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Background: Adherence-to-colonoscopy in cascade screening of colorectal cancer (CRC) is crucial to the effectiveness of screening, but it has not been systematically evaluated. We aimed to evaluate the colonoscopy adherence among average-risk populations globally. Methods: We searched Pubmed, Embase, Web of Science, and Cochrane Library for observational and experimental studies published in English up to December 31, 2018 and reporting the colonoscopy adherence following positive initial screening. We calculated pooled adherence with its 95% confidence intervals (CIs) using a random-effects meta-analysis. Subgroup and mixed-effects meta-regression analysis were performed to evaluate heterogeneous factors for adherence. Findings: Of 9,772 articles identified, 191 (313 studies) were included in the systematic review. The pooled adherence-to-colonoscopy was 81·6% (95% CI: 79·6-83·4), with the estimates varying substantially by continents, CRC incidence, GDP per capita, recruitment method, screening round and type of initial test. Type of initial test was the most modifiable heterogeneous factor for adherence across studies (Q=53·00, P

OBJECTIVES This study aimed to evaluate the most updated worldwide distribution, risk factors, and temporal trends of cervical cancer for different countries and age groups. METHODS The Global Cancer Observatory database was retrieved for the age-standardized rates (ASRs, per 100,000 persons) for incidence and mortality of cervical cancer in 2018. The associations with risk factors were examined by multivariable regression analysis, adjusting for human development index (HDI) and gross domestic products (GDP) per capita. Joinpoint regression analysis was used to calculate the 10-year annual average percent change (AAPC) for incidence and mortality. RESULTS A total of 568,847 new cases (ASR, 13.1) and 311,365 deaths (ASR, 6.9) of cervical cancer were reported globally in 2018. The highest incidence and mortality were observed in Southern Africa (ASRs, 43.1 and 20.0) and countries with low HDI (ASRs, 29.8 and 23.0). Countries with higher incidence and mortality had lower HDI (β = -8.19, 95% CI -11.32 to -5.06, p

BACKGROUND Pneumococcal infection is a leading cause of disability and death globally. The Hong Kong Government has launched two programmes for pneumococcal vaccination - The Vaccination Subsidy Scheme (VSS) and the Government Vaccination Programme (GVP). This study aimed to examine the enabling factors, obstacles and perception of pneumococcal vaccination, and their association with its uptake in a general Chinese population. METHODS We performed a population-based, telephone survey in the general public aged 65 or above via simple random sampling. A validated survey based on the Health Belief Model (HBM) was used. Their socio-demographic information; history of previous participation in the GVP or VSS; and self-perceived health status were captured. Binary logistic regression models were constructed to examine the factors independently associated with vaccination. RESULTS A total of 1,000 respondents were enrolled in the study, with 402 (40.2%) respondents having intention to join the GVP/VSS in 12 months. Respondents with long-term medical consultant and medication (adjusted odds ratios [aOR] = 1.541, 95% confidence interval (CI): 1.008-2.356, p = 0.046); high levels of perceived susceptibility of infections (aOR = 3.624, 95 %CI: 2.318-5.665, p

Background Alcohol screening and brief intervention (SBI) is recommended to be implemented in primary care settings to intervene against hazardous/harmful drinking. However, studies showed that the uptake rate was low in many regions/countries. This systematic review presented current findings on the facilitators and barriers of SBI implemented by health professionals in primary care settings using the Consolidated Framework for Implementation Research (CFIR). Methods We included qualitative, quantitative, and mixed-method studies identified through four electronic databases (PubMed, MEDLINE, PsycInfo, and Web of Science) from inception to June 2020. Included articles had to address barriers and facilitators of SBI implementation and provide sufficient details that the CFIR domains could be identified and data were abstracted using a standardized extraction form. Results A total of 74 studies published from 1985 to 2019 were finally analysed and summarized. The most common facilitators were knowledge and positive beliefs about SBI (characteristics of the individuals) and available resources (inner setting). In contrast, the most common barriers were cost related to implementing SBI (intervention characteristics), negative beliefs about SBI (characteristics of the individuals), and lack of self-efficacy in implementing SBI (characteristics of the individuals). It could be observed that factors related to the inner setting and characteristics of individuals were extensively studied whilst the process received the least attention. Conclusions Most of the facilitators and barriers are modifiable. Additionally, most literature focused on various kinds of available assets to implement SBI. To promote the spread of SBI implementation, more high-quality studies on the implementation process are needed. This systematic review could serve as a reference framework for health authorities to devise strategies for improving the implementation of SBI in primary care settings. Trial registration This systematic review was registered in PROSPERO (CRD42021258833).

Blockchain is a mainstream technology in which many untrustworthy nodes work together to maintain a distributed ledger with advantages such as decentralization, traceability, and tamper-proof. The network layer communication mechanism in its architecture is the core of the networking method, message propagation, and data verification among blockchain nodes, which is the basis to ensure blockchain’s performance and key features. When blocks are propagated in peer-to-peer (P2P) networks with gossip protocol, the high propagation delay of the protocol itself reduces the propagation speed of the blocks, which is prone to the chain forking phenomenon and causes double payment attacks. To accelerate the propagation speed and reduce the fork probability, this paper proposes a blockchain network propagation mechanism based on proactive network provider participation for P2P (P4P) architecture. This mechanism first obtains the information of network topology and link status in a region based on the internet service provider (ISP), then it calculates the shortest path and link overhead of peer nodes using P4P technology, prioritizes the nodes with good local bandwidth conditions for transmission, realizes the optimization of node connections, improves the quality of service (QoS) and quality of experience (QoE) of blockchain networks, and enables blockchain nodes to exchange blocks and transactions through the secure propagation path. Simulation experiments show that the proposed propagation mechanism outperforms the original propagation mechanism of the blockchain network in terms of system overhead, rate of data success transmission, routing hops, and propagation delay.

Introduction The association between proton pump inhibitors' (PPIs) use and mortality remains unclear. Methods This was a prospective analysis of 440,840 UK residents and 13,154 deaths. We evaluated the associations with multivariate Cox regression. Results After adjusting for confounders, such as over health status and longstanding diseases, the regular use of PPIs was not associated with an increased risk of all-cause mortality and mortality due to neoplasms, circulatory system diseases, respiratory system diseases, digestive system diseases, external causes, and other causes. Discussion Regular use of PPIs was not associated with an increased risk of all-cause and cause-specific mortality.

