The effect of coronary stent policies on the risk of percutaneous coronary intervention among acute coronary syndrome patients in Shanghai: Real-world evidence.

OBJECTIVE: This study aimed to analyze the effect of coronary stent policies implemented in Shanghai on the risk of percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) inpatients based on real-world data. METHODS: Two retrospective cohorts of inpatients with a first diagnosis of ACS who had undergone PCI for the first time in the previous year in Shanghai hospitals were examined (one for the postpolicy period and the other for the prepolicy period). χ2 tests were used to compare categorical variables between the two cohorts. Single- and multivariate Cox proportional hazards models were used to compare the risk of major adverse cardiovascular events (MACEs) between the two cohorts. RESULTS: A total of 31,760 ACS patients were included in this study. The proportion of ACS inpatients who had at least one bid-winning stent and 3 or more coronary stents implanted for first-time PCI in the postpolicy cohort was higher than that in the prepolicy cohort (86.52% vs. 55.67% and 6.27% vs. 4.39%, respectively; all p values < 0.0001). The single- and multivariate Cox proportional hazards models revealed that the unadjusted and adjusted hazard ratios for MACEs at 1 year after PCI for the postpolicy cohort relative to the prepolicy cohort were 0.869 (P<0.0001) and 0.814 (P = 0.0007), respectively. CONCLUSIONS: The implementation of coronary stent policies changed coronary stent utilization but had no significant adverse effects on the risk of PCI among ACS patients in Shanghai in the short term. However, the reasons for changes in the number of coronary stents implanted should be analyzed and addressed in the future.

Association between Alzheimer's disease and risk of cancer: A retrospective cohort study in Shanghai, China.

INTRODUCTION: We investigated the association between Alzheimer's disease (AD) and the risk of cancer in the Chinese population. METHODS: In this retrospective cohort study, multivariate Cox proportional hazard regression analysis was used to determine the correlation between AD and the risk of various cancers, as shown by hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: Of 8097 AD patients, the HR for all subsequent cancers was 0.822 (95% CI, 0.728-0.928; P = .002). Among them, three specific cancers were associated with AD: lung cancer (HR, 0.656; 95% CI, 0.494- 0.871; P = .004), prostate and testicular cancer (HR, 0.414; 95% CI, 0.202-0.847; P = .016), and lymphoma (HR, 2.202; 95% CI, 1.005-4.826; P = .049). CONCLUSION: Patients with AD might have a lower chance of developing several cancers, including lung cancer and prostate and testicular cancer. Meanwhile, a positive association between AD and a higher incident rate of lymphoma was observed.

The association between diabetes mellitus and HRQoL of older people in Shanghai.

BACKGROUND: This study aimed to explore the association between diabetes mellitus and health-related quality of life (HRQoL) of older people in Shanghai, China, especially regarding the differences in each aspect of the EQ-5D and how large the score gaps are between older people with and without diabetes. METHODS: A total of 11,103 people of either sex older than 60 years were enrolled from 17 districts of Shanghai. The EQ-5D-3L was used to assess the HRQoL of older people. The Wilcoxon rank sum test and t-test were used to compare the difference in HRQoL between people with or without diabetes. After univariate regression, multiple linear regression and ordinal logistic regression were conducted to evaluate the influence of diabetes mellitus and other confounding variables on the EQ VAS scores and on the five dimensions of the EQ-5D. RESULTS: Twelve percent of all participants had diabetes mellitus, and the proportion was almost the same between men and women. The EQ VAS scores of people with diabetes mellitus were approximately 3.70 points lower than those of people without diabetes (95% CI = -4.40, -2.99, p < 0.001) after adjusting for confounding variables. People with diabetes mellitus had increased problems with mobility (OR = 1.57, 95% CI = 1.33, 1.85), self-care (OR = 1.65, 95% CI = 1.35, 2.01), usual activities (OR = 1.78, 95% CI = 1.51, 2.11), pain/discomfort (OR = 1.42, 95% CI = 1.24, 1.64), and anxiety/depression (OR = 1.33, 95% CI = 1.07, 1.64). CONCLUSIONS: This study showed that diabetes mellitus was associated with the HRQoL of older people and that older people with diabetes had poorer performance in every aspect of EQ-5D measurements.

