Systematic review of risk factors,prognosis,and management of colorectal signet-ring cell carcinoma

BACKGROUND Colorectal signet-ring cell carcinoma(CSRCC)is a rare clinical entity which accounts for approximately 1%of all colorectal cancers.Although multiple studies concerning this specific topic have been published in the past decades,the pathogenesis,associated risk factors,and potential implications on treatment are still poorly understood.Besides the low incidence,historically confusing histological criteria have resulted in confusing data.Nevertheless,the rising incidence of CSRCC along with relatively young age at presentation and associated dismal prognosis,highlight the actual interest to synthesize the known literature regarding CSRCC.AIM To provide an updated overview of risk factors,prognosis,and management of CSRCC.METHODS A literature search in the MEDLINE/PubMed database was conducted with the following search terms used:‘Signet ring cell carcinoma’and‘colorectal’.Studies in English language,published after January 1980,were included.Studies included in the qualitative synthesis were evaluated for content concerning epidemiology,risk factors,and clinical,diagnostic,histological,and molecular features,as well as metastatic pattern and therapeutic management.If possible,presented data was extracted in order to present a more detailed overview of the literature.RESULTS In total,67 articles were included for qualitative analysis,of which 54 were eligible for detailed data extraction.CSRCC has a reported incidence between 0.1%-2.4%and frequently presents with advanced disease stage at the time of diagnosis.CSRCC is associated with an impaired overall survival(5-year OS:0%-46%)and a worse stagecorrected outcome compared to mucinous and not otherwise specified adenocarcinoma.The systematic use of exploratory laparoscopy to determine the presence of peritoneal metastases has been advised.Surgery is the mainstay of treatment,although the rates of curative resection in CSRCC(21%-82%)are lower compared to those in other histological types.In case of peritoneal metastasis,cytoreductive surgery with hyperthermic intraperitoneal chemotherapy should only be proposed in selected patients.CONCLUSION CSRCC is a rare clinical entity most often characterized by young age and advanced disease at presentation.As such,diagnostic modalities and therapeutic approach should be tailored accordingly.

Comparing the efficacy and safety of low,medium,and high dosages of selexipag for treating pulmonary hypertension:A systematic review and meta-analysis

Background:The maintenance dosage of selexipag is categorized as low,medium or high.In order to assess the efficacy and safety of different dosages of selexipag for the risk stratification of pulmonary arterial hypertension(PAH),we performed a sys-tematic review and meta-analysis.Methods:Studies assessing PAH risk stratification indices,such as the World Health Organization functional class(WHO-FC),six-minute walk distance(6MWD),N-terminal pro-B-type natriuretic peptide(NT-proBNP)level,right atrial pressure(RAP),cardiac index(CI)and mixed venous oxygen saturation(SvO2),were included.Results:Thirteen studies were included.Selexipag led to improvements in the 6MWD(MD:24.20 m,95%CI:10.74-37.67),NT-proBNP(SMD:-0.41,95%CI:-0.79-0.04),CI(MD:0.47 L/min/m^(2),95%CI:0.17-0.77)and WHO-FC(OR:0.564,95%CI:0.457-0.697).Subgroup analysis demonstrated that all three dosages improved the 6MWD.A moderate dosage led to improvements in the CI(MD:0.30 L/min/m^(2),95%CI:0.15-0.46)and WHO-FC(OR:0.589,95%CI:0.376-0.922).Within 6 months of treatment,only the WHO-FC and CI were significantly improved(OR:0.614,95%CI:0.380-0.993;MD:0.30 L/min/m^(2),95%CI:0.16-0.45,respectively).More than 6 months of treatment significantly improved the 6MWD,WHO-FC and NT-proBNP(MD:40.87 m,95%CI:10.97-70.77;OR:0.557,95%CI:0.440-0.705;SMD:-0.61,95%CI:-1.17-0.05,respectively).Conclusions:Low,medium,and high dosages of selexipag all exhibited good effects.When treatment lasted for more than 6 months,selexipag exerted obvious effects,even in the low-dosage group.This finding is important for guiding individualized treatments.

