The burden and long-term trends of breast cancer by different menopausal status in China

Background: The burden of breast cancer in women of different menopausal status has not been assessed in China previously. We aim to evaluate and project the burden of breast cancer in different menopausal status in China. Methods: The incidence and mortality of breast cancer were estimated using the data of 554 cancer registries in 2017 and the trends of incidence and mortality of 112 cancer registries from 2010 to 2017. Data from 22 continued cancer registries from 2000 to 2017 were applied for long-term trend projection to 2030 using the Bayesian age- period-cohort model. Menopausal status was stratified by age, with premenopause defined as chronological age < 45 years, perimenopause defined as 45-54 years, and postmenopause defined as ≥ 55 years. Results: Approximately 352,300 incident cases and 74,200 deaths of breast cancer occurred in China in 2020, contributing to 2.6 million disability-adjusted life years (DALYs). Perimenopausal women had the highest inci- dence, prevalence, and DALYs rates, with the rates being 100.3 per 100,000, 819.2 per 100,000 and 723.1 per 100,000 persons. While postmenopausal women had the highest mortality rates (25.5 per 100,000 persons). From 2000 to 2017, the largest increase in incidence and mortality for breast cancer was observed in postmenopausal women with an average annual percentage change (AAPC) of 5.6% and 2.94%. The number of breast cancer cases and deaths will increase to 452,000 and 98,800 in 2030, resulting in 3.2 million DALYs. Conclusions: The burden of breast cancer is rapidly increasing in China and varies among different menopausal status. Specific prevention and control strategies for women in different menopausal status will be more helpful in reducing the rapidly growing trends of breast cancer.

Combination of atezolizumab and chidamide to maintain long-term remission in refractory metastatic extranodal natural killer/T-cell lymphoma:A case report

BACKGROUND The prognosis of refractory extranodal natural killer/T-cell lymphoma(ENKTL)is poor.Recent data have indicated that immune checkpoint blockade with a programmed cell death protein-1(PD-1)antibody in combination with administration of histone deacetylase inhibitors represents a potentially effective treatment strategy.Compared with PD-1 antibodies,programmed death-ligand 1 antibodies have fewer side effects.Here,we present a rare case of a patient with refractory metastatic ENKTL who achieved sustained remission of approximately 10 mo with minor adverse effects after combination therapy with atezolizumab,chidamide,and radiotherapy.CASE SUMMARY A 56-year-old woman underwent resection of a tumour in her left nasal cavity and was diagnosed with ENKTL(nasal type).Medical examination revealed tumours observed in the bilateral nasal mucosa,the subcutaneous soft tissue of the inner side of the left eye,the soft tissue of the nasopharynx,the bilateral tonsils,and the left preauricular,right hilar,bilateral neck lymph nodes and bone marrow.However,tomography/computed tomography showed increased metabolism of the bilateral nasal mucosa and subcutaneous soft tissue of the inner side of the left eye and newly increased metabolism of the left cervical lymph node after chemotherapy.Therefore,combination therapy with chidamide,atezolizumab,and radiotherapy was performed.Fortunately,the patient achieved a complete response following 10 mo of combination therapy.CONCLUSION The outcome in this case suggests that the combination of atezolizumab,chidamide,and radiotherapy is a promising regimen for treating refractory metastatic ENKTL following chemotherapy treatment failure.

Effects of insurance status on long-term survival among non-small cell lung cancer(NSCLC) patients in Beijing,China: A population-based study