Background Surgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC) and the survival of patients after radical resection is closely related to relapse. We aimed to develop models to predict the risk of relapse using machine learning methods based on multiple clinical parameters. Methods Data were collected and analysed of 262 PDAC patients who underwent radical resection at 3 institutions between 2013 and 2017, with 183 from one institution as a training set, 79 from the other 2 institution as a validation set. We developed and compared several predictive models to predict 1- and 2-year relapse risk using machine learning approaches. Results Machine learning techniques were superior to conventional regression-based analyses in predicting risk of relapse of PDAC after radical resection. Among them, the random forest (RF) outperformed other methods in the training set. The highest accuracy and area under the receiver operating characteristic curve (AUROC) for predicting 1-year relapse risk with RF were 78.4% and 0.834, respectively, and for 2-year relapse risk were 95.1% and 0.998. However, the support vector machine (SVM) model showed better performance than the others for predicting 1-year relapse risk in the validation set. And the k neighbor algorithm (KNN) model achieved the highest accuracy and AUROC for predicting 2-year relapse risk. Conclusions By machine learning, this study has developed and validated comprehensive models integrating clinicopathological characteristics to predict the relapse risk of PDAC after radical resection which will guide the development of personalized surveillance programs after surgery.

This paper introduces and studies hypo-EP matrices of adjointable operators on Hilbert C ∗ -modules, based on the generalized Schur complement. The necessary and sufficient conditions for some modular operator matrices to be hypo-EP are given, and some special circumstances are also analyzed. Furthermore, an application of the EP operator in operator equations is given.

Background: This study investigated socioeconomic inequalities in premature cancer mortality by cancer types, and evaluated the associations between socioeconomic status (SES) and premature cancer mortality by cancer types. Methods: Using multiple databases, cancer mortality was linked to SES and other county characteristics. The outcome measure was cancer mortality among adults ages 25–64 years in 3,028 U.S. counties, from 1999 to 2018. Socioeconomic inequalities in mortality were calculated as a concentration index (CI) by income (annual median household income), educational attainment (% with bachelor's degree or higher), and unemployment rate. A hierarchical linear mixed model and dominance analyses were used to investigate SES associated with county-level mortality. The analyses were also conducted by cancer types. Results: CIs of SES factors varied by cancer types. Low-SES counties showed increasing trends in mortality, while high-SES counties showed decreasing trends. Socioeconomic inequalities in mortality among high-SES counties were larger than those among low-SES counties. SES explained 25.73% of the mortality. County-level cancer mortality was associated with income, educational attainment, and unemployment rate, at −0.24 [95% (CI): −0.36 to −0.12], −0.68 (95% CI: −0.87 to −0.50), and 1.50 (95% CI: 0.92–2.07) deaths per 100,000 population with one-unit SES factors increase, respectively, after controlling for health care environment and population health. Conclusions: SES acts as a key driver of premature cancer mortality, and socioeconomic inequalities differ by cancer types. Impact: Focused efforts that target socioeconomic drivers of mortalities and inequalities are warranted for designing cancer-prevention implementation strategies and control programs and policies for socioeconomically underprivileged groups.

Background and study aims Serrated lesions are precursors of approximately one-third of colorectal cancers (CRCs). Information on their detection rate was lacking as an important reference for CRC screening. This study was a systematic review and meta-analysis to determine the overall detection rate for serrated lesions and their subtypes in average-risk populations undergoing CRC screening with colonoscopy. Patient and methods MEDLINE and Embase were searched to identify population-based studies that reported the detection rate for serrated lesions. Studies on average-risk populations using colonoscopy as a screening tool were included. Metaprop was applied to model within-study variability by binomial distribution, and Freeman-Tukey Double Arcsine Transformation was adopted to stabilise the variances. The detection rate was presented in proportions using random-effects models. Results In total, 17 studies involving 129,001 average-risk individuals were included. The overall detection rates for serrated lesions (19.0 %, 95 % CI = 15.3 %–23.0 %), sessile serrated polyps (2.5 %, 95 % CI = 1.5 %–3.8 %), and traditional serrated adenomas (0.3 %, 95 % CI = 0.1 %–0.8 %) were estimated. Subgroup analysis indicated a higher detection rate for serrated lesions among males (22.0 %) than females (14.0 %), and Caucasians (25.9 %) than Asians (14.6 %). The detection rate for sessile serrated polyps was also higher among Caucasians (2.9 %) than Asians (0.7 %). Conclusions This study determined the overall detection rate for serrated lesions and their different subtypes. The pooled detection rate estimates can be used as a reference for establishing CRC screening programs. Future studies may evaluate the independent factors associated with the presence of serrated lesions during colonoscopy to enhance their rate of detection.

Appearance information is one of the most important matching indicators for multi-object data association. In tracking by detection model, appearance information and detection information are usually integrated in the same sub-network for learning and output. This phenomenon will result in the appearance embedding vectors to be coupled to the network inference method during learning stage. As a result, the appearance embedding vectors contains too much background information and affects the accuracy of data association. Based on the non-end-to-end tracking model, we design an appearance guidance attention module for the appearance extraction branch. This module can effectively strengthen the network’s learning of the object visual appearance features and reduce the attention in the learning of background features. Finally, we utilize the appearance embedding vectors that decoupled from the inference method as the input of the back-end tracker and perform data association. The proposed method is tested on the MOT16 and MOT17 datasets. Experiments show that the proposed method provides more high-quality appearance representation information for the back-end tracker and the tracking performance on two datasets is better than other comparison models. At the same time, our model can reach 24.9FPS on a single 1080Ti GPU. The code is available at: https://github.com/JoJoliking/AGM

BACKGROUND: Vaccines for COVID-19 are anticipated to be available by 2021. Vaccine uptake rate is a crucial determinant for herd immunity. We examined factors associated with acceptance of vaccine based on (1). constructs of the Health Belief Model (HBM), (2). trust in the healthcare system, new vaccine platforms and manufacturers, and (3). self-reported health outcomes. METHODS: A population-based, random telephone survey was performed during the peak of the third wave of COVID-19 outbreak (27/07/2020 to 27/08/2020) in Hong Kong. All adults aged ≥ 18 years were eligible. The survey included sociodemographic details; self-report health conditions; trust scales; and self-reported health outcomes. Multivariable regression analyses were applied to examine independent associations. The primary outcome is the acceptance of the COVID-19 vaccine.RESULTS: We conducted 1200 successful telephone interviews (response rate 55%). The overall vaccine acceptance rate after adjustment for population distribution was 37.2% (95% C.I. 34.5–39.9%). The projected acceptance rates exhibited a “J-shaped” pattern with age, with higher rates among young adults (18–24 years), then increased linearly with age. Multivariable regression analyses revealed that perceived severity, perceived benefits of the vaccine, cues to action, self-reported health outcomes, and trust in healthcare system or vaccine manufacturers were positive correlates of acceptance; whilst perceived access barriers and harm were negative correlates. Remarkably, perceived susceptibility to infection carried no significant association, whereas recommendation from Government (aOR = 10.2, 95% C.I. 6.54 to 15.9, p < 0.001) was as the strongest driving factor for acceptance. Other key obstacles of acceptance included lack of confidence on newer vaccine platforms (43.4%) and manufacturers without track record (52.2%), which are of particular relevance to the current context.CONCLUSIONS: Governmental recommendation is an important driver, whereas perceived susceptibility is not associated with acceptance of COVID-19 vaccine. These HBM constructs and independent predictors inform evidence-based formulation and implementation of vaccination strategies.

