An evaluation of 20-year survival of radiofrequency ablation for hepatocellular carcinoma as first-line treatment.

OBJECTIVES: To evaluate the changes in clinical characteristics, overall survival (OS), and progression-free survival (PFS) by investigating a 20-year cohort of patients with HCC who underwent RFA treatment. METHODS: From 2000 to 2020, 505 consecutive patients with HCC underwent ultrasound-guided percutaneous RFA as first-line therapy at a tertiary cancer hospital. We divided the cohort according to the time when hepatitis-B antiviral therapy was covered by national medical insurance coverage (early 2011), including the first decade (2000-2010) and second decade (2011-2020). The prognostic factors for OS were analyzed by the Cox proportional hazard model. OS and PFS in different groups were compared using the Kaplan-Meier method. To reduce selection bias, matched groups of patients were selected using the propensity score matching (PSM) method. RESULTS: In total, 726 RFA sessions were performed to treat 867 HCC lesions. Patients treated in the second decade were younger (p =.047), had smaller tumors (p <.001), had lower Child-Pugh scores (p <.001), and had a higher proportion of antiviral treatment (p <.001). A total of 96.0% of patients achieved technical efficacy from the initial RFA. After PSM analysis, improved PFS was found for the second decade (median, 68 vs. 49 months, p =.003), but no significant difference in OS was observed between the two groups (median, 71 vs. 65 months, p =.20). CONCLUSIONS: This study demonstrated that improved PFS was achieved in patients with HCC receiving RFA as first-line treatment in the second decade. However, long-term OS was not significantly increased compared to the first decade suggesting that while RFA treatment has improved, it still might not substantially affect OS results.

Epidemiological and clinical features of functional dyspepsia in a region with a high incidence of esophageal cancer in China.

BACKGROUND: Functional dyspepsia (FD) has rarely been investigated in areas with a high prevalence of esophageal squamous cell carcinoma (ESCC). This study aims to reveal the epidemiological and clinical features of FD and organic dyspepsia (OD) in such a population. METHODS: A middle-aged and elderly population-based study was conducted in a region with a high incidence of ESCC. All participants completed the Gastroesophageal Reflux Disease Questionnaire and Functional Gastrointestinal Disease Rome III Diagnostic Questionnaire, and they underwent gastroscopy. After exclusion of gastroesophageal reflux disease, uninvestigated dyspepsia (UID) was divided into OD and FD for further analyses. RESULTS: A total of 2916 participants were enrolled from July 2013 to March 2014 in China. We detected 166 UID cases with questionnaires, in which 17 patients with OD and 149 with FD were diagnosed via gastroscopy. OD cases presented as reflux esophagitis (RE), ESCC, and duodenal ulcer. Heartburn (52.94%) and reflux (29.41%) were common in OD, but no symptomatic differences were found between FD and OD. Male sex, low education level, and liquid food were the risk factors for OD, while frequent fresh vegetable consumption was a protective factor. FD included 56 (37.58%) cases of postprandial distress syndrome (PDS), 52 (34.89%) of epigastric pain syndrome (EPS), nine (6.04%) of PDS + EPS, and 32 (21.48%) of FD + functional esophageal disorders. The Helicobacter pylori infection rate in FD patients was not higher than that in the control group (34.23% vs. 42.26%, P = 0.240). Frequent spicy food consumption was associated with PDS (odds ratio [OR]: 2.088, 95% confidence interval [CI]: 1.028-4.243), while consumption of deep well water was protective for PDS (OR: 0.431, 95% CI: 0.251-0.741). CONCLUSIONS: The prevalence of FD was 5.11% in the studied population. Gastroscopy should be prescribed for dyspepsia patients in case that ESCC and RE would be missed in UID cases diagnosed solely by the Rome III questionnaire. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01688908; https://clinicaltrials.gov/ct2/show/record/NCT01688908.

Family history of esophageal cancer modifies the association of serum lipids and malignant esophageal lesions: a nested case-control study from the "Endoscopic Screening for Esophageal Cancer in China" trial.