Person-environment fit and medical professionals' job satisfaction, turnover intention, and professional efficacy: A cross-sectional study in Shanghai.

OBJECTIVES: Using the person-environment (PE) fit theory, this study aims to explore factors affecting medical professionals' job satisfaction, turnover intention, and professional efficacy, and to examine individual characters associated with PE fit. DESIGN AND METHODS: This study used data from the sixth National Health Service Survey conducted in 2018, with a focus on job outcomes among medical professionals in Shanghai. The reliability and validity of the tools for measuring PE and job outcomes were calculated. A structural equation model was used to examine the relationship among person-job (PJ) fit and person-group (PG) fit, job satisfaction, turnover intention, and professional efficacy. Finally, a hierarchical regression model was used to analyze the association between demographic variables and the PJ and PG fit. RESULTS: PG fit was directly and positively associated with job satisfaction and professional efficacy. PJ fit had a direct and positive association with job satisfaction but had a direct and negative association with turnover intention. The indirect association of PJ fit with turnover intention was statistically significant. The results from the hierarchical regression analysis showed that younger physicians generally had a lower level of PJ fit and older physicians with higher education tended to have a lower level of PG fit. CONCLUSIONS: Medical professionals with higher PJ or PG fit have higher job satisfaction, and those with higher PG fit have higher professional efficacy. The impact of PJ fit on turnover intention was mediated by job satisfaction. Healthcare managers should take actions to effectively promote medical professionals' PJ and PG fit to improve their retention and efficiency.

Microstructure and Mechanical Properties of Nano-Carbon Reinforced Titanium Matrix/Hydroxyapatite Biocomposites Prepared by Spark Plasma Sintering.

Nano-carbon reinforced titanium matrix/hydroxyapatite (HA) biocomposites were successfully prepared by spark plasma sintering (SPS). The microstructure, mechanical properties, biocompatibility, and the relationship between microstructure and properties of biocomposites were systematically investigated. Results showed there are some new phases in sintered composites, such as ß-Ti, TiO3, ZrO2, etc. Moreover, a small amount of Ti17P10, CaTiO3, Ca3(PO4)2 were also detected. The reaction that may occur during the preparation process is suppressed to some extent, which is because that the addition of second phases can prevent the direct contact of titanium with HA and reduce the contact areas. Transmission electron microscope (TEM) analysis proved the existence of elemental diffusion and chemical reactions in sintered composites. Compared with results of composites prepared by hot-pressed sintering before, mechanical properties (microhardness, compressive strength, and shear strength) of 0.5-GNFs composites prepared by SPS were increased by about 2.8, 4.8, and 4.1 times, respectively. The better mechanical properties of 0.5-GNFs composite in nano-carbon reinforced composites are mainly due to the lower degree of agglomeration of tubular carbon nanotubes (CNTs) compared to lamellar graphene nanoflakes (GNFs). Moreover, the strengthening and toughening mechanisms of nano-carbon reinforced titanium alloy/HA biocomposite prepared by spark plasma sintering (SPS) mainly included second phase strengthening, grain refinement strengthening, solution strengthening, graphene extraction, carbon nanotubes bridging, crack tail stripping, etc. In addition, in vitro bioactivity test revealed that the addition of nano-carbon was beneficial to promote the adhesion and proliferation of cells on the surface of titanium alloy/HA composite, because nano-carbon can enhance the formation of mineralized necks in the composites after transplantation, stimulate biomineralization and promote bone regeneration.

Research Progress Regarding Interfacial Characteristics and the Strengthening Mechanisms of Titanium Alloy/Hydroxyapatite Composites.