Stock profiling using time–frequency‑varying systematic risk measure

This study proposes a wavelets approach to estimating time–frequency-varying betas in the capital asset pricing model(CAPM)framework.The dynamic of systematic risk across time and frequency is analyzed to investigate stock risk-profile robustness.Furthermore,we emphasize the effect of an investor’s investment horizon on the robustness of portfolio characteristics.We use a daily panel of French stocks from 2012 to 2022.Results show that varying systematic risk varies in time and frequency,and that its short and long-run evolutions differ.We observe differences in short and long dynamics,indicating that a stock’s betas differently fluctuate to early announcements or signs of events.However,short-run and long-run betas exhibit similar dynamics during persistent shocks.Betas are more volatile during times of crisis,resulting in greater or lesser robustness of risk profiles.Significant differences exist in short-run and longrun risk profiles,implying a different asset allocation.We conclude that the standard CAPM assumes short-run investment.Then,investors should consider time–frequency CAPM to perform systematic risk analysis and portfolio allocation.

Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis

AIM To perform a systematic review and meta-analysis on proton pump inhibitors(PPIs) therapy and the risk of Clostridium difficile infection(CDI). METHODS We conducted a systematic search of MEDLINE/Pub Med and seven other databases through January 1990 to March 2017 for published studies that evaluated the association between PPIs and CDI. Adult case-control and cohort studies providing information on the association between PPI therapy and the development of CDI were included. Pooled odds ratios(ORs) estimates with 95% confidence intervals(CIs) were calculated using the random effect. Heterogeneity was assessed by I^2 test and Cochran's Q statistic.Potential publication bias was evaluated via funnel plot, and quality of studies by the Newcastle-Otawa Quality Assessment Scale(NOS). RESULTS Fifty-six studies(40 case-control and 16 cohort) involving 356683 patients met the inclusion criteria and were analyzed. Both the overall pooled estimates and subgroup analyses showed increased risk for CDI despite substantial statistical heterogeneity among studies. Meta-analysis of all studies combined showed a significant association between PPI users and the risk of CDI(pooled OR = 1.99, CI: 1.73-2.30, P < 0.001) as compared with non-users. The association remained significant in subgroup analyses: by design-case-control(OR = 2.00, CI: 1.68-2.38, P < 0.0001), and cohort(OR = 1.98, CI: 1.51-2.59, P < 0.0001); adjusted(OR = 1.95, CI: 1.67-2.27, P < 0.0001) and unadjusted(OR = 2.02, CI: 1.41-2.91, P < 0.0001); unicenter(OR = 2.18, CI: 1.72-2.75, P < 0.0001) and multicenter(OR = 1.82, CI: 1.51-2.19, P < 0.0001); age ≥ 65 years(OR = 1.93, CI: 1.40-2.68, P < 0.0001) and < 65 years(OR = 2.06, CI: 1.11-3.81, P < 0.01). No significant differences were found in subgroup analyses(test for heterogeneity): P = 0.93 for case-control vs cohort, P = 0.85 for adjusted vs unadjusted, P = 0.24 for unicenter vs multicenter, P = 0.86 for age ≥ 65 years and < 65 years. There was significant heterogeneity across studies(I^2 = 85.4%, P < 0.001) as well as evidence of publication bias(funnel plot asymmetry test, P = 0.002). CONCLUSION This meta-analysis provides further evidence that PPI use is associated with an increased risk for development of CDI. Further high-quality, prospective studies are needed to assess whether this association is causal.

