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Neutrophil extracellular traps (NETs) are network structures comprised of decondensed DNA strands coated with granule proteins. There have been three types of NETs recorded. NETs have been discovered concerning the progression of some malignancies, including gastric cancer, breast cancer, ovarian cancer, hepatocellular carcinoma, colorectal cancer, glioblastoma, diffuse large B cell lymphoma (DLBCL), and lung cancer, among others. In various methods, tumors encourage the formation of NETs, and NETs, in turn, promote tumor growth. NETs can stimulate primary tumor cell proliferation, suppress immune cells to create a tumor-friendly immune microenvironment, and stimulate epithelial-mesenchymal transition (EMT). NETs significantly promote liver and lung metastasis, possibly by altering vascular permeability, inducing cytoskeleton rearrangement and directional cell migration, and reawakening dormant cancer cells. NETs are therapeutically promising targets for cancer patients. Cancer patients may benefit from anti-NETs therapy, especially when combined with immune checkpoint inhibitors.

The application of nanoparticle-based delivery systems is limited by uncontrolled drug release, limited tumor penetration, and poor stability. To solve these problems, a tumor microenvironment pH and enzyme double-responsive shrinkable nanoparticle was developed in this study and defined as LDC (the complex of laponite (LP), doxorubicin (DOX), and chito-oligosaccharides (COS)). LDC has a 100 nm size and contains the anticancer medication DOX, which is stable in serum-containing aqueous solutions and can efficiently accumulate in tumors in vivo. The tumor extracellular matrix is in rich of lysozymes, which can degrade COS and release smaller DOX-containing nanoparticles, making LDC shrink from the initial 100 nm into 30 nm (in diameter) to facilitate the drug to penetrate deeply into the tumor tissue. Furthermore, after being taken up by tumor cells, the acidic and enzymatic cellular microenvironment triggers quick DOX release and rapid killing of cancer cells. LDC exhibits hardly any in vivo toxicity to mice's major organs. These results demonstrated that LDC can ensure a systematically tumor-targeting controlled drug release, deep tumor penetration, and stability in circulation to avoid damages on healthy organs/tissues, demonstrating its potential as an effective thereaputic delivery approach for cancer treatment.

β-elemene is known to play a critical role in tumorigenesis as well as tyrosine kinase inhibitor (TKI) resistance in lung cancer. However, the biological function and molecular mechanism remain largely unknown.In this study, the common genes involved in gefitinib resistance and β-elemene were identified using bioinformatic analysis. The expression of FBP1 was examined by qRT-PCR and Western blot analysis. Cell proliferation, flow cytometry, clone formation and IC50 assays were performed to assess the effects of β-elemene and FBP1. Western blot analysis was used to evaluate apoptosis-related gene expression. Finally, in vivo experiments were conducted to assess the crucial role of FBP1 in gefitinib-resistant HCC827/GR cells in nude mice.Screening analysis demonstrated that fructose-1,6-bisphosphatase (FBP1) was induced by β-elemene and downregulated in gefitinib-resistant lung cells. Functionally, overexpression of FBP1 inhibited proliferation and gefitinib resistance and promoted apoptosis of PC9/GR and HCC827/GR cells in vitro. Mechanistically, FBP1 impeded the nuclear translocation of p-STAT3. The FBP1/STAT3 axis was required for FBP1-mediated apoptosis-related gene expression. In vivo experiments further confirmed the enhanced effects of FBP1 on lung cancer cell sensitivity to gefitinib.Our research indicated that β-elemene suppressed proliferation and enhanced sensitivity to gefitinib by inducing apoptosis through the FBP1/STAT3 axis in gefitinib-resistant lung cancer cells.

The translation of nanoparticles in cancer treatment is limited by their low drug-loading capacity, poor colloidal stability, insufficient tumor penetration, and uncontrolled drug release. Herein, gelatin/nanochitosan/doxorubicin nanoparticles (GND) are developed by crosslinking nanochitosan (NCT) with gelatin for doxorubicin delivery. The hydrophilicity and stability properties of GND allow it to be protected and have a long circulation time in blood. The GND formulation exhibited shedding and triggered release effects as well as improved colloidal stability. When reaching the tumor site, matrix metallopeptidase-2 (MMP-2) from the tumor environment degrades gelatin from 178-nm GND to release smaller 4 nm nanochitosan/doxorubicin (ND) nanoparticles for deep tumor penetration and efficient tumor cell endocytosis. Following endocytosis by tumor cells, the intracellular low pH and MMP-2 further trigger doxorubicin release, resulting in superior inhibitory capacity against cancer cells. Using a mouse tumor-bearing model, the superior anticancer activity and good in vivo biocompatibility of GND were verified. The rational design of tumor-penetrating GND enables MMP-2/pH sequentially triggered intelligent drug delivery, providing a practical approach for anticancer therapy.

