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Background This study aims to investigate the impact of varying coronal alignments of femoral prostheses on stress and strain distributions within the lateral compartment following unicompartmental knee arthroplasty (UKA) in patients with normal bone density and osteoporosis using finite element analysis. Additionally, it examines the relationship between osteoporosis and the progression of osteoarthritis in the lateral compartment postoperatively. Methods UKA models were developed for both normal bone and osteoporotic conditions using a validated finite element model of the knee. Seven alignment conditions for the femoral prosthesis were simulated: 0° (neutral alignment), varus angles of 3°, 6°, and 9°, and valgus angles of 3°, 6°, and 9°, resulting in a total of 14 scenarios. Stress and strain distributions in the meniscus, tibial cartilage, and femoral cartilage of the lateral compartment were evaluated. Results The results indicated that stress and strain in the meniscus, tibial cartilage, and femoral cartilage of the lateral compartment increased with greater varus alignment and decreased with greater valgus alignment in both normal and osteoporotic models. At equivalent alignment angles, stress and strain were consistently higher in the osteoporotic model (M2) compared to the normal bone model (M1), although the peak equivalent stress in the tibial cartilage was lower in the M2 model than in the M1 model. Conclusions In patients with osteoporosis undergoing fixed-bearing medial UKA, varus malalignment of the femoral prosthesis can lead to increased stress and strain in the lateral compartment’s meniscus, tibial cartilage, and femoral cartilage. These findings suggest that osteoporosis may contribute to abnormal stress and strain distributions in the lateral compartment following UKA, potentially accelerating the progression of osteoarthritis in this region postoperatively.

PURPOSETo characterize the pattern of post-treatment quality of life (QoL) for esophageal cancer (EC) survivors and construct models predicting their long-term QoL.METHODSOn the basis of a randomized trial in an EC high-risk region in China, we interviewed 363 EC survivors and 25,245 permanent residents matched with the survivors on age, sex, and township as the baseline. QoL was measured using three-level version of European Quality of Life 5-Dimensions instrument. We constructed piecewise mixed models estimating the QoL of EC survivors that varied by age, sex, patient type, hospital level, and therapy to ascertain QoL determinants.RESULTSThe post-treatment QoL of EC survivors dropped by 15.7% within the first year and recovered by 9.3% between 1 and 9 years compared with the baseline. Therapy was found to be a determinant of QoL, and a series of therapy-specific models were fitted accordingly, which all showed the pattern of decreasing rapidly and recovering gradually. Endoscopic treatment had the least impact on post-treatment QoL (7.5% drop within 5 years) compared with esophagectomy (12.2% drop within 1 year) and chemoradiotherapy (37.8% drop within 2 years). The usual activities dimension showed the greatest impairment among those patients (34.4% drop within 1 year).CONCLUSIONThis community-based study described the long-term QoL trajectory for EC survivors after different therapeutic modalities and constructed models to predict therapy-specific QoL at different time points after treatment. It provided new insights into decision making in treatment for EC from the perspective of QoL protection, offering a convenient tool for estimating quality-adjusted life-years.

Summary: Using noninvasive biomarkers to identify high-risk individuals prior to endoscopic examination is crucial for optimization of screening strategies for esophageal squamous cell carcinoma (ESCC). We conducted a nested case-control study based on two community-based screening cohorts to evaluate the warning value of serum metabolites for esophageal malignancy. The serum samples were collected at enrollment when the cases had not been diagnosed. We identified 74 differential metabolites and two prominent perturbed metabolic pathways, and constructed Metabolic Risk Score (MRS) based on 22 selected metabolic predictors. The MRS generated an area under the receiver operating characteristics curve (AUC) of 0.815. The model performed well for the within-1-year interval (AUC: 0.868) and 1-to-5-year interval (AUC: 0.845) from blood draw to diagnosis, but showed limited ability in predicting long-term cases (>5 years). In summary, the MRS could serve as a potential early warning and risk stratification tool for establishing a precision strategy of ESCC screening.

Abstract Background Current guidelines recommend only severe dysplasia and above (SDA) lesions of the esophageal squamous epithelium for clinical intervention. However, the histopathologic diagnosis derived from tissue biopsies may be subject to underestimation of severity. Methods 1073 participants from whom biopsies were taken at baseline chromoendoscopic examination in a population‐based screening trial were enrolled in this study. The size of the Lugol‐unstained lesions (LULs) was mainly analyzed. The outcome was defined as SDA lesions either identified at baseline screening, or during follow‐up, collectively referred to as the cumulative risk of SDA. Multivariable logistic regression models were used to evaluate the cumulative risk of SDA. Results One hundred and forty‐six SDA cases were identified in the study period. Participants with large LULs had a high cumulative incidence of SDA (cumulative incidence16–20mm: 55.88%; cumulative incidence>20mm: 76.92%) in the median of 7‐year duration. LULs of large size were significantly associated with a higher cumulative risk of SDA, regardless of the pathologic diagnosis (adjusted OR16–20mmvs.≤5mm = 21.02, 95% CI: 7.56–58.47; adjusted OR>20mmvs.≤5mm = 33.62, 95% CI: 11.79–95.87). Conclusions Results from this study suggest physician–patient shared decision‐making regarding clinical treatment or intensive surveillance should be carried out for LULs >20 mm in the esophagus, regardless of the histologic diagnosis. For those with LULs of 16–20 mm, intensive surveillance would also best be considered.