Systematic review of risk factors for progressive ischemic stroke

OBJECTIVE： To determine the risk factors for progressive ischemic stroke, and to prevent onset and make a prognosis of disease, the present study systemically evaluated 19 cohort studies and 10 case-controlled studies of progressive ischemic stroke. SEARCH STRATEGY： A computer-based, online, literature search of PubMed （1966/2007）, China Biological Medicine Database （CBM-disc, 1979/2007） and CNKI （www.cnki.net, 1979/2007） was performed to screen for related studies. DATA SELECTION： Cohort or case-controlled studies that focused on risk factors of progressive ischemic stroke were selected for review. Two reviewers independently extracted data and assessed study quality according to Cochrane Collaboration guidelines. Statistical analysis was performed using RevMan software. MAIN OUTCOME MEASUREMENT： Risk factors for progressive ischemic stroke. RESULTS： Using the inclusion criteria, 29/781 studies published in English and Chinese were initially reviewed, including 19 cohort studies and 10 case-control studies. Despite variations in determination of progressive ischemic stroke and the intervals between 2 evaluations, all studies described the diagnostic criteria for progressive ischemic stroke. Logistic analysis was employed in 20 of the studies. Meta-analysis of primary data in the related studies determined that the following factors that significantly correlated with progressive ischemic stroke： fever [risk ratio （RR） = 2.26, 95% confidence interval （CO： 1.20-4.26, P = 0.01; odds ratio （OR） = 2.85, 95% CI： 1.64-4.98, P 〈 0.01 ）]; diabetes （RR = 1.38, 95% CI： 1.18-1.61, P 〈 0.01 ; OR = 2.48, 95% Ch 1.93-3.19, P 〈 0.01 ）; coronary heart disease （RR = 1.22, 95% CI： 1.08-1.38, P 〈 0.01）; neuroimaging transformation （RR= 1.55, 95%CI： 1.34-1.80, P〈 0.01; OR= 2.29, 95% CI： 1.47-3.58, P〈 0.01）; and hyperglycemia （RR = 2.62, 95% CI： 1.86-3.68, P 〈 0.01 ; OR = 3.49, 95% CI： 1.92-6.35, P 〈 0.01）. CONCLUSION： Fever, diabetes, coronary heart disease, neuroimaging transformation, and hyperglycemia are important risk factors for progressive ischemic stroke. Interventions for these risk factors could effectively prevent occurrence of progressive ischemic stroke.

A Systematic Assessment of Blood Lead Level in Children and Associated Risk Factors in China

In this study, we searched multiple databases for all relevant original articles (1996-2013). To investigate blood lead levels (BLL) and possible risk factors for lead exposure among children in China A total of 388 articles met our inclusion criteria. The overall geometric mean (GM) BLL was 71 μg/L, and the prevalence of elevated BLL (EBLL, defined as BLL &ge;100 μg/L) was 18.48% among children. The prevalence of EBLL remained significantly higher among boys. In children less than 6 years of age, there were significantly increasing trends in both BLL and prevalence of EBLL in an age-dependent manner. The ban on leaded gasoline significantly reduced the BLL as well as EBLL prevalence; however, children whose parents had lower educational levels or were exposed to lead in the workplace had a higher EBLL prevalence. Despite its decline over time, the average BLL among children in China remains higher than the average level most recently reported in the United States. Childhood lead poisoning remains a public health problem in China.

Risk factors from HBV infection among blood donors:A systematic review

Objective:To perform a systematic review of the scientific literature to identify risk factors associated with hepatitis B viruses(HBV) infection among blood donors.Methods:The literature search was carried out on Pub Med and Scopus databases using the keywords "risk factors" "HBV infection" and "blood donors".No date or language restrictions were applied to the search.This literature review was completed in March2014.The selection process and the reporting of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.The Newcastle Ottawa scale was using to evaluate the quality of each single primary study.Results:Out of 172 records resulted in the search,5 papers were included in the final analysis because they are within acceptance criteria.Two of the selected studies were cross-sectional and three of them were case-control studies.Significant association resulted with some demographic and behavioral risk factors,such as marital status,dental treatment/procedure history,no stable relationship or multiple partners and family history of HBV infection.Conclusions:The systematic review performed encourages to conduct further research among blood donors in order to fully understand risk factors among donors in more extensive thus to provide valuable information about surveillance.