Objective: To evaluate the effects of health insurance status on long-term cancer-specific survival of non-small cell lung cancer(NSCLC) in Beijing, China, using a population-based cancer registry data.Methods: Information on NSCLC patients diagnosed in 2008 was derived from the Beijing Cancer Registry.The medical records of 1,134 cases were sampled and re-surveyed to obtain information on potential risk factors.Poorly-insured status was defined as Uninsured and New Rural Cooperative Medical Insurance Scheme(NRCMS),while well-insured included Urban Employees Basic Medical Insurance(UEBMI) and Free Medical Care(FMC).To estimate survival outcomes, individuals were followed-up until December 31, 2018. Cancer-specific survival probabilities at 5 and 10 years after diagnosis were estimated using the Kaplan-Meier method. Log-rank test was used to compare long-term survival with different characteristics. Multivariable Cox proportional hazard regression model was used to examine the relative effect of insurance status on cancer-specific mortality.Results: Well-insured NSCLC patients have longer cancer-specific survival than poorly-insured individuals[hazard ratio(HR)=0.81;95% confidence interval(95% CI): 0.67-0.97), even after adjusting for age, gender, cancer stage, smoking status, family history and residential area. Older age and rural residence were associated with a higher risk of cancer-specific mortality(HR=1.03;95% CI: 1.02-1.03 and HR=1.25;95% CI: 1.07-1.46,respectively). Smoking individuals had a 41% higher long-term cancer-specific mortality risk than non-smoking ones(HR=1.41;95% CI: 1.20-1.66).Conclusions: NSCLC patients with good insurance status had better survival rates than those with poor insurance. An association was significant even after 10 years. Large population-based studies are needed to validate that high reimbursement insurance status can lead to the improvement of long-term cancer prognosis in China.

Infliximab trough level combined with inflammatory biomarkers predict long-term endoscopic outcomes in Crohn’s disease under infliximab therapy

BACKGROUND Infliximab trough level(ITL)severely affects therapeutic outcomes of Crohn’s disease(CD)patients under infliximab(IFX).Recently,frontier research has focused on identifying ITL based on different therapeutic targets.Although previous studies have elaborated clinical value of ITL monitoring on short-term outcomes in CD patients during therapy,studies contraposing the predictive value of ITL on long-term endoscopic outcomes in CD patients are still scarce domestically and overseas.AIM To explore the predictive value of ITL in combination with inflammatory biomarkers on long-term endoscopic outcomes in CD with clinical remission during IFX maintenance therapy.METHODS CD patients with endoscopic remission under long-term IFX maintenance therapy in the First Affiliated Hospital of Zhejiang Chinese Medicine University from January 2012 to December 2020 were collected.ITL and inflammatory biomarkers were continuously monitored during the therapy.The Step I study was conducted from weeks 14 to 54 of IFX treatment.The Step II study was conducted from weeks 54 to 108 of IFX treatment.Endoscopic outcomes were defined as endoscopic activity(Crohn’s disease endoscopic index of severity score>2 points or Rutgeerts score>i1)and endoscopic remission(Crohn’s disease endoscopic index of severity score≤2 points or Rutgeerts≤i1).Endoscopic relapse free survival was defined as endoscopic remission at the beginning of the study stage and maintaining endoscopic remission during the study stage.RESULTS At week 14,low ITL[odds ratio(OR)=0.666,95%confidence interval(CI):0.514-0.862,P<0.01]and high fecal calprotectin(FCP)level(OR=1.002,95%CI:1.001-1.004,P<0.01)increased the risk of endoscopic activity at week 54.At week 54,low ITL(OR=0.466,95%CI:0.247-0.877,P<0.01)and high C-reactive protein(CRP)level(OR=1.590,95%CI:1.007-2.510,P<0.01)increased the risk of endoscopic activity at week 108.At week 14,ITL≤5.60μg/mL[area under the curve(AUC)=0.83,95%CI:0.73-0.90,P<0.001]and FCP>238μg/g(AUC=0.82,95%CI:0.72-0.89,P<0.001)moderately predicted endoscopic activity at week 54.ITL≤5.60μg/mL in combination with FCP>238μg/g indicated 82.0%possibility of endoscopic activity.At week 54,ITL≤2.10μg/mL(AUC=0.85,95%CI:0.72-0.93,P<0.001)and CRP>3.00 mg/L(AUC=0.73,95%CI:0.60-0.84,P=0.012)moderately predicted moderate endoscopic activity at week 108.ITL≤2.10μg/mL in combination with CRP>3.00 mg/L indicated 100.0%possibility of endoscopic activity.From weeks 14 to 54 of IFX treatment,patients with ITL>5.60μg/mL had higher rate of endoscopic relapse free survival than those with ITL≤5.60μg/mL(95.83%vs 46.67%).From weeks 54 to 108 of IFX treatment,patients with ITL>2.10μg/mL had higher rate of endoscopic survival free relapsed rate than those with ITL≤2.10μg/mL(92.68%vs 30.77%).CONCLUSION Combination of ITL,CRP,and FCP contribute to long-term endoscopic prognosis monitoring.During IFX maintenance treatment,low ITL,high CRP level,and high FCP level were independent risk factors of CD patients with clinical remission in adverse endoscopy outcomes within 1-year follow-up.