BackgroundTumor markers are routinely used in clinical practice. However, for resectable patients with esophageal squamous cell carcinoma (ESCC), they are applied infrequently as their prognostic significance is incompletely understood.MethodsThis historical cohort study included 2769 patients with resected ESCC from 2011 to 2018 in a high-risk area in northern China. Their clinical data were extracted from the Electronic Medical Record. Survival analysis of eight common tumor markers was performed with multivariable Cox proportional hazards regressions.ResultsWith a median follow-up of 39.5 months, 901 deaths occurred. Among the eight target markers, elevated postoperative serum SCC (Squamous cell carcinoma antigen) and CEA (Carcinoembryonic antigen) predicted poor overall survival (SCC HRadjusted: 2.67, 95% CI: 1.70-4.17; CEA HRadjusted: 2.36, 95% CI: 1.14-4.86). In contrast, preoperative levels were not significantly associated with survival. Stratified analysis also demonstrated poorer survival in seropositive groups of postoperative SCC and CEA within each TNM stage. The above associations were generally robust using different quantiles of concentrations above the upper limit of the clinical normal range as alternative cutoffs. Regarding temporal trends of serum levels, SCC and CEA were similar. Their concentrations fell rapidly after surgery and thereafter remained relatively stable.ConclusionPostoperative serum SCC and CEA levels predict the overall survival of ESCC surgical patients. More importance should be attached to the use of these markers in clinical applications.

The detection of abnormal lane-changing behavior in road vehicles has applications in traffic management and law enforcement. The primary approach to achieving this detection involves utilizing sensor data to characterize vehicle trajectories, extract distinctive parameters, and establish a detection model. Abnormal lane-changing behaviors can lead to unsafe interactions with surrounding vehicles, thereby increasing traffic risks. Therefore, solely focusing on individual vehicle perspectives and neglecting the influence of surrounding vehicles in abnormal lane-changing behavior detection has limitations. To address this, this study proposes a framework for abnormal lane-changing behavior detection. Initially, the study introduces a novel approach for representing vehicle trajectories that integrates information from surrounding vehicles. This facilitates the extraction of feature parameters considering the interactions between vehicles and distinguishing between different phases of lane-changing. The Light Gradient Boosting Machine (LGBM) algorithm is then employed to construct an abnormal lane-changing behavior detection model. The results indicate that this framework exhibits high detection accuracy, with the integration of surrounding vehicle information making a significant contribution to the detection outcomes.

Due to the low incidence of posteromedial tibial plateau fractures and limited clinical data available, the optimal treatment for this type of fracture remains to be established. This type of fracture, also known as Hoffa-like fracture of the tibial plateau, shares a similar mechanism of injury with the Hoffa fracture of the femoral condyle. In the field of orthopedics, finite element analysis is considered a valuable method to guide clinical decision-making. In this study, four methods used for internal fixation of Hoffa-like fractures of the tibial plateau were compared using computer simulation and applying a finite element method (FEM). The methods compared were lateral L-plate fixation alone (Model A); lateral L-plate combined with posterior anti-slip plate (reconstruction plate/T-plate) fixation (Model B); lateral L-plate combined with posterior hollow nail fixation of the fracture block (Model C); and lateral L-plate combined with anterior hollow nail fixation of the fracture (Model D). The maximum displacement of the model and the maximum stress of the internal fixation material were analyzed by applying an axial load of 2,500 N. The results showed that, in the normal bone model, the maximum displacement of the fracture in Model A was 0.60032 mm, with improved stability through the addition of posterior lateral plate fixation in Model B and reduction of the displacement to 0.38882 mm. The maximum displacement in Model C and Model D was comparable, amounting to 0.42345 mm and 0.42273 mm, respectively. Maximum stress was 1235.6 MPa for Model A, 84.724 MPa for Model B, 99.805 MPa for Model C, and 103.19 MPa for Model D. In the internal fixation analysis of the osteoporotic fracture model, we observed patterns similar to the results of the normal bone model. The results indicated that Model B yielded the overall best results in the treatment of Hoffa-like fractures of the tibial plateau. The orthopedic surgeon may wish to implement these insights into the perioperative algorithm, thereby refining and optimizing clinical patient care. In addition, our findings pave the way for future research efforts.

Postzygotic mutations are acquired in normal tissues throughout an individual’s lifetime and hold clues for identifying mutagenic factors. Here, we investigated postzygotic mutation spectra of healthy individuals using optimized ultra-deep exome sequencing of the time-series samples from the same volunteer as well as the samples from different individuals. In blood, sperm, and muscle cells, we resolved three common types of mutational signatures. Signatures A and B represent clock-like mutational processes, and the polymorphisms of epigenetic regulation genes influence the proportion of signature B in mutation profiles. Notably, signature C, characterized by C>T transitions at GpCpN sites, tends to be a feature of diverse normal tissues. Mutations of this type are likely to occur early during embryonic development, supported by their relatively high allelic frequencies, presence in multiple tissues, and decrease in occurrence with age. Almost none of the public datasets for tumors feature this signature, except for 19.6% of samples of clear cell renal cell carcinoma with increased activation of the hypoxia-inducible factor 1 (HIF-1) signaling pathway. Moreover, the accumulation of signature C in the mutation profile was accelerated in a human embryonic stem cell line with drug-induced activation of HIF-1α. Thus, embryonic hypoxia may explain this novel signature across multiple normal tissues. Our study suggests that hypoxic condition in an early stage of embryonic development is a crucial factor inducing C>T transitions at GpCpN sites; and individuals’ genetic background may also influence their postzygotic mutation profiles.

