Effectiveness Evaluation of Low-dose Spiral Computed Tomography for Lung Cancer Screening in Minhang District of Shanghai / 中国肺癌杂志

BACKGROUND@#Low-dose spiral computed tomography (LDCT) has been recommended for lung cancer screening in high-risk populations. However, evidence from Chinese populations was limited due to the different criteria for high-risk populations and the short-term follow-up period. This study aimed to evaluate the effectiveness in Chinese adults based on the Lung Cancer Screening Program in Minhang District of Shanghai initiated in 2013.@*METHODS@#A total of 26,124 subjects aged 40 years or above were enrolled in the Lung Cancer Screening Program during the period of 2013 and 2017. Results of LDCT examination, and screen-detected cancer cases in all participants were obtained from the Reporting System of the Lung Cancer Screening Program. The newly-diagnosed cases and their vital status up to December 31, 2020 were identified through a record linkage with the Shanghai Cancer Registry and the Shanghai Vital Statistics. Standardized incidence ratio (SIR) and 95%CI were calculated using the local population at ages of 40 or above as the reference. Proportions of early-stage cancer (stage 0-I), pathological types, and 5-year observed survival rates of lung cancer cases were estimated and compared between the cases derived from the screened and non-screened populations. Cox regression models were applied to evaluate the hazard ratio (HR) and 95%CI of LDCT screening with all-cause death of the lung cancer cases.@*RESULTS@#The crude and age-standardized incidence of lung cancer in screened population were 373.3 (95%CI: 343.1-406.1) and 70.3 per 100,000 person-years, respectively, with an SIR of 1.8 (95%CI: 1.6-1.9), which was observed to decrease with following-up time. The early-stage cancer accounted for 49.4% of all lung cancer cases derived from the screened population, significantly higher than 38.4% in cases from the non-screened population during the same period (P<0.05). The proportion of lung adenocarcinoma (40.7% vs 35.9%) and 5-year survival rate (53.7% vs 41.5%) were also significantly higher in the cases from the screened population (all P<0.05). LDCT screening was associated with 30% (HR=0.7, 95%CI: 0.6-0.8) reduced all-cause deaths of the cases.@*CONCLUSIONS@#The participants of the screening program are at high-risk of lung cancer. LDCT favors the early-detection of lung cancer and improves 5-year survival of the screened cases, indicating a great potential of LDCT in reducing the disease burden of lung cancer in Chinese populations.

Risk analysis of hypertension among community-dwellers at risk for high blood pressure in Minhang District of Shanghai / 上海预防医学

ObjectiveTo investigate the incidence of hypertension and its influencing factors in community-dwellers at risk for high blood pressure in Minhang District of Shanghai， and to provide scientific evidence for the community management. MethodsA retrospective cohort study was conducted using the electronic health records of community-dwellers at risk for high blood pressure in Minhang District， Shanghai from January 1， 2011 to December 31， 2017. The study end-point was the occurrence of hypertension，and the followup was finished in December 2021. A total of 17 265 community-dwellers at risk for high blood pressure were enrolled in our study. Log-rank test and Cox regression analysis were used to determine the influencing factors. ResultsAfter 6.04 years of follow-up， the hypertension incidence among community-dwellers at risk for high blood pressure in Minhang District of Shanghai was 25.5%. Family history of hypertension （HR=1.250， 95%CI： 1.168‒1.338）， family history of stroke （HR=1.295， 95%CI： 1.080‒1.553）， history of diabetes （HR=1.203， 95%CI： 1.076‒1.345）， daily smoking （HR=1.187， 95%CI： 1.087‒1.296）， overweight （HR=1.393， 95%CI：1.308‒1.484）， obesity（HR=1.903， 95%CI： 1.719‒2.106）， high values of normal blood pressure （HR=1.275， 95%CI： 1.195‒1.359） and advanced age （HR=1.033， 95%CI： 1.030‒1.036） were all risk factors. Emaciation （HR=0.649， 95%CI： 0.500‒0.840） was a protective factors. ConclusionBlood pressure monitoring should be strengthened for people elderly， with family history of hypertension， family history of stroke， diabetes or high values of normal blood pressure， so as to diagnose hypertension early. Timely intervention measures should be taken for community-dwellers with unhealthy lifestyles such as smoking， overweight and obesity.