Objectives The objective of this study was to evaluate the effectiveness of percutaneous mechanical thrombectomy as the initial thrombus removal method in the treatment of acute lower extremity ischemia. Methods The patients with acute lower limb ischemia who underwent percutaneous mechanical thrombectomy between August 2016 and February 2018 were retrospectively reviewed. The patients were diagnosed by clinical examination and computed tomography angiography. The percutaneous mechanical thrombectomy was performed as the initial thrombus removal method, followed by anticoagulation therapy. The patients were followed up by clinical examination, imaging, and ankle brachial index (ABI) examination. Results Thirty-two patients (21 males, 11 females; average age of 68.53 ± 8.05; three cases of grade III, 29 cases of grade IIB) were reviewed. Recanalization of the thromboembolic occlusions were achieved in all patients. ABI significantly ( p Conclusions The immediate result appeared to be effective to use percutaneous mechanical thrombectomy as the first thrombus removal method in the treatment of acute thromboembolic occlusions in the lower extremity, while the midterm result needs to be further improved.

To gain insights into the role of testosterone in the development of atherosclerosis and its related metabolic pathways, we applied a proton nuclear magnetic resonance (1H NMR)-based metabolomics approach to investigate urine metabolic profiles in miniature pigs fed a high-fat and high-cholesterol (HFC) diet among intact male pigs (IM), castrated male pigs (CM) and castrated male pigs with testosterone replacement (CMT). Our results showed that testosterone deficiency significantly increased atherosclerotic lesion areas, intima-media thickness, as well as serum lipid levels in the CM pigs. Moreover, seventeen significantly changed metabolites were identified in both IM vs. CM and CMT vs. CM groups. Among these, seven were shared between the two comparative groups and were all significantly reduced in the urine of the CM group but rescued in the CMT group. In addition, the correlation analysis demonstrated that several metabolites, including niacinamide, myo-inositol, choline and 3-hydroxyisovalerate, were negatively correlated with atherosclerotic lesion areas. Our study demonstrated that testosterone deficiency accelerated early AS formation in HFC diet-fed pigs, which involved several metabolites predominantly related to lipid metabolism, inflammation, oxidative stress and endothelial disorders. Our results reveal potential pathways in the pathogenesis of atherosclerosis caused by testosterone deficiency and HFC diet.

The Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) is believed to share similar characteristics with SARS in 2003 and Mediterranean East Respiratory Syndrome (MERS) in 2012. We hypothesized that countries with previous exposure to SARS and MERS were significantly more likely to have fewer cases and deaths from coronavirus disease 2019 (COVID-19). We retrieved the incidence of COVID-19 per 100,000 population within 30 days since the first confirmed case was reported from the 2019 Novel COVID-19 data repository by the Johns Hopkins Centre for Systems Science and Engineering for 94 countries. The association between previous exposure to SARS and/or MERS and the 30-day COVID-19 incidence rate was examined by multivariable linear regression analysis, whilst controlling for potential confounders including the INFORM COVID-19 Risk Index, Testing Policies, Democracy Index, Scientific Citation Index, Gross Domestic Product (GDP), Human Development Index (HDI) and the population density of each country. We found that countries with previous exposure to SARS and/or MERS epidemics were significantly more likely to have lower incidence of COVID-19 (β coefficient - 225.6, 95% C.I. - 415.8,- 35.4, p = 0.021). However, countries being classified as having "full democracy" using Democracy Index had higher incidence of COVID-19 (reference: authoritarian regime; β coefficient 425.0, 95% C.I. 98.0, 752.0, p = 0.011). This implies that previous exposure to global epidemics and Democracy Index for a country are associated its performance in response to COVID-19. We recommend future studies should evaluate the impact of various pandemic control strategies at individual, community, and policy levels on mitigation of the disease.

Background Autologous adipose tissue grafting is a valuable strategy for breast reconstruction in breast cancer patients. However, adipose tissue is absorbed and liquefies easily, and the cosmetic effects do not last. The purpose of this study is to evaluate the cosmetic effects and histopathologic changes of the prostheses produced by inactivated autologous subcutaneous adipose tissue and dermal outer capsule in the mini-pig model. Methods This prospective study was conducted in 6 Bama adult female mini-pigs weighing 15.5–20 kg. Autologous subcutaneous adipose tissue and dermis were harvested and made into the different prostheses. Then, the prostheses were implanted into abdominal subcutaneous tissue of the mini-pigs. At the 14th and 30th day after implantation, the skin appearances were observed, and the prostheses were harvested. The histopathologic changes of adipocytes and dermis in the different prostheses were evaluated. Results In vitro experiments showed that there were no significant changes in the size and histomorphology of autologous adipose tissue and/or dermis in the different prostheses. However, the results of the in vivo experiment found that the prosthesis produced by the inactivated adipose tissue with a dermal outer capsule produced the best cosmetic effect and the least fibrous connective tissue proliferation around the prosthesis. Moreover, the fewest proliferative fibrous connective tissues and infiltrated inflammatory cells were found in the adipocytes wrapped by dermis. The adipocyte morphology was normal. Conclusions Results in this animal model indicated that the prosthesis produced by inactivated autologous subcutaneous adipose tissue with a dermal outer capsule may be a promising prosthesis for breast reconstruction. Validation of this new prosthesis requires more experiments to assess the long-term cosmetic effects and histopathologic changes.

Background Although randomized controlled trials (RCTs) have suggested a non-significant increased risk of stroke among proton pump inhibitor (PPI) users, the association has not been confirmed. We evaluated the association between regular use of PPIs and incident stroke and identified population groups at high net risk. Methods This is a prospective analysis of 492,479 participants free of stroke from the UK biobank. Incident stroke was identified through linkage to hospital admission and death registries using the International Classification of Diseases (ICD)-10 codes (I60, I61, I63, and I64). We evaluated hazard ratios (HRs) adjusting for demographic factors, lifestyle habits, prevalent comorbidities, concomitant use of medications, and indications of PPIs. We assessed the risk differences (RDs) according to the baseline Framingham Stroke Risk Score. In the meta-analysis, we searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (from 1988 to 1 June 2020) for randomized trials comparing PPIs with other interventions, placebo, or no treatment on stroke risk. Results were combined using a fix-effect meta-analysis (Mantel-Haenszel method). Results We documented 5182 incident strokes over 3,935,030 person-years of follow-up. Regular PPI users had a 16% higher risk of stroke than non-users (HR 1.16, 95% CI 1.06 to 1.27). The estimated effect was similar to our meta-analysis of nine RCTs (case/participants 371/26,642; RR 1.22, 95% CI 1.00 to 1.50; quality of evidence: moderate). The absolute effect of PPI use on stroke increased with the baseline Framingham Stroke Risk Score, with an RD of 1.34‰, 3.32‰, 4.83‰, and 6.28‰ over 5 years for the lowest, quartile 2, quartile 3, and the highest quartile, respectively. Conclusions Regular use of PPIs was associated with an increased risk of stroke, with a higher absolute risk observed in individuals with high baseline stroke risk. Physicians should therefore exercise caution when prescribing PPIs. An assessment of the underlying stoke risk is recommended for individualized use of PPIs.