The meshing force distribution of the harmonic reducer has a great effect on its carrying capacity，transmission efficiency，transmission accuracy and service life. An analytical model based on no-load backlash and circumferential meshing stiffness is proposed to describe the meshing condition between flexible wheel and rigid wheel more accurately under load status. The no-load backlash in the assembled state is calculated by geometric method，and the circumferential meshing stiffness is obtained through establishing and analyzing the mechanical model of the flexspline under load. The distribution of meshing force under different load conditions is obtained by iterative solution based on the no-load backlash and the circumferential meshing stiffness matrix. A finite element model is established to verify the accuracy of the analytical model，and the results are basically consistent.

Abstract Background The association of early-life undernutrition and dyslipidemia found in previous studies may be confounded by the uncontrolled age difference between exposed and unexposed participants. The study aimed to investigate the association of early-life undernutrition and the risk of dyslipidemia in adulthood with good control of the age variable. Methods We took the Great Chinese Famine (1959–1961) as a natural experiment of severe undernutrition. This study was based on the baseline investigation of a population-based cohort in rural China. Undernutrition in early life was defined as being exposed to famine at younger than 3 years of age. Three approaches including Adjustment, Restriction, and Matching were applied to control the confounding effect of age. Logistic regression models were applied to evaluate the association between early-life famine and the presence of dyslipidemia. Stratified analysis by gender was also performed, and potential effect modification was tested by adding the interaction term of the famine exposure variable and gender into the model. Results Undernutrition in early life was associated with increased risk of borderline high and above (BHA) levels of total cholesterol (TC, ORAdjustment = 1.61; ORRestriction = 1.56; ORMatching = 1.87), triglycerides (TG, ORAdjustment = 1.33; ORRestriction = 1.30; ORMatching = 1.34), low-density lipoprotein cholesterol (LDL-C, ORAdjustment = 1.75; ORRestriction = 1.53; ORMatching = 1.77) and dyslipidemia (ORAdjustment = 1.52; ORRestriction = 1.45; ORMatching = 1.60), as well as high levels of TC, TG, LDL-C and dyslipidemia. An inverse association of undernutrition and risk of low high-density lipoprotein cholesterol (HDL-C) was found. Female participants with undernutrition experience had an increased risk of BHA TG and LDL-C (TG: ORAdjustment, female = 1.45; ORRestriction, female = 1.39; ORMatching, female = 1.51; LDL-C: ORAdjustment, female = 2.11; ORRestriction, female = 1.80; ORMatching, female = 2.15), but this association was not found in males. Conclusion Early-life undernutrition increased the risk of TC, TG, LDL-C, and dyslipidemia. Gender would significantly modify this effect for TG and LDL-C. These results emphasize the importance of nutritional conditions in the early stages of life to long-term health consequences.

BackgroundConventional universal endoscopic screening with pathology-based endoscopic re-examination for esophageal squamous cell carcinoma is in need of reform in China. We established a “two-step” precision screening strategy using two risk prediction models and have evaluated the cost-effectiveness of this precision strategy compared with the traditional strategy based on a large population-level randomized controlled trial from a healthcare provider’s perspective.MethodsFour precision screening strategies with different risk cutoffs at baseline screening and endoscopic surveillance were constructed, and then compared with traditional strategy through modeling using subjects from the screening cohort of the ESECC (Endoscopic Screening for Esophageal Cancer in China) trial. Total screening costs and the number of SDA (severe dysplasia and above in lesions of the esophagus) cases were obtained to calculate the average screening cost per SDA detected, the incremental cost-effectiveness ratio (ICER) and protection rates. Sensitivity analysis was conducted to evaluate uncertainties.ResultsCompared to traditional strategy, all precision screening strategies have much lower average costs for detection of one SDA case ($7,148~$11,537 vs. $14,944). In addition, precision strategies 1&2 (strategies 1,2,3,4 described below) achieved higher effectiveness (143~150 vs. 136) and higher protection rates (87.7%~92.0% vs. 83.4%) at lower cost ($1,649,727~$1,672,221 vs. $2,032,386), generating negative ICERs (-$54,666/SDA~-$25,726/SDA) when compared to the traditional strategy. The optimal strategies within different willingness-to-pay (WTP) ranges were all precision screening strategies, and higher model sensitivities were adopted as WTP increased.ConclusionsPrecision screening strategy for esophageal cancer based on risk stratification is more cost-effective than use of traditional screening strategy and has practical implications for esophageal cancer screening programs in China.

Alcoholic hepatitis is characterized by intense liver inflammation driven by excessive cytokines and chemokines production and immune cell infiltration. Here the authors identify a super-enhancer that regulates the expression of multiple CXCL chemokines in alcoholic hepatitis and may be a potential therapeutic target.

Multiple rib fractures caused by trauma are common injuries and the internal fixation methods of these injuries have been paid more and more attention by surgeons. Absorbable plates and screws are the effective way to treat rib fractures, but there are no reports on which type of screw fixation method is most effective. In this study, finite element analysis was used to study the effects of five different types of screw fixation methods on anterior rib, lateral rib and posterior rib. The finite element model of the ribs was reconstructed from CT images, and the internal pressure (40 kPa) and intercostal force (30 N) on the surfaces of the ribs were simulated accordingly. An intercostal force of 30 N was applied to the upper and lower surfaces of the ribs to simulate the effect of intercostal muscle force. The pressure of 40 kPa was applied to the inner surface of the ribs, and the normal direction was applied to the inner surface of the ribs. The positive direction was considered inspiratory pressure, and the negative direction was considered expiratory pressure. The results indicate the optimal type of screw fixation on the absorbable plate for rib fractures, and provide a basis and reference for clinical application.

