比分散决策,集中决策最优解更优;奖惩系数在合理的区间内,考虑奖惩的农产品供应链契约实现了供应链参与者的双赢,农户和农产品零售商利润均得到帕累托改善。

新征管趋势下高收入人群的涉税风险及合规管理

个人所得税是调节居民收入分配的重要手段,通过对高收入人群实行更严厉的税收政策和强化征管,有助于缓解收入分配不公的矛盾。在新的个人所得税征管趋势下,高收入人群在薪酬发放、股权转让、境外所得等多方面存在大量的涉税风险。高收入人群应主动提高税法遵从度,积极进行合规管理,防范和降低涉税风险。

基于改进DEMATEL-ISM模型的道路拥堵下行车风险评估方法

为准确识别城市道路拥堵条件下的行车风险系统中各影响因素之间的内在联系以及该系统中的关键因素,本文提出一种改进DEMATEL-ISM的评估方法。首先,分析城市道路拥堵条件下的行车风险,选取18个风险因子;其次,运用多群体问询的调查问卷方法,并结合最大类间方差法对标准的集成决策试验和评价试验室(DEMATEL)以及解释结构模型(ISM)改进,建立城市道路拥堵的行车风险评估模型。最后,实例验证结果表明:基于改进DEMATEL-ISM模型的道路拥堵条件下行车风险评估体系能准确划分层次解释结构图的层级,与其他方法相比更加符合实际;交通密度、车头时距、停车次数、换道频次等关键链接因素对其他因素有较强联动影响,并且会增加发生交通事故或二次交通拥堵的概率。