Sodium valproate suppresses abnormal neurogenesis induced by convulsive status epilepticus

Status epilepticus has been shown to activate the proliferation of neural stem cells in the hippocampus of the brain, while also causing a large amount of neuronal death, especially in the subgranular zone of the dentate gyrus and the subventricular zone. Simultaneously, proliferating stem cells tend to migrate to areas with obvious damage. Our previous studies have clearly confirmed the effect of sodium valproate on cognitive function in rats with convulsive status epilepticus. However, whether neurogenesis can play a role in the antiepileptic effect of sodium valproate remains unknown. A model of convulsive status epilepticus was established in Wistar rats by intraperitoneal injection of 3 mEq/kg lithium chloride, and intraperitoneal injection of pilocarpine 40 mg/kg after 18–20 hours. Sodium valproate(100, 200, 300, 400, 500, or 600 mg/kg) was intragastrically administered six times every day(4-hour intervals) for 5 days. To determine the best dosage, sodium valproate concentration was measured from the plasma. The effective concentration of sodium valproate in the plasma of the rats that received the 300-mg/kg intervention was 82.26 ± 11.23 μg/mL. Thus, 300 mg/kg was subsequently used as the intervention concentration of sodium valproate. The following changes were seen: Recording excitatory postsynaptic potentials in the CA1 region revealed high-frequency stimulation-induced long-term potentiation. Immunohistochemical staining for BrdU-positive cells in the brain revealed that sodium valproate intervention markedly increased the success rate and the duration of induced long-term potentiation in rats with convulsive status epilepticus. The intervention also reduced the number of newborn neurons in the subgranular area of the hippocampus and subventricular zone and inhibited the migration of newborn neurons to the dentate gyrus. These results indicate that sodium valproate can effectively inhibit the abnormal proliferation and migration of neural stem cells and newborn neurons after convulsive status epilepticus, and improve learning and memory ability.

Long-term survival of more than 3 years among patients with advanced non-small cell lung cancer treated with chemotherapy

AIM: To evaluate the prognostic factors of long-term survival of more than 3 years in patients with advanced non-small cell lung cancer(NSCLC). METHODS: We retrospectively analyzed the records of 474 patients with advanced ⅢB/Ⅳ NSCLC who received chemotherapy as initial treatment between September 2002 and March 2007.RESULTS: The median survival time(MST) was 12.5 mo and the 3 year and 5 year survival rates were 14.6% and 5.3%, respectively. Long-term survival of more than 3 and 5 years was observed in 65 and 16 patients, respectively. The MST for the 65 patients was61.5 mo(range, 60.1-81.0 mo). In the 474 patients, a good performance status(PS), female sex, non-smoking status and adenocarcinoma histology were significantly associated with a favorable outcome. Furthermore, female sex, a good PS, non-smoking status and adenocarcinoma histology were significantly correlated with longterm survival of more than 3 years and most of these patients(89.2%, 58/65) received epidermal growth factor receptor-tyrosine kinase inhibitors as any line treatment. Survival analysis of long-term survivors showed that a PS of 0 was an independent prognostic factor for predicting favorable outcomes. CONCLUSION: Our results suggest that a good PS and adenocarcinoma histology play an important role in long-term survival of more than 3 years. A PS of 0 was an independent prognostic factor for predicting favorable outcomes in patients with advanced NSCLC who survived for more than 3 years.

