Household air pollution and lung cancer in China:a review of studies in Xuanwei

Over half of the world's population is exposed to household air pollution from the burning of solid fuels at home. Household air pollution from solid fuel use is a leading risk factor for global disease and remains a major public health problem, especially in low- and mid-income countries. This is a particularly serious problem in China, where many people in rural areas still use coal for household heating and cooking. This review focuses on several decades of research carried out in Xuanwei County, Yunnan Province, where household coal use is a major source of household air pollution and where studies have linked household air pollution exposure to high rates of lung cancer. We conducted a series of case-control and cohort studies in Xuanwei to characterize the lung cancer risk in this population and the factors associated with it. We found lung cancer risk to vary substantially between different coal types, with a higher risk associated with smoky(i.e., bituminous) coal use compared to smokeless(i.e., anthracite) coal use. The installation of a chimney in homes resulted in a substantial reduction in lung cancer incidence and mortality. Overall, our research underscores the need among existing coal users to improve ventilation, use the least toxic fuel, and eventually move toward the use of cleaner fuels, such as gas and electricity.

Colorectal cancer mortality in Hong Kong of China,Japan,South Korea,and Singapore

To clarify the trend in colorectal cancer mortality in Asian countries.We analyzed the colorectal cancer mortality in four Asian countries using the World Health Organization mortality database and the Korea National Statistics Office database.The annual age-standardized rates and truncated rated for the three age groups(30-49,50-69 and ≥ 70 years) for Hong Kong of China(1969-2009),Japan(1955-2009),South Korea(1985-2006),and Singapore(1966-2009) were estimated.A joinpoint regression model was used to detect significant trends in mortality rates.Colorectal cancer mortality in men started to decrease in 1992 in Japan followed by Singapore and Hong Kong of China in 1995.The mortality rates in women stared to decrease in 1980 in Singapore,followed by Hong Kong of China and Japan in 1996.In all countries and both genders,except for women in Singapore,the decrease in mortality began in the younger age groups.The colorectal cancer mortality in the four studied Asian countries has started to decrease,and the decrease occurred first in the younger age groups.

Dietary flavonoid intake and risk of stomach and colorectal cancer

Stomach and colorectal cancers are common cancers and leading causes of cancer deaths.Because the alimentary tract can interact directly with dietary components,stomach and colorectal cancer may be closely related to dietary intake.We systematically searched published literature written in English via PubMed by searching for terms related to stomach and colorectal cancer risk and dietary flavonoids up to June 30,2012.Twenty-three studies out of 209 identified articles were finally selected for the analysis.Log point effect estimates and the corresponding standard errors were calculated using covariate-adjusted point effect estimates and 95%CIs from the selected studies.Total dietary flavonoid intake was not associated with a reduced risk of colorectal or stomach cancer [odds ratio(OR)(95%CI) = 1.00(0.90-1.11) and 1.07(0.70-1.61),respectively].Among flavonoid subclasses,the intake of flavonols,flavan-3-ols,anthocyanidins,and proanthocyanidins showed a significant inverse association with colorectal cancer risk [OR(95%CI) = 0.71(0.63-0.81),0.88(0.79-0.97),0.68(0.56-0.82),and 0.72(0.61-0.85),respectively].A significant association was found only between flavonols and stomach cancer risk based on a limited number of selected studies [OR(95%CI) = 0.68(0.46-0.99)].In the summary estimates from casecontrol studies,all flavonoid subclasses except flavones and flavanones were inversely associated with colorectal cancer risk,whereas neither total flavonoids nor any subclasses of flavonoids were associated with colorectal cancer risk in the summary estimates based on the cohort studies.The significant association between flavonoid subclasses and cancer risk might be closely related to bias derived from the case-control design.There was no clear evidence that dietary flavonoids are associated with reduced risk of stomach and colorectal cancer.