Summary: Background: Previous risk prediction models taking esophageal malignant lesions detected during endoscopy as the primary outcome are not always sufficient to identify prevalent cases which are “overlooked” at screening. We aimed to update and externally validate our previous risk prediction model for malignant esophageal lesions by redefining the predicted outcome. Methods: 15,192 individuals from the Endoscopic Screening for Esophageal Cancer in China randomized controlled trial (ESECC trial, NCT01688908) were included as the training set, and 4576 participants from another population-based esophageal squamous cell carcinoma (ESCC) screening cohort (Anyang Esophageal Cancer Cohort Study, AECCS) served as the external validation set. Lesions with severe dysplasia or worse diagnosed at chromoendoscopy or identified via follow-up within 1 year after screening were defined as main outcome. Logistic regressions were applied to reconstruct the questionnaire-based prediction model using information collected before screening, with Akaike Information Criterion to determine the model structure. Findings: The final prediction model included age and its quadratic term, family history of ESCC, low body mass index (≤22 kg/m2), use of coal or wood as main fuel for cooking, eating rapidly, and ingestion of leftover food. The area under the curve was 0·77 (95% CI: 0·73–0·80) and 0·71 (95% CI: 0·65–0·78) in the training and validation set. When screening the top 50% or 10% of high-risk individuals within population, the detection rates can be increased in both cohorts, as compared to universal screening. Interpretation: The described tool may promote the efficiency of current national screening programs for ESCC and contribute to a precision screening strategy in high-risk regions in China. Funding: This work was supported by the National Natural Science Foundation of China (82073626, 81773501), the National Science & Technology Fundamental Resources Investigation Program of China (2019FY101102), the National Key R&D Program of China (2021YFC2500405), the Beijing-Tianjin-Hebei Basic Research Cooperation Project (J200016), the Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (XXZ0204) and the Beijing Nova Program (Z201100006820093). Sponsors had no role in the study design, data collection, analysis, and interpretation of data.

ObjectivesUpper gastrointestinal (G.I.) cancer screening has been conducted in China for decades. However, the economic burden for treatment “intensively” occurred in advance due to screening in resource-limited communities remain unclear.MethodsWe compared the treatment costs for upper G.I. cancers from the screening and control arms of a population-based randomized trial in a high-risk area for esophageal cancer (EC) in China based on claims data from the health insurance system in the local area which included whole population coverage.ResultsThe average out-of-pocket cost per treatment of EC in the screening arm was lower than that in the control arm ($5,972 vs. $7,557). This difference was a consequence of down-staging from screening which resulted in lower cost therapy for earlier stage cancers. Moreover, this result is similar for cardial and non-cardial gastric cancer in the two study arms ($7,933 vs. $10,605). However, three times as many (103 vs. 36) families in the screening arm suffered catastrophic health expenditure for all cancer types. The overall treatment cost for all EC patients in the screening arm ($1,045,119) was 2.44 times that in the control arm ($428,292), and the ratio for cardial and non-cardial gastric cancer was 1.12 ($393,261 vs. $351,557).ConclusionCancer treatment secondary to screening may triple the likelihood of catastrophic patient medical expenditure, and sharply increase the economic pressure on the local community, particularly for cancer types which are of high prevalence. Financial support for patients and the health insurance system should be taken into consideration when planning budgets for cancer screening programs in communities which are resource-limited.

A non-contact torque sensor based on a magnetostrictive Fe30Co70 rod wound with an excitation coil and a pickup coil is proposed in this paper. In the magnetic field range 0–30 kA/m, the changing rate and linearity of magnetostriction with a loading magnetic field of Fe30Co70 samples are significantly improved after heat treatment. Maximum magnetostriction is 103 ppm in the annealed sample in the parallel direction, while its tensile strength and allowable shear stress are 608 and 194.56 MPa, respectively. According to the mathematical model presented in this work, there is a linear relationship between the output voltage and torque. An apparent increase in the induced voltage signal (peak voltage) of 48.23 mV is observed as the torque increases to 20 Nm in the case of applying sinusoidal excitation signals. In addition, the experimental results are consistent with the calculated values within the torque range 0–16 Nm, and a good sensitivity of 2.87 mV/Nm is obtained. This work shows the prospect of Fe30Co70 alloy for non-contact torque sensing for the appropriate magnetostrictive property with no orientation requirement.