Brassiere wearing and breast cancer risk:A systematic review and meta-analysis

AIM:To evaluate existing evidence for the association between different type of brassiere exposures and the risk of breast cancer.METHODS:Ovid Medline,CINAHL,Cochrane Data Base of Systematic Reviews,Pubmed,Scopus,Proquest,Sciencedirect,Wiley Online Library,WanF ang Data,Hong Kong Index to Chinese Periodicals,China Journal Net,Chinese Medical Current Contents,Chinese Biomedical Literature Database,China Academic Journals FullText database,Taiwan Electronic Periodical Services and HyR ead; reference lists of published studies; original research studies published in English or Chinese examining the association between type and duration of brassiere-wearing and breast cancer risk.Data were abstracted by a first reviewer and verified by a second.Study quality was rated according to predefined criteria."Fair" or "good" quality studies were included.Results were summarised by meta-analysis whenever adequate material was available.RESULTS:Twelve case-control studies were included in the review.Meta-analysis showed brassiere wearing during sleep was associated with a 1.3 times of increased risk.The odd ratio for more than 12 h of daily brassiere use in relation to breast cancer risk was 1.08(95%CI:1.01-1.14).CONCLUSION:The present review demonstrates insufficient evidence to establish a positive association between the duration and type of brassiere wearing and breast cancer.Further research is essential; specifically,a large-scale epidemiological study of a better design is needed to examine the association between various forms of brassiere exposure in detail and breast cancer risk,with adequate control of confounding variables.

Evidence for the Reliability and Validity of the Arabic Version of the Student Risk Screening Scale for Internalizing and Externalizing Behaviors (SRSS-IE)

School-based universal screening for behavioral/emotional risk is a necessary first step to providing services in an educational setting for students with emotional and behavioral disorders (EBDs). Psychometric properties are critical to making decisions about choosing a screening instrument. The purpose of the present study was to examine the psychometric properties of the student risk screening scale for internalizing and externalizing behaviors (SRSS-IE). Participants included 3145 students and their teachers. Item-level analyses of the current sample supported the retention of all items. The internal consistency of the SRSS items ranged from 0.83 to 0.85. Convergent validity between the SRSS-IE and a well-established screening tool, the strength and difficulties questionnaire (SDQ), was found for the total score (r = 0.70). Additionally, the results of this study demonstrate strong social validity, suggesting the SRSS-IE to be a useful and functional screening tool. We conclude that the SRSS-IE is a valid and reliable instrument for assessing the level of emotional and behavioral difficulties among elementary students.

Recognition and Measurement of Losses Caused by Systematic Risk in Damages of False Statements

Based on the single-factor market model,this paper examines the confirmation basis and measurement of the losses arising from systematic risk in the civil damages of false statements.The paper argues that the systematic risk not only affects the investment in securities during times of financial crisis,but also causes losses in daily securities trading.The paper carries out an empirical analysis on the existence of ft coefficient for China's listed companies within a period of one year,and examines the impact of systematic risk on the losses of investors.The civil damages of false statements should take full account of the losses arising from systematic risk.After analysis,the paper uses the correlation coefficient to represent the ratio of losses arising from systematic risk of all the transactions of a particular stock during a certain period of time,and tries to develop two methods to measure the damages after adjusting the losses caused by the systematic risk The paper has a theoretical foundation for the estimation of losses caused by systematic risk,and matches the risks and returns.The result of the paper has provided an effective method of calculation in the determination of reasonable damages in the case of China Langfang Development Co.,Ltd.

A Systematic Analysis of Systems Approach and Flood Risk Management Research:Trends,Gaps,and Opportunities

Flooding is a global threat,necessitating a comprehensive management approach.Due to the complexity of managing flood hazards and risks,researchers have advocated for holistic,comprehensive,and integrated approaches.This study,employing a systems thinking perspective,assessed global flood risk management research trends,gaps,and opportunities using132 published documents in BibTeX format.A systematic review of downloaded documents from the Scopus and Web of Science databases revealed slow progress of approximately 11.61% annual growth in applying systems thinking and its concomitant approaches to understanding global flood risk management over the past two decades compared to other fields like water resource management and business management systems.A significant gap exists in the application of systems thinking methodologies to flood risk management research between developed and developing countries,particularly in Africa,highlighting the urgency of reoriented research and policy efforts.The application gaps of the study methodology are linked to challenges outlined in existing literature,such as issues related to technical expertise and resource constraints.This study advocates a shift from linear to holistic approaches in flood risk management,aligned with the Sendai Framework for Disaster Risk Reduction 2015-2023 and the Sustainable Development Goals.Collaboration among researchers,institutions,and countries is essential to address this global challenge effectively.