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. Funding Bill & Melinda Gates Foundation.

Background To evaluate the long-term association between organised colorectal cancer (CRC) screening and reduction of CRC-related mortality. Methods We systematically reviewed studies on organized CRC screening through PubMed, Ovid Medline, Embase and Cochrane database from its inception to November 2020. Moreover, we retrieved the matched CRC-related mortality (over 50 years) of those areas from the initial year of CRC screening programmes to the latest data available obtained from the International Agency for Research on Cancer (IARC). The mortality in the initial year and the latest year was used to calculate the age-standardised mortality ratio (ASMR). We adopted a random-effects model to synthesis the ASMR. Subgroup analyses were performed according to the screening period and modalities. Furthermore, a linear mixed model (LMM) was conducted as a sensitivity analysis. Results CRC screening programmes have been conducted in 58 countries/regions. After matching with the IARC database, we recorded >2.5 million CRC-related deaths from 22 countries where rollout screening programmes were performed. The screening modality with a provision of choice between faecal tests and colonoscopy as the primary screening test was associated with a 38.1% reduction in CRC mortality (ASMR=0.619, 95%CI: 0.549-0.698), which was higher than programmes that offered guaiac faecal occult blood test (gFOBT) (0.894, 0.835-0.958), faecal immunochemical tests (FIT) (0.879, 0.847-0.913), gFOBT or FIT (0.882, 0.835-0.932), and faecal tests or flexible sigmoidoscopy (0.840, 0.786-0.898). The longer duration of screening was associated with a higher reduction in the pooled ASMR. In particular, the pooled ASMR became non-significant (0.987, 0.934-1.043) when the FIT screening was implemented for less than 5 years (IDDF2021-ABS-0179 Figure 1. The pooled age-standardised colorectal cancer-related mortality ratio by screening modalities and screening duration). The LMM result also showed a 0.172 decrease in ASMR (P Conclusions A CRC screening programme running for >5 years was associated with a reduction of CRC-related mortality. Countries with a heavy burden of CRC should implement sustainable, organised CRC screening providing a choice between faecal tests and colonoscopy as a preferred primary screening test.

Over the past years, wind energy has been considered as a promising solution for clean and sustainable energy development, but wind curtailment remains a challenge to wind power development. On this basis, utilization of non‐grid‐connected wind power becomes crucial and necessary as it can mitigate wind curtailment and improve energy efficiency. This paper proposes the collaboration strategy and optimization model of wind farm‐hybrid energy storage system (WF‐HESS) for non‐grid‐connected wind power based on battery and superconducting magnetic energy storage (SMES) whose combination can effectively cope with fluctuation and intermittence of wind input. The optimization problem is simultaneously investigated by the minimization of total cost, wind curtailment magnitude, and loss of power supply probability (LPSP). The multi‐objective particle swarm optimization (MOPSO) is introduced to find available solutions, and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) is applied to determine the optimal one. Results are obtained for a case study, and the effectiveness and the feasibility of proposed model are verified by a comparative analysis and a sensitivity analysis. Results analysis and discussion show that the WF‐HESS model and the application of HESS have important influence on promoting utilization of non‐grid‐connected wind power and mitigating wind curtailment.

Globally, colorectal cancer (CRC) is a substantial public health burden, and it is increasingly affecting populations in Asian countries. The overall prevalence of CRC is reported to be low in Asia when compared with that in Western nations, yet it had the highest number of prevalent cases. This review described the prevalence of CRC in Asia according to the International Agency for Research on Cancer from World Health Organization (WHO) database and summarized its major risk factors. Non-modifiable factors include genetic factors, ethnicity, age, gender, family history and body height; smoking, alcohol drinking, weight, Westernized diet, physical inactivity, chronic diseases and microbiota were involved in environmental factors. These risk factors were separately discussed in this review according to published literature from Asian countries. CRC screening has been playing an important role in reducing its disease burden. Some recommendations on its screening practices have been formulated in guidelines for Asia Pacific countries.

Key Points Question Is the global burden of gastric cancer increasing in younger adults compared with older adults? Findings In this cohort study of data from 1980 to 2018 covering more than 1 million cases of gastric cancer, an increasing incidence of gastric cancer was observed in individuals younger than 40 years in a significant number of countries, including Sweden, the UK, and Ecuador. Meaning These findings suggest that the prevention of gastric cancer should become a priority in clinical guidelines and policy agendas to ameliorate its associated morbidity and mortality, especially among younger populations., Importance Gastric cancer is one of the most common cancers, with a high mortality-to-incidence ratio. It is uncertain whether developed nations may encounter an increasing burden of gastric cancer in young adults, as occurs for other cancers. Objectives To evaluate the incidence and mortality of gastric cancer and compare the global incidence trends between younger (, This cohort study uses data from national and global cancer registries to evaluate the incidence and mortality of gastric cancer between 1980 and 2018 and compares the global incidence between younger and older populations.

This study aimed to evaluate the global distribution, associated factors, and epidemiologic trends of gallbladder cancer (GBC) by country, sex, and age groups. The Global Cancer Observatory was interrogated for the disease burden of GBC using age-standardized rates (ASR). The prevalence of different potential risk factors for each country was extracted from Global Health Observatory and their associations with GBC incidence and mortality were examined by linear regression analysis using beta coefficients (β). The Cancer Incidence in Five Continents I-XI and the WHO Mortality database were searched and Average Annual Percent Change (AAPC) was generated from joinpoint regression analysis. The incidence (ASR = 2.3) and mortality (ASR = 1.7) of GBC varied globally in 2018 and were higher in more developed countries and among females. Countries with higher incidence had higher human development index (βmale = 0.37; βfemale = 0.27), gross domestic products (βmale = 0.13) and higher prevalence of current smoking (βfemale = 0.05), overweight (βmale = 0.02), obesity (βmale = 0.03), and hypercholesterolaemia (βmale = 0.07). Similar patterns of associations were also observed for mortality with an additional association found for diabetes (βfemale = 0.07). Although there was an overall decreasing trend in mortality, an increasing trend in incidence was observed among some populations, particularly in males (AAPCs, 8.97 to 1.92) and in younger individuals aged

We propose the new problem of learning to recover reasoning chains from weakly supervised signals, i.e., the question-answer pairs. We propose a cooperative game approach to deal with this problem, in which how the evidence passages are selected and how the selected passages are connected are handled by two models that cooperate to select the most confident chains from a large set of candidates (from distant supervision). For evaluation, we created benchmarks based on two multi-hop QA datasets, HotpotQA and MedHop; and hand-labeled reasoning chains for the latter. The experimental results demonstrate the effectiveness of our proposed approach.