Value of multi-quadrants biopsy:Pooled analysis of 11 population-based cervical cancer screening studies

Objective:The accuracy of colposcopy-guided biopsy is key to the success of colposcopic triage in cervical cancer screening programs.However,there is no widely adopted biopsy guideline up to date.Our study aimed to determine whether multi-quadrants biopsy improves the yield of cervical lesions.Methods:Eleven population-based cervical cancer screening studies were conducted in China.Cytology,highrisk human papillomavirus(hrHPV)testing and visual inspection were performed for primary screening.Females positive on one or more tests were referred for colposcopy and biopsy.The proportion of detected cervical intraepithelial neoplasia(CIN)2+and yields by quadrant lesion-targeted biopsy or 4-quadrant random biopsy were compared.Results:Among 4,923 females included,1,606 had quadrant lesion-targeted biopsy,and 3,317 had 4-quadrant random biopsy.The cumulative CIN2+yield increased from 0.10 for only one quadrant-targeted biopsy to 0.21,0.34,and 0.58 for at most two,three and four quadrants targeted biopsies.Among hrHPV positive females with high-grade squamous intraepithelial lesion(HSIL)+cytology,the cumulative CIN2+yield of a second targeted biopsy in another quadrant was significantly increased(P<0.05).Among hrHPV-negative females,the yield of 4-quadrant random biopsies was 0.005,and the yield by lesion-targeted biopsies was 0.017.For hrHPV positive females who had 4-quadrant random biopsy,the additional CIN2+yield for HSIL+,low-grade squamous intraepithelial lesion(LSIL)cytology,or abnormal visual inspection via acetic acid and Lugol’s iodine(VIA/VILI)were 0.46,0.11,0.14.Conclusions:A 4-quadrant random biopsy is recommended only for hrHPV positive females with HSIL cytology,and is acceptable if hrHPV positive with LSIL cytology or with abnormal VIA/VILI.Our findings add evidences for an objective and practical biopsy standard to guide colposcopy in cervical cancer screening programs in low-and middle-income countries.

Colors of vegetables and fruits and the risks of colorectal cancer

AIM To investigate the relationship between the colors of vegetables and fruits and the risk of colorectal cancer in Korea.METHODS A case-control study was conducted with 923 colorectal cancer patients and 1846 controls recruited from the National Cancer Center in Korea. We classified vegetables and fruits into four groups according to the color of their edible parts(e.g., green, orange/yellow, red/purple and white). Vegetable and fruit intake level was classified by sex-specific tertile of the control group. Logistic regression models were used for estimating the odds ratios(OR) and their 95% confidence intervals(CI).RESULTS High total intake of vegetables and fruits was strongly associated with a reduced risk of colorectal cancer in women(OR = 0.32, 95%CI: 0.21-0.48 for highest vs lowest tertile) and a similar inverse association was observed for men(OR = 0.60, 95%CI: 0.45-0.79). In the analysis of color groups, adjusted ORs(95%CI) comparing the highest to the lowest of the vegetables and fruits intake were 0.49(0.36-0.65) for green, and 0.47(0.35-0.63) for white vegetables and fruits in men. An inverse association was also found in women for green, red/purple and white vegetables and fruits. However, in men, orange/yellow vegetables and fruits(citrus fruits, carrot, pumpkin, peach, persimmon, ginger) intake was linked to an increased risk of colorectal cancer(OR = 1.61, 95%CI: 1.22-2.12).CONCLUSION Vegetables and fruits intake from various color groups may protect against colorectal cancer.

Non-exercise estimated cardiorespiratory fitness and cancer incidence:The NIH-AARP diet and health study