BACKGROUND: The association of lipids and cancer has varied greatly among different cancer types, lipid components and study populations. This study is aimed to investigate the association of serum lipids and the risk of malignant lesions in esophageal squamous epithelium. METHODS: In the "Endoscopic Screening for Esophageal Cancer in China" (ESECC) trial, serum samples were collected and tested for total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol at the time of subject enrollment. Cases were defined as malignant esophageal lesions identified by baseline endoscopic examination or by follow-up to May 31, 2018. Controls were randomly selected using incidence density sampling in the same cohort. Conditional logistic models were applied to identify the association of serum lipids and the risk of malignant esophageal lesions. Effect modification was evaluated by testing interaction terms of the factor under assessment and these serum lipid indicators. RESULTS: No consistent association between serum lipid levels and esophageal malignant lesions were found in a pooled analysis of 211 cases and 2101 controls. For individuals with a family history of esophageal cancer (EC), high TC, and LDL-C were associated with a significantly increased risk of having malignant lesions (odds ratio [OR]High vs. Low TC = 2.22, 95% confidence interval [CI]: 1.14-4.35; ORHigh vs. Low LDL-C = 1.93, 95% CI: 1.01-3.65). However, a negative association was observed in participants without an EC family history (ORHigh vs. Low TC = 0.69, 95% CI: 0.48-0.98, Pinteraction = 0.002; ORHigh vs. Low LDL-C = 0.50, 95% CI: 0.34-0.76, Pinteraction < 0.001). CONCLUSIONS: In this study, we found that the association of serum lipids and malignant esophageal lesions might be modified by EC family history. The stratified analysis would be crucial for population-based studies investigating the association of serum lipids and cancer. The mechanism by which a family history of EC modifies this association warrants further investigation.

A population-based survey of gastroesophageal reflux disease in a region with high prevalence of esophageal cancer in China.

BACKGROUND: The exact relationship between gastroesophageal reflux disease (GERD) and esophageal squamous cell cancer (ESCC) is far from clarification. The aim of this study was to investigate the epidemiology of GERD in a region with high prevalence of ESCC in China. METHODS: A population-based, cross-sectional study was conducted in a high ESCC prevalent area, Anyang, Henan, China. All subjects fulfilled questionnaires and underwent gastroendoscopy with routine esophageal biopsy. The subjects were divided into GERD subtypes (reflux esophagitis [RE] and non-erosive reflux disease [NERD]) and controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine risk factors for RE and NERD. RESULTS: A total of 2844 subjects were finally enrolled. The prevalence of GERD (RE + NERD) was 17.3%. Among them, 271 (9.53%) adults were diagnosed with RE. The prevalence of RE increased with age (7.09% in 45-50 years, 8.00% in 51-60 years, and 9.53% in 61-69 years, χ = 62.216, P < 0.001). Sixty-seven (2.36%) subjects were diagnosed with the silent RE. A total of 221 (7.77%) subjects were diagnosed with NERD. Frequent liquid food consumption (OR [95% CI]: 1.502 [1.076-2.095]) was independent risk factor for RE as well as age, male gender, high body mass index (BMI), ever smoking. Age was independent risk factor for NERD. For silent RE, age, male gender, and frequent liquid food consumption were risk factors. CONCLUSIONS: In the population with high prevalence of ESCC, a high prevalence of GERD and inverted proportion of RE/NERD were presented. Age was an independent risk factor for GERD. The male gender, high BMI, smoking, and frequent liquid food consumption may be risk factors for RE but not for NERD.

[Prevalence and risk factors for hepatitis B in Hua County, Henan Province].

OBJECTIVE: To determine the epidemiological characteristics and associated risk factors of hepatitis B surface antigens (HBsAg) prevalence in rural areas of Hua County, Henan Province, and to provide scientific evidence for Hepatitis B prevention and control in local areas. METHODS: On the basis of an ongoing esophageal cancer cohort study in rural Anyang, a total of 5 104 subjects aged 25-65 years were clustered and selected from 5 targeted villages for this study in rural areas of Hua County, Henan Province. HBsAg was detected in their blood samples and a questionnaire was completed by all the subjects in a manner of one-on-one interview. All statistical analyses were conducted using SPSS for Windows version 13.0. RESULTS: Of the 5 104 studied subjects (overall participation rate: 92.05%), 5.17% were positive for HBsAg. The detection rate was significantly higher in males than in females (6.54% vs. 3.87%, P<0.001) and the highest detection rates were observed in the 25-29 and 55-59 years groups in both males and females. Multiple Logistic analyses showed unmarried status (OR=1.80, 95% CI: 1.00-3.25) and high frequency of sexual intercourse (Ptrend=0.049) were associated with higher the risk for hepatitis B virus (HBV) infection. CONCLUSION: The prevalence of HBsAg in rural Hua County, Henan Province, was slightly lower than the national average of the same time period. More attention should be attached to high risk groups of HBV infection in this population, i.e. males aged 25-29 years and 55-59 years and sexually active population. Immunization and health education projects against hepatitis B should be carried out in this population to further reduce the overall prevalence of hepatitis B.

[Waist circumference distribution of Chinese school-age children and adolescents].

OBJECTIVE: To study the distribution of waist circumference (WC) in a representative group of Chinese children for establishing the Chinese WC cut-off points. METHODS: Cross-sectional data obtained from 15 mainland provinces and Hong Kong were collected. There were 178 865 children and adolescents, aged 7 - 18 years-old in total. All subjects were divided into five regional groups-costal city, non-coastal city, northern rural, southern rural, and Hong Kong, for analyzing the distribution of WC. RESULTS: Large variations in WC distribution were found among Netherlands demonstrated the necessity of setting up China's own WC cutoffs. Sex and age-specific percentiles were obtained and smoothed by using the LMS method. CONCLUSION: Data obtained from this study could be used to develop the national WC cutoff points for Chinese children and adolescents.