This study aimed to evaluate the association between aluminum (Al), arsenic (As), barium (Ba), cobalt (Co), manganese (Mn), selenium (Se), strontium (Sr), thallium (Tl), and vanadium (V) levels in whole blood and the cognitive ability of people over 60 years old. A total of 1217 eligible participants were enrolled in our study in Lu'an city, Anhui province, China. The inductively coupled plasma mass spectrometry (ICP-MS) was used to determine the concentration of nine trace elements in the whole blood, which reflect their exposure levels. Mini-mental State Examination (MMSE) scale was employed to screen the cognitive function of the elderly. Logistic regression was applied to assess the associations of nine whole blood trace elements with cognition. In the work, it has found that high levels of whole blood As and Se are risk factors for cognitive dysfunction. As and Se quartile were correlated with increased risk of cognitive dysfunction, and with the odds ratio (OR) of 2.06 (95% CI 1.30-3.25; p-trend = 0.002), 1.947 (95% CI 1.20-3.17; p-trend = 0.007) in the highest quartile. However, high concentration of Al, V, and Ba in whole blood were protective factors for cognitive function [OR = 0.63 (95% CI 0.40-0.98; p-trend = 0.040), 0.549 (95% CI 0.36-0.85; p-trend = 0.007), 0.460 (95% CI 0.28-0.75; p-trend = 0.002) respectively]. The study suggested that the exposure of some trace elements (As, Se) were associated with the increased risk of cognitive dysfunction; on the contrary, other elements (Al, V, Ba) could be protective factor for cognitive function. These findings need to be confirmed in additional research of a large elderly population.

Tumor-associated macrophages (TAMs), one of the dominating constituents of tumor microenvironment, are important contributors to cancer progression and treatment resistance. Therefore, regulation of TAMs polarization from M2 phenotype towards M1 phenotype has emerged as a new strategy for tumor immunotherapy. Herein, we successfully initiated antitumor immunotherapy by inhibiting TAMs M2 polarization

In this study, we use a phase field framework to examine multizone hydraulic fracture propagation in a poroelastic medium from a new perspective. Biot poroelasticity theory is used for coupling the displacement and fluid fields. We construct a total energy functional to include an additional pressure-related term, and achieve the governing equations of the phase field model by the variational approach. Darcy's law is used to model fluid flows in the calculation domain including the fully damaged (fractured) region. Two indicator functions based on the phase field are used to construct the relation between the properties of the intact and fully fractured media. The phase field method is implemented by using the finite element method as well as a staggered scheme for decoupling. After validating the phase field model in the example of a pre-cracked plaster sample with a circular hole, several numerical examples are presented to show the effects of multizone hydraulic fracturing treatment in the porous medium as well as the robustness of the phase field framework. These examples include an isolated hydro-fracture and multizone hydraulic fractures subjected to an identical fluid injection rate or pressure. Our simulations indicate that all possible fracture scenarios including fracture branching and coalescence, diverted, converging, and asynchronous fractures can be predicted by the presented phase field framework. The phase field model provides more insights that are hard to be gained through purely experimental tests and other numerical methods.

Background A vegetarian diet may be a risk factor for depression, but this relationship was unclear in the elderly Chinese population. Methods Self-report data were gathered from 1051 elderly persons using the Cohort of Elderly Health and Environment Controllable Factors, which was created in West Anhui, China. The depressive symptoms were set as binary, ordinal, and continuous outcomes, respectively, whereas the dietary structures were computed as an ordinal variable and a dummy variable. Multiple logistic regression, ordinal regression, and linear regression were used to assess the relationship by adjusting the potential confounding variables with p-values of Results The elderly participants who had a vegetable-based diet had the highest GDS scores of 8.78 ± 6.894 (p = 0.001) and the highest rate of depression (32.9%, p = 0.003). After adjustment for the potential confounders, elderly men who had a vegetable-based diet had a higher rate of depression (OR[95%CI]: 1.62[1.07–2.46], 4.71[1.38–16.03]), more severe symptoms of depression (OR[95%CI]: 8.85[2.94–34.12]), and higher GDS scores (β[95%CI]: 1.46[0.70–2.22], 2.97[1.28–4.67]) than male participants who had a meat-based diet, but this was not the case in women. Limitations All data were self-reported. The study lacked quantitatively evaluated dietary intake. The duration of the current dietary structures and comorbidities were not reported. The cross-sectional study made the causal role uncertain. Conclusions Vegetarian diets may pose a greater risk of depressive symptoms among the elderly Chinese population, especially elderly men. Given the cross-sectional nature of this study, the causal role was uncertain. Further prospective studies, in particular among elderly women, are needed.

Hubei province in China has had the most confirmed coronavirus disease 2019 (COVID-19) cases and has reported sustained transmission of the disease. Although Lu'an city is adjacent to Hubei province, its community transmission was blocked at the early stage, and the impact of the epidemic was limited. Therefore, we summarised the overall characteristics of the entire epidemic course in Lu'an to help cities with a few imported cases better contain the epidemic. A total of 69 confirmed COVID-19 cases and 11 asymptomatic carriers were identified in Lu'an during the epidemic from 12 January to 21 February 2020. Fifty-two (65.0%) cases were male, and the median age was 40 years. On admission, 56.5% of cases had a fever as the initial symptom, and pneumonia was present in 89.9% of cases. The mean serial interval and the mean duration of hospitalisation were 6.5 days (95% CI: 4.8–8.2) and 18.2 days (95% CI: 16.8–19.5), respectively. A total of 16 clusters involving 60 cases (17 first-generation cases and 43 secondary cases) were reported during the epidemic. We observed that only 18.9% (7/37) index cases resulted in community transmission during the epidemic in Lu'an, indicating that the scale of the epidemic was limited to a low level in Lu'an city. An asymptomatic carrier caused the largest cluster, involving 13 cases. Spread of COVID-19 by asymptomatic carriers represents an enormous challenge for countries responding to the pandemic.