Finding codes given natural language query isb eneficial to the productivity of software developers. Future progress towards better semantic matching between query and code requires richer supervised training resources. To remedy this, we introduce the CoSQA dataset.It includes 20,604 labels for pairs of natural language queries and codes, each annotated by at least 3 human annotators. We further introduce a contrastive learning method dubbed CoCLR to enhance query-code matching, which works as a data augmenter to bring more artificially generated training instances. We show that evaluated on CodeXGLUE with the same CodeBERT model, training on CoSQA improves the accuracy of code question answering by 5.1%, and incorporating CoCLR brings a further improvement of 10.5%., ACL 2021 main conference. The CoSQA data and leaderboard are available at https://github.com/microsoft/CodeXGLUE/tree/main/Text-Code/NL-code-search-WebQuery. The code is available at https://github.com/Jun-jie-Huang/CoCLR

Existing acoustical tweezers (ATs) modulate source geometries to achieve monochromatic focusing, the wide frequency space allowed by sources is neglected. Here an analogous approach is proposed to synthesize AT fields in temporal frequency instead of wave vector. The base element is a standing wave, its counterpart in beam ATs is the field of a pitch. After field periodization, radiation-force theory is extended to nonmonochromatic waves having arbitrary in-period force based on discrete-frequency Fourier analysis. Fourier acoustical tweezers (FATs) achieve a minimal spacing of $\ensuremath{\lambda}/4$ for independent trapping. System complexity is reduced to two sources per dimension.

Accurate and rapid blood typing plays a vital role in a variety of biomedical and forensic scenarios, but recognizing weak agglutination remains challenging. Herein, we demonstrated a flipping identification with a prompt error-discrimination (FLIPPED) platform for automatic blood group readouts. Bromocresol green dye was exploited as a characteristic chromatography indicator for the differentiation of plasma from whole blood by presenting a teal color against a brown color. After integrating these color changes into a quick-response (QR) code, prompt typing of ABO and Rhesus groups was automatically achieved and data could be uploaded wirelessly within 30 s using a commercially available smartphone to facilitate blood cross-matching. We further designed a color correction model and algorithm to remove potential errors from scanning angles and ambient light intensities, by which weak agglutination could be accurately recognized. With comparable accuracy and repeatability to classical column assay in grouping 450 blood samples, the proposed approach further demonstrates to be a versatile sample-to-result platform for clinical diagnostics, food safety, and environmental monitoring.

In this paper, we contribute a new million-scale face benchmark containing noisy 4M identities/260M faces (WebFace260M) and cleaned 2M identities/42M faces (WebFace42M) training data, as well as an elaborately designed time-constrained evaluation protocol. Firstly, we collect 4M name list and download 260M faces from the Internet. Then, a Cleaning Automatically utilizing Self-Training (CAST) pipeline is devised to purify the tremendous WebFace260M, which is efficient and scalable. To the best of our knowledge, the cleaned WebFace42M is the largest public face recognition training set and we expect to close the data gap between academia and industry. Referring to practical scenarios, Face Recognition Under Inference Time conStraint (FRUITS) protocol and a test set are constructed to comprehensively evaluate face matchers. Equipped with this benchmark, we delve into million-scale face recognition problems. A distributed framework is developed to train face recognition models efficiently without tampering with the performance. Empowered by WebFace42M, we reduce relative 40% failure rate on the challenging IJB-C set, and ranks the 3rd among 430 entries on NIST-FRVT. Even 10% data (WebFace4M) shows superior performance compared with public training set. Furthermore, comprehensive baselines are established on our rich-attribute test set under FRUITS-100ms/500ms/1000ms protocol, including MobileNet, EfficientNet, AttentionNet, ResNet, SENet, ResNeXt and RegNet families. Benchmark website is https://www.face-benchmark.org., Accepted by CVPR2021. Benchmark website is https://www.face-benchmark.org

COVID-19 is a major global public health challenge and difficult to control in a short time completely. To prevent the COVID-19 epidemic from continuing to worsen, global scientific research institutions have actively carried out studies on COVID-19, thereby effectively improving the prevention, monitoring, tracking, control, and treatment of the epidemic. However, the COVID-19 electronic medical records (CEMRs) among hospitals worldwide are managed independently. With privacy consideration, CEMRs cannot be made public or shared, which is not conducive to in-depth and extensive research on COVID-19 by medical research institutions. In addition, even if new research results are developed, the disclosure and sharing process is slow. To address this issue, we propose a blockchain-based medical research support platform, which can provide efficient and privacy-preserving data sharing against COVID-19. First, hospitals and medical research institutions are treated as nodes on the alliance chain, so consensus and data sharing among the nodes is achieved. Then, COVID-19 patients, doctors, and researchers need to be authenticated in various institutes. Moreover, doctors and researchers need to be registered with the Fabric certificate authority. The CEMRs for COVID-19 patients uses the blockchain's pseudonym mechanism to protect privacy. After that, doctors upload CEMRs on the alliance chain, and researchers can obtain CEMRs from the alliance chain for research. Finally, the research results will be published on the blockchain for doctors to use. The experimental results show that the read and write performance and security performance on the alliance chain meet the requirements, which can promote the wide application of scientific research results against COVID-19.

Background: This study aimed to evaluate the updated disease burden, risk factors, and temporal trends of liver cancer based on age, sex, and country. Methods: We estimated the incidence of liver cancer and its attribution to hepatitis B virus (HBV) and hepatitis C virus (HCV) in 2018 based on the Global Cancer Observatory and World Health Organization (WHO) Cancer Causes database. We extracted the prevalence of risk factors from the WHO Global Health Observatory to examine the associations by weighted linear regression. The trend analysis used data from the Cancer Incidence in Five Continents and the WHO mortality database from 48 countries. Temporal patterns of incidence and mortality were calculated using average annual percent change (AAPC) by joinpoint regression analysis. Results: The global incidence of liver cancer was (age-standardized rate [ASR]) 9.3 per 100,000 population in 2018, and there was an evident disparity in the incidence related to HBV (ASR 0.2–41.2) and HCV (ASR 0.4–43.5). A higher HCV/HBV-related incidence ratio was associated with a higher level of alcohol consumption (β 0.49), overweight (β 0.51), obesity (β 0.64), elevated cholesterol (β 0.70), gross domestic product (β 0.20), and Human Development Index (HDI; β 0.45). An increasing trend in incidence was identified in many countries, especially for male individuals, population aged ≥50 years, and countries with a higher HCV/HBV-related liver cancer incidence ratio. Countries with the most drastic increase in male incidence were reported in India (AAPC 7.70), Ireland (AAPC 5.60), Sweden (AAPC 5.72), the UK (AAPC 5.59), and Norway (AAPC 4.87). Conclusion: We observed an overall increasing trend of liver cancer, especially among male subjects, older individuals, and countries with a higher prevalence of HCV-related liver cancer. More efforts are needed in enhancing lifestyle modifications and accessibility of antiviral treatment for these populations. Future studies should investigate the reasons behind these epidemiological changes.