[Cloning and phylogenetic analysis of low-molecular-weight glutenin subunit genes at Glu-B3 locus in common wheat relative species].

The common wheat relative species are important germplasm for wheat breeding. In the present study, novel allelic variants at Glu-B3 locus were cloned to provide gene resources for wheat quality improvement. Four Glu-B3-locus specific primer sets LB1F/LB1R, LB2F/LB2R, LB3F/LB3R, and LB4F/LB4R were employed to isolate novel allelic variants of GluB3-1, GluB3-2, GluB3-3, and GluB3-4 from seven common wheat relative species, i.e., T. durum, T. dicoccum, T. dicoccoides, Aegilops longissima, Ae. searsii, Ae. Bicornis, and Ae. speltoides, and the software MEGA 4 was used to construct a phylogenetic tree. In total, 16 novel allelic variants of GluB3-1, GluB3-3, and GluB3-4 genes were isolated from the seven common wheat relative species, designated GluB3-16, GluB3-35, GluB3-36, GluB3-37, GluB3-46, GluB3-47, GluB3-48, GluB3-49, GluB3-410, GluB3-411, GluB3-412, GluB3-413, GluB3-414, GluB3-415, GluB3-416 and GluB3-417, respectively. In detail, GluB3-16 was cloned from T. dicoccoides with LB1F/LB1R, and the molecular weight of the de-duced amino acid was 39.2 kDa. GluB3-35, GluB3-36, and GluB3-37 were isolated from T. durum and T. dicoccum with the primer set LB3F/LB3R, and the molecular weights of their deduced peptides were 44.5 kDa (GluB3-36) and 44.6 kDa (GluB3-35 and GluB3-37). The molecular weight of deduced peptides of GluB3-4 ranged from 38.6 kDa (GluB3-414) to 42.5 kDa (GluB3-413). All the 16 new allelic variants showed a single open reading frame (ORF), and their deduced amino-acid sequences had a typical sequence structure of LMW-GS. The allelic variants at Glu-B3 locus identified in com-mon wheat relative species provide potential gene resources for wheat quality breeding and gene transformation. The results suggested that these Glu-B3 genes originated from different evolution processes.

Waist circumference distribution of Chinese school-age children and adolescents.

BACKGROUND: Waist circumference (WC), a proxy measure of central body fat, is a better predictor than overall body fat for cardiovascular risk factors in both adults and children. WC cutoffs have been established in many countries, but the national WC reference has not been developed in China. OBJECTIVE: To study the distribution of WC in a representative group of Chinese children for establishing Chinese WC cutoff points. METHODS: Cross-sectional data obtained from 15 mainland provinces and Hong Kong were collected. There were 160,225 children and adolescents aged 7-18 years old in total. The subjects were divided into five regional groups namely costal city, other city, north rural, south rural, and Hong Kong, for analyzing the distribution of WC. RESULTS: A large variation in WC distribution was found among the five groups for both sexes. Coastal city group had the highest P85 WC values consistently from the early school ages to 18-year-old compared with other groups. In contrast, south rural group had P85 values consistently lagged behind not only the city groups but also the north rural group. Hong Kong group had a high P85 WC at early ages, but because of the smaller increments of WC during adolescence, the P85 curve was gradually exceeded by the north rural groups. Catch-up trend was found in the two rural groups since the peak of puberty. These disparities were caused by not only socioeconomic and urban-rural factors but also north-south differences. Because of the regional variation of WC, a "gradient" prevalence of central obesity was prospected among these groups. Comparisons of WC distributions between the Chinese and the U.S.A. or Netherlands demonstrated the necessary of setting up China's own WC cutoffs. Sex and age-specific percentiles were obtained and smoothed by using LMS method. CONCLUSION: The data obtained from this study could be used to develop national WC cutoff points for Chinese children and adolescents.

[Investigation of HIV/AIDS related knowledge and attitude among 6,487 high school students].