As China implements the voluntary vaccination programme of one-dose of varicella vaccine (VarV) for decades, robust estimates of the impact of voluntary vaccination era on epidemiology of varicella are needed. We estimated the vaccination coverage (VC) of VarV by using surveillance data on immunisation. The descriptive epidemiological method was used to describe the changing epidemiology of varicella from 2007 to 2018. The screening method was used to estimate the vaccine effectiveness (VE) of VarV. The overall VC for VarV was 71.7%, ranged from 47.7% to 79.5% among 2008–2017 birth cohorts. In total, 16 660 varicella cases were reported during 2007–2018, the incidence increased from 10.0 cases per 100 000 population in 2007 to 65.2 cases per 100 000 population in 2018. A shift in age group of varicella was observed since 2012, with the age increased from 5–9 years to 10–14 years. The overall VE was 79.9%, and the VE increased from 60.1% in 2008 birth cohort to 96.2% in 2017 birth cohort. We found that the overall VE for VarV is moderate, but appears highly effective within 5 years after vaccination. In addition, a shift varicella infection to older ages has occurred at the long-term moderate level VC of one-dose VarV. Therefore, to contain the incidence of varicella and prevent any potential shift to older ages, the introduction of VarV into routine immunisation programme is likely needed in Lu'an.

Background: miR-375 plays a role in tumor progression; however, its potential as a prognostic factor in cancer remains unclear. This meta-analysis assessed the value of miR-375 as a global prognostic biomarker in human cancer. Methods: A systematic literature review was performed to retrieve publications with relevant survival data. Pooled hazard ratios (HRs) were calculated for low miR-375 expression. Publication bias was examined. Results: Data were extracted from 11 studies of 1,797 patients (low expression in 769 cases; high in 1,028 cases). The pooled HR for overall/cumulative survival (OS/CS) was 1.90 (95% confidence interval (CI) 1.57-2.29) and the pooled HR for disease-free, recurrence-free or progression-free survival (DFS/RFS/PFS) was 1.93 (95% CI 1.39-2.67), indicating low miR-375 expression was associated with significantly poorer outcomes compared to normal/high miR-375 expression. Subgroup analysis revealed miR-375 might be a good prognostic factor in cancer, regardless of population, sample type, and cancer type. The prognostic value of miR-375 in non-Chinese patients was particularly high (pooled HR > 2). Conclusion: Low miR-375 expression could represent a valuable prognostic marker in various cancers. Circulating miR-375 levels may provide a useful non-invasive, practical prognostic biomarker. However, the prognostic value of miR-375 in specific cancer types remains unclear; further studies are warranted.

Objective On May 2, 2017, an outbreak of unexplained fever with rashes was reported in Lu'an, China. In this study, we aimed to identify the possible pathogens, epidemiological characteristics, and risk factors of this outbreak. Methods We conducted descriptive field epidemiological studies. Blood samples were tested using an indirect immunofluorescence assay for Rickettsia rickettsii antibody, and nested polymerase chain reaction and gene sequencing assays were performed. Results We recruited 39 cases who had symptomatic onset from April 20 to June 8, 2017. Among these, 9 were suspected cases, 18 were probable cases, and 12 were confirmed cases. No one died. The main clinical manifestations were fever (100%), rash (100%), fatigue (97.3%), myalgia (83.8%), and anorexia (83.8%). None of the patients died. Thirty-seven patients who were treated with antibiotics during hospitalization showed significant improvement. The cases were distributed across 14 townships in 2 counties. The median age was 59 (43.0–81.0) years, of which 93.3% had a history of tea picking (28/30), and 77.3% (17/22) had a history of tick bites. The mean incubation period was 5.0 days (2.0–13.0 days). Serum IgG titers were higher in convalescent patients than in the general population (p = 0.016). Phylogenetic analysis revealed that the ompA sequences of Rickettsia sp. Lu'an-2018 had an 86.8%–99.0% sequence identity with the 23 strains of Rickettsia found worldwide. Conclusions This was the first reported outbreak of an undetermined species of a human infection with the spotted fever group of Rickettsia in China, which might be caused by ticks biting local residents when picking tea.

Tamoxifen is effective for treating estrogen receptor-alpha (ERα)-positive breast cancers. However, few molecular mediators of tamoxifen resistance have been elucidated. In the present study, we determine the underlying roles of Brachyury in tamoxifen resistance. Loss- and gain-of-function assay are utilized to confirm the oncogenic roles of Brachyury in breast cancer. Compared with the normal MCF10A cells, Brachyury is commonly overexpressed in breast cancer cell lines. Knockdown of Brachyury inhibits tamoxifen resistance, whereas overexpression of Brachyury enhances tamoxifen resistance as demonstrated increased cell viability and reduced cell apoptosis. Mechanistically, we demonstrate for the first time that Brachyury mediates tamoxifen resistance by regulating Sirtuin-1 (SIRT1). Collectively, our data, as a proof of principle, indicate that Brachyury is a candidate marker for predicting the clinical efficacy of tamoxifen and targeting SIRT1 could overcome resistance to tamoxifen in breast cancer cells.