Abstract Background This study aims to compare the performance of the recently developed Chinese (city) tariff of the EQ-5D-3L against the UK, US, Japanese and Korean tariffs in a general rural population in China. Methods From November 2015 to September 2016, 12,085 permanent residents aged 45–69 from 257 villages randomly selected from Hua County, Henan Province, China, were interviewed using EQ-5D-3L, and a one-on-one questionnaire investigation was used to collect data on factors associated with HRQOL. The health utility scores were calculated using the UK, US, Japanese, Korean and Chinese (city) tariffs. The agreement, known-groups validity and sensitivity of these five tariffs were evaluated. Transition scores for pairs of observed EQ-5D-3L health states were calculated and compared. Results The Korean tariff yielded the highest mean health utility score (0.963), followed by the Chinese (city) (0.948), US (0.943), UK (0.930) and Japanese (0.921) tariffs, but the differences in the scores of any two tariffs did not exceed the MCID. The Chinese (city) tariff showed higher ICC values (ICCs> 0.89, 95% CI:0.755–0.964) and narrower limits of agreement (0.099–0.167) than the Korean tariff [(ICCs> 0.71, 95% CI:0.451–0.955); (0.146–0.253)]. The Chinese (city) tariff had a higher relative efficiency and effect size statistics in 10 out of 11 variables as compared to the UK, US and Japanese tariffs. The Chinese (city) tariff (0.215) was associated with moderate mean absolute transition scores compared with the UK (0.342), US (0.230), Japanese (0.149) and Korean (0.189) tariffs for 1485 observed pairs of the EQ-5D-3L health states. Conclusions Health utility scores derived from the five tariffs differed. The Chinese (city) tariff was the most suitable of these tariffs and was without obvious weakness. We recommend adopting the Chinese (city) tariff when applying EQ-5D-3L to assess quality of life among the elderly in China’s agricultural region with socio-economic status similar to Hua County. Results of this study had provided a crucial basis for health surveys, health promotion projects, health intervention trials, and health economic evaluation taking HRQOL as a target in rural areas of China.

Abstract Background Heterogeneity should be carefully addressed to facilitate establishment of effective population-level blood lipid management. The primary aim of the study was to investigate gender heterogeneity in prevalence of dyslipidemia, including trends with age and associated factors in middle age rural Chinese. Methods This is a cross-sectional study based on a baseline investigation of a population-based randomized controlled trial in rural China, involving 26,378 permanent residents of age 45–69. The age-specific prevalence of dyslipidemia was estimated for men and women, and the trends of prevalence with age were compared. Logistic regression was used to explore the factors associated with prevalent risk of dyslipidemia. Results The overall prevalence of dyslipidemia was significantly higher in females than in males for borderline high and above (BHA) total cholesterol (TC ≥ 200 mg/dL), BHA triglycerides (TG ≥ 150 mg/dL) and BHA low-density lipoprotein cholesterol (LDL-C ≥ 130 mg/dL), but was lower for low high-density lipoprotein cholesterol (HDL-C

Patients who sustain a traumatic brain injury (TBI) are known to have a significantly quicker fracture healing time than patients with isolated fractures, but the underlying mechanism has yet to be identified. In this study, we found that the upregulation of miRNA-26a-5p induced by TBI correlated with a decrease in phosphatase and tensin homolog (PTEN) in callus formation. In vitro, overexpressing miRNA-26a-5p inhibited PTEN expression and accelerated osteoblast differentiation, whereas silencing of miRNA-26a-5p inhibited osteoblast activity. Reduction of PTEN facilitated osteoblast differentiation via the PI3K/AKT signaling pathway. Through luciferase assays, we found evidence that PTEN is a miRNA-26a-5p target gene that negatively regulates the differentiation of osteoblasts. Moreover, the present study confirmed that preinjection of agomiR-26a-5p leads to increased bone formation. Collectively, these results indicate that miRNA-26a-5p overexpression may be a key factor governing the improved fracture healing observed in TBI patients after the downregulation of PTEN and PI3K/AKT signaling. Upregulation of miRNA-26a-5p may therefore be a promising therapeutic strategy for promoting fracture healing. Keywords: traumatic brain injury, fracture, miRNA, PTEN

We aimed to develop an improved version of the diagnostic model predicting the risk of malignant esophageal lesions in opportunistic screening and validate it in external populations. The development set involved 10,595 outpatients receiving endoscopy from a hospital in Hua County, a high-risk region for esophageal squamous cell carcinoma in northern China. Validation set A enrolled 9453 outpatients receiving endoscopy in a non-high-risk region in southern China. Validation set B involved 17,511 residents in Hua County. The improved diagnostic model consisted of seven predictors including age, gender, family history of esophageal squamous cell carcinoma, smoking, body mass index, dysphagia, and retrosternal pain, with an area under the receiver operating characteristic curve (AUC) of 0.860 (95% confidence interval: 0.835–0.886) in the development set. Ideal discrimination ability was achieved in external validations (AUC validation set A: 0.892, 95% confidence interval: 0.858–0.926; AUC validation set B: 0.799, 95% confidence interval: 0.705–0.894). This improved model also markedly increased the detection rate of malignant esophageal lesions compared with universal screening, demonstrating great potential for use in opportunistic screening of malignant esophageal lesions in heterogeneous populations.

Sulfidization xanthate flotation remains the most promising method for the beneficiation of malachite. In this study, L-arginine (LA) was first used to modify the malachite surface and improve the efficiency of sulfidization flotation. The performance of LA was evaluated by the flotation experiments. The mechanism of interaction between LA and the malachite surface was investigated by adsorption experiments, zeta potential measurements, scanning electron microscopy (SEM-EDS) and X-ray photoelectron spectroscopy (XPS) analysis. Flotation experiments showed that LA had a significantly promoting effect on malachite sulfidization flotation. Adsorption experiments and SEM-EDS results indicated that LA improved the adsorption of S (II) species into the malachite surface and promoted the formation of sulfides. This finding was further confirmed by the XPS analysis. The XPS measurements results determined that S (II) species reacted with Cu (II) on the malachite surface and form polysulfides, adding LA promoted the reaction. The zeta potential measurements showed that LA increased the positive electrical properties of the mineral surface, which was conducive to S (II) species adsorption and the sulfidization reaction. This work sheds new light on the development of sulfidization activation.

