Active surveillance in low risk papillary thyroid carcinoma

In recent decades,while the incidence of thyroid cancer has increased exponentially around the world,mortality has remained stable.The vast majority of this increase is attributable to the identification of intrathyroidal papillary microcarcinomas,which exhibit slow growth rates with indolent courses.A diagnosis of thyroid cancer based upon the presence of these small tumors could be considered as an overdiagnosis,as the majority of these tumors would not likely result in death if left untreated.Although surgical resection was the classical standard therapy for papillary microcarcinomas,active surveillance(AS)has emerged over the last three decades as an alternative approach that is aimed to recognize a minority group of patients who will clinically progress and would likely benefit from rescue surgery.Despite the encouraging results of AS,its implementation in clinical practice is strongly influenced by psychosocial factors.The aim of this review is to describe the epidemiology,clinical evolution,prognostic factors,and mortality of papillary thyroid microcarcinomas.We also summarize the AS strategy according to published evidence,characterize the criteria for selecting patients for AS according to risk factors and environmental characteristics,as well as analyze the current limitations for AS implementation.

The Effect of COVID-19 on the Cancer Patients Treated with Radiotherapy in Low Risk Area: A Single-Center Descriptive

Objective: To investigate the influence of the new coronavirus epidemic on tumor radiotherapy patients in Zigong City, and provide radiotherapy feasibility and safety in other prefecture-level or low-risk areas. Methods: Retrospective Collection of data from January 31, 2020, in our hospital, this time period is an epidemic group. The control group was data from January 31, 2019-May 31, in our hospital. Patient data includes gender, age, tumor type, hospitalization fee, average hospitalization day, radiotherapy completion, treatment destination, and other information. Results: The patients with epidemic groups and control groups were 320 and 237, respectively, and the radiotherapy patients increased by 25.9%, increasing patients mainly from other departures outside the tumor department underperformance reform intervention. The epidemic group of brain and breast tumor patients were 39 and 37, respectively, with statistical differences (P < 0.05) compared to the control group (25 and 16 respectively). The number of tumor radiotherapy patients in other parts increased, but there was no statistical difference (P > 0.05). Inpatient costs, the average hospitalization day, radiotherapy completion, the purpose of treatment, and other data epidemic groups and control groups have no statistical difference (P > 0.05). Conclusion: The number of COVID-2019 epidemic interventions has increased the number of cancer radiotherapy patients in our hospital, and the epidemic situation has no effect on hospitalization, the average hospitalization day, radiotherapy, and the like. Optimizing the process of clinical treatment, strict prevention and control measures can ensure timely and safe radiotherapy in low-risk areas.

Pelvic Organs Prolapse in Low-Resources Countries: Epidemiology, Risk Factors, Quality of Life. Narrative Review

Objective: Pelvic organ prolapse is an emerging public health problem affecting adult women of all ages with a negative impact on social, physical well-being, and psychological. Its presents several challenges in countries with low resources. This literature review aims to examine POP in its epidemiological aspects, risk factors, and staging by taking up the challenges associated with low-resource settings and identifying some avenues for future research. Methods: We searched the PubMed, Google Scholar, and Scopus databases. The other studies were identified by checking the secondary references in the original citation. We have collected studies on adult women published in English for the last 30 years. In total, 71 articles were read. We excluded studies from all newspaper articles, Studies presenting co-morbidities (fistulas, cervical cancer, pregnancy), those evaluating treatment, letters, comments, case reports, practice guidelines, news, historical articles, legal cases, published erratum, and congresses. Results: 16 studies examining the epidemiology have been identified with 11 in countries defined by the World Bank as limited or intermediate resources. 18 on risk factors whose 10 in countries with limited or intermediate resources, 10 on staging and 27 on physiopathology. Conclusion: POP affects the young more in low-resource settings. Its prevalence remains underestimated for several reasons. Several risk factors found are the same as those of women in countries with a high standard of living. However, there are some specific risk factors for these resource-limited settings.