Our objective was to evaluate the relationship of blood metal levels including strontium, cadmium, lead, vanadium, aluminum, cobalt, and manganese with dyslipidemia in the elderly Chinese population. In this study, stratified cluster sampling was adopted in the elderly in two communities of Lu'an City from June to September 2016, and 1013 participants were finally included. The inductively coupled plasma mass spectrometry (ICP-MS) was used to measure the metals' concentrations in whole blood. After multivariable adjustment, the odds ratios (95% confidence interval [CI]) of dyslipidemia associated with the highest quartile of metal concentrations were 1.32 (0.89 ~ 1.96), 1.28 (0.83 ~ 1.97), 1.86 (1.23 ~ 2.80), 0.80 (0.55 ~ 1.16), 0.76 (0.51 ~ 1.13), 0.76 (0.53 ~ 1.11), and 1.14 (0.78 ~ 1.67) for strontium, cadmium, lead, vanadium, aluminum, cobalt, and manganese, respectively, compared with the lowest quartile. After reducing the dimensionality of metal elements by principal component analysis, we found that the combined exposure of aluminum, cobalt, and vanadium was the protective factor of non-dyslipidemia, while the combined exposure of cadmium, strontium, and lead was the risk factor of dyslipidemia.

In 2016, an outbreak of mumps occurred in a primary school in China with a student population having high vaccination coverage. An unmatched case-control study was performed to identify risk factors contributing to this outbreak, and a retrospective cohort study was conducted to evaluate the effectiveness of mumps-containing vaccine (MuCV). A total of 97 cases were identified during the outbreak, and the overall attack rate was 8.2%. Among students with confirmed vaccination status, 90% had received at least one dose of MuCV. Cases were more likely than non-cases to report taking the school bus during the epidemic period (adjusted OR = 2.3, 95% CI: 1.4–3.7). Vaccine effectiveness (VE) was higher for two-dose MuCV (76%, 95% CI:49–89%) than for one-dose MuCV (59%, 95% CI: 36–74%. The protection afforded by both one-dose and two-dose MuCV waned over time, from 82% among students vaccinated within 5 years to 41% among those vaccinated more than 10 years previously for one-dose VE, and from 90% to 25% over the same time period for two-dose VE. We found that outbreaks of mumps can occur in schools despite high coverage of one-dose MuCV vaccination. Although the VE of both two-dose and one-dose MuCV wanes over time, the overall VE for two-dose MuCV was superior than that of one-dose MuCV. Therefore, a two-dose MuCV schedule through routine services is likely needed in order to control mumps epidemics in China.

To explore the relationship between waist circumference( WC), waist hip ratio( WHR), waist-to-height( WHtR) and hypertriglyceridemia( HTG) in older adults in Lu'an City.In total, 1029 participants aged ≥ 60 years using cluster sampling method from two communities in Jin' an District and Yu' anDistrict of Lu'an City were invited to participate in this community-based study from June to September 2016. A questionnaire was used to collect the information of demographic characteristics, disease history, lifestyles, etc. Height, waist circumference, hip circumference, and blood triglyceride levels were measured. Binary logistic regression analysis was conducted to analysis the association between WC, WHR, WHtR and hypertriglyceridemia. The receiver operating characteristic( ROC) curve was used to evaluated the distinguishable effect of three indices on HTG.Prevalence of HTG was 19. 7%( 14. 0% in male, 24. 5% in female, χ~2= 17. 71, P0. 001). After controlling the confounding factors, including area, gender, age, family history, educational level, sedentary time, physical exercise, smoking, alcohol consumption, diet habits, binary Logistics regression analysis showed that the risk of HTG was higher in the elderly with high WC, high WHR, high WHtR, the ORs were 5. 18( 95% CI 2. 81-9. 57), 3. 69( 95% CI 1. 95-6. 95) and 4. 93( 95% CI 2. 72-8. 91), respectively. The area under ROC curves of WC, WHR and WHtR were 0. 67, 0. 67 and 0. 69, respectively.WC, WHR and WHtR are closely related with the prevalence of HTG. WC and WHR were significant than others for male HTG and female HTG.

Salinomycin (Sal) is a potent inhibitor with effective anti-breast cancer properties in clinical therapy. The occurrence of various side effect of Sal greatly limits its application. The epidermal growth factor receptor (EGFR) family is a family of receptors highly expressed in most breast cancer cells. GE11 is a dodecapeptide which shows excellent EGFR affinity. A series of nanoparticles derivatives with GE11 peptide conjugated PLGA/TPGS were synthesized. Nanoprecipitation method was used to prepare the Sal loaded nanoparticles at the optimized concentration. The characterization, targeting efficacy, and antitumor activity were detected both in vitro and in vivo. Encapsulation of Sal in GE11 modified PLGA/TPGS nanoparticles shows an improved therapy efficacy and lower systemic side effect. This represents the delivery system a promising strategy to enhance the therapeutic effect against EGFR highly expressed breast cancer.

Triple-negative breast cancer (TNBC) is a special subtype of breast cancer, which is characterized by the negative form of estrogen receptor (ER), progesterone receptor (PR) and human epithelial growth factor receptor 2 (HER2). TNBC accounts for ~15% of all breast cancer forms, and often leads to high mortality and poor prognosis. Structural maintenance of chromosome 1 (SMC1) is a subunit of the cohesion protein complex. Brachyury is a protein that is encoded by the T gene in humans, which is a transcription factor within the T-box complex of genes. Epithelial-mesenchymal transition (EMT) is a ubiquitous process in the body, and in particular, induces metastasis and the proliferation of cancer cells. In the present study, we found that SMC1 expression in TNBC tissues exceeded its expression in adjacent non-tumor tissues. Similarly, the expression of SMC1 in TNBC cell lines (hs578T and HCC1937) was found to be higher than in MCF10a and MCF7 cells. Subsequently, SMC1 was overexpressed and silenced in hs578T and HCC1937 cells through plasmid and siRNA transfection, respectively. The results showed that the high expression of SMC1 often promoted EMT, accompanied by the enhanced expression of Brachyury. Besides, upregulated expression of Brachyury through plasmid transfection also significantly improved the level of EMT, which further indicated that SMC1 increased EMT in TNBC through the induction of Brachyury expression. Taken together, these results contributed to a better understanding of the pathogenesis of TNBC, which also provided an experimental basis for the prevention, diagnosis and treatment of TNBC.