Background Non-exercise estimated cardiorespiratory fitness(NEE-CRF)has been shown to be associated with mortality,although its association with cancer incidence is unknown.The study aimed to assess the prospective association between NEE-CRF and cancer incidence in a large cohort of men and women.Methods The National Institutes of Health-American Association of Retired Persons diet and health study is a prospective cohort that included 402,548 participants aged 50–71 years who were free from cancer at baseline(1995–1996)(men(n=238,835)and women(n=163,713))and were followed until December 31,2015.The exposure variable was NEE-CRF expressed in metabolic equivalents.NEE-CRF was estimated using a validated equation of self-reported predictors on demographics and lifestyle behaviors derived from baseline questionnaires.Primary outcomes were total cancer incidence and incidence of prostate,breast,lung,and colorectal cancers.Cox proportional hazards models were analyzed for the association between NEE-CRF and cancer incidence outcomes adjusted for established cancer risk factors.Results During 13.7±3.2 years of follow-up(mean±SD),64,344 men and 31,315 women developed a new cancer.For every 1-metabolic equivalent higher NEE-CRF,the hazard ratios and 95%confidence intervals(95%CIs)were 0.96(95%CI:0.94–0.97)and 0.88(95%CI:0.84–0.92)of total and colorectal cancer incidence among men,and 0.95(95%CI:0.93–0.97)and 0.94(95%CI:0.91–0.97)of total and breast cancer incidence among women,respectively(all p<0.001).NEE-CRF was not associated with incidence of prostate and lung cancers in men or colorectal and lung cancers in women.Conclusion These results suggest that higher CRF levels,as assessed by the applied non-exercise estimated method,may provide preventive benefits against the development of cancer,while low CRF could potentially serve as a modifiable cancer risk factor.Integrating NEE-CRF into screening paradigms and referring low-fit individuals to improve CRF could complement the public health prevention strategy against cancer.

Gene-diet interactions in gastric cancer risk: A systematic review

AIM:To conduct a systematic review of the published epidemiological studies investigating the association of the interactions between gene variants and dietary intake with gastric cancer risk.METHODS:A literature search was conducted in PubMed,EMBASE,and MEDLINE for articles published between January 2000 and July 2013,and 38 studies were identified.Previous studies included various dietary factors(e.g.,fruits and vegetables,soybean products,salt,meat,and alcohol)and genetic variants that are involved in various metabolic pathways.RESULTS:Studies suggest that individuals who carry high-risk genetic variants and demonstrate particular dietary habits may have an increased risk of gastric cancer compared with those who do not carry high-risk genetic variants.Distinctive dietary patterns and variations in the frequency of genetic variants may explain the higher incidence of gastric cancer in a particular region.However,most previous studies have limitations,such as a small sample size and a retrospective casecontrol design.In addition,past studies have been unable to elucidate the specific mechanism in gene-diet interaction associated with gastric carcinogenesis.CONCLUSION:Additional large prospective epidemiological and experimental studies are required to identify the gene-diet metabolic pathways related to gastric cancer susceptibility.

Factors associated with metastasis in superior mesenteric vein lymph node in subtotal gastrectomy for gastric cancer:Retrospective case control study

Objective: The revised Japanese treatment guideline for gastric cancer recommends dissection of the superior mesenteric vein lymph node(No. 14v LN) if there is metastasis in infrapyloric lymph node(No. 6 LN). However,it is still controversial whether LN dissection is necessary. The aim of this study was to investigate the factors associated with metastasis in No. 14v LN.Methods: Patients who underwent D2 lymphadenectomy between 2003 and 2010 were included. We excluded patients who underwent total gastrectomy, had multiple lesions, or had missing data about the status of metastasis in the LNs that were included in D2 lymphadenectomy. Clinicopathologic characteristics and the metastasis in regional LNs were compared between patients with No. 14v LN metastasis(14v+) and those without(14v-).Results: Five hundred sixty patients were included in this study. Univariate analysis showed that old age, larger tumor size, tumor location, differentiation, lymphatic invasion, venous invasion, perineural invasion, T classification, and N classification were related to metastasis in No. 14v LN. Multivariate analysis showed differentiation(P=0.027) and N classification(P<0.001) were independent related factors. Metastasis in infrapyloric lymph node(No. 6 LN) and proxiaml splenic lymph node(No. 11p LN) was independently associated with metastasis in No. 14v LN.Conclusions: Differentiation and N classification were independent factors associated with No. 14v LN metastasis, and No. 6 and No. 11p LN metastasis were independent risk factors for No. 14v LN metastasis.

