Long-term follow-up of cumulative incidence of hepatocellular carcinoma in hepatitis B virus patients without antiviral therapy

BACKGROUND China has a high prevalence of hepatitis B virus(HBV),but most chronic hepatitis B(CHB)patients do not receive standardized antiviral therapy.There are few relevant reports addressing the outcomes of the large number of CHB patients who do not receive antiviral therapy.AIM To observe the outcomes of long-term follow-up of patients with CHB without antiviral treatment.METHODS This study included 362 patients with CHB and 96 with hepatitis B cirrhosis without antiviral treatment and with only liver protection and anti-inflammatory treatment from 1993 to 1998.The median follow-up times were 10 and 7 years,respectively.A total of 203 CHB and 129 hepatitis B cirrhosis patients receiving antiviral therapy were selected as the control groups.The median follow-up times were 8 and 7 years,respectively.Kaplan-Meier curves were used to analyze the cumulative incidence of hepatocellular carcinoma(HCC),and the Cox regression model was used to analyze the risk factors for HCC.RESULTS Among the patients in the non-antiviral group,16.9%had spontaneous decreases(HBeAg)seroconversion.In the antiviral group,87.2%of patients had undetectable HBV DNA,and 52%showed HBeAg seroconversion.Among CHB and hepatitis B cirrhosis patients,the cumulative incidence rates of HCC were 14.9%and 53.1%,respectively,in the non-antiviral group and were 10.7%and 31.9%,respectively,in the antiviral group.There was no difference between the two groups regarding the CHB patients(P=0.842),but there was a difference between the groups regarding the hepatitis B cirrhosis patients(P=0.026).The cumulative incidence rates of HCC were 1.6%and 22.3%(P=0.022)in the groups with and without spontaneous HBeAg seroconversion,respectively.The incidence rates of HCC among patients with and without spontaneous declines in HBV DNA to undetectable levels were 1.6%and 19.1%,respectively(P=0.051).There was no difference in the cumulative incidence of HCC between the two groups regarding the patients with drug-resistant CHB(P=0.119),but there was a significant difference between the two groups regarding the patients with cirrhosis(P=0.004).The Cox regression model was used for regression of the corrected REACH-B score,which showed that alanine aminotransferase>400 U/L,history of diabetes,and family history of liver cancer were risk factors for HCC among men aged>40 years(P<0.05).Multifactorial analysis showed that a family history of HCC among men was a risk factor for HCC.CONCLUSION Antiviral therapy and non-antiviral therapy with liver protection and antiinflammatory therapy can reduce the risk of HCC.Antiviral therapy may mask the spontaneous serological response of some patients during CHB.Therefore,the effect of early antiviral therapy on reducing the incidence of HCC cannot be overestimated.

Advances in Management of Retinoblastoma

Retinobiastoma is a highly malignant intraocular tumor of children that requires accurate diagnosis to prompt treatment. This article reviewed clinical, pathological and follow-up data on 1 147 cases of retinobiastoma registered in Japan from 1975 to 1982. It is obvious that the prognosis of children with retinobiastoma has improved remarkably in recent years. The current advances in the management of the retinobiastoma were discussed.

On pancreatic cancer screening by magnetic resonance imaging with the recent evidence by Del Chiaro and colleagues

Pancreatic cancer is a lethal disease because incidence and mortality rates are nearly identical.The 5-year survival rate in Western countries is 4%,the lowest among all types of cancer（1）.In China,pancreatic cancer is the sixth leading cause of death from malignant disease,with an overall cumulative 5-year survival rate of 1%to 3%（2,3）.

Can patients with mild non-neoplastic lesions diagnosed at baseline screening be safely exempt from surveillance: evidence from multicenter community-based cohorts