Despite the great progress in the treatment of gastric cancer, it is still the third leading cause of cancer death worldwide. Patients often miss the opportunity for a surgical cure, because the cancer has already developed into advanced cancer when identified. Compared to best supportive care, chemotherapy can improve quality of life and prolong survival time, but the overall survival is often short. Due to the molecular study of gastric cancer, new molecular targeted drugs have entered the clinical use. Trastuzumab, an antibody targeting human epidermal growth factor receptor 2 (HER2), can significantly improve survival in advanced gastric cancer patients with HER2 overexpression. Second-line treatment of advanced gastric cancer with ramucirumab, an antibody targeting VEGFR-2, alone or in combination with paclitaxel, has been proved to provide a beneficial effect. The VEGFR-2 tyrosine kinase inhibitor, apatinib, can improve the survival of advanced gastric cancer patients after second-line chemotherapy failure. Unfortunately, none of the EGFR targeting antibodies (cetuximab or panitumumab), VEGF targeting monoclonal antibodies (bevacizumab), mTOR inhibitor (everolimus), or HGF/MET pathway targeting drugs has a significant survival benefit. Many other clinical trials based on molecular markers are underway. This review will summarize targeted therapies for advanced gastric cancer.

Surface tension can cause important deformations in fluids but is usually overlooked in solids. Recent work has shown that surface tension can become significant in the deformations of soft solids. Here, we present an isogeometric-analysis-based numerical example of cantilever beams under a point load for modeling the influences of surface tension on the flexoelectric energy harvesting system. The interface of the fluid/solid is implicitly represented using level set method. These results show that the maximum electric potential decreases when the number of liquid inclusions increases. However, the electric potential near the solid/liquid interface increases when considering the surface tension effect.

Background Severe fever with thrombocytopenia syndrome (SFTS) is a severe viral disease caused by SFTSV. It is important to estimate the rate of missed SFTS diagnosis and to further understand the actual incidence in high endemic areas in China. Methods This study was conducted in two high SFTS endemic provinces in 2015. Patients hospitalized in 2014 or within 1 year before investigation were selected after considering their clinical manifestations, specifically, fever, platelet, and white blood cell. During retrospective investigation, sera were collected to detect SFTSV antibodies to assess SFTSV infection. To further understand SFTSV infection, acute phase sera were detected; SFTSV infection rate among a healthy population was also investigated to determine the basic infection level. Results In total, 246 hospitalized cases were included, including 83 cases (33.7%) with fever, thrombocytopenia and leukopenia, 38 cases (15.4%) with fever and thrombocytopenia but without leukopenia, and 125 cases (50.8%) without fever but with thrombocytopenia and leukopenia. In total, 13 patients (5.3%) were SFTSV IgM antibody-positive, 48 (19.5%) were IgG-positive. Of the 13 IgM-positive cases, 11 (84.6%) were IgG-positive (9 with titres ≥1:400). Seropositive rates of antibodies were high (8.4% for IgM and 30.1% for IgG) in patients with fever, thrombocytopenia and leukopenia. Furthermore, among IgG-positive cases in this group, 76% (19/25) of patients’ IgG antibody titres were ≥1:400. Additionally, 28 of 246 cases were initially diagnosed with suspected SFTS and were then excluded, and 218 patients were never diagnosed with SFTS; the seropositive rates of IgM and IgG in these two groups were 25% and 67.9% and 2.8% and 13.3%, respectively. These rates were 64.3% and 21.4% in 14 sera collected during acute phase of the 28 cases mentioned above. Seropositive rate of SFTSV IgG was only 1.3% in the patient-matched healthy group, and no IgM antibody was detected. A preliminary estimate of 8.3% of SFTS cases were missed in SFTS high endemic provinces. Conclusions The actual SFTS incidence was underestimated. Effective measures such as adding a new SFTS case category - “SFTS clinical diagnosis cases” or using serological detection methods during acute phase should be considered to avoid missed diagnoses. Electronic supplementary material The online version of this article (10.1186/s12879-018-2970-7) contains supplementary material, which is available to authorized users.