Clinical relevance of fluorodeoxyglucose positron emission tomography/computed tomography and magnifying endoscopy with narrow band imaging in decision-making regarding the treatment strategy for esophageal squamous cell carcinoma

BACKGROUND Recent advances in endoscopic technology,especially magnifying endoscopy with narrow band imaging(ME-NBI)enable us to detect superficial esophageal squamous cell carcinoma(ESCC),but determining the appropriate method of resection,endoscopic resection(ER)vs surgical resection,is often challenging.Recently,several studies have reported that 18F-fluorodeoxyglucose positron emission tomography(FDG-PET)is a useful indicator for decision-making regarding treatment for superficial ESCC.Although,there are not enough reports on association between FDG-PET uptake and clinicopathological characteristics of superficial ESCC.And,there are not enough reports on evaluating the usefulness of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.This study evaluated clinical relevance of FDG-PET and ME-NBI in decision-making regarding the treatment strategy for ESCC.AIM To investigate the association between FDG uptake and the clinicopathological characteristics of superficial ESCC and its usefulness of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.METHODS A database of all patients with superficial ESCC who had undergone both MENBI and FDG-PET for pre-treatment staging at Aichi Cancer Center Hospital between January 2008 and November 2018 was retrospectively analyzed.FDG uptake was defined positive or negative whether the primary lesion was visualized or could be distinguished from the background,or not.The invasion depth of ESCC was classified according to the Japan Esophageal Society.Primary endpoint is to evaluate the association between FDG uptake and clinicopathological characteristics of superficial ESCC.Secondary endpoint is to investigate the efficacy of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.RESULTS A total of 82 lesions in 82 patients were included.FDG-PET showed positive uptake in 29(35.4%)lesions.Univariate analysis showed that uptake of FDG-PET had significant correlations with circumferential extension(P=0.014),pathological depth of tumor invasion(P<0.001),infiltrative growth pattern(P<0.001),histological grade(P=0.002),vascular invasion(P=0.001),and lymphatic invasion(P<0.001).On multivariate analysis,only depth of tumor invasion was independently correlated with FDG-PET/computed tomography visibility(P=0.018).The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of Type B2 in ME-NBI for the invasion depth of T1a muscularis mucosae and T1b upper submucosal layer were 68.4%/79.4%/50.0%/89.3%/76.8%,respectively,and those of Type B3 for the depth of T1b middle and deeper submucosal layers(SM2 and SM3)were 46.7%/100%/100%/89.3%/90.2%,respectively.On the other hand,those of FDGPET for SM2 and SM3 were 93.3%/77.6%/48.2%/98.1%/80.5%,respectively,whereas,if the combination of positive FDG uptake and type B2 and B3 was defined as an indicator for radical esophagectomy or definitive chemoradiotherapy,the sensitivity,specificity,PPV,NPV,and accuracy were 78.3%/91.5%/78.3%/91.5%/87.8%,respectively.CONCLUSION FDG uptake was correlated with the invasion depth of superficial ESCC.Combined use of FDG-PET and ME-NBI,especially with the microvascular findings of Type B2 and B3,is useful to determine whether ER is indicated for the lesion.

Clinicopathological parameters predicting recurrence of pT1N0 esophageal squamous cell carcinoma