Evolut Low Risk研究两年随访结果解读

对于重度主动脉瓣狭窄患者,经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)已成为一种成熟的治疗方式,尤其是针对具有外科手术中、高风险的患者,TAVR均展示出了不劣于甚至优于外科主动脉瓣置换术(surgical aortic valve replacement,SAVR)的疗效,且5年随访结果稳定。但是对于外科手术低风险患者,TAVR与SAVR治疗对比的随机对照研究尚缺乏较长随访时间的结果。本文就Evolut Low Risk的研究概况、阶段性研究结果及其给主动脉瓣介入治疗带来的启示进行阐述。

Prevalence and risk factors for eye diseases, blindness, and low vision in Lhasa, Tibet

AIM: To determine the prevalence and risk factors for eye diseases, blindness, and low vision in Tibet, and to assist the development of eye disease prevention and treatment schemes.METHODS: We carried out a survey of eye diseases among a population living at high altitude. A total of 1 115 Tibetan permanent residents aged 40 years or older from the towns and villages of Qushui County, Lhasa Prefecture, Tibet Autonomous Region, participated in this study. All participants completed a detailed questio-nnaire, and underwent presenting and pinhole visual acuity tests,and a comprehensive ophthalmic examination.RESULTS: There were 187 blind eyes (8.43%), 231 eyes with low vision (10.41% ). The leading cause of visual impairment was cataract of 55.0% (101/187) blindness and of 50.2% (116/231) low vision, followed by fundus lesions of 22.9% blindness and 23.8% low vision, while only a low prevalence of glaucoma of 9.6% blindness and 1.7% low vision was observed. The analysis of 2 219 eyes showed that the most common external eye disease was pterygium (27.2%) in Tibet.CONCLUSION: The high prevalence of blindness and low vision in the Tibetan population at high altitude is a serious public health issue. There is a need to establish and maintain an appropriate effective eye care program in Tibet.

A meta-analysis of 1-year outcomes of transcatheter versus surgical aortic valve replacement in low-risk patients with severe aortic stenosis

Background Transcatheter aortic valve replacement(TAVR)for the treatment symptomatic severe aortic stenosis(AS)is indicated in patients with intermediate or higher surgical risk.Latest trials showed TAVR,and surgical aortic valve replacement(SAVR)perform similarly at 1-year for the composite outcomes of mortality,stroke and rehospitalization.We performed a comprehensive meta-analysis to compare individual outcomes at 1-year for TAVR compared to SAVR in low-risk patients.Methods Pub Med,Embase,and Cochrane central were searched for all the randomized controlled trials(RCTs)that reported 1-year comparative outcomes of TAVR and surgical aortic valve replacement(SAVR).Our conclusions are based upon the random-effects model using Der Simonian-Laird estimator.Results Data from 4 trials and 2887 randomized patients showed that TAVR had lower rates of all-cause mortality,cardiovascular mortality,and atrial fibrillation compared to SAVR at 1-year follow-up(P<0.05 for all).Also,TAVR was also associated with a significantly higher risk of permanent pacemaker implantation and moderate-severe paravalvular leak(P<0.05).Conclusions The latest randomised trial data demonstrates that in short-term,TAVR is safe and effective in reducing all-cause mortality or stroke.Longer follow-up of RCTs is needed to determine the durability of clinical benefits in TAVR over SAVR in low-risk patients.

Risk Factors for Low Birth Weight and Preterm Birth：A Population-based Case-control Study in Wuhan,China

Low birth weight（LBW） and preterm birth（PB） are associated with newborn mortality and diseases in adulthood.We explored factors related to LBW and PB by conducting a population-based case-control study from January 2011 to December 2013 in Wuhan,China.A total of 337 LBW newborn babies,472 PB babies,and 708 babies with normal birth weights and born from term pregnancies were included in this study.Information of newborns and their parents was collected by trained investigators using questionnaires and referring to medical records.Univariate and logistic regression analyses with the stepwise selection method were used to determine the associations of related factors with LBW and PB.Results showed that maternal hypertension（OR=6.78,95% CI：2.27–20.29,P=0.001）,maternal high-risk pregnancy（OR=1.53,95% CI：1.06–2.21,P=0.022）,and maternal fruit intake ≥300 g per day during the first trimester（OR=1.70,95% CI：1.17–2.45,P=0.005） were associated with LBW.BMI ≥24 kg/m^2 of mother prior to delivery（OR=0.48,95% CI：0.32–0.74,P=0.001） and gestation ≥37 weeks（OR=0.01,95% CI：0.00–0.02,P〈0.034） were protective factors for LBW.Maternal hypertension（OR=3.36,95% CI：1.26–8.98,P=0.016）,maternal high-risk pregnancy（OR=4.38,95% CI：3.26–5.88,P〈0.001）,maternal meal intake of only twice per day（OR=1.88,95% CI：1.10–3.20,P=0.021）,and mother liking food with lots of aginomoto and salt（OR=1.60,95% CI：1.02–2.51,P=0.040） were risk factors for PB.BMI ≥24 kg/m^2 of mother prior to delivery（OR=0.66,95% CI：0.47–0.93,P=0.018）,distance of house from road ≥36 meters（OR=0.72,95% CI：0.53– 0.97,P=0.028）,and living in rural area（OR= 0.60,95% CI：0.37–0.99,P=0.047） were protective factors for PB.Our study demonstrated some risk factors and protective factors for LBW and PB,and provided valuable information for the prevention of the conditions among newborns.

Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis

Anastomotic leakage(AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection(LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR.

Risk Factors of Low Back Pain among the Chinese Occupational Population:A Case-control Study

Objective To explore the risk factors of low back pain among the Chinese occupational population in several major industries. Methods A total of 7200 subjects （3600 cases and 3600 controls） were randomly sampled from a cross-sectional study, and they were investigated for individual and occupational factors of low back pain. The potential risk factors were first selected by using chi-square tests. Secondly, collinearity diagnosis proceeded by using the Kendall＇s rank correlation. Finally, binary logistic regression model was used for multi-factor analysis. Results Collinearity diagnosis showed that there was a severe collinearity problem among the potential risk factors of low back pain. Logistic regression model included 20 variables with statistical significance. Bending neck forward or holding neck in a forward posturefor long periods （0R=1.408） was the most important risk factor inducing low back pain in this study, followed by bending heavily with the trunk （0R=1.402）, carrying out identical work almost for the whole day （0R=1.340）. Additionally, suHicient normal break was a protective factor of low back pain. Conclusion Low back pain among the Chinese occupational population was associated with body height, occupation, work organization, physical work, working posture, and others. All these risk factors could be regarded as the indicators of low back pain, and some relevant preventive measures should be taken to reduce low back pain risk.

Pathologic and Prognostic Outcomes of Very Low- and Low-Risk Prostate Cancer According to the National Comprehensive Cancer Network Guidelines in Japanese Patients with Radical Prostatectomy

Background: The purpose of this study was to validate the treatment strategy for a cohort of Japanese patients with very low-risk (VLR) and low-risk (LR) prostate cancer according to the National Comprehensive Cancer Network (NCCN) guidelines. Methods: We studied 751 patients with T1- 3N0M0 prostate cancer treated with radical prostatectomy at our institution between 2000 and 2012. Patients with neoadjuvant treatments were excluded. We retrospectively reviewed the clinical and pathological outcomes for patients with VLR or LR prostate cancers that were classified by NCCN guidelines. Results: We identified 45 patients with VLR and 137 with LR prostate cancer. Non-biochemical recurrence rate at 5-year for 45 patients with VLR was 86.9% and 81.2% for 137 patients with LR (p = 0.56). However, none of the 19 patients >65 years old with VLR progressed, while 19% of 26 patients ≤65 years old with VLR cancer, 14% of patients >65 years old with LR cancer, and 17% of patients ≤65 years old with LR cancer progressed during the follow-up period (p = 0.04, p = 0.04 and p = 0.05, respectively). In analyses of prostatectomy specimens, both VLR and LR had similarly favorable outcomes, but patients >65 years old with VLR had the smallest tumors, with a mean of 5 mm in diameter. Conclusions: Our results support the treatment strategy of the NCCN that patients with VLR cancer and age >65 years old are good candidates for active surveillance, and that other treatment options—including active surveillance and aggressive treatments—can be applied to the remaining patients with VLR or LR cancers.