Titanium alloy/Hydroxyapatite (HA) composites have become a hot research topic in biomedical materials, while there are some challenges concerning bioactivity and mechanical properties such as low interface adhesion at the interface between metal and ceramic, complex interfacial reactions, and so on. Nevertheless, composites with reinforced phases can reach special properties that meet the requirements of biomedical materials due to the strong interfacial interactions between reinforcing phases (nano-carbon, partial oxides, and so on) and Titanium alloys or HA. This review summarizes the interface properties and mechanisms of Titanium alloy/HA composites, including interfacial bonding methods, strengthening and toughening mechanisms, and performance evaluation. On this basis, the interface characteristics and mechanisms of the Titaniumalloy/HA composites with enhanced phase are prospected. The results show that the interfacial bonding methods in the Titanium alloy/HA composites include chemical reactions and mechanical effects. The strengthening and toughening mechanisms contain grain refinement strengthening, second phase strengthening, solution strengthening, cracks and pulling out mechanisms, etc. This review provides a guidline for the fabrication of biocomposites with both mechanical properties and bioactivity.

Investigation of the Microstructure and Mechanical Properties of Copper-Graphite Composites Reinforced with Single-Crystal α-Al2O3 Fibres by Hot Isostatic Pressing.

Single-crystal α-Al2O3 fibres can be utilized as a novel reinforcement in high-temperature composites owing to their high elastic modulus, chemical and thermal stability. Unlike non-oxide fibres and polycrystalline alumina fibres, high-temperature oxidation and polycrystalline particles boundary growth will not occur for single-crystal α-Al2O3 fibres. In this work, single-crystal α-Al2O3 whiskers and Al2O3 particles synergistic reinforced copper-graphite composites were fabricated by mechanical alloying and hot isostatic pressing techniques. The phase compositions, microstructures, and fracture morphologies of the composites were investigated using X-ray diffraction, a scanning electron microscope equipped with an X-ray energy-dispersive spectrometer (EDS), an electron probe microscopic analysis equipped with wavelength-dispersive spectrometer, and a transmission electron microscope equipped with EDS. The mechanical properties have been measured by a micro-hardness tester and electronic universal testing machine. The results show that the reinforcements were unevenly distributed in the matrix with the increase of their content and there were some micro-cracks located at the interface between the reinforcement and the matrix. With the increase of the Al2O3 whisker content, the compressive strength of the composites first increased and then decreased, while the hardness decreased. The fracture and strengthening mechanisms of the composite materials were explored on the basis of the structure and composition of the composites through the formation and function of the interface. The main strengthening mechanism in the composites was fine grain strengthening and solid solution strengthening. The fracture type of the composites was brittle fracture.

Microstructure and Mechanical Properties of Graphene-Reinforced Titanium Matrix/Nano-Hydroxyapatite Nanocomposites.

Biomaterial composites made of titanium and hydroxyapatite (HA) powder are among the most important biomedicalmaterials due to their good mechanical properties and biocompatibility. In this work, graphene-reinforced titanium matrix/nano-hydroxyapatite nanocomposites were prepared by vacuum hot-pressing sintering. The microstructure and mechanical properties of graphene-reinforced titanium matrix/nano-hydroxyapatite nanocomposites with different graphene content were systematically investigated. Microstructures of the nanocomposites were examined by X-ray diffraction (XRD), back scattered electron imaging (BSE), scanning electron microscope (SEM) equipped with energy dispersive spectrometer (EDS), electron probe microanalyzer (EPMA), and transmission electron microscope (TEM). The mechanical properties were determined from microhardness, shear strength, and compressive strength. Results showed that during the high-temperature sintering process, complex chemical reactions occurred, resulting in new phases of nucleation such as Ca3(PO4)2, TixPy, and Ti3O.The new phases, which easily dropped off under the action of external force, could hinder the densification of sintering and increase the brittleness of the nanocomposites. Results demonstrated that graphene had an impact on the microstructure and mechanical properties of the nanocomposites. Based on the mechanical properties and microstructure of the nanocomposites, the strengthening and fracture mechanisms of the graphene-reinforced titanium matrix/nano-hydroxyapatite nanocomposites with different graphene content were analyzed.