This study aims at examining the effects of stressful life events on risk of impaired fasting glucose among left-behind farmers in rural China.The study collected data about stressful life events, family history of diabetes, lifestyle, demographics and minimum anthropometrics from left-behind famers aged 40-70 years. Calculated life event index was applied to assess the combined effects of stressful life events experienced by the left-behind farmers and its association with impaired fasting glucose was estimated using binary logistic regression models.The prevalence of abnormal fasting glucose was 61.4% by American Diabetes Association (ADA) standard and 32.4% by World Health Organization (WHO) standard. Binary logistic regression analysis revealed a coefficient of 0.033 (P.001) by ADA standard or 0.028 (P.001) by WHO standard between impaired fasting glucose and life event index. The overall odds ratios of impaired glucose for the second, third and fourth (highest) versus the first (lowest) quartile of life event index were 1.419 [95% CI=(1.173, 1.717)], 1.711 [95% CI=(1.413, 2.071)] and 1.957 [95% CI=(1.606, 2.385)] respectively by ADA standard. When more and more confounding factors were controlled for, these odds ratios remained statistically significant though decreased to a small extent.The left-behind farmers showed over two-fold prevalence rate of pre-diabetes than that of the nation's average and their risk of impaired fasting glucose was positively associated with stressful life events in a dose-dependent way. Both the population studied and their life events merit special attention.

To determine the seroprevalence, latent infection rate and risk factors for severe fever with thrombocytopenia syndrome virus (SFTSV) infection, a cross-sectional study was conducted in the general population of the Western region of Anhui Province of China from 1 September to 31 December 2014.Twelve villages with the highest rates of endemic SFTS infection were selected from six towns in two counties in the western region of Anhui Province. Blood samples were collected and tested for the presence of SFTSV-IgG antibodies by ELISA. Each participant was interviewed using a structured questionnaire before blood collection. Participants with seropositive specimens were further investigated using another structured questionnaire.Of 2126 blood specimens collected, 99 (4.66%) were seropositive for SFTSV. None of the participants had been diagnosed with SFTS before the blood collection or were accompanied by fever, thrombocytopenia and leukocytopenia after blood collection. Multivariate logistic regression model analysis revealed living in areas of uncontrolled vegetation growth, long-term residents of the locality and tick bites as high risk factors for SFTSV infection.The overall seroprevalence of SFTSV is higher in the western region of Anhui, possibly due to latent infection, with the main risk factors being living in areas of uncontrolled vegetation growth, long-term residents of the locality and tick bites. Further investigations are warranted to clarify the modes of SFTS virus transmission, while vector management, education on tick bite prevention and personal hygiene management should be implemented for high risk groups in endemic areas.

Supplemental Digital Content is available in the text, This study aims to analyze the postsurgical health-related quality of life (HRQOL) and quality of voice (QOV) of patients with laryngeal carcinoma with an expectation of improving the treatment and HRQOL of these patients. Based on the collection of information of patients with laryngeal carcinoma regarding clinical characteristics (age, TNM stage, with or without laryngeal preservation and/or neck dissection, with or without postoperative irradiation and/or chemotherapy, etc.), QOV using Voice Handicap Index (VIH) scale and HRQOL using EORTC QLQ-C30 and EORTCQLQ-H&N35 scales, the differences of postsurgical HRQOL related to their clinical characteristics were analyzed using univariate nonparametric tests, the main factors impacting the postsurgical HRQOL were analyzed using regression analyses (generalized linear models) and the correlation between QOV and HRQOL analyzed using spearman correlation analysis. A total of 92 patients were enrolled in this study, on whom the use of EORTC QLQ-C30, EORTC QLQ-H&N35 and VHI scales revealed that: the differences of HRQOL were significant among patients with different ages, TNM stages, and treatment modalities; the main factors impacting the postsurgical HRQOL were pain, speech disorder, and dry mouth; and QOV was significantly correlated with HRQOL. For the patients with laryngeal carcinoma included in our study, the quality of life after open surgeries were impacted by many factors predominated by pain, speech disorder, and dry mouth. It is suggested that doctors in China do more efforts on the patients’ postoperative pain and xerostomia management and speech rehabilitation with the hope of improving the patients’ quality of life.

Background Proven cost-effectiveness contrasted by low uptake of cancer screening (CS) calls for new methodologies promoting the service. Contemporary interventions in this regard relies primarily on strategies targeting general or specific groups with limited attention being paid to individualized approaches. This trial tests a novel package promoting CS utilization via continuous and tailored counseling delivered by primary caregivers. It aims at demonstrating that high risk individuals in the intervention arm will, compared to those in the delayed intervention condition, show increased use of CS service. Methods/Design The trial adopts a quasi-randomized controlled trial design and involves 2160 high risk individuals selected, via rapid and detailed risk assessments, from about 72,000 farmers aged 35+ in 36 administrative villages randomized into equal intervention and delayed intervention arms. The CS intervention package uses: a) village doctors and village clinics to deliver personalized and thus relatively sophisticated CS counseling; b) two-stage risk assessment models in identifying high risk individuals to focus the intervention on the most needed; c) standardized operation procedures to guide conduct of counseling; d) real-time effectiveness and quality monitoring to leverage continuous improvement; e) web-based electronic system to enable prioritizing complex determinants of CS uptake and tailoring counseling sessions to the changing needs of individual farmers. The intervention arm receives baseline and semiannual follow up evaluations plus CS counseling for 5 years; while the delayed intervention arm, only the same baseline and follow-up evaluations for the first 5 years and CS counseling starting from the 6th year if the intervention proved effective. Evaluation measures include: CS uptake by high risk farmers and changes in their knowledge, perceptions and self-efficacy about CS. Discussion Given the complexity and heterogeneity in the determinant system of individual CS service seeking behavior, personalized interventions may prove to be an effective strategy. The current trial distinguishes itself from previous ones in that it not only adopts a personalized strategy but also introduces a package of pragmatic solutions based on proven theories for tackling potential barriers and incorporating key success factors in a synergetic way toward low cost, effective and sustainable CS promotion. Trial registration ISRCTN33269053 Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1688-9) contains supplementary material, which is available to authorized users.