Objectives We examined if the WHO International Health Regulations (IHR) capacities were associated with better COVID-19 pandemic control. Design Observational study. Setting Population-based study of 114 countries. Participants General population. Main outcome measures For each country, we extracted: (1) the maximum rate of COVID-19 incidence increase per 100,000 population over any 5-day moving average period since the first 100 confirmed cases; (2) the maximum 14-day cumulative incidence rate since the first case; (3) the incidence and mortality within 30 days since the first case and first COVID-19-related death, respectively. We retrieved the 13 country-specific International Health Regulations capacities and constructed linear regression models to examine whether these capacities were associated with COVID-19 incidence and mortality, controlling for the Human Development Index, Gross Domestic Product, the population density, the Global Health Security index, prior exposure to SARS/MERS and Stringency Index. Results Countries with higher International Health Regulations score were significantly more likely to have lower incidence (β coefficient −24, 95% CI −35 to −13) and mortality (β coefficient −1.7, 95% CI −2.5 to −1.0) per 100,000 population within 30 days since the first COVID-19 diagnosis. A similar association was found for the other incidence outcomes. Analysis using different regression models controlling for various confounders showed a similarly significant association. Conclusions The International Health Regulations score was significantly associated with reduction in rate of incidence and mortality of COVID-19. These findings inform design of pandemic control strategies, and validated the International Health Regulations capacities as important metrics for countries that warrant evaluation and improvement of their health security capabilities.

Background: The high recurrence rate after radical resection of pancreatic ductal adenocarcinoma (PDAC) leads to its poor prognosis. We aimed to develop a model to preoperatively predict the risk of recurrence based on computed tomography (CT) radiomics and multiple clinical parameters. Methods: Datasets were collected and analysed of 220 PDAC patients who underwent contrast-enhanced computed tomography (CE-CT) and received radical resection at 3 institutions between 2013 and 2017, with 153 from one institution as a training set, the remaining 67 as a validation set. For each patient, CT radiomics features were extracted from intratumoral and peritumoral regions to establish intratumoral, peritumoral and combined radiomics models using artificial neural network (ANN) algorithm. By incorporating clinical factors, radiomics-clinical nomograms were finally built by multivariable logistic regression analysis to predict 1- and 2-year recurrence risk. Findings: The developed radiomics model integrating intratumoral and peritumoral radiomics features was superior to the conventionally constructed model merely using intratumoral radiomics features. Further, radiomics-clinical nomograms outperformed other models in predicting 1-year recurrence with an area under the receiver operating characteristic curve (AUROC) of 0.920 in the training set and 0.744 in the validation set, and 2-year recurrence with an AUROC of 0.902 in the training set and 0.780 in the validation set. Interpretation: This study has developed and externally validated a radiomics-clinical nomogram integrating intra- and peritumoral CT radiomics signature as well as clinical factors to predict the recurrence risk of PDAC after radical resection, which will facilitate optimized and individualized treatment strategies. Funding: This work was supported by the General Program of National Natural Science Foundation of China [grant number: 81772562, 2017] (Yulian Wu), the Fundamental Research Funds for the Central Universities [grant number: 2021FZZX005-08] (Xiawei Li), the National Key R&D Program of China [grant number: 2018YFE0114800](Tianye Niu), the General Program of Natural Science Foundation of China [grant number: 81871351, 2018](Tianye Niu) and Zhejiang Provincial Key Projects of Technology Research [grant number: WKJZJ- 2033] (Tianye Niu). Declaration of Interest: The authors declare no potential conflicts of interest. Ethical Approval: This retrospective analysis was approved by the institutional ethical review boards of three centers including the Second Affiliated Hospital (Institution I), the Forth Affiliated Hospital (Institution II), Zhejiang University school of Medicine and the Zhejiang Cancer Hospital (Institution III).

Node injection attack on Graph Neural Networks (GNNs) is an emerging and practical attack scenario that the attacker injects malicious nodes rather than modifying original nodes or edges to affect the performance of GNNs. However, existing node injection attacks ignore extremely limited scenarios, namely the injected nodes might be excessive such that they may be perceptible to the target GNN. In this paper, we focus on an extremely limited scenario of single node injection evasion attack, i.e., the attacker is only allowed to inject one single node during the test phase to hurt GNN's performance. The discreteness of network structure and the coupling effect between network structure and node features bring great challenges to this extremely limited scenario. We first propose an optimization-based method to explore the performance upper bound of single node injection evasion attack. Experimental results show that 100%, 98.60%, and 94.98% nodes on three public datasets are successfully attacked even when only injecting one node with one edge, confirming the feasibility of single node injection evasion attack. However, such an optimization-based method needs to be re-optimized for each attack, which is computationally unbearable. To solve the dilemma, we further propose a Generalizable Node Injection Attack model, namely G-NIA, to improve the attack efficiency while ensuring the attack performance. Experiments are conducted across three well-known GNNs. Our proposed G-NIA significantly outperforms state-of-the-art baselines and is 500 times faster than the optimization-based method when inferring., Comment: Accepted by the CIKM 2021; Code: https://github.com/TaoShuchang/G-NIA

Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. For complete list of authors see http://dx.doi.org/10.1016/S2468-2667(21)00065-7

OBJECTIVE This study aimed to evaluate how the knowledge and perception towards colorectal cancer (CRC) screening had been changed in a large population, and identified factors associated with its participation based on factors pertinent to the Health Belief Model (HBM). METHODS Data from 3600 screening participants and 3600 non-participants were collected through a telephone survey via simple random sampling of telephone numbers in a territory-wide directory from December 2016 to November 2018. Sociodemographic factors; the enabling factors of screening as well as the barriers of screening were collected. The changes in these factors were evaluated by Pearson's chi-square trend test. A logistic regression model was constructed to identify the association between the above factors and CRC screening participation. RESULTS The knowledge level (67.9% to 85.4%, p