Anterior bone loss after cervical disc replacement: A systematic review

BACKGROUND Anterior bone loss(ABL)is a relatively easily neglected condition after cervical disc replacement(CDR).Whether this phenomenon is a radiological anomaly or a complication remains controversial.Several studies have reported the clinical characteristics of ABL and speculated on the pathogenic mechanism based on a certain type of artificial disc,while the overall understanding of ABL is lacking.AIM To describe the prevalence,impacts,and risk factors of ABL after CDR.METHODS We searched the PubMed,Cochrane Library,and Excerpta Medica databases using the terms“bone loss”or“bone remodeling”or“bone absorption”or“osteolysis”or“implant loosening”or“implant migration”or“hypersensitivity”or“hyperreactivity”,“cervical disc replacement”or“cervical disc arthroplasty”or“total disc replacement”.Eligible manuscripts on the prevalence and impacts of ABL were reviewed by the authors.Data extraction was performed using an established extraction form.The results of the included studies were described narratively.RESULTS Six studies met the inclusion and exclusion criteria.One was a prospective study and the others were retrospective studies.A total of 440 patients with 536 segments were included.The artificial cervical discs included Bryan,Baguera-C,Discocerv,and Mobi-C.The prevalence of ABL ranged from 3.13%to 91.89%,with a combined overall prevalence of 41.84%.ABL occurred within 6 mo and stopped 12 mo after surgery.Several cases were noted to have a self-healing process.Severe ABL resulted in segmental kyphosis,implant subsidence,and persistent neck pain.ABL may be related to heterotopic ossification.Multilevel surgery may be one of the risk factors for ABL.CONCLUSION ABL is a common condition after CDR.The underlying mechanisms of ABL may include stress concentration and injury to nutrient vessels.ABL should be considered a complication after CDR as it was associated with neck pain,implant subsidence,and heterotopic ossification.

Systematic overview of hepatitis C infection in the Middle East and North Africa

AIM To assess the quality of and to critically synthesize the available data on hepatitis C infections in the Middle East and North Africa(MENA) region to map evidence gaps.METHODS We conducted an overview of systematic reviews(SRs) following an a priori developed protocol(CRD42017076736). Our overview followed the preferred reporting items for systematic reviews and metaanalyses guidelines for reporting SRs and abstracts and did not receive any funding. Two independent reviewers systematically searched MEDLINE and conducted a multistage screening of the identified articles. Out of 5758 identified articles, 37 SRs of hepatitis C virus(HCV) infection in populations living in 20 countries in the MENA region published between 2008 and 2016 were included in our overview. The nine primary outcomes of interest were HCV antibody(anti-) prevalences and incidences in different at-risk populations; the HCV viremic(RNA positive) rate in HCV-positive individuals; HCV viremic prevalence in the general population(GP); the prevalence of HCV co-infection with the hepatitis B virus, human immunodeficiency virus, or schistosomiasis; the HCV genotype/subtype distribution; and the risk factors for HCV transmission. The conflicts of interest declared by the authors of the SRs were also extracted. Good quality outcomes reported by the SRs were defined as having the population, outcome, study time and setting defined as recommended by the PICOTS framework and a sample size > 100.RESULTS We included SRs reporting HCV outcomes with different levels of quality and precision. A substantial proportion of them synthesized data from mixed populations at differing levels of risk for acquiring HCV or at different HCV infection stages(recent and prior HCV transmissions). They also synthesized the data over long periods of time(e.g., two decades). Anti-HCV prevalence in the GP varied widely in the MENA region from 0.1%(study dates not reported) in the United Arab Emirates to 2.1%-13.5%(2003-2006) in Pakistan and 14.7%(2008) in Egypt. Data were not identified for Bahrain, Jordan, or Palestine. Good quality estimates of anti-HCV prevalence in the GP were reported for Algeria, Djibouti, Egypt, Iraq, Morocco, Pakistan, Syria, Sudan, Tunisia, and Yemen. Anti-HCV incidence estimates in the GP were reported only for Egypt(0.8-6.8 per 1000 person-year, 1997-2003). In Egypt, Morocco, and the United Arab Emirates, viremic rates in anti-HCV-positive individuals from the GP were approximately 70%. In the GP, the viremic prevalence varied from 0.7%(2011) in Saudi Arabia to 5.8%(2007-2008) in Pakistan and 10.0%(2008) in Egypt. Anti-HCV prevalence was lower in blood donors than in the GP, ranging from 0.2%(1992-1993) in Algeria to 1.7%(2005) in Yemen. The reporting quality of the outcomes in blood donors was good in the MENA countries, except in Qatar where no time framework was reported for the outcome. Some countries had anti-HCV prevalence estimates for children, transfused patients, contacts of HCV-infected patients, prisoners, sex workers, and men who have sex with men.CONCLUSION A substantial proportion of the reported outcomes may not help policymakers to develop micro-elimination strategies with precise HCV infection prevention and treatment programs in the region, as nowcasting HCV epidemiology using these data is potentially difficult. In addition to providing accurate information on HCV epidemiology, outcomes should also demonstrate practical and clinical significance and relevance. Based on the available data, most countries in the region have low to moderate anti-HCV prevalence. To achieve HCV elimination by 2030, up-to-date, good quality data on HCV epidemiology are required for the GP and key populations such as people who inject drugs and men who have sex with men.