AIM To identify the clinicopathological characteristics of pT1 N0 esophageal squamous cell carcinoma(ESCC) that are associated with tumor recurrence. METHODS We reviewed 216 pT1 N0 thoracic ESCC cases who underwent esophagectomy and thoracoabdominal two-field lymphadenectomy without preoperative chemoradiotherapy. After excluding those cases with clinical follow-up recorded fewer than 3 mo and those who died within 3 mo of surgery, we included 199 cases in the current analysis. Overall survival and recurrencefree survival were assessed by the Kaplan-Meier method, and clinicopathological characteristics associated with any recurrence or distant recurrence were evaluated using univariate and multivariate Cox proportional hazards models. Early recurrence(≤ 24 mo) and correlated parameters were assessed using univariate and multivariate logistic regression models.RESULTS Forty-seven(24%) patients had a recurrence at 3 to 178(median, 33) mo. The 5-year recurrence-free survival rate was 80.7%. None of 13 asymptomatic cases had a recurrence. Preoperative clinical symptoms, upper thoracic location, ulcerative or intraluminal mass macroscopic tumor type, tumor invasion depth level, basaloid histology, angiolymphatic invasion, tumor thickness, submucosal invasion thickness, diameter of the largest single tongue of invasion, and complete negative aberrant p53 expression were significantly related to tumor recurrence and/or recurrence-free survival. Upper thoracic tumor location, angiolymphatic invasion, and submucosal invasion thickness were independent predictors of tumor recurrence(Hazard ratios = 3.26, 3.42, and 2.06, P < 0.001, P < 0.001, and P = 0.002, respectively), and a nomogram for predicting recurrence-free survival with these three predictors was constructed. Upper thoracic tumor location and angiolymphatic invasion were independent predictors of distant recurrence. Upper thoracic tumor location, angiolymphatic invasion, submucosal invasion thickness, and diameter of the largest single tongue of invasion were independent predictors of early recurrence.CONCLUSION These results should be useful for designing optimal individual follow-up and therapy for patients with T1 N0 ESCC.

Management of Helicobacter pylori infection in Latin America: A Delphi technique-based consensus

AIM: To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature.METHODS: Relevant questions were distributed among the experts, who generated draft statements for consideration by the entire panel. A modified three-round Delphi technique method was used to reach consensus. Critical input was also obtained from representatives of the concerned medical community. The quality of the evidence and level of recommendation supporting each statement was graded according to United States Preventive Services Task Force criteria.RESULTS: A group of ten experts was established. The survey included 15 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 50% in the first round, 73.3% in the second round and 100% in the third round. Main consensus recommendations included:(1) when available, urea breath and stool antigen test(HpSA) should be used for non-invasive diagnosis;(2) detect and eradicate Helicobacter pylori(H. pylori) in all gastroscopy patients to decrease risk of peptic ulcer disease, prevent o retard progression in patients with preneoplastic lesions, and to prevent recurrence in patients treated for gastric cancer;(3) further investigate implementation issues and health outcomes of H. pylorieradication for primary prevention of gastric cancer in high-risk populations;(4) prescribe standard 14-d triple therapy or sequential therapy for first-line treatment;(5) routinely assess eradication success post-treatment in clinical settings; and(6) select second- and third-line therapies according to antibiotic susceptibility testing.CONCLUSION: These achievable steps toward better region-specific management can be expected to improve clinical health outcomes.

Association of late-life changes in blood pressure and cognitive status

BackgroundDisagreement 在血压和认知缺陷在在变化之间的协会上存在。我们试图检验在收缩、心脏舒张的血压( SBP 和 DBP )的4年的变化是否从一件基于人口的德国样品(年老的 60-87 年)的 854 个参加者在老人的一件代表性的样品和纵的数据的 women.MethodsAnalysis 与认知地位被联系与标准认知屏蔽和血被执行迫使大小。在 SBP 和 DBP 的变化的效果(10 mmHg 和 5 mmHg 分别地作为回归效果联合起来测量) 用非参量、线性的回归 modeling.ResultsNo 在认知地位上被评估清楚的协会在 SBP 或在 DBP 和认知分数在变化之间被看见。小效果为性别和高血压了解在层化以后被发现。明确地，在 SBP 的更大的减少在知道他们的高血压的那些人与更高认知的分数被联系(在 SBP 的 10 mmHg 减少， &#x003b2；=&#x02212； 0.26， &#x000a0； 95% CI：&#x02212； 0.51 到 &#x02212； 0.02 ) 并且有控制高血压的人(在 SBP 的 10 mmHg 减少， &#x003b2；=&#x02212； 0.44， &#x000a0； 95% CI：&#x02212； 0.92 到 &#x02212； 0.03 ) 。DBP 的另外更大的增加与控制高血压在人与更高认知的分数被联系(DBP 的 5 mmHg 增加， &#x003b2；= 0.67， &#x000a0； 95% CI：0.19-1.15 ) 。为知道他们的高血压的女人，在 DBP 的更大的减少与更高认知的分数被联系(在 DBP 的 5 mmHg 减少， &#x003b2；=&#x02212； 0.26；95%CI：&#x02212； 0.51 到 &#x02212； 0.01 ) 在血压的 .ConclusionsChanges 仅仅微弱地与认知地位被联系。明确地，在 SBP 的减少在知道他们医学上被控制的高血压和特别那些的男人与更高认知的分数被联系。