Simple Summary Esophageal cancer is the seventh most common cancer globally. Preventive measures and clinical management differ based on histologic subtype. However, information has been lacking on its most recent patterns according to histological subtype, associated risk factors, and epidemiological trends on a global scale. This study is a global analysis of the incidence/mortality trends of esophageal cancer in more than 48 countries/regions based on high quality population-based registries. We conclude that adenocarcinoma has already surpassed squamous cell carcinoma as the most frequent type of esophageal cancer in some western countries and is expected to increase in other countries. It is important to closely monitor and slow down the growing rates of obesity and metabolic syndrome, which are the important risk factors for adenocarcinoma. With the development of more advanced and less invasive technology, population-based targeted screening endoscopy would be recommended for high-risk individuals. Abstract This study aimed to examine the global burden, risk factors, and trends of esophageal cancer based on age, sex, and histological subtype. The data were retrieved from cancer registries database from 48 countries in the period 1980–2017. Temporal patterns of incidence and mortality were evaluated by average annual percent change (AAPC) using joinpoint regression. Associations with risk factors were examined by linear regression. The highest incidence of esophageal cancer was observed in Eastern Asia. The highest incidence of adenocarcinoma (AC) was found in the Netherlands, the United Kingdom, and Ireland. A higher AC/squamous cell carcinoma (SCC) incidence ratio was associated with a higher prevalence of obesity and elevated cholesterol. We observed an incidence increase (including AC and SCC) in some countries, with the Czech Republic (female: AAPC 4.66), Spain (female: 3.41), Norway (male: 3.10), Japan (female: 2.18), Thailand (male: 2.17), the Netherlands (male: 2.11; female: 1.88), and Canada (male: 1.51) showing the most significant increase. Countries with increasing mortality included Thailand (male: 5.24), Austria (female: 3.67), Latvia (male: 2.33), and Portugal (male: 1.12). Although the incidence of esophageal cancer showed an overall decreasing trend, an increasing trend was observed in some countries with high AC/SCC incidence ratios. More preventive measures are needed for these countries.

Background This study aimed to evaluate the updated incidence, mortality, risk factors, and epidemiologic trends of colorectal cancer (CRC) for different regions and sex using publicly available data from 186 countries. Methods The Global Cancer Observatory (GLOBOCAN) database was retrieved for the age-standardized rates (ASR) for incidence and mortality of CRC in 2018 and 2012. The prevalence of risk factors (2008–2016) was retrieved from the Global Health Observatory database. The associations between the prevalence of risk factors and incidence and mortality of CRC and were measured using beta coefficients (β) with 95% confidence intervals (CI) generated from a univariable linear regression analysis. Results In 2018, the highest incidence and mortality of CRC were in regions of very high human development index (HDI) (ASRs, 30.6 and 11.1) with men to women ratio of 1.4 and 1.2. Population in countries with higher incidence have higher alcohol consumption (β=1.30, 95% CI 1.02 to 1.57 for men; β=0.46, CI 0.35 to 0.57 for women), higher prevalence of tobacco use (β=0.11, CI 0.02 to 0.19 for women), insufficient physical activity (β=0.59, CI 0.34 to 0.84; β=0.19, CI 0.09 to 0.29), overweight (β=0.47, CI 0.38 to 0.57; β=0.16, CI 0.12 to 0.20), obesity (β=0.24, CI 0.11 to 0.38; β=0.34, CI 0.25 to 0.43), and elevated cholesterol (β=1.80, CI 1.53 to 2.07; β=1.22, CI 1.05 to 1.38). Similar associations were also found for mortality (figure 1). From 2012 to 2018, there was an overall increase in the trend of incidence and mortality, particularly in Asia (+29.7% and +17.4%) and Africa (+24.3% and +17.6%), and among men (+14.6% and +8.0%) compared with women (+14.0% and +4.3%). Conclusions The variation in disease burden of CRC was associated with HDI and the prevalence of risk factors. There was an increasing trend in the incidence and mortality of CRC, particularly in regions with low and middle incomes and among men. More intensive lifestyle modifications and population-based screening are recommended for these populations.

Background The success of population-based colorectal cancer (CRC) screening is dependent on the optimal achievement of various targets. We estimated the pooled performance indicators of CRC screening programmes that used faecal immunochemical tests (FIT) as a primary screening modality and colonoscopy as a subsequent confirmatory test in various countries. Methods We searched PubMed, Ovid MEDLINE, Embase, and Cochrane from inception to 1st Jan 2020. We included original articles published in the English language describing population-based CRC screening programme that used FIT and colonoscopy, and relevant national CRC screening reports by hand searching. We extracted data to pool early performance indicators, including participation rate, invalid FIT rate, FIT positive rate, adenoma/CRC detection rate of FIT, colonoscopy compliance rate, rate of adequate bowel preparation, colonoscopy completion rate, colonoscopy complication rate, and positive predictive values (PPV) of FIT for adenoma/CRC. We used Metaprop to conduct a meta-analysis via R software (version 3.6.3). The Freeman-Tukey double arcsine transformation was used to stabilise the variances, and a random-effects model was used to pool the rates with proportions. Results A total of 85 studies (64 articles and 21 reports) were included in this meta-analysis. The pooled participation rate was 52.2%, and the pooled proportion of invalid FIT was 1.0%. The FIT positive rate was 7.0%, the adenoma detection rate was 21.8‰, and the CRC detection rate was 2.5‰. In addition, the colonoscopy compliance rate (79.1%), rate of adequate bowel preparation (86.3%), and the colonoscopy completion rate (93.1%) were high. We found the pooled complication rate of 0.3%, with PPVs of FIT being 39.2% (for adenoma) and 4.7% (for CRC). The range of all indicators varied substantially. In subgroup analysis, a higher FIT cut-off value indicated lower positivity and lower adenoma detection rate. Compared with CRC screening programmes with one FIT, those with two FIT had lower participation rate (48.8% vs 55.5%) but higher positive rate (8.9% vs 5.8%) and adenoma detection rate (21.8‰ vs 17.3‰). Conclusions Our findings reported the pooled performance indicators of different CRC screening programmes. The summary measures could inform the benchmarking of performance indicator targets across different CRC screening programmes.