Modeling the relationship between baseline lactate dehydrogenase and prognosis in patients with extensive-disease small cell lung cancer: a retrospective cohort study.

BACKGROUND: Elevated pretreatment lactate dehydrogenase (LDH) has been reported to be associated with poor survival in small cell lung cancer (SCLC). The present study aimed to investigate the continuous relationship between baseline LDH level and survival in patients with extensive-disease SCLC (ED-SCLC). METHODS: Data were retrospectively collected from Shanghai Health Information Network. Patients primarily diagnosed as ED-SCLC from April 2011 to August 2014 were eligible for our study. Patients' survival status was checked in March 2016. A multivariate Cox proportional hazard model was used to detect the association between baseline serum LDH and overall survival. The corresponding continuous relationship was analyzed by using natural spline functions in the Cox model. RESULTS: A total of 132 eligible ED-SCLC patients were analyzed. Elevated LDH at baseline was associated with poor survival (HR =1.92; 95% CI, 1.29-2.86). An increment of LDH would still raise the risk of death even in abnormal range. Among patients with elevated LDH, those who had relatively higher LDH levels (>370 U/L) would have a poorer prognosis than those with moderately elevated LDH levels (245-370 U/L; median survival time, 114 vs. 274 days; P value of log rank test, 0.007). CONCLUSIONS: LDH is a significant prognostic biomarker for ED-SCLC patients. The interpretation of continuous relationship between LDH and patients' survival can provide more accurate information for clinical practice.

Synergetic Effect of Graphene and MWCNTs on Microstructure and Mechanical Properties of Cu/Ti3SiC2/C Nanocomposites.

Multi-walled carbon nanotubes (MWCNTs) and graphenes have been taken for novel reinforcements due to their unique structure and performance. However, MWCNTs or graphenes reinforced copper matrix composites could not catch up with ideal value due to reinforcement dispersion in metal matrix, wettability to metal matrix, and composite material interface. Taking advantage of the superior properties of one-dimensional MWCNTs and two-dimensional graphenes, complementary performance and structure are constructed to create a high contact area between MWCNTs and graphenes to the Cu matrix. Mechanical alloying, hot pressing, and hot isostatic pressing techniques are used to fabricate Cu matrix self-lubricating nanocomposites. Effects of MWCNTs and graphenes on mechanical properties and microstructures of Cu/Ti3SiC2/C nanocomposites are studied. The fracture and strengthening mechanisms of Cu/Ti3SiC2/C nanocomposites are explored on the basis of structure and composition of Cu/Ti3SiC2/C nanocomposites with formation and function of interface.

A varying-coefficient cox model for the effect of CA19-9 kinetics on overall survival in patients with advanced pancreatic cancer.

PURPOSE: To evaluate the relationship between serum CA19-9 and overall survival in patients with advanced pancreatic cancer. METHODS: 109 advanced pancreatic cancer patients with gemcitabine based first-line chemotherapy were included. The effect of pretreatment CA19-9 level on overall survival was modeled by Cox proportional hazard regression. The effect of CA19-9 kinetics on overall survival was modeled by an extended Cox regression with a time varying coefficient and a time varying covariate. RESULTS: Univariate analysis indicated that baseline CA19-9 correlated with OS (HR = 1.66, p < 0.01) and this association remained significant within multivariate analysis (HR = 1.56, P < 0.01). For the analysis of CA19-9 kinetics, the extended Cox model showed that the effect of CA19-9 on overall survival changed with time: increased in the first two months and reached the top at a HR of about 2, then decreased for the next two months to a HR of about 1.56 and finally tended to be stable. The combination of pretreatment CA19-9 and CA19-9 at 2 month may better evaluate the patients' prognosis compared to pretreatment CA19-9 alone. CONCLUSION: Pretreatment CA19-9 and CA19-9 kinetics may serve as a useful serum biomarker in advanced pancreatic cancer.