Measurement of Electron Return Effect and Skin Dose Reduction by a Bolus in an Anthropomorphic Physical Phantom under a Magnetic Resonance Guided Linear Accelerator (MR-LINAC) System

Background: Magnetic resonance image-guided radiation therapy (MR-IGRT) promises more precise and effective radiation treatments compared to conventional IGRT by using real-time on-board MR imaging. Under the influence of a magnetic field, however, secondary electrons exiting a surface can be forced in a circular path and re-enter the medium, resulting in dose increase at a beam-exit surface, called the electron return effect (ERE). The purpose of the study is to compare the exit skin dose computed by Monte Carlo dose calculation with measurements using an adult anthropomorphic phantom and to measure the effect of skin dose reduction by adding 1 cm-thick bolus. Method: The plan was compared with measurements using an adult anthropomorphic phantom combined with radiochromic films and thermoluminescent dosimeters. We also measured the skin dose reduction by adding 1 cm-thick bolus on the frontal surface of the phantom. Results: We found that 1 cm-thick bolus reduced the skin dose by up to 20% both in measurements and calculations. The plan was found to overestimate the measured skin dose by about 10% and there was no significant difference in the bolus effect between the breast skin and the skin (without breast attachment) doses. Conclusion: In conclusion, we confirmed the ERE effect on the anthropomorphic phantom under the magnetic field and the exit skin dose reduction by adding a bolus. Skin dose measurements using anthropomorphic phantom may be helpful to evaluate more realistic skin dose and the bolus effect in the magnetic field.

Microalbuminuria in hepatitis C-genotype 4:Effect of pegylated interferon and ribavirin

AIM:To study the relation between hepatitis C virus (HCV) genotype 4 and microalbuminuria and renal impairment in relation to hepatic histology, and viremia in the absence of cryoglobulinemia, and to examine the effect of treatment on microalbuminuria.METHODS: Three hundred subjects, including 233 HCV genotype-4 infected patients, were tested for cryoglobulinemia, microalbuminuria, albumin creatinine ratio (ACR), urea, creatinine, and estimated glomerular filtration rate (eGFR). The parameters were measured again in the HCV patients after 48 wk of treatment with pegylated interferon and ribavirin.RESULTS: Significantly higher levels of microalbumin- uria were detected in HCV-positive patients compared to HCV-negative controls (median 9.5 vs 5.9, respectively, Kruskal-Wallis P=0.017). Log microalbuminuria was significantly correlated with hepatic inflammation (r=0.13, P=0.036) and f ibrosis (r=0.12, P=0.061), but not with viral load (r=-0.03, P=0.610), or alanine transaminase (r=-0.03, P=0.617). Diabetes mellitus neither significantly moderated (χ2=0.13, P=0.720), nor mediated (Sobel test P=0.49) the HCV effect. HCV status was signifi cantly associated with log microalbu-minuria (χ2=4.97, P=0.026), adjusting for age, gender, diabetes, cryoglobulinemia, urea and creatinine. A positive HCV status was not significantly associated with low eGFR (<60 mL/min every 1.73 m2) [odds ratio (OR): 0.5, 95% confidence interval (CI):0.2-1.4], nor with high ACR (OR: 1.7, 95% CI:0.7-4.1). End-of-treatment response (ETR) was achieved in 51.9% of patients. Individuals with ETR had significantly lower microalbuminuria post-treatment (χ2=8.19, P=0.004).CONCLUSION: HCV affected the development of microalbuminuria independent of diabetes or cryoglobulinemia. Combination therapy of pegylated interferon-ribavirin had a positive effect in reducing microalbuminuria.