On the Association between Travel Distance and Treatment Choice for Low-Risk Prostate Cancer: Results from a Rural State

Background: Evidence suggests that cancer patients with increased travel burden to treatment centers may have limited treatment options. Purpose: To investigate the association between travel distance to a treatment facility and initial treatment choice among young men with low-risk prostate cancer in a rural state. Methods: A retrospective medical charts review was conducted of young men (65 years or younger) newly diagnosed with low-risk prostate cancer from January 1, 2005 through December 31, 2014 who were treated with either active surveillance, radical prostatectomy, or brachytherapy at either of the two major hospital systems in Bismarck, ND, USA. Results: Information on a random sample of 242 patients was studied. The majority of patients (66%) received radical prostatectomy. Patients who received radical prostatectomy were significantly younger (p-value 0.001). PSA at diagnosis, clinical stage, and Gleason score were not associated with treatment choice (p-value = 0.06;p-value = 0.1794;and p-value = 1.00;respectively). Adjusting for age at diagnosis, PSA at diagnosis, and treatment facility, treatment choice was not associated with travel distance (p-value = 0.309). Patients treated at St. Alexius facility were more likely to undergo radical prostatectomy than Sanford health patients (p-value Conclusions: We found no association between travel distance and treatment choice for low-risk prostate cancer. Treatment choice was associated with institution which may suggest institutional bias in patterns of care.

Low Birth Weight at Term: Risk Factors and Perinatal Prognosis in the Teaching Hospital Yalgado Ouédraogo, Burkina Faso

Objective: The objective of our study was to study the risk factors of low birth weight at term in the Teaching Hospital Yalgado (CHU-YO) Ouédraogo. Patients and Methods: This dealt with a comparative and analytical control case study. The group of cases was made up of female patients who gave birth to newborns with low birth weight at term and that of control cases included female patients who delivered a normal-weighted newborn at term. Results: The frequency of low birth weight at term was therefore estimated at 4.4%. The average age of the parturients was 25 ± 6.36 years. Female patients living in a marital setting accounted for 93.1% of cases and 64.4% of them had no income-generating activities. A maternal underweight, a height below 155 cm, passive smoking, and malaria during pregnancy have been identified as the factors associated with a low birth weight. Conclusion: Quality prenatal care could reduce the incidence of low birth weight at term.

Passive Smoking and Other Principal Risk Factors Associated with Low Birth Weight

Background: Neonatal morbidity and mortality is one of the most public health problems in the world. A lot of neonatal deaths occur in foetus with low birth weight (LBW). Several risk factors of LBW have been described in the literature such as maternal age, chronic and gestational hypertension infection and anémia. Smoking is one of the most important preventable risk factor of LBW in developed and developing countries. Aims: In this study, we evaluated the incidence and the impact of passive smoking and some other principle risk factors of LBW. Material & Methods: This case control study was conducted in the department of obstetrics and gynecology of Marrakesh university hospital in Morocco. During a period of 3 years, all LBW babies were included in the study. Data analysis was performed by SPSS software. The association between LBW and each variable was studied by the chi square test comparing cases and controls groups. Logistic regression analysis was performed after including all variables found to have significant differences on univariate analysis. Results: 288 cases of LBW have been identified representing 2.19% of all births. The study of the categories showed that 84.3% of babies were moderate LBW (1500 - 2500 g), including 49 babies from twin pregnancies. 15.7% were very LBW (<1500 g). Several risk factors have been identified in LBW. Passive smoking was significantly associated with LBW [(OR 1.77;CI: 1.22 - 2.25)]. Conclusion: A number of risk factors are related to low birth weight, which is one of the main predictors of infant mortality. This study shows that passive smoking is one of those risk factors and it is a preventable one.

Is low postoperative cholesterol level really an independent risk factor of adverse outcomes after living donor liver transplantation?

To the Editor:We read with great interest the article by Yang et al.[1]evaluating the effects of postoperative serum total cholesterol(s TC)changes on early allograft dysfunction and survival after living donor liver transplantation(LDLT).By the multivariate regression analysis,they showed that patients with s TC<1.42 mmol/L on postoperative day 3 had 4.08-fold and 2.72-fold greater risks of

Factors of Low Birth Weight Risk in the Department of Gynecology-Obstetrics of the Ignace Deen National University Teaching Hospital in Conakry, Guinea