Prevalence of anal human papillomavirus infection in patients with human immunodeficiency virus infection:A systematic review

BACKGROUND Human papillomavirus(HPV)is one of the most common sexually transmitted viruses nowadays.AIM To analyze the prevalence of HPV infection in human immunodeficiency virus(HIV)-positive patients and the risk factors associated with this infection through a review of studies published in the period from January 2010 to April 2020.METHODS A total of 384 articles were initially identified in our searches,of which ten were selected according to previously defined eligibility criteria.RESULTS Anal intercourse,absence of condom use,multiple partners,other specific sexual and life habits,and HIV infection are among the risk factors associated with anal HPV infection.CONCLUSION In general,there is a higher prevalence of anal HPV infection among HIV-positive patients,mostly in individuals over 30 years old,those with multiple partners,those who had an early homosexual debut,and cigarette,alcohol,and drug users.

中国实现碳中和:降碳风险的识别与应对

中国实现碳中和目标必将引发能源利用模式的深度变革,重塑各领域生产生活方式既是一场系统性变革,也面临微观与宏观的转型风险。从系统视角阐释中国零碳转型过程中降碳风险及其风险的系统传导机制,并基于低碳/零碳/负碳技术创新及转化的“研发—应用—推广”的阶段过程,解析了零碳转型过程中风险因素的传导路径;指出技术成熟度、产品绿色溢价、资产沉没成本、技术应用及供应链保障五类主要降碳风险,评估其对中国碳中和目标实现和社会经济发展的影响。提出中国需从系统视角慎重把握目标实现过程中的降碳风险,从政策引领、监测核算、科技人才、创新环境、国际合作等多方面共同发力和协同推进,全局把控设计应对政策措施,应深入实施低碳技术领跑者政策、加强碳排放核算与碳减排风险评估、积极培育壮大低碳技术研发力量、营造有利于低碳创新的社会环境。

数字经济市场风险的结构展开、成因分析与法治应对

数字经济成为当前推动我国经济结构转型、实现创新发展的新动能。但是在其发展中也表现出因技术的过度使用导致的数据安全以及市场垄断风险、因数字资产属性不明及监管滞后所导致的市场过度投机风险以及因数字经济环境关联性所导致的系统性金融风险。需要以法治化的方式应对数字经济的市场风险,首先以法律方式规范数字经济的技术使用标准与使用方式;其次以法律促进数字经济主体合规建设,同时并重对数字经济市场的法律监管;最后针对数字经济市场的系统性风险,以法律方式明确风险预警机制。将数字经济的发展引上健康发展轨道。