Varying postresection lactate dehydrogenase with overall survival of early stage pancreatic cancer patients: A retrospective study.

Several previously published studies revealed a hazardous role of pretreatment lactate dehydrogenase (LDH) in survival of advanced or metastatic pancreatic cancer (PC) patients. Nevertheless, in early stage PC patients who are eligible for curative resection, the prognostic role of postresection LDH has never been discussed. In this study, we aimed to explore the prognostic significance of varying postresection LDH among early stage PC patients. In total, 80 PC patients who received curative resection were retrospectively selected from a population-based electronic inpatients database which originated from Shanghai, China. A dynamic survival analysis method, counting process approach in combination with the multiple failure-time Cox model, was applied to evaluate the association between postresection LDH and OS. The multiple failure-time Cox model found that age, resection modality, and postresection LDH were significantly associated with OS: an elevated LDH (defined as > 250 U/L) was related to 2.93 (95% CI: 1.26-6.79) folds of death hazard. Further analysis disclosed an identifiable dose-response association between LDH and OS: compared with LDH≤155 U/L, the HRs for 155 U/L < LDH < 196 U/L, and LDH≥196 U/L were 2.07 (95% CI: 0.88-4.88) and 3.15 (95% CI: 1.30-7.59), respectively. Our study results suggest that postresection LDH is a prominent prognostic factor in this group of early stage PC patients. Maintaining normally ranged LDH after resection might bring about survival benefit in early stage PC patients.

Prognostic relevance of lactate dehydrogenase in advanced pancreatic ductal adenocarcinoma patients.

BACKGROUND: The prognostic role of pretreatment serum lactate dehydronegase (LDH) has been well established in many malignant tumors, albeit it remains under-discussed in pancreatic cancer. In the present study, we aimed to assess the association between baseline LDH levels and overall survival (OS) in advanced pancreatic ductal adenocarcinoma (PDAC) patients who did and did not receive subsequent chemotherapy. METHODS: In total, 135 retrospectively determined patients with locally advanced or metastatic PDAC, who were diagnosed between 2012 and 2013, were analyzed. Baseline LDH levels were detected within 20 days after histopathological confirmation of the diagnosis. Multivariate Cox proportional hazards regression model was applied to estimate the adjusted hazards ratio (HR) for LDH levels and OS of PDAC. We used restricted cubic spline (RCS) to further investigate dose-effect relationship in the association. RESULTS: Having adjusted for possible confounders, we found that in advanced PDAC patients who went through subsequent chemotherapy, an elevated pretreatment LDH level (≥250 U/L) had an adjusted HR of 2.47 (95% CI = 1.28-4.77) for death, but patients, who did not receive chemotherapy, had no significant HR (adjusted HR = 1.57; 95% CI = 0.83-2.96). RCS fitting results revealed a steep increase in HR for PDAC patients received chemotherapy with a baseline LDH > 500 U/L. CONCLUSIONS: Pretreatment LDH levels had noticeable prognostic value in PDAC patients who received subsequent chemotherapy. Tackling elevated LDH levels before the initiation of chemotherapy might be a promising measure for improving OS of patients after treatment for their advanced PDAC. Studies with a large sample size and a prospective design are warranted to substantiate our findings.

Prognostic value of postdiagnostic inflammation-based scores in short-term overall survival of advanced pancreatic ductal adenocarcinoma patients.

The prognostic relevance of commonly used composite inflammation-based scores remains severely underdiscussed in pancreatic cancer (PC), especially for advanced PC. In this retrospective cohort study, we aimed to discuss the association between multiple inflammatory scores and the short-term overall survival (OS) of advanced pancreatic ductal adenocarcinoma (PDAC) patients. A total of 66 histologically confirmed PDAC patients were retrospectively analyzed. A multivariate Cox proportional hazards model was used to explore the association between 6 commonly used inflammatory scores measured right after diagnosis, Glasgow Prognostic Score (GPS), Modified Glasgow Prognostic Score (mGPS), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), prognostic index (PI), prognostic nutritional index (PNI), and the short-term OS of advanced PDAC. Analytical results revealed that among GPS, mGPS, NLR, PLR, PI and PNI only PLR was significantly associated with short-term OS of PDAC. For both 1-year and 2-year OS, every 10 increase of PLR value resulted in 1.10 (95% CI: 1.04, 1.16) folds hazard ratio (HR). Further analysis identified a statistically significant dose-response relationship between PLR and HR. Our study results probably suggested that PLR is a promising prognostic factor of advanced PDAC; maintaining normally ranged platelet count may gain short-term survival benefit among such patients.