Introduction: The underweight at birth is recognized as a major cause of morbidity and mortality in childhood. Objective: To identify maternal and obstetric sociodemographic factors associated with low birth weight. Patients and Methods: This is a retrospective study of analytical type that examined the records of women who gave birth in the Obstetrics and Gynecology department of Ignace Deen National University Teaching Hospital from 1st December 2016 to 30th April 2017. The analysis was made with the R version 3.3.1 software. We did a univariate and multivariate analysis. Outcomes: Out of the 1633 live births of single pregnancies that occurred during the study period, 109 children were born with a low weight (<2500 g) corresponding to a rate of 6.7%. In univariate analysis, we found a significant association between low birth weight and maternal single status (p = 0.019), maternal weight less than 60 kg (p = 0.038), primary parity (p = 0.018), maternal history of abortion (p = 0.001), history of preterm birth (p < 0.001), arterial hypertension (p < 0.001), anemia (p < 0.001) and malaria (p < 0.001). In multivariate analysis, the variables associated with low birth weight were: history of preterm delivery with OR of 8.5 [1.8 - 40.1], history of abortion (OR = 4.4 [1.4 - 13.9]), malaria (OR = 23.8 [6.1 - 92.5]), anemia (OR = 11.8 [3.7 - 38.2]) and high blood pressure (OR = 5.4 [1.6 - 17.9]). Conclusion: The decrease in frequency of low birth weight in Guinea will be done by improving the quality of prenatal care with an emphasis on screening, prevention and treatment of malaria, anemia and high blood pressure during pregnancy, prevention of abortion and premature birth.

The rate of patients at high risk for cardiovascular disease with an optimal low-density cholesterol level: a multicenter study from Thailand

Background Hypercholesterolemia is a major risk factor for cardiovascular events in patients with established atherosclerotic disease (EAD) and in those with multiple risk factors (MRFs). This study aimed to investigate the rate of optimal low-density lipoprotein (LDL) cholesterol level in a multicenter registry of patients at high risk for cardiovascular events. Methods A multicenter registry of EAD and MRF patients was conducted. Demographic data,medical history,cardiovascular risk factors,anthropometric data,laboratory data,and medications were recorded and analyzed. We classified patients according to target LDL levels based on recommendation by the European Society of Cardiology (ESC) 2011 into Group 1 which is EAD and diabetes or chronic kidney disease (CKD)–target LDL below 70 mg/dL,and Group 2 which is MRF without diabetes or CKD–target LDL below 100 mg/dL. The rate of optimal LDL level in patients with Group 1 and Group 2 was analyzed and stratified according to the treatment pattern of lipid-lowering medications. Results A total of 3100 patients were included. Of those,51.7% were male. Average age was 65.8 ± 9.7 years. Average LDL level was 96.3 ± 32.6 mg/dL. A vast majority (92.7%) received statin and 9.3% received ezetimibe. Optimal LDL level was achieved in 20.3% of patients in Group 1 (LDL < 70 mg/dL),and in 46.6% in Group 2 (LDL < 100 mg/dL). The overall rate of optimal LDL control was 23% since 89.6% of study population belongs to Group 1. The rate of optimal LDL was not different between high and low potency statin. Factors that were associated with optimal LDL control were older age,the presence of coronary artery disease or peripheral artery disease. Conclusions The rates of optimal LDL level were unacceptably low in this study population. As such,a strategy to improve LDL control in high-risk population should be implemented.

Risk Regionalization of Low-temperature Disasters for Flue-cured Tobacco Planting in Qujing Area Based on GIS

There is a prominent,complex and diverse three-dimensional climate and a variety of meteorological disasters in Qujing area. The risk zoning of low-temperature disasters for flue-cured tobacco planting in Qujing area was studied to provide reference for drawing on advantages and avoiding disadvantages in flue-cured tobacco planting,disaster reduction,and disaster relief services. According to the production practice of fluecured tobacco and local climate analysis,it was determined that flue-cured tobacco in Qujing area was very vulnerable to low temperature during the seedling stage（ from early February to middle April） and in the mature period（ from early July to early September）. Based on the quantitative analysis and evaluation of risk of disaster-causing factors,sensitivity of disaster-breeding environment,vulnerability of carriers,and disaster prevention and reduction capability,a risk assessment model of meteorological disasters was established to precisely evaluate and zone the risk of low-temperature disasters for flue-cured tobacco planting in allusion to the seedling and mature stage in Qujing area by using GIS technology. The risk of lowtemperature disasters for flue-cured tobacco planting during the two periods was divided into four grades,namely low,medium,high and very high risk.