Care of inflammatory bowel disease patients in remission

Inflammatory bowel disease(IBD)comprises two distinct conditions:ulcerative colitis and Crohn’s disease,both of which are chronic,relapsing disorders carrying significant morbidity,mortality and healthcare costs.With growing attention to coordinated healthcare for patients with chronic systemic diseases,this review focuses on the care of IBD patients in remission,their concerns,quality of life,follow-up,the role of primary care physicians and the IBD-specific aspects of long-term care.We did an extensive PubMed search for articles pertaining to IBD patients in remission and,along with the authors’experience,formulated a comprehensive review.The difficulties faced by IBD patients in remission include but are not limited to education and employment concerns,psychosocial issues,problems related to health insurance,nutrition,fertility and infections.This review also addresses newer treatment modalities,the debatable effects of smoking on IBD and the importance of vaccination.IBD in remission can be a challenge due to its multifaceted nature;however,with a coordinated approach by gastroenterologists and other involved practitioners,several of these issues can be addressed.

Treat-to-target in Crohn's disease:Will transmural healing become a therapeutic endpoint?

Crohn's disease(CD) represents a chronic transmural inflammatory condition of the gastrointestinal tract, which usually leads to structural damage and signific-ant disability. Deep remission--defined by both clinical and endoscopic remission, signifying mucosal healing-represents the current endpoint in the treat--to--target strategy, significantly improving patients' long--term outcomes. Transmural healing(TH) could be a more effe-ctive target, but this possibility remains unclear. This narrative review aims to critically review and summarize the available literature relating TH to long--term outcomes, being the first of its kind and to the best of the author's knowledge. A systematic literature search(from incep-tion to March 31 2018) was performed, using multiple databases, and identifying seven full--text manuscripts. In those studies, long--term favorable outcomes(≥ 52 wk) included sustained clinical remission, as well as fewer therapeutic changes, CD--related hospitalizations, and surgeries. Despite heterogeneous design and me-thodological limitations, six of the studies demonstrated that TH or intestinal healing(TH plus mucosal healing) were predictive for the aforementioned favorable out-comes. Therefore, TH may become a reasonable the-rapeutic target and be included in the concept of deep remission. Further prospective, well-designed, multicenter trials aiming to better define the role of TH in personalized therapy for CD and to determine the long-term influence of TH on bowel damage and disability are warranted.

Study on the quality of life and the factors influencing it in elderly patients

A society of advanced age is arriving with the increasing number of elderly patients. Little attention has been paid to the quality of life of elderly patients, which is decreasing gradually. This article aims to study the quality of life among elderly patients and explore the factors influencing it, in addition to exploring effective ways to improve the quality of life of elderly patients.

Effect of Missing Nutrient Elements on Grain Yield of Wet Season Rice in Bangladesh

Background and objective: Long-term fertility study is one of the important factors to monitor changes in yield because of different nutrient management options and cropping systems involved in Asian regions. Many short-term and long-term fertilizer trials were conducted for intensive irrigated rice cropping patterns mostly to provide fertilizer rate, but did not considered sustainable soil management for soil health. The objective of the present study was to examine the effect of missing nutrient elements for a long time on rice yield, photosynthetic rate and residual soil fertility. Materials and Methods: The experiment was initiated on a permanent layout at the Bangladesh Rice Research Institute (BRRI) farm, Gazipur during 2000 to 2008 in wet season. Seven treatments in randomized complete block design with four replications were imposed. Grain yield was determined at physiological maturity from three 5 m2 areas within each plot followed by bagging and threshing. Photosynthetic was measure by Li Cor 6400 (USA) machine during study period. Soil sample was analyzed for following standard methods. Results: It was found that grain yield was in decreasing trends for the missing elements that were similar with BR 11 and BRRI dhan 31. On an average, grain yield reductions were 11.6, 7.0, 10.6, 1.1 and 3.4 percent for -N, -P, -K, -S and -Zn, than complete fertilizer treatment (NPKSZn) respectively. Under no fertilization, the ability of soil was to produce 2.9 t&middot;ha-1 of BR11 and 3.1 t&middot;ha-1 of BRRI dhan 31 respectively. Photosynthetic rate of rice plant was always higher in complete fertilizer treatment (NPKSZn) than missing of any nutrient element. The decrease in photosynthetic rate was more pronounced with N missing than others for both the rice varieties. Conclusion: It is concluded that balance chemical fertilizers (NPKSZn) are to be used for sustained and/or increased rice production and to maintain soil fertility.