Measurement of the Trace Elements Cu, Zn, Fe, and Mg and the Ultratrace Elements Cd, Co, Mn, and Pb in Limited Quantity Human Plasma and Serum Samples by Inductively Coupled Plasma-Mass Spectrometry

In public health studies limited volumes of blood are often collected and stored for future hypothesis testing. Archived samples are irreplaceable and therefore it is valuable to develop analytical techniques that require minimal sample vo-lume. This work describes the measurement of trace elements Mg, Cu, Fe, Zn and ultratrace elements Cd, Co, Mn, Pb in limited quantity (150 μL) human serum or plasma samples. Samples were digested using a hotblock and analyzed using inductively coupled plasma mass spectrometry (ICP-MS). The analytical method was evaluated using a quadrupole (Q) and sector field high resolution (SF) instrument to analyze trace elements in Seronorm? quality control serum material. The method was used to analyze 1888 blinded human plasma samples which were archived for the National Cancer Institute from the Nutrition Intervention Trial in Linxian China. The inductively coupled plasma method was capable of accurately analyzed limited quantity samples of human serum and plasma for the trace elements Mg, Cu, Fe Zn and the ultra trace elements Co, Mn and Pb. The concentration of Cd in human plasma samples was below the level of detection for 75% of the samples analyzed.

Somatic CDKN2A copy number variations are associated with the prognosis of esophageal squamous cell dysplasia

Background:Somatic copy number variations(SCNVs)in the CDKN2A gene are among the most frequent events in the dysplasia-carcinoma sequence of esophageal squamous cell carcinoma.However,whether CDKN2A SCNVs are useful biomarkers for the risk stratification and management of patients with esophageal squamous cell dysplasia(ESCdys)is unknown.This study aimed to investigate the characteristics and prognostic value of CDKN2A SCNVs in patients with mild or moderate(m/M)ESCdys.Methods:This study conducted a prospective multicenter study of 205 patients with a baseline diagnosis of m/M ESCdys in five high-risk regions of China(Ci County,Hebei Province;Yanting,Sichuan Province;Linzhou,Henan Province;Yangzhong,Jiangsu Province;and Feicheng,Shandong Province)from 2005 to 2019.Genomic DNA was extracted from paraffin biopsy samples and paired peripheral white blood cells from patients,and a quantitative polymerase chain reaction assay,P16-Light,was used to detect CDKN2A copy number.The cumulative regression and progression rates of ESCdys were evaluated using competing risk models.Results:A total of 205 patients with baseline m/M ESCdys were enrolled.The proportion of ESCdys regression was significantly lower in the CDKN2A deletion cohort than in the diploid and amplification cohorts(18.8%[13/69]vs.35.0%[28/80]vs.51.8%[29/56],P<0.001).In the univariable competing risk analysis,the cumulative regression rate was statistically significantly lower(P=0.008),while the cumulative progression rate was higher(P=0.017)in ESCdys patients with CDKN2A deletion than in those without CDKN2A deletion.CDKN2A deletion was also an independent predictor of prognosis in ESCdys(P=0.004)in the multivariable analysis.Conclusion:The results indicated that CDKN2A SCNVs are associated with the prognosis of ESCdys and may serve as potential biomarkers for risk stratification.