Surveillance recommendations for gastric cancer(GC)in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions.We aimed to develop a less endoscopy-related equipment-dependent risk-stratification tool,and assessed whether mild-precursor-lesion patients can be safely exempt from surveillance.In the multicenter communitybased cohort,75,051 participants receiving baseline endoscopy were enrolled during 2015–2017 and followed-up until 2021.Cumulative incidence rates(CIRs)of GC for precancerous-conditions were calculated by Kaplan-Meier method and compared by Log-rank tests.Mixedeffects Cox regression models were used to detect potential factors for progression towards GC.A risk score was calculated as counts of selected factors.An independent cohort,including 26,586 participants was used for external validation.During a median follow-up of 6.25 years,CIRs of GC were 0.302%,0.436%,and 4.756%for normal group,non-neoplastic(atrophic gastritis/intestinal metaplasia)and neoplastic lesions(low-grade/high-grade dysplasia),respectively(Ptrend<0.001).Four predictors,including male,≥60 years,smoking,and limited vegetable consumption,were selected for risk-stratification.High-risk patients(≥3 risk factors)with non-neoplastic lesions showed higher GC risks(adjusted HR=7.73,95%CI:4.29–13.92),and their four-year CIR reached the one-year CIR of neoplastic lesions.Further categorizing non-neoplastic lesions by histological grade,both patients with moderate-to-severe lesions(aHR=3.07,95%CI:1.67–5.64)and high-risk patients with mild lesions(aHR=7.29,95%CI:3.58–14.86)showed higher risks.Consistent trends were observed in validation cohort.High-risk mild-precursor-lesion patients should receive surveillance within 3–5 years after baseline screening.Our study provides evidence on supplementing current guideline recommendations.

Spatial cluster analysis of human cases of Crimean Congo hemorrhagic fever reported in Pakistan

Background:Crimean Congo hemorrhagic fever(CCHF)is a tick-borne viral zoonotic disease that has been reported in almost all geographic regions in Pakistan.The aim of this study was to identify spatial clusters of human cases of CCHF reported in country.Methods:Kulldorff’s spatial scan statisitc,Anselin’s Local Moran’s I and Getis Ord Gi*tests were applied on data(i.e.number of laboratory confirmed cases reported from each district during year 2013).Findings:The analyses revealed a large multi-district cluster of high CCHF incidence in the uplands of Balochistan province near it border with Afghanistan.The cluster comprised the following districts:Qilla Abdullah;Qilla Saifullah;Loralai,Quetta,Sibi,Chagai,and Mastung.Another cluster was detected in Punjab and included Rawalpindi district and a part of Islamabad.Conclusion:We provide empirical evidence of spatial clustering of human CCHF cases in the country.The districts in the clusters should be given priority in surveillance,control programs,and further research.

Mortality of Amur tigers:The more things change,the more they stay the same

Poaching as well as loss of habitat and prey are identified as causes of tiger population declines.Although some studies have examined habitat requirements and prey availability,few studies have quantified cause-specific mortality of tigers.We used cumulative incidence functions(CIFs)to quantify cause-specific mortality rates of tigers,expanding and refining earlier studies to assess the potential impact of a newly emerging disease.To quantify changes in tiger mortality over time,we re-examined data first collected by Goodrich et al.(2008;study period 1:1992–2004)as well as new telemetry data collected since January 2005(study period 2:2005–2012)using a total of 57 tigers(27 males and 30 females)monitored for an average of 747 days(range 26–4718 days).Across the entire study period(1992 to 2012)we found an estimated average annual survival rate of 0.75 for all tigers combined.Poaching was the primary cause of mortality during both study periods,followed by suspected poaching,distemper and natural/unknown causes.Since 2005,poaching mortality has remained relatively constant and,if combined with suspected poaching,may account for a loss of 17–19%of the population each year.Canine distemper virus(CDV)may be an additive form of mortality to the population,currently accounting for an additional 5%.Despite this relatively new source of mortality,poaching remains the main threat to Amur tiger survival and,therefore,population growth.

An Additive-Multiplicative Cox-Aalen Subdistribution Hazard Model for Competing Risks Data

This paper proposes a flexible additive-multiplicative Cox-Aalen hazard model which allows time-varying covariate effects for the subdistribution in a competing risks study.Weigh ted estimating equation approaches under an covariates-dependent adjusted weight by fitting the Cox proportional hazard model for the censoring distribution are established for inference on the model parametric and nonparametric components.In addition,large number properties are presented and the finite sample behavior of the proposed estimators is evaluated through simulation studies,estimators from the proposed method perform satisfactorily on reduction of the bias.The authors apply our model to a competing risks data set from a tamoxifen trail for breast cancer study.