Advances in the Treatment of Autoimmune Hepatitis

Autoimmune hepatitis(AIH)is a chronic,progressive inflammatory liver disease caused by autoimmune reactions,with an unknown etiology.If left untreated,it can progress to cirrhosis,liver failure,or even death.While most patients respond well to first-line treatments,a significant number experience poor responses or intolerance,requiring the use of second-or third-line therapies.Ongoing research into the pathogenesis of AIH is leading to the development of novel therapeutic approaches.This review summarized recent advancements in the treatment of AIH both domestically and internationally.

A Fast Calculation Method for Long-term Security-constrained Unit Commitment of Large-scale Power Systems with Renewable Energy

With the increase in the penetration rate of renewable energy, the planning and operation of power systems will face huge challenges. To ensure the sufficient utilization of renewable energy, the reasonable arrangement for the long-term power generation plan has become more crucial. Security-constrained unit commitment(SCUC) is a critical technical means to optimize the long-term power generation plan. However, the plentiful power sources and the complex grid structure in largescale power systems will bring great difficulties to long-term SCUC. In this paper, we propose a fast calculation method for long-term SCUC of large-scale power systems with renewable energy. First, a method for unit status reduction based on temporal decomposition is proposed, which will reduce plenty of binary variables and intertemporal constraints in SCUC. Then,an efficient redundant constraint identification(RCI) method is developed to reduce the number of network constraints. Furthermore, a joint accelerated calculation framework for status reduction and RCI is formed, which can reduce the complexity of long-term SCUC while ensuring a high-precision feasible solution. In case studies, numerical results based on two test systems ROTS2017 and NREL-118 are analyzed, which verify the effectiveness and scalability of the proposed calculation method.

A multicenter retrospective study on the real-world outcomes of autologous vs. allogeneic hematopoietic stem cell transplantation for peripheral T-cell lymphoma in China

Background:There were few studies on real-world data about autologous hematopoietic stem cell transplantation(auto-HSCT)or allogeneic HSCT(allo-HSCT)in peripheral T-cell lymphoma(PTCL).This study aimed to investigate the clinical outcomes of patients who received auto-HSCT or allo-HSCT in China.Methods:From July 2007 to June 2017,a total of 128 patients who received auto-HSCT(n=72)or allo-HSCT(n=56)at eight medical centers across China were included in this study.We retrospectively collected their demographic and clinical data and compared the clinical outcomes between groups.Results:Patients receiving allo-HSCT were more likely to be diagnosed with stage III or IV disease(95%vs.82%,P=0.027),bone marrow involvement(42%vs.15%,P=0.001),chemotherapy-resistant disease(41%vs.8%,P=0.001),and progression disease(32%vs.4%,P<0.001)at transplantation than those receiving auto-HSCT.With a median follow-up of 30(2–143)months,3-year overall survival(OS)and progression-free survival(PFS)in the auto-HSCT group were 70%(48/63)and 59%(42/63),respectively.Three-year OS and PFS for allo-HSCT recipients were 46%(27/54)and 44%(29/54),respectively.There was no difference in relapse rate(34%[17/63]in auto-HSCT vs.29%[15/54]in allo-HSCT,P=0.840).Three-year non-relapse mortality rate in auto-HSCT recipients was 6%(4/63)compared with 27%(14/54)for allo-HSCT recipients(P=0.004).Subanalyses showed that patients with lower prognostic index scores for PTCL(PIT)who received auto-HSCT in an upfront setting had a better outcome than patients with higher PIT scores(3-year OS:85%vs.40%,P=0.003).Patients with complete remission(CR)undergoing auto-HSCT had better survival(3-year OS:88%vs.48%in allo-HSCT,P=0.008).For patients beyond CR,the outcome of patients who received allo-HSCT was similar to that in the atuo-HSCT group(3-year OS:51%vs.46%,P=0.300).Conclusions:Our study provided real-world data about auto-HSCT and allo-HSCT in China.Auto-HSCT seemed to be associated with better survival for patients in good condition(lower PIT score and/or better disease control).For patients possessing unfavorable characteristics,the survival of patients receiving allo-HSCT group was similar to that in the auto-HSCT group.