[Efficacy and safety of total neoadjuvant therapy versus neoadjuvant chemoradiotherapy in the treatment of locally advanced rectal cancer: a meta-analysis].

Objective: To systematically evaluate the efficacy and safety of total neoadjuvant therapy (TNT) in the comprehensive treatment of locally advanced rectal cancer. Methods: Literatures were screened from PubMed, Embase, Web of Science, Cochrane Library, CBM, Wanfang Data, VIP and CNKI from the inception date to May 2021 to collect the randomized controlled clinical trials (RCTs) of TNT followed by total mesorectal excision (TME) versus neoadjuvant chemotherapy (nCRT) followed by TME in the treatment of locally advanced rectal cancer. The data of overall survival, disease-free survival, R0 radical resection rate, pathological complete response (pCR) rate, T downstaging rate, the incidence of adverse events ≥ grade III, including neutropenia, nausea and vomiting, diarrhea, radiation dermatitis and nervous system toxicity, and the morbidity of complications within postoperative 30 days of the two groups were extracted from the included literatures. Review Manager 5.3 software was utilized for statistical meta-analysis. Results: Nine RCTs were finally enrolled including 2430 patients. Meta-analysis results showed that compared with nCRT group, patients in TNT group had longer overall survival (HR=0.80, 95%CI: 0.65-0.97, P=0.03) and higher pCR rate (RR=1.73, 95%CI: 1.44-2.08, P<0.01) with significant differences. Besides, there were no significant differences between two groups in disease-free survival (HR=0.86, 95%CI:0.71-1.05, P=0.14), R0 radical resection rate (RR=1.02, 95%CI: 0.99-1.06, P=0.17) and T downstaging rate (RR=1.04, 95%CI: 0.89-1.22, P=0.58) between two groups. In terms of treatment safety, the incidence of adverse events ≥ grade III (RR=1.09, 95%CI: 0.70-1.70, P=0.70) and morbidity of complications within postoperative 30 days (RR=1.07, 95%CI: 0.97-1.18, P=0.19) did not significantly differ between two groups. Conclusions: In the treatment of locally advanced rectal cancer, TNT may bring more survival benefits than nCRT and does not increase the incidence of adverse events and postoperative complications. Therefore, TNT could be used as a recommended treatment for patients with locally advanced rectal cancer.

[Application of multi-group structural equation model in comparative study of HBM related to recreational physical activity among population with high risk of chronic diseases and healthy people].

OBJECTIVE: To explore mechanism of health beliefs by application of health belief model (HBM) and structural equation modeling (SEM) with regard to recreational physical activity (PA), to identify the differences of among population with high risk of chronic diseases and healthy people, and to provide the specific interventions of recreational physical activity and reference for health relevant policy-making in the future. METHODS: A total of 2 736 residents with high risk of chronic diseases and 1 514 healthy people were involved. A questionnaire survey, physical examination and biochemical examination were conducted. The questionnaire based on HBM had acceptable validity and reliability. The proposed model based on the total sample size of the two groups was developed using the structural equation modeling and multi-comparison in the ways of appearance and parameters were also validated. RESULTS: The median amount of recreational (PA) among population with high risk of chronic diseases and healthy people were 0.0 thousand-step equivalent with quartile of (0.0, 4.6) and 0.0 thousand-step equivalent with quartile of (0.0, 4.0) respectively. The results of SEM suggested that the direct effects of perceived objective barriers (ß=-0.245), perceived subjective barriers (ß=-0.057), cues to action (ß=-0.043) and self-efficacy (ß=0.117) on recreational (PA) were significant. Self-efficacy was the most important mediator. The multi-group comparisons indicated that the models of the two groups had the same appearance but the parameters between them were significant (δ χ2=27.4, P<0.05). The multi-group structural equation model (MSEM) indicated that two paths from cues to action and from perceived subjective barriers to recreational (PA) were not statistically significant among the population with high-risk of chronic diseases. In the two groups, one path coefficient from perceived objective barriers to subjective barriers (P=0.007) was statistically significant (P<0.05). CONCLUSION: The recreational (PA) levels of both groups were lower. Health beliefs on recreational (PA) of the two groups played different roles and some paths were also different. Therefore, specific interventions and strategies should be developed for different people. For residents with high risk of chronic diseases, much more attention should be paid to reduce the objective and subjective barriers of recreational physical activity and to improve self-efficacy so as to delay or prevent the occurrence of chronic diseases and then to improve the quality of life of this kind of population.

[Physical activity level and its influence factors among residents in one suburb district of Beijing].

OBJECTIVE: To study the physical activity level and its influence factors among residents in one suburb of Beijing, so as to provide specific interventions for different people in different circumstances and to provide reference for health relevant policy-making in the future. METHODS: In the study, 7 319 subjects aged 18 years or above were involved. The self-designed questionnaires based on Health Belief Model (HBM) had acceptable validity and reliability. The physical activity levels were calculated to classify sufficient or insufficient amount by a thousand-step equivalent greater than or equal to 6 or 10. Multiple variable Logistic regression was used to explore the influence factors of the physical activity among the residents. RESULTS: The residents' median amount of physical activity in the suburb district of Beijing were 9.1 thousand-step equivalent with quartile of (3.8, 20.4). The percentages of the thousand-step equivalent greater than or equal to 6 or 10 were 63.7% and 47.7%, respectively. The median amounts of physical activity from work or household chores, transportation and recreation physical activities were 4.0, 1.0, 0.0 and the components of the total amount of physical activity from those were 61.7%, 18.3% and 20.1%, respectively. There were 8.6% residents whose life did notinvolve moderate or vigorous intensity activities. By using factor analysis, five factors were extracted from the scale based on the HBM; These factors together contributed to 63.7% of the sum of the squared loadings. The differences of physical activity levels on education level, age, gender, self-efficacy, cues, subjective and objective barriers were statistically significant (P<0.05).Those who were female, with older age, lower education level, higher self-efficacy, fewer cues, fewer subjective and objective barriers preferred to do more physical activities. CONCLUSION: The physical activity levels among the residents in the suburb district of Beijing are moderate and high, and most amount of physical activities from work or household chores. Those who are male and whose ages are from 18 to 29 years and whose education levels are of university or above should be focused on intervention. Specific interventions should be developed for different people in different situations; More attention should be paid to improve the residents' self-efficacy and reduce the subjective and objective barriers of physical activity, and we also should actively advocate people to have more leisure exercise so as to improve the physical activity level among all residents.