Neutrophil and lymphocyte counts at diagnosis are associated with overall survival of pancreatic cancer: A retrospective cohort study.

Neutrophil to lymphocyte ratio (NLR) has been found to be significantly associated with pancreatic cancer (PC) survival. However, no existing studies discussed the association between neutrophil count, lymphocyte count, and PC survival jointly. In this study, we aimed to analyze the influence of neutrophil and lymphocyte counts measured at disease diagnosis on the overall survival (OS) of PC. A total of 288 PC patients diagnosed between January 1, 2012, and December 31, 2013, were retrospectively selected from a population-based electronic inpatients database. Multivariate Cox model and restricted cubic spline (RCS) were used to estimate the associations between neutrophil count, lymphocyte count, and OS of PC. We found that a decreased lymphocyte count at diagnosis was significantly associated with OS of PC: for PC patients whose lymphocyte counts were less than 1.5 × 10/L, the hazard ratio (HR) was 1.82 (95% confidence interval: 1.37-2.40). Although abnormally increased baseline neutrophil count in general was not associated with OS of PC, RCS found a prominently deteriorated survival for PC patients whose baseline neutrophil counts were close to the cutoff point (7.0 × 10/L). Our study results indicate that neutrophil and lymphocyte counts at diagnosis may have prognostic relevance in PC survival, especially lymphocyte count. The clinical significance of neutrophil inhibition and lymphocyte promotion treatments in PC patients should be further discussed.

Comparison of the Glasgow Prognostic Score (GPS) and the modified Glasgow Prognostic Score (mGPS) in evaluating the prognosis of patients with operable and inoperable non-small cell lung cancer.

PURPOSE: The Glasgow Prognostic Score (GPS) and modified Glasgow Prognostic Score (mGPS) are shown to be reliable prognostic indexes in patients with operable and inoperable non-small cell lung cancer (NSCLC). Considering the difference between the two indexes lies in whether hypoalbuminemia without an elevated C-reactive protein (CRP) is associated with worse survival, this study aims to evaluate the prognostic performance of hypoalbuminemia in patients without an elevated CRP and to compare the prognostic value of GPS and mGPS in patients with operable and inoperable NSCLC. METHODS: The data of 2988 patients were retrospectively collected from the Shanghai Health Information Network. Univariate and multivariate Cox regression was performed to investigate the prognostic effect of albumin, CRP, GPS and mGPS. Restricted cubic spline was also performed to evaluate the relationship between albumin and hazard ratio. Kaplan-Meier survival curves were estimated and compared using the log-rank test. Additional discriminative ability of GPS and of mGPS was evaluated using the area under the curve and Harrell's concordance index. RESULTS: Hypoalbuminemia was associated with worse survival in both operable and inoperable patients without an elevated CRP. The Kaplan-Meier survival curve of hypoalbuminemic patients without an elevated CRP was more close to the curve of patients with an elevated CRP and a normal albumin than to the curve of patients with neither of these abnormalities. Multivariate analysis, AUC and C-index all indicated that GPS had a higher prognostic value than mGPS. CONCLUSIONS: Hypoalbuminemia was associated with worse survival in patients with or without an elevated CRP. GPS was superior to mGPS in predicting survival in operable and inoperable NSCLC patients.

Kinetics of postdiagnosis platelet count with overall survival of pancreatic cancer: a counting process approach.