既往疾病史与胰腺癌关系的流行病学研究

目的：探讨既往疾病史与胰腺癌的关系。方法：采用全人群病例一对照研究，研究对象为1990年10月～1993年6月期间确诊的、年龄在35～74岁的上海市区451例胰腺癌新发病例以及按性别、年龄（5岁1组）频数配对的1552例人群对照。采用非条件logistic回归模型分析既往疾病史与胰腺癌的关系。结果：男性中，糖尿病患者（OR=4．49，95％CI：2．21～9．12）、慢性胰腺炎患者（OR=7．05，95％CI：1．93～25．75）、胆囊切除者（OR=4．02。95％CI：1．75～9．26）以及肝硬化者（OR=4．22，95％CI：1．68～10．59）发生胰腺癌的危险性显著增加；女性糖尿病患者（OR=3．58，95％CI：1．89～6．76）、慢性胰腺炎患者（OR=6．15，95％CI：1．88～20．06）、胆囊切除者（OR=2．91，95％CI：1．54～5．48）以及肝硬化者（OR=6．92，95％CI：1．08～44．49）。去除胰腺癌诊断前或调查前5年内出现上述疾病史的研究对象后，男性糖尿病患者胰腺癌危险性仍显著增加（OR=3．47，95％CI：1．09～11．06）。其余结果虽多数危险性也升高，但均未达显著水平。结论：糖尿病、慢性胰腺炎、胆囊切除以及肝硬化病史可能会增加胰腺癌的发病风险，上述疾病史可能在胰腺癌病因学中起一定的作用。

手术对Ⅳ期胆囊癌预后的影响

目的分析不同手术方式对Ⅳ期胆囊癌预后的影响。方法对1997年6月～2001年5月间上海市172例Ⅳ期胆囊癌病例进行临床病理分析,并对获得随访的164例的预后与手术方式的关系进行探讨。数据分析采用Kaplan-Meier法。结果 172例中未手术者44例(25．6％),手术者128例(74．4％),其中包括单纯胆囊切除术45例(35．1％)、胆囊癌根治性切除术17例(13．3％)、胆囊癌扩大根治性切除术5例(3．9％)和剖腹探查术61例(47．7％)。在行根治性切除者中,Ⅳa和Ⅳb期的1年生存率分别为69．2％和40．7％,明显好于胆囊未切除或单纯切除者,在Ⅳa和Ⅳb期中各有2例存活期超过5年。结论有选择地进行Ⅳ期胆囊癌根治性或扩大根治性手术,有助于改善预后。

上海市胆道癌病理形态特征的初步观察：附487例分析

目的研究上海市区居民胆道癌病理形态特征和鉴别诊断。方法自1997年6月～2001年5月在上海市区开展基于全人群的胆道癌病例-对照研究,总共收集病理切片1228例,包括胆道癌487例(其中胆囊癌322例,肝外胆管癌105例和壶腹癌60例),胆道结石和胆囊炎对照病例721例,胆道腺瘤20例,由中、美资深病理医师复查,按世界卫生组织1991年胆囊和肝外胆管肿瘤组织学分型进行分类。结果病理标本以切除标本为主,肿瘤大小为多数小于4cm,组织学类型中70％以上为腺癌,肿瘤组织学分级以高分化和中分化占绝大多数,TNM分期中0～Ⅱ期的胆囊癌和肝外胆管癌约占1／3,壶腹癌近2／3。病理复查结果显示诊断过头占1．8％,诊断不足占0．6％,漏诊占0．1％；随访结果显示根治术后的5年生存率：胆囊癌40．7％、肝外胆管癌11．1％和壶腹癌26．9％。结论病理复查可以统一诊断标准,提高确诊率,为全人群病例-对照研究和多学科协作积累经验。

上海市区195例胆管癌临床分析

目的:总结胆管癌诊治现状。方法:分析1997年5月至2001年5月上海市区常住居民中35～74岁的195例胆管癌新病例资料。结果:上、中、下段胆管癌分别占56.4%、13.4%和17.4%,联合部位者占12.8%。胆管癌明显好发于老年病人,60～74岁年龄段病人占74.9%。就诊时94.4%的病人已出现黄疸。50例行根治性切除术,术后1、2、3年生存率分别为57.1%、44.7%和26.1%。80例行姑息性引流术,1年、2年、3年生存率分别为27.5%、5.5%和1.8%。38例行胆管内支撑法治疗,平均生存时间7个月左右。经1～5年随访,全组仅9.7%(19/195)的病人存活。结论:胆管癌诊断困难,预后很差。提高疗效的措施在于:规范诊疗操作技术;积极进行手术探查;普及应用新技术;术后采用综合性治疗措施。