Background This study investigates the relationships between life events and chronic physical conditions among left behind farmers, a newly emerged weak group in vast rural China. Methods The study collected information about life events, chronic physical conditions, blood pressure and fasting blood glucose from 4681 famers living in 18 randomly selected villages (Lu’an, Anhui, China) from early November 2013 to the end of December 2013. It compared the risk and odds ratios (RRs/ORs) among different subgroups divided according two life event indices derived by adding up un-weighted-ratings and weighted-ratings based on multivariate logistic regression coefficients respectively. Results A total of 4040 (86.3 % eligible) farmers completed the survey. RRs between farmers with lower than the first 1/15-percentile of life event index and with higher life event index scores ranged 1.43–5.79 for chronic gastritis and 0.42–9.07 for prostatitis, 1.01–4.97 for cervicitis/vaginitis, 1.45–3.28 for cardio-cerebrovascular diseases, 1.12–1.58 for hypertension, 1.00–1.66 for diabetes, 1.07–3.35 for pre-diabetes and 5.00–55.00 for “other chronic physical conditions”. Conclusions Life events were independently linked with most of the chronic physical conditions in a dose-effectiveness way. RRs between subgroups divided by given percentile cutoff points of life event index compiled using logistic regression models turned out to be substantially higher than that between subgroups divided by same cutoff points of life event index produced via summing up the un-weighted Likert ratings of all the events studied. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1877-0) contains supplementary material, which is available to authorized users.

The big gap between efficacy of population level prevention and expectations due to heterogeneity and complexity of cancer etiologic factors calls for selective yet personalized interventions based on effective risk assessment. This paper documents our research protocol aimed at refining and validating a two-stage and web- based cancer risk assessment tool, from a tentative one in use by an ongoing project, capable of identifying individuals at elevated risk for one or more types of the 80% leading cancers in rural China with adequate sensitivity and specificity and featuring low cost, easy application and cultural and technical sensitivity for farmers and village doctors. The protocol adopted a modified population-based case control design using 72, 000 non-patients as controls, 2, 200 cancer patients as cases, and another 600 patients as cases for external validation. Factors taken into account comprised 8 domains including diet and nutrition, risk behaviors, family history, precancerous diseases, related medical procedures, exposure to environment hazards, mood and feelings, physical activities and anthropologic and biologic factors. Modeling stresses explored various methodologies like empirical analysis, logistic regression, neuro-network analysis, decision theory and both internal and external validation using concordance statistics, predictive values, etc..

Supplemental Digital Content is available in the text, The whole range of blood pressure (BP) has important implications. Yet, published studies focus primarily on hypertension and hypotension, the two extremes of BP continuum. This study aims at exploring quantile-specific associations of BP with common factors. The study used cross-sectional survey, collected information about gender, age, education, body mass index (BMI), alcohol intake, diet risk behavior, life event index, physical activity, fasting capillary glucose (FCG), and systolic/diastolic blood pressure (SBP/DBP) and pulse pressure (PP) from farmers living in 18 villages from rural Anhui, China, and performed descriptive and multivariate and quantile regression (QR) analysis of associations of SBP, DBP, or PP with the 9 factors surveyed. A total of 4040 (86.3%) eligible farmers completed the survey. Average hypertension prevalence rate and SBP, DBP, and PP values estimated 43.20 ± 0.50% and 141.37 ± 21.98, 87.76 ± 12.23, and 53.63 ± 15.72 mm Hg, respectively. Multivariate regression analysis revealed that all the 9 factors were significantly (P

Project subject sampling and randomization. (DOCX 80 kb)

Questions for soliciting evaluation data and calculation of outcome measures. (DOCX 26 kb)

Background Effective prevention against cancers depends heavily on sustained individual efforts practicing protective behaviors and avoiding risk factors in a complex sociocultural context, which requires continuous and personalized supports. Contemporary prevention relies primarily on strategies targeting general population with limited attention being paid to individualized approaches. This study tests a novel package called, in acronym of core intervention components, eCROPS-CA that leverages protective behaviors against over 80% leading cancers among high risk individuals via continuous and tailored counseling by village doctors. Methods/Design The study utilizes a quesi-RCT design involving 4320 high risk individuals selected, via rapid and detailed risk assessments, from about 72,000 farmers aged 35+ in 36 administrative villages randomized into equal intervention and delayed intervention arms. The intervention arm receives baseline and semiannual follow up evaluations plus eCROPS-CA for 5 years; while the control arm, only the baseline and follow-up evaluations for the first 5 years and eCROPS-CA starting from the 6th year if the intervention is proved effective. eCROPS-CA comprises electronic supports and supervision (e), counseling cancer prevention (C), recipe for objective behaviors (R), operational toolkit (O), performance-based incentives (P), and screening and assessment (S). Evaluation measures include: incidence and stage of the leading cancers, cancer-related knowledge, attitudes and practices; easy biophysical indicators (e.g., body mass index, blood pressure); intervention compliance, acceptance of the package. Discussion The prevention package incorporates key success factors in a synergetic way toward cost-effectiveness and long-term sustainability. It targets a set rather than any single cancer; choses village doctors as key solution to the widespread lack of professional manpower in implementing personalized and thus relatively sophisticated prevention; adopts real-time monitoring in reaching continuous improvement; utilizes smart web aids to enable prioritizing complex determinants of objective behaviors, linking counseling sessions happened at different time points and hence delivering highly coordinated prevention; uses 2-stage risk assessment models in identifying high risk individuals so as to focus on the most needed; applies standardized operation procedures in simplifying and smoothing behavior intervention yet ensuring delivery of essential steps and key elements. Trials registry ISRCTN33269053 Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1253-6) contains supplementary material, which is available to authorized users.