Risk assessment and influencing factors of malnutrition among community-dwelling older adults in Minhang District of Shanghai / 环境与职业医学

Background The prevalence of malnutrition in older adults is high. Early use of appropriate screening scales for malnutrition risk and early intervention can effectively improve life quality of the elderly in communities. Objective To evaluate the risk of malnutrition among the community-dwelling elderly in a district of Shanghai and explore its influencing factors. Methods From October to December 2021, a total of 960 seniors aged 65 years and above in community committees (villages) of Minhang District were selected by stratified random sampling. Trained investigators conducted one-to-one interviews with included seniors using questionnaires. The questionnaires included the Geriatric Depression Scale (GDS), the Activity of Daily Living Scale (ADL), and the malnutrition risk assessment for elderly adults. Height, weight, waist circumference, and calf circumference were measured. Chi-square test and logistic regression were used to analyze potential influencing factors of malnutrition in the elderly. Results Among the 960 community-dwelling seniors of Minhang District, 13 (1.35%) were malnourished and 311 (32.40%) were at the risk of malnutrition. There were statistically significant differences in nutritional status across different categories of age, sex, monthly family income, education level, marital status, waist circumference, dental health status, activity of daily living, nutrition knowledge, suffering from chronic diseases, having > 3 chronic diseases, taking > 3 long-term prescriptions, depression symptoms, sleeping duration, daily outdoor activity time, number of daily food species (milk/soy products/fish/meat/poultry/eggs), daily intake of vegetables and fruits, daily consumption of cooking oil, frequency of physical exercise, frequency of smoking, and living alone (P < 0.05). The logistic regression analysis results showed that poor dental conditions, insufficient daily intake of milk/soy products/fish/meat/poultry/eggs (<3 kinds), insufficient daily intake of vegetables and fruits (<500 g), excessive daily consumption of cooking oil (>25 g), insufficient daily outdoor activities (<1 h·d−1), living alone, low educational level (primary school and below), suffering from chronic diseases, having > 3 chronic diseases, taking > 3 long-term prescriptions, and being single/widowed/divorced were the main risk factors for nutritional abnormalities in the elderly (P< 0.05). Conclusion The elderly in Minhang District of Shanghai have a high malnutrition risk, and their nutritional status is affected by multiple factors, including poor dental status, irrational dietary structure, insufficient time for outdoor activities, suffering from chronic diseases, having > 3 chronic diseases, taking > 3 long-term prescriptions, low educational level, living alone, and being single/widowed/divorced.

Metabolic interventions combined with CTLA-4 and PD-1/PD-L1 blockade for the treatment of tumors: mechanisms and strategies / 医学前沿

Immunotherapies based on immune checkpoint blockade (ICB) have significantly improved patient outcomes and offered new approaches to cancer therapy over the past decade. To date, immune checkpoint inhibitors (ICIs) of CTLA-4 and PD-1/PD-L1 represent the main class of immunotherapy. Blockade of CTLA-4 and PD-1/PD-L1 has shown remarkable efficacy in several specific types of cancers, however, a large subset of refractory patients presents poor responsiveness to ICB therapy; and the underlying mechanism remains elusive. Recently, numerous studies have revealed that metabolic reprogramming of tumor cells restrains immune responses by remodeling the tumor microenvironment (TME) with various products of metabolism, and combination therapies involving metabolic inhibitors and ICIs provide new approaches to cancer therapy. Nevertheless, a systematic summary is lacking regarding the manner by which different targetable metabolic pathways regulate immune checkpoints to overcome ICI resistance. Here, we demonstrate the generalized mechanism of targeting cancer metabolism at three crucial immune checkpoints (CTLA-4, PD-1, and PD-L1) to influence ICB therapy and propose potential combined immunotherapeutic strategies co-targeting tumor metabolic pathways and immune checkpoints.

Shanghai community-based practice of early lung cancer screening with low-dose spiral computed tomography / 中国癌症杂志

Background and purpose:As one of the most fatal malignant tumors in China, the morbidity and mortality of lung cancer remain high. Early diagnosis and normative treatment is the key to improve the prognosis of lung cancer. The aim of this study was to explore the practice of early lung cancer screening with low-dose spiral computed tomography (CT) based on the current situation in community health service, with integration of superior resources of med-ical institutions at all levels in Shanghai.Methods:From Aug. 2013 to Aug. 2014, we screened high-risk population in selected communities of Minhang District, Shanghai, for early diagnosis of lung cancer with low-dose spiral CT combined with multidisciplinary comprehensive treatment models including minimally invasive surgery, exploring the medical service network covering prevention, diagnosis, treatment, rehabilitation and follow-up.Results:Screening population is 11 332 (male 7 144, female 4 188); Twenty-nine cases with pathological diagnosis of malignant tumor, including 27 cases of pri-mary lung cancer, 1 case of lung metastasis, 1 case of breast cancer. The morbidity of primary lung cancer is 238.26×10-5. There were 22 cases of Stage 0-Ⅰ lung cancer accounting for 81.48% of all diagnosed primary lung cancer.Conclusion:Based on community health service, screening with low-dose spiral CT could improve the early diagnosis rate of lung can-cer with feasibility and validity, which could be applicable in qualified eligible medical center and community in China.