Background: To fully realize efficacy in cancer screening, timely and appropriate treatment for participants with malignant lesions is critical. However, the health-seeking behavior of patients with upper gastrointestinal (G.I.) cancer identified in population-level screening programs in China is unknown. Methods: A community-based real-world investigation was conducted with 136 upper G.I. cancer patients detected in a large screening cohort in an area of high-risk for upper G.I. cancer in China. Using local medical claims data and semi-structured face-to-face interview, we collected information regarding the clinical treatment regimen and factors which result in the lack of timely and appropriate treatment. Findings: The treatment records for 133 upper G.I. cancer patients were acquired. Among these, 48 (36•09%) patients did not receive treatment within three months of initial diagnosis, and treatment of early-stage cancer was more likely to be delayed. Sixteen patients did not seek further diagnostic testing due to their low health-awareness and socio-economic status. Another 20 participants proactively sought further diagnostic evaluation in health care facilities but were prevented from receiving further treatment due to low sensitivity of given diagnostic test(s), failure to recognize the significance of screening results, and/or lack of basic knowledge of diagnosis and treatment for early cancer on the part of clinicians. The treatment regimen offered to patients depended largely on the level of health care facilities they visited, and non-medical factors were the main reasons for choice of health care facilities. Interpretation: A coordinated, system-based management strategy is urgently needed to support the design of upper G.I. cancer screening programs in rural populations in China. Funding: The Charity Project of the National Ministry of Health (201202014), the National Key R & D Program of China (2016YFC0901404), the National Science & Technology Fundamental Resources Investigation Program of China (2019FY101102), and the National Natural Science Foundation of China (82073626).

Ulcers are a lower-extremity complication of diabetes with high recurrence rates. Oxidative stress has been identified as a key factor in impaired diabetic wound healing. Hyperglycemia induces an accumulation of intracellular reactive oxygen species (ROS) and advanced glycation end products, activation of intracellular metabolic pathways, such as the polyol pathway, and PKC signaling leading to suppression of antioxidant enzymes and compounds. Excessive and uncontrolled oxidative stress impairs the function of cells involved in the wound healing process, resulting in chronic non-healing wounds. Given the central role of oxidative stress in the pathology of diabetic ulcers, we performed a comprehensive review on the mechanism of oxidative stress in diabetic wound healing, focusing on the progress of antioxidant therapeutics. We summarize the antioxidant therapies proposed in the past 5 years for use in diabetic wound healing, including Nrf2- and NFκB-pathway-related antioxidant therapy, vitamins, enzymes, hormones, medicinal plants, and biological materials.

Background: We aimed to establish a new approach for surveillance of cancer prevalence and survival in China, based on the Medical-Insurance-System-based Cancer Surveillance System (MIS-CASS). Methods: We constructed a standard procedure for data collection, cleaning, processing, linkage, verification, analysis, and estimation of cancer prevalence and survival (including both actual observations and model estimates) by conjoint use of medical insurance claims data and all-cause death surveillance data. As a proof-of-principle study, we evaluated the performance of this surveillance approach by estimating the latest prevalence and survival for upper gastrointestinal cancers in Hua County, a high-risk region for oesophageal cancer in China. Findings: In Hua County, the age-standardised relative 5-year survival was 39·2% (male: 36·8%; female: 43·6%) for oesophageal cancer and 33·3% (male: 29·6%; female: 43·4%) for stomach cancer. For oesophageal cancer, better survival was observed in patients of 45–64 years compared with national average estimates, and women of

Abstract Background Tennis elbow or lateral epicondylitis is a common source of pain among craftsmen. Although it cannot be completely resolved, extracorporeal shock wave therapy (ESWT) and ultrasonics (US) have been found to be effective for tennis elbow as highlighted in previously published randomized controlled trials (RCTs) and reviews. However, the efficacy of these two therapies in treating tennis elbow is unknown. This meta-analysis compares the effectiveness of ESWT and US in relieving pain and restoring the functions of tennis elbow following tendinopathy. Methods RCTs published in the PubMed, Embase, Cochrane Library, and SpringerLink databases comparing ESWT and US in treating tennis elbow were identified by a software and manual search. The risk of bias and clinical relevance of the included studies were assessed. Publication bias was explored using funnel plot and statistical tests (Egger’s test and Begg’s test). The major outcomes of the studies were analyzed using the Review Manager 5.3. Results Five RCTs comprising five patients were included in the present meta-analysis. The results revealed a significantly lower VAS score of pain in the ESWT group (1 month: MD = 4.47, p = 0.0001; 3 months: MD = 20.32, p

Widespread hexavalent chromium (Cr (VI)) in the environment has become a worldwide problem, and economical and efficient treatment is urgently needed. In this paper, the treatment method of Cr (VI) by microorganisms and iron minerals (pyrite and magnetite) under anaerobic conditions was investigated. Furthermore, the influence of Cr (VI) on the microbial community structure was explored. The reduction test demonstrated that the removal rate of Cr (VI) in a single biological group was 54.96%; however, in the pyrite and biological groups and magnetite and biological groups, the removal rates of Cr (VI) increased to 83.06% and 78.23%, respectively. Microorganisms and iron minerals work together to produce a better removal effect on the removal rate of Cr (VI). Mechanistic studies have found that in the process of Cr (VI) reduction, a passivation layer is formed on the surface of the mineral that hinders the progress of the reaction. The addition of bacteria can reduce the negative impact of the passivation layer. At the same time, iron minerals have better electron-receiving and -conducting ability and can be used as electron carriers for bacteria to reduce Cr (VI). In addition, iron minerals and the disappearance of Cr (VI) will change the structure of the community and affect the expression of its functions, which is more conducive to reducing Cr (VI). This work sheds new light on the treatment of heavy metal pollution and the understanding of the synergistic reduction mechanism of Cr (VI).