Background Liver cancer is the sixth most common cancer and the fourth leading cause of cancer mortality globally. The global ASR of incidence of liver cancer was 9.3 per 100,000 persons in 2018. There was an estimated total of 471,000 and 168,200 new cases of liver cancer attributable to HBV and HCV in 2018, respectively. This study aimed to evaluate the association between incidence of liver cancer and its risk factors among 185 countries. Methods The Age-standardised rates (ASR) for incidence of liver cancer in 2018 were extracted from Global Cancer Observatory (GLOBOCAN). The prevalence of smoking, alcohol consumption, obesity, and diabetes in 2010 for each country were retrieved from the Global Health Observatory (GHO). Primary Outcome: To determine the association between incidence (ASR) and prevalence of risk factors by using multivariable linear regression adjusting for human development index (HDI) and gross domestic product (GDP) per capita. Results The country with higher incidence was associated with a higher prevalence of smoking (males: β=0.25, p=0.028) and alcohol consumption (females: β=0.94, p=0.042) (table 1: β, beta coefficient refers to how much does the incidence (ASR) change per unit increase in risk factor). No association between the incidence and body mass index (BMI) or diabetes were found in the current analysis (p>0.05). Conclusions Smoking and alcohol consumption remain as important risk factors for liver cancer at a country level. Smoking was associated with an increased risk of Country-specific preventive strategies in the reduction of liver cancer burden includes promoting smoking cessation and alcohol control for high-risk populations.

Background This study aimed to evaluate the global incidence, mortality of gallbladder cancer, and their associations with human development index (HDI), gross domestic products (GDP), smoking, alcohol drinking, and overweight for 180 countries. Methods The regional and national incidence and mortality figures for gallbladder cancer in 2018 were retrieved from the GLOBALCAN database. Age-standardized rates (ASRs) were evaluated by the Segi–Doll world standard population. HDI and GDP per capita in 2018 for each country were collected from the United Nation and World Bank. Prevalence of smoking, alcohol drinking, and overweight in 2010 was retrieved from the Global Health Observatory. The association between the incidence/mortality and these factors was examined by Pearson’s correlation coefficient (r). Results The global ASR of the incidence of gallbladder cancer was 2.3 per 100,000 persons in 2018. The highest rates were reported in Eastern Asia (ASR=3.0), whilst the lowest rates were found in Middle Africa (0.35). The incidence was the highest in countries with very high HDI (2.5) as compared to those with high (2.4), medium (2.0), and low HDI (0.55). Countries with higher incidence were correlated with higher HDI (r=0.31, p 0.05). Conclusions Higher incidence and mortality of gallbladder cancer were found in regions with higher HDI, higher prevalence of smoking and overweight. With population aging and growth, we might expect a further substantial increase in its disease burden, especially for countries with high socioeconomic development. Preventive interventions on reducing the prevalence of risk factors for gallbladder cancer are warranted.

Background Worldwide, oesophageal cancer is one of the most common cancers and a leading cause of cancer mortality. Owing to its aggressive disease nature and poor survival rate, it contributes to a substantial burden to global health and clinical practice. This study aimed to estimate the worldwide incidence and risk factors of oesophageal cancer by histological subtypes using data from 178 countries. Methods The data on the incidence of oesophageal cancer by histological types in 2018 were estimated from GLOBALCAN and Cancer Incidence in Five Continents (CI5). Age-standardized rates (ASRs) for oesophageal cancer incidence by histological subtypes were evaluated by Segi–Doll population. The prevalence of tobacco use, alcohol drinking, physical inactivity, obesity, diabetes, and lipid disorders for each country were retrieved from the Global Health Observatory. The association between the ratio of histological subtypes and risk factors was examined by multivariable linear regression. Results We estimated a total of 63,470 (12.6%) and 502,669 new cases of oesophageal adenocarcinoma (AC) and squamous cell carcinoma (SCC) in 2018, respectively. The incidence among males was 3.6-fold and 2.2-fold of that among females for AC and SCC, respectively. The highest AC:SCC ratio was found in the UK (ratio 2.880, ASR 7.5), New Zealand (2.667, 4.2), the Netherlands (2.536, 7.7), Bahrain (2.143, 0.9), and Canada (2.000, 3.7) among males (figure 1). As for females, the highest AC:SCC ratio was observed in Moldova (1.000, 0.2), the Netherlands (0.800, 1.2), Iceland (0.750; 0.5), the UK (0.700; 1.4), and Cyprus (0.667; 0.3). A higher AC:SCC ratio was associated with a higher prevalence of obesity (male: β 0.039, 95% CI 0.023 to 0.055; female: 0.009, 0.004 to 0.146) and high cholesterol (male: 0.028, 0.010 to 0.047; female: 0.011, 0.004 to 0.019); but a lower prevalence of tobacco use (male: -0.007, -0.014 to -0.001) and diabetes (male: 0.009, 0.004 to 0.146; female: -0.021, -0.038 to -0.003). Conclusions While SCC is the predominant subtype of oesophageal cancer, the incidence of AC has surpassed SCC in a substantial proportion of countries, probably due to the increasing prevalence of obesity and metabolic disorders. Future research should investigate the reasons behind these epidemiological changes.

There are minimal data regarding the prevalence of cancer in patients with coronavirus disease 2019 (COVID-19), as well as the incidence of severe illness and rate of mortality in COVID-19 patients with cancer. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched, from database inception to July 15, 2020, for studies of patients with COVID-19 that included information regarding comorbid cancer. In total, 109 eligible global studies were included in this systematic review. Ninety studies with 94,845 COVID-19 patients, among which 4106 exhibited comorbid cancer, were included in the meta-analysis regarding prevalence of comorbid cancer. Twenty-three studies with 71,969 COVID-19 patients, among which 4351 with comorbid cancer had severe illness or death, were included in the meta-analysis. The overall prevalence of cancer among COVID-19 patients was 0.07 (95% CI 0.05-0.09). The cancer prevalence in COVID-19 patients was higher in Europe (0.22, 95% CI 0.17-0.28) than in the Asia-Pacific region (0.04, 95% CI 0.03-0.06) or North America (0.05, 95% CI 0.04-0.06). The cancer prevalence in COVID-19 patients aged >60 years was 0.10 (95% CI 0.07-0.14), while the prevalence among patients aged ≤60 years was 0.05 (95% CI 0.03-0.06). The pooled prevalence of severe illness among COVID-19 patients with cancer was 0.34 (95% CI 0.26-0.42) and the pooled mortality rate of COVID-19 patients with cancer was 0.20 (95% CI 0.16-0.25). Pooled incidences of severe illness among COVID-19 patients with cancer from Asia Pacific, Europe, and North America were 0.38 (95% CI 0.24-0.52), 0.39 (95% CI 0.25-0.53), and 0.26 (95% CI 0.20-0.31), respectively; pooled mortality rates from the Asia-Pacific region, Europe, and North America were 0.17 (95% CI 0.10-0.24), 0.26 (95% CI 0.18-0.35), and 0.19 (95% CI 0.13-0.25), respectively.

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases., Central Illustration, Highlights • The burden of CVD, in number of DALYs and deaths, continues to increase globally. • CVD burden attributable to modifiable risk factors continues to increase globally. • Countries should invest in existing cost-effective public health programs and clinical interventions to target modifiable risks, promote healthy aging across the lifespan, and reduce disability and premature death due to CVD.

No abstract available.