不同慢性病中老年女性骨折风险及低骨量切点预测分析

背景:中老年女性是骨质疏松的高发人群,慢性病增加骨质疏松罹患风险。低骨量是骨质疏松发病前的危险阶段,目前缺少常见慢性病人群的骨折风险差异及诊断指标切点值的相关报道。目的:通过对不同慢性病中老年女性骨折风险的分析,探讨肥胖、高血压、高血脂、糖尿病、动脉硬化与骨密度的相关性,找到可预测低骨量指标的切点值,为防治骨质疏松提供参考。方法:将45-70岁203名女性受试者分为正常组和慢性病组,采用超声骨密度测量仪进行跟骨骨密度测试,采用动脉硬化仪测试肱-踝脉搏波传导速度,采用全自动生化分析仪测试血糖、血脂,采用身体成分分析仪测试体质量指数、脂肪质量及肌肉质量。结果与结论:①61-70岁女性骨密度和骨折风险系数及51-60岁、61-70岁骨强度与<50岁比较,差异有显著性意义(P<0.05);②糖尿病组骨折风险明显高于其余各组,动脉硬化组则高于正常组和肥胖组(P<0.05);③骨密度与年龄、左侧血管弹性程度、右侧血管弹性程度、三酰甘油呈负相关,与体质量指数呈正相关(P<0.05);上述指标与骨密度受试者工作特征(ROC)曲线下面积介于0.5-0.7之间,低骨量对应切点分别为55.5岁(年龄)、756.0 cm/s(左侧血管弹性)、789.0 cm/s(右侧血管弹性)、1.115 mmol/L(三酰甘油)、22.35 kg/m^(2)(体质量指数);④结论:糖尿病和动脉硬化增加中老年女性骨折风险,测定体质量指数、血管弹性和三酰甘油对女性低骨量预测具有一定早期诊断价值。

Epidemioclinical Profile and Immediate Outcome of Low Birth Weight at the Reference Health Center in Commune VI of the District of Bamako, Mali

Introduction: Low birth weight is responsible for 9.1 million child deaths each year worldwide. It is the leading cause of perinatal and infant mortality. The objective of this work was to determine the epidemio-clinical profile as well as the future of low birth weight at the Reference Health Center of commune VI in the district of Bamako, Mali. Methods: Our study was descriptive and prospective over a year from April 1, 2018 to March 31, 2019. Data were taken from hospital records and newborn referral/evacuation forms. Data processing was performed using Epi Info software version 3.5.4 and Word. Results: The frequency of low birth weight was 34.94%. Multiparity accounted for 47.84%, sex ratio was 0.93, maternal arterial hypertension was present in 41.66%, genitourinary infection was in 58.37% and delivery was by low way in 86.12%. The majority of newborns had a gestational age between 28SA-33SA (56.52%) and a weight between 1501-1999 grams (47.36%). Mortality accounted for 18.66%. Conclusion: Low birth weight is common in our settings with modifiable risk factors. Practitioners must play on them to minimize its importance.

Opportunities and Risks of Natural Gas Investment in China under the Circumstance of Low Oil Prices

After more than 30 years of rapid growth, the Chinese economy has entered the "new normal" of moderately high growth. Due to the effects of multiple factors, the international oil price has remained consistently low. The low oil price has exerted critical effects on international natural gas investment. At the same time, the market-oriented price mechanism of natural gas in China is gradually taking shape; the concept of low carbon development is widely advocated; and the use of natural gas gains popularity in the city. Such factors provide great opportunities for investment in the natural gas market of China, including boiler coal-to-gas transformation, natural gas distributed energy and natural gas vehicles. However, risks also exist, such as the lower competitiveness of natural gas, its excess production capacity and dwindling consumption in some gas consumption industries, an insufficient driving force for facilitating the coal-to-gas transformation of industrial fuel users, reverse substitution of "coal in place of gas" in some enterprises, nontransparent costs of the downstream link of the natural gas price chain, and mismatches and nonsynchronous adjustments in natural gas prices and electricity prices.