An assessment of association of thyroid volume with growth indicators and comparison of different thyroid volume indexes in school-aged children / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the association between thyroid volume and physical growth of school-age children, and to compare volume indexes of individual thyroids for reference of selection of assessment indicators.</p><p><b>METHODS</b>All the students of the 12 classes of grades 3-5 at a primary school in Minhang district, Shanghai were rounded up with a multi-stage cluster sampling, for physical examinations to measure their height, weight, Body mass index (BMI) and body surface area (BSA), followed by B-ultrasonography to measure their thyroid volume. Data of the measurements were calculated to learn their height corrected volume index (HVI), weight and height corrected volume index (WHVI), BMI corrected volume (BMIV), and BSA corrected volume (BSAV) individually. Their urine and salt samples were collected to measure iodine concentration in urine and salt. Individual indexes were studied for their association with the growth and development indexes of children.</p><p><b>RESULTS</b>Thyroid volume data were collected for 485 students, including 258 boys (53.2%) and 227 girls (46.8%). Their height, weight, BMI and BSA were found to be positively correlated with their age (P < 0.05). For children of the same age group, their thyroid volume was also positively correlated with their physical development indexes. Of all the thyroid indexes, the difference between BSAV physical development factors had no statistical association (with partial-correlation coefficients for age, gender, height, and weight being 0.07, 0.05, 0.01 and 0.02 respectively), and their thyroid volume, HVI, BMI and weight were correlated to age, height and weight.</p><p><b>CONCLUSION</b>Thyroid volume was associated with age and weight. It was inappropriate to diagnose goiter with criteria of age, gender and thyroid volume. BSAV was recommended for its non-association with age, gender and weight and its stability.</p>

Effect of endostar combined with radiotherapy on expression of integrin αvβ3 mRNA and MVD in lung cancer of Lewis rats / 实用肿瘤学杂志

Objective To observe the MVD and integrin αvβ3 mRNA expression changes in tumor -bearing rats by using endostar combined with radiotherapy ,and to explore the potential synergy mechanism .Meth-ods We randomly divided the tumor -bearing rats into four groups:control group(NC),endostar group(ES), radiation treatment group ( RT) and endostar combined radiotherapy group ( ES +RT) .Tumor inhibition rate was calculated every other day .Microvessel density and αvβ3mRNA were texted by immunohistochemical or real time PCR in each group.Results (1)ES+RT group showed the most obvious inhibition rate;(2)Compared with NC group,microvessel density of RT was increased ,but decreased in ES group and ES +RT group significantly ( P<0.05);(3)Compared with NC group,αvβ3 mRNA expression of RT group was increased,while decreased in ES group and ES+RT group,and ES +RT group displayed a greater decrease when compared to ES group ( P<0.05).Conclusion Endostar combined radiotherapy can inhibit the growth of cancer and the expression ofαvβ3mRNA,improve the disorders of tumor vascular network .It may be one of the mechanisms of increasing radi-osensitization.

Effectiveness and Safety of Recombinant Human Endostatin Combined with Concurrent Chemoradiotherapy for Advanced Non-small Cell Lung Cancer:a Meta-Analysis / 医药导报

Objective To evaluate the effectiveness and safety of recombinant human endostatin combined with concurrent chemoradiotherapy versus concurrent chemoradiotherapy for advanced non small cell lung cancer ( NSCLC) . Methods Electronic databases including the Cochrane library, PubMed, the Chinese biomedical literature database, China national knowledge internet(,EMbase,VIP and Wanfang database system were searched,until August,2013. The inclusion criteria was efficacy and safety studies of randomized controlled clinical studies in which recombinant human endostatin combined with concurrent chemoradiotherapy was compared with concurrent chemoradiotherapy alone for patients with advanced NSCLC. Cochrane handbook 5. 1. 0 was applied in evaluating the quality of included trials and RevMan 5. 1. 0 software was used for data analysis.Results Five studies including 217 cases of advanced NSCLC were included. The results of the meta-analysis exhibited that compared with concurrent chemoradiotherapy alone, recombinant human endostatin combined with concurrent chemoradiotherapy could increase effective rate [OR=2. 62,95%CI(1. 41,4. 86),P=0. 002]. But there were no significant differences in clinical benefit rate [OR=2. 08,95%CI(0. 92,4. 73),P=0. 08],one year survival rate [OR=1. 18,95%CI(0. 53,2. 66),P=0. 68], improvement in quality of life [OR=1. 57,95%CI(0. 40,6. 07),P=0. 52],rate of leucopenia [OR=1. 25,95%CI(0. 72,2. 17), P=0.43],radioactive esophagitis [OR=1. 16,95%CI(0. 42,3. 21),P=0. 77] and radiation pneumonitis [OR=2. 47,95%CI (0. 34,17. 68),P=0. 37]. Conclusion Compared with concurrent chemoradiotherapy alone,recombinant human endostatin combined with concurrent chemoradiotherapy may be more effective for advanced NSCLC,whereas improvement of life quality and toxicities are similar. For the quality restriction and possible publication bias of the included studies,more high quality randomized controlled trials are required to further verify this conclusion.