Background Being an intermediate stage in the development of diabetes, pre-diabetics were estimated as high as 14% to 63% in China and one to three quarters of them will develop into diabetes within 10 years. It is well established that the risk of diabetes progression can be modified substantially and a whole range of proven guidelines, protocols and methodologies are available. Unfortunately, most proven interventions are seldom used in daily practice and this is especially true in resource poor rural China. This project aims at demonstrating that an evolutionary intervention package featuring low cost, integration with routine services, cultural sensitization and self-optimization, is effective and sustainable in preventing diabetes. Methods/design This project utilizes a quasi cluster randomized controlled trial and a batched implementation strategy in which villages are recruited in 7 blocks within 7 consecutive years respectively. Block 0 involves 3 villages and provides an opportunity for piloting and refining primitive intervention methodologies and protocols. The following 6 blocks consist of 14 villages each and serve as intervention arm; while all the villages not yet started intervention form the control arm. For each block, measurement happens at baseline and every 12 months (for plasma glucose) or monthly (for body weight and blood pressure) after baseline. These arrangements enable documentation of up to 6 years of consecutive measures and detection of lower incidence of progression into diabetes, improved body max index and blood pressure, and increased service use and involvement in healthy dietary and physical activities among pre-diabetics receiving the experimental intervention compared to themselves at baseline or those in the delayed-intervention control condition. Discussion China has a long history of separating disease prevention and treatment systems and there is a clear need to leverages key success factors in a synergetic way toward integrated and sustainable diabetes prevention. This project is owned and managed by local health authorities and utilizes available resources. It introduces a package of long-term incentives, establishes ongoing mechanisms for continuous capacity building and quality improvement, and builds up an operational cycle for catalyzing similar efforts in the local prefecture even throughout rural China. Trial registration Current Controlled Trials: ISRCTN66772711.

BackgroundIncreasing cases of diabetes, a general lack of routinely operational prevention, and a long history of separating disease prevention and treatment call for immediate engagement of frontier clinicians. This applies especially to village doctors who work in rural China where the majority of the nation’s vast population lives. ObjectiveThis study aims to develop and test an online Smart Web Aid for Preventing Type 2 Diabetes (SWAP-DM2) capable of addressing major barriers to applying proven interventions and integrating diabetes prevention into routine medical care. MethodsDevelopment of SWAP-DM2 used evolutionary prototyping. The design of the initial system was followed by refinement cycles featuring dynamic interaction between development of practical and effective standardized operation procedures (SOPs) for diabetes prevention and Web-based assistance for implementing the SOPs. The resulting SOPs incorporated proven diabetes prevention practices in a synergetic way. SWAP-DM2 provided support to village doctors ranging from simple educational webpages and record maintenance to relatively sophisticated risk scoring and personalized counseling. Evaluation of SWAP-DM2 used data collected at baseline and 6-month follow-up assessment: (1) audio recordings of service encounters; (2) structured exit surveys of patients’ knowledge, self-efficacy, and satisfaction; (3) measurement of fasting glucose, body mass index, and blood pressure; and (4) qualitative interviews with doctors and patients. Data analysis included (1) descriptive statistics of patients who received SWAP-DM2–assisted prevention and those newly diagnosed with prediabetes and diabetes; (2) comparison of the variables assessed between baseline and follow-up assessment; and (3) narratives of qualitative data. ResultsThe 17 participating village doctors identified 2219 patients with elevated diabetes risk. Of these, 84.85% (1885/2219) consented to a fasting glucose test with 1022 new prediabetes and 113 new diabetes diagnoses made within 6 months. The prediabetic patients showed substantial improvement from baseline to 6-month follow-up in vegetable intake (17.0%, 43/253 vs 88.7%, 205/231), calorie intake (1.6%, 4/253 vs 71.4%, 165/231), leisure-time exercises (6.3%, 16/253 vs 21.2%, 49/231), body weight (mean 62.12 kg, SD 9.85 vs mean 58.33 kg, SD 9.18), and body mass index (mean 24.80 kg/m2, SD 3.21 vs mean 23.36 kg/m2, SD 2.95). The prediabetic patients showed improvement in self-efficacy for modifying diet (mean 5.31, SD 2.81 vs mean 8.53, SD 2.25), increasing physical activities (mean 4.52, SD 3.35 vs mean 8.06, SD 2.38), engaging relatives (mean 3.93, SD 3.54 vs mean 6.93, SD 2.67), and knowledge about diabetes and risks of an imbalanced diet and inadequate physical activity. Most participating doctors and patients viewed SWAP-DM2 as useful and effective. ConclusionsSWAP-DM2 is helpful to village doctors, acceptable to patients, and effective in modifying immediate determinants of diabetes at least in the short term, and may provide a useful solution to the general lack of participation in diabetes prevention by frontier clinicians in rural China. Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 66772711; http://www.controlled-trials.com/ISRCTN66772711 (Archived by WebCite at http://www.webcitation.org/6OMkAqyEy).