OBJECTIVE: To investigate HIV/AIDS related knowledge and attitude among high school students in China, and to preliminarily evaluate the effects of the special HIV/AIDS prevention education programme. METHODS: A total of 6487 high school students from 24 high schools of Beijing, Zhengzhou and Tangshan were investigated by using questionnaire, among which, 6487 students completed the questionnaire (96.08%). chi(2) test, t test and one way ANOVA were used to test the group differences and logistic regression was employed for further analysis. P < 0.05 was considered as statistically significance. RESULTS: The mean knowledge and attitude scores of the students were separately 14.42 out of 20 and 6.47 out of 10. Students from Tangshan had the significantly (P < 0.001) highest knowledge and attitude level (average score of knowledge = 15.11, average score of attitude = 7.21) followed by Beijing (average score of knowledge = 14.62, average score of attitude = 6.15) and Zhengzhou (average score of knowledge = 13.56, average score of attitude = 6.07). The significant differences were observed in all except the varying attitude between Zhengzhou and Beijing (Knowledge comparison: t(Tangshan vs Beijing) = 0.49, P < 0.001, t(Tangshan vs Zhengzhou) = 1.56, P < 0.001, t(Zhengzhou vs Beijing) = 1.07, P < 0.001; Attitude Comparison: t(Tangshan vs Beijing) = 1.06, P < 0.001, t(Tangshan vs Zhengzhou) = 1.14, P < 0.001, t(Zhengzhou vs Beijing) = 0.08, P = 0.282). Boys had higher knowledge scores (average score of knowledge = 14.61) than those of girls (average score of knowledge = 14.23, t = 4.22, P < 0.001) but no significant difference was found (average knowledge score of boys = 6.47, average knowledge score of girls = 6.48, t = 0.16, P = 0.869). Higher knowledge level (OR = 1.21, P < 0.001) and being a rural student (OR = 1.31, P < 0.001) were significantly associated with higher attitude level, while higher grade (OR = 0.85, P = 0.003) and better academic performance (OR = 0.94, P = 0.003) were negative predictors of attitude. CONCLUSION: The HIV/AIDS related knowledge among high school students in China was relatively limited and instability positive attitude under the pressure of social desirability. It is necessary to tailor the special education strategies for further education effect improvement.

[Effects of ascorbic acid and citric acid on iron bioavailability in an in vitro digestion/ Caco-2 cell culture model].

OBJECTIVE: To study the effects of ascorbic acid and citric acid on iron bioavailability using an in vitro digestion/Caco-2 cell culture model and evaluate the validity of this cell model. METHODS: This model combined in vitro digestion technique with Fe uptake by Caco-2 cells by utilizing an inserted ring attached to a dialysis membrane to simulate the gastrointestinal environment to allow simultaneous food digestion and uptake processes. Ferritin formation in the Caco-2 cells was measured as the indicator of Fe uptake by exposing Caco-2 cells to the digests containing Fe plus ascorbic acid or citric acid. RESULTS: When Fe concentration in the digest was below 100 micromol/L, ferritin formation increased with the Fe concentration in the digest. The iron digest containing ascorbic acid exhibited a significant increase in ferritin formation relative to the iron digest containing citric acid. The model was more sensitive to lower iron concentrations when ascorbic acid was present in the digest, while wider range of iron concentration could be assessed by addition of citric acid. CONCLUSIONS: The in vitro digestion/ Caco-2 cell culture model is a valuable tool for iron bioavailability assessment. Ascorbic acid has a stronger effect than citric acid in promoting iron bioavailability.

[Secular growth trends in the Chinese urban youth and its implications on public health].

OBJECTIVE: To analyze the secular growth trends of the Chinese urban youth from 1979 to 2005, in order to make national intervention strategies and measures to improve their physical fitness and health. METHODS: Subjects were sampled from 16 provincial-capital cities in China. They were all Han primary and secondary school students aged 7 to 18 years. The increments of stature, weight and BMI, and the increments per decade of these indicators at different stages were analyzed. RESULTS: In recent 26 years, the overall increments were 6.5 and 4.7 cm for stature, and 8.9 and 5.2 kg for weight, for boys and girls, respectively. Swiftest rates were found in the period of 1985-1995, with the increments which were as high as 3.8 and 3.0 cm/decade for height, and 4.7 and 3.1 kg/decade for weight, for boys and girls respectively. These trends are still strong at present, without any tendency of going to the plateau. Advanced puberty plays the most contributing role in these trends, with the peak height rates being 2.4 cm/decade for girls at the age of 12 and 3.3 cm/decade for boys at the age of 14, respectively. The increments of adult height were 3.2 and 2.1 cm, while the rates were 1.2 and 0.8 cm/decade, for males and females, respectively. The distributing curves of BMI show an accelerating tendency of going to the right side, which suggests that the prevalence of childhood obesity is increasing rapidly. CONCLUSION: China is now experiencing an overall and positive secular trend, which is reflected not only by the accelerating physical growth in childhood, advanced puberty, and steady increments of adult height, but also by the dramatic changes of body shape. We should not only feel proud of the achievements of these secular growth changes and the active socioeconomic influences, but also pay much attention to their negative effects, especially those that may induce the dangers of hypertension, hyperglycemia, type 2 diabetes mellitus and other adulthood diseases, as well as the disease risks of metabolic syndrome that may even occur early in childhood and adolescence.