The association between long-term variation of postdiagnosis platelets and survival of pancreatic cancer (PC) has never been discussed by using dynamic survival analysis method. In this retrospective study, we analyzed 311 histologically confirmed PC patients identified from a mega population-based electronic inpatients database from 2012 to 2013 in China. Counting process approach was applied to restructure the original survival data, the association between post-diagnosis platelet count and overall survival (OS) of PC was evaluated by multiple failure-time Cox proportional hazards model. After counting process adjustment, multiple failure-time Cox proportional hazards model revealed that, regardless of the treatment modalities PC patients received, postdiagnosis thrombocytopenia was prominently associated with OS, compared with PC patients with normally ranged platelet count, the HRs ranged from 2.04 (95% CI: 1.14-3.67) to 10.82 (95% CI: 2.63-44.54), and this inverse association was robust based on further sensitivity analysis. On the contrary, the association between thrombocytosis and OS of PC tended to be inconclusive. Our findings suggested that postdiagnosis thrombocytopenia was associated with significantly compromised survival among PC patients from this large retrospective cohort. Underlying mechanisms behind this association should be further investigated.

Dispersion Characteristics of Multi-Walled Carbon Nanotubes with Gallic Acid.

Dispersions of multi-walled carbon nanotubes (MW-CNTs) assisted by non-covalent surface modification and covalent surface modification were prepared using different concentration of gallic acid aqueous solution. Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were used to investigate the dispersion states and effect of MWNTs. FTIR results demonstrate that concentration of gallic acid has great effect on the surface modification of multi-walled carbon nanotubes. With the content of gallic acid increasing, modification effect were firstly increased and then decreased in that the optimal concentration is about 10 µg/ml as it is its solubility in water. SEM and TEM results also show that gallic acid not only can ensure the integrity of the MW-CNTs, but also can purify it. These results confirmed achievement of a good dispersion state and effect of MW-CNTs with gallic acid. The dispersion mechanism of non-covalent surface modification and covalent surface modification was analyzed.

Incidence and survival of non-small cell lung cancer in Shanghai: a population-based cohort study.

OBJECTIVES: Large population-based studies on the incidence and outcome of non-small cell lung cancer (NSCLC) are lacking in mainland China. This study aimed to investigate the NSCLC incidence, demographic features and survival as well as factors affecting survival of patients with NSCLC in Shanghai. DESIGN: Prospective observational cohort study. SETTING: Baseline information was collected from Shanghai Health Information Network, which is based on the Health Information Systems from all the comprehensive hospitals and specialist hospitals qualified for cancer diagnosis in the Shanghai metropolitan area. PARTICIPANTS: All NSCLC cases identified from the database between 2011 and 2013 were recruited (15,020 patients). MAIN RESULTS: The crude and age-adjusted incidences of NSCLC were 54.20 per 100,000 people (55.90 per 100,000 for men, 52.39 per 100,000 for women) and 39.05 per 100,000 people (41.43 per 100,000 for men and 37.13 per 100,000 for women), respectively. The median survival time was 22.7 months (95% CI 21.8 to 24.2 months) with an overall 1-year survival rate of 71.8% (95% CI 69.8% to 73.8%). The 1-year survival rate was 96.5% (95% CI 94.0% to 98.6%) in patients with stage I NSCLC, 89.1% (95% CI 83.3% to 94.9%) in patients with stage II NSCLC, 78.8% (95% CI 74.1% to 83.5%) in patients with stage IIIa NSCLC and 58.9% (95% CI 56.1% to 61.7%) in patients with stage IIIb/IV NSCLC. Multivariate analysis showed surgical resection (HR=0.607, 95% CI 0.511 to 0.722) and chemotherapy (HR=0.838, 95% CI 0.709 to 0.991) significantly improved survival. Factors associated with poor survival included older age, male sex, larger tumour size, lymph node metastasis, distant metastasis and squamous cell carcinoma. CONCLUSIONS: A higher incidence and better survival rates for patients with NSCLC were identified when compared with previously published studies, which may provide evidence on the incidence and survival of NSCLC in China.