Nature organisms, after billions of years of evolution, have evolved elegant morphologies, structures, patterns, or surface wettabilities with unique functionalities. Among all the intriguing characteristics observed in nature organisms, their drag reduction abilities with low energy consumption have always attracted wide attentions of human beings, because of its great potentiality in various fields, e.g., marine vehicles, aircraft, pipeline transportation, microfluidics, etc. Recently, in-depth studies have been carried out to uncover various biological structures with distinguished drag reduction performance including shark skins, penguin feathers, dolphin skins, lotus leaves, and Nepenthes pitcher. In this review, we will give a succinct account of their drag-reduction mechanisms as well as introduce the recent biomimetic processes to create artificial drag-reduction surfaces. Meanwhile, the remaining challenges and future prospective of bio-inspired drag reduction are also briefly proposed. We hope this review can help people to learn about the natural wisdoms to reduce fluid resistance and stimulate people to develop efficient drag reduction approaches, which are essential for submarine and cargo ship navigation, air vehicles, pipeline transportation, microfluidic system, and so forth.

Summary: Background: We aimed to establish a Medical-Insurance-System-based Cancer Surveillance System (MIS-CASS) in China and evaluate the completeness and timeliness of this system through reporting cancer incidence rates using claims data in two regions in northern and southern China. Methods: We extracted claims data from medical insurance systems in Hua County of Henan Province, and Shantou City in Guangdong Province in China from Jan 1, 2012 to Jun 30, 2019. These two regions have been considered to be high risk regions for oesophageal cancer. We developed a rigorous procedure to establish the MIS-CASS, which includes data extraction, cleaning, processing, case ascertainment, privacy protection, etc. Text-based diagnosis in conjunction with ICD-10 codes were used to determine cancer diagnosis. Findings: In 2018, the overall age-standardised (Segi population) incidence rates (ASR World) of cancer in Hua County and Shantou City were 167·39/100,000 and 159·78/100,000 respectively. In both of these areas, lung cancer and breast cancer were the most common cancers in males and females respectively. Hua County is a high-risk region for oesophageal cancer (ASR World: 25·95/100,000), whereas Shantou City is not a high-risk region for oesophageal cancer (ASR World: 11·43/100,000). However, Nanao island had the highest incidence of oesophageal cancer among all districts and counties in Shantou (ASR World: 36·39/100,000). The age-standardised male-to-female ratio for oesophageal cancer was lower in Hua County than in Shantou (1·69 vs. 4·02). A six-month lag time was needed to report these cancer incidences for the MIS-CASS. Interpretation: MIS-CASS efficiently reflects cancer burden in real-time, and has the potential to provide insight for improvement of cancer surveillance in China. Funding: The National Key R&D Program of China (2016YFC0901404), the Digestive Medical Coordinated Development Center of Beijing Municipal Administration of Hospitals (XXZ0204), the Sanming Project of Shenzhen (SZSM201612061), and the Shantou Science and Technology Bureau (190829105556145, 180918114960704). Keywords: Medical insurance system, Claims data, Cancer surveillance, Cancer incidence, China

Abstract Self-rated health (SRH) has been shown to be a good predictor of mortality. Data on SRH and its associated factors in the Chinese general population are limited. This study aims to assess the epidemiology of SRH in rural Anyang, China. SRH (categorized as “healthy”, “fair” or “unhealthy”) was measured in a population-based study of 2,814 adults (including 697 couples) aged 25 to 69 who were recruited from rural Anyang in 2014. Of 2,814 subjects, 63.1% rated their health as “healthy”, whereas 28.1% and 8.8% rated their health as “fair” and “unhealthy”. Compared to males, females had a higher likelihood of reporting a better SRH. Health ratings declined with increasing age, unmarried status, lower education levels. Poor SRH was positively correlated with medical history as well as high levels of fasting plasma glucose and total cholesterol, but not with unhealthy lifestyle indicators including smoking, drinking, and obesity. High household income was predictive of better SRH in men but not in women. Among couples, a positive spousal SRH concordance was observed, although the strength of this concordance was low. These findings will be useful for formulation of appropriate strategies for improving risk perception and promoting general health in economically developing regions.

Sulfuration flotation is the most widely used technology in malachite beneficiation. However, the inhomogeneity of malachite surfaces usually results in a non-uniform sulfuration surface. The motivation of this work is attempt to adopt different functional combination collectors to enhance the sulfuration flotation of malachite. Accordingly, the flotation behaviors and adsorption mechanisms of benzohydroxamic acid (BHA) and sodium butyl-xanthate (SBX) on the surface of malachite were systematically investigated using flotation tests, zeta-potential measurements, Fourier-transform infrared (FTIR) spectroscopy, Raman spectroscopy, and first-principle calculations. The test results of vulcanization flotation showed that the combined collectors of SBX with BHA possessed a higher recovery than only using SBH by 20%, indicating that there may be a synergistic effect between BHA and SBX. The IR and Raman spectroscopy demonstrated that both BHA and SBX could chemically adsorb onto the malachite surface. The density functional theory (DFT) calculation results further indicated that the combined adsorption energy of BHA and SBX was much lower than that of only BHA or SBX, which confirmed the synergistic effects of BHA and SBX on the malachite surface. This work may shed new light on the design and development of more efficient combined flotation reagents.

The effectiveness of health interventions can be impaired by low socio-economic status and poor living conditions of the target population. However, the specifics of this problem in rural China are still unclear, and appropriate strategies should be explored.In 2013, we conducted a questionnaire-based investigation among 410 participants from a population-based esophageal cancer cohort study in rural Anyang, China. Information regarding their demographic characteristics, levels of exposure to four health-risk behaviors, including smoking, alcohol consumption, risky dietary behaviors and poor hygiene, as well as willingness to change these behaviors, and data on potential predictors of willingness to change behaviors were collected.In this study, 33.3% (23/69), 25.0% (13/52), 60.7% (68/112) and 62.2% (237/381) of respondents reported that they were willing to change smoking, alcohol consumption, risky dietary behaviors and poor hygiene, respectively. Older people had higher exposure levels and less willingness to change these four health-risk behaviors. The levels of these four health-risk behaviors were negatively associated with willingness to change, while faith in people and behavioral change in surrounding people increased willingness to change risky behaviors.In behavior-intervention-based health-promotion programs in rural China, the elderly and highly exposed populations should be the most difficult part and community- or household-based intervention would be more efficient.

Recent studies showed that kidney-specific inactivation of Kif3a produces kidney cysts and renal failure, suggesting that kinesin-mediated intracellular transportation is important for the establishement and maintenance of renal epithelial cell polarity and normal nephron functions. Kif5b, one of the most conserved kinesin heavy chain, is the mouse homologue of the human ubiquitous Kinesin Heavy Chain (uKHC). In order to elucidate the role of Kif5b in kidney development and function, it is essential to establish its expression profile within the organ. Therefore, in this study, we examined the expression pattern of Kif5b in mouse kidney. Kidneys from embryonic (E) 12.5-, 16.5-dpc (days post coitus) mouse fetuses, from postnatal (P) day 0, 10, 20 pups and from adult mice were collected. The distribution of Kif5b was analyzed by immunostaining. The possible involvement of Kif5b in kidney development was investigated in conditional mutant mice by using a Cre-LoxP strategy. This study showed that the distribution of Kif5b displayed spatiotemporal changes during postnatal kidney development. In kidneys of new born mice, Kif5b was strongly expressed in all developing tubules and in the ureteric bud, but not in the glomerulus or in other early-developing structures, such as the cap mesenchyme, the comma-shaped body, and the S-shaped body. In kidneys of postnatal day 20 or of older mice, however, Kif5b was localized selectively in the basolateral domain of epithelial cells of the thick ascending loop of Henle, as well as of the distal convoluted tubule, with little expression being observed in the proximal tubule or in the collecting duct. Conditional knock-down of Kif5b in mouse kidney did not result in detectable morphological defects, but it did lead to a decrease in cell proliferation rate and also to a mislocalization of Na+/K+/-ATPase, indicating that although Kif5b is non-essential for kidney morphogenesis, it is important for nephron maturation.

To investigate the distribution of Human papillomavirus (HPV)-31 A, B and C variants as well as the common amino acid polymorphisms in Chinese women, all 14 HPV-31 positive cervical exfoliated cell specimens identified from a descriptive study including ∼2700 women from Northern China were analyzed. HPV-31 positive specimens were identified by Mass Spectrometry and the fragments of partial Long Control Region, E6 and E7 were amplified and directly sequenced or cloned into vector and then sequenced to confirm the variant information. HPV-31 prevalence in Northern Chinese female population was 0.52%. Six different sequences represented all 14 isolates, and these isolates were subsequently classified into variant lineage A (9), B (0) and C (5) by phylogenetic analysis. Five common amino acid polymorphism sites (2 in E6 and 3 in E7) and a novel non-synonymous mutation were detected in the current study. Our investigation suggested that HPV-31 was much less detected in Chinese women population than that in western countries. A and C variants were commonly detected while B variants were rarely detected in this population.

We have previously synthesized a series of hybrid compounds by linking ferulic acid to tacrine as multifunctional agents based on the hypotheses that Alzheimer's disease (AD) generates cholinergic deficiency and oxidative stress. Interestingly, we found that they may have potential pharmacological activities for treating AD. Here we report for the first time that tacrine-6-ferulic acid (T6FA), one of these compounds, can prevent amyloid-β peptide (Aβ)-induced AD-associated pathological changes in vitro and in vivo. Our results showed that T6FA significantly inhibited auto- and acetylcholinesterase (AChE)-induced aggregation of Aβ(1-40)in vitro and blocked the cell death induced by Aβ(1-40) in PC12 cells. In an AD mouse model by the intracerebroventricular injection of Aβ(1-40), T6FA significantly improved the cognitive ability along with increasing choline acetyltransferase and superoxide dismutase activity, decreasing AChE activity and malondialdehyde level. Based on our findings, we conclude that T6FA may be a promising multifunctional drug candidate for AD.