A clinicopathological-imaging nomogram for the prediction of pathological complete response in breast cancer cases administered neoadjuvant therapy.

OBJECTIVE: To construct a user-friendly nomogram with MRI and clinicopathological parameters for the prediction of pathological complete response (pCR) after neoadjuvant therapy (NAT) in patients with breast cancer (BC). METHODS: We retrospectively enrolled consecutive female patients pathologically confirmed with breast cancer who received NAT followed by surgery between January 2018 and December 2022 as the development cohort. Additionally, we prospectively collected eligible candidates between January 2023 and December 2023 as an external validation group at our institution. Pretreatment MRI features and clinicopathological variables were collected, and the pre- and post-treatment background parenchymal enhancement (BPE) and the changes in BPE on two MRIs were compared between patients who achieved pCR and those who did not. Multivariable logistic regression analysis was used to identify independent variables associated with pCR in the development cohort. These independent variables were combined into a predictive nomogram for which performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration plot, decision curve analysis, and external validation. RESULTS: In the development cohort, there were a total of 276 female patients with a mean age of 48.3 ± 8.7 years, while in the validation cohort, there were 87 female patients with a mean age of 49.0 ± 9.5 years. Independent prognostic factors of pCR included small tumor size, HER2(+), high Ki-67 index,high signal enhancement ratio (SER), low minimum value of apparent diffusion coefficient (ADCmin), and significantly decreased BPE after NAT(change of BPE). The nomogram, which incorporates the above parameters, demonstrated excellent predictive performance in both the development and external validation cohorts, with AUC values of 0.900 and 0.850, respectively. Additionally, the nomogram showed excellent calibration capacities, as indicated by Hosmer-Lemeshow test p values of 0.508 and 0.423 in the two cohorts. Furthermore, the nomogram provided greater net benefits compared to the default simple schemes in both cohorts. CONCLUSION: A nomogram constructed using tumor size, HER2 status, Ki-67 index, SER, ADCmin, and changes in pre- and post-NAT BPE demonstrated strong predictive performance, calibration ability, and greater net benefits for predicting pCR in patients with BC after NAT. This suggests that the user-friendly nomogram could be a valuable imaging biomarker for identifying suitable candidates for NAT.

The features associated with mammography-occult MRI-detected newly diagnosed breast cancer analysed by comparing machine learning models with a logistic regression model.

PURPOSE: To compare machine learning (ML) models with logistic regression model in order to identify the optimal factors associated with mammography-occult (i.e. false-negative mammographic findings) magnetic resonance imaging (MRI)-detected newly diagnosed breast cancer (BC). MATERIAL AND METHODS: The present single-centre retrospective study included consecutive women with BC who underwent mammography and MRI (no more than 45 days apart) for breast cancer between January 2018 and May 2023. Various ML algorithms and binary logistic regression analysis were utilized to extract features linked to mammography-occult BC. These features were subsequently employed to create different models. The predictive value of these models was assessed using receiver operating characteristic curve analysis. RESULTS: This study included 1957 malignant lesions from 1914 patients, with an average age of 51.64 ± 9.92 years and a range of 20-86 years. Among these lesions, there were 485 mammography-occult BCs. The optimal features of mammography-occult BC included calcification status, tumour size, mammographic density, age, lesion enhancement type on MRI, and histological type. Among the different ML models (ANN, L1-LR, RF, and SVM) and the LR-based combined model, the ANN model with RF features was found to be the optimal model. It demonstrated the best discriminative performance in predicting mammography false- negative findings, with an AUC of 0.912, an accuracy of 86.90%, a sensitivity of 85.85%, and a specificity of 84.18%. CONCLUSION: Mammography-occult MRI-detected breast cancers have features that should be considered when performing breast MRI to improve the detection rate for breast cancer and aid in clinician management.

Alcohol intake and cause-specific mortality: conventional and genetic evidence in a prospective cohort study of 512 000 adults in China.

BACKGROUND: Genetic variants that affect alcohol use in East Asian populations could help assess the causal effects of alcohol consumption on cause-specific mortality. We aimed to investigate the associations between alcohol intake and cause-specific mortality using conventional and genetic epidemiological methods among more than 512 000 adults in China. METHODS: The prospective China Kadoorie Biobank cohort study enrolled 512 724 adults (210 205 men and 302 519 women) aged 30-79 years, during 2004-08. Residents with no major disabilities from ten diverse urban and rural areas of China were invited to participate, and alcohol use was self-reported. During 12 years of follow-up, 56 550 deaths were recorded through linkage to death registries, including 23 457 deaths among 168 050 participants genotyped for ALDH2-rs671 and ADH1B-rs1229984. Adjusted hazard ratios (HRs) for cause-specific mortality by self-reported and genotype-predicted alcohol intake were estimated using Cox regression. FINDINGS: 33% of men drank alcohol most weeks. In conventional observational analyses, ex-drinkers, non-drinkers, and heavy drinkers had higher risks of death from most major causes than moderate drinkers. Among current drinkers, each 100 g/week higher alcohol intake was associated with higher mortality risks from cancers (HR 1·18 [95% CI 1·14-1·22]), cardiovascular disease (CVD; HR 1·19 [1·15-1·24]), liver diseases (HR 1·51 [1·27-1·78]), non-medical causes (HR 1·15 [1·08-1·23]), and all causes (HR 1·18 [1·15-1·20]). In men, ALDH2-rs671 and ADH1B-rs1229984 genotypes predicted 60-fold differences in mean alcohol intake (4 g/week in the lowest group vs 255 g/week in the highest). Genotype-predicted alcohol intake was uniformly and positively associated with risks of death from all causes (n=12 939; HR 1·07 [95% CI 1·05-1·10]) and from pre-defined alcohol-related cancers (n=1274; 1·12 [1·04-1·21]), liver diseases (n=110; 1·31 [1·02-1·69]), and CVD (n=6109; 1·15 [1·10-1·19]), chiefly due to stroke (n=3285; 1·18 [1·12-1·24]) rather than ischaemic heart disease (n=2363; 1·06 [0·99-1·14]). Results were largely consistent using a polygenic score to predict alcohol intake, with higher intakes associated with higher risks of death from alcohol-related cancers, CVD, and all causes. Approximately 2% of women were current drinkers, and although power was low to assess observational associations of alcohol with mortality, the genetic evidence suggested that the excess risks in men were due to alcohol, not pleiotropy. INTERPRETATION: Higher alcohol intake increased the risks of death overall and from major diseases for men in China. There was no genetic evidence of protection from moderate drinking for all-cause and cause-specific mortality, including CVD. FUNDING: Kadoorie Charitable Foundation, National Natural Science Foundation of China, British Heart Foundation, Cancer Research UK, GlaxoSmithKline, Wellcome Trust, Medical Research Council, and Chinese Ministry of Science and Technology.

Association between sleep duration and hypertension in southwest China: a population-based cross-sectional study.

OBJECTIVE: Hypertension is a major risk factor and cause of many non-communicable diseases in China. While there have been studies on various diet and lifestyle risk factors, we do not know whether sleep duration has an association to blood pressure in southwest China. This predictor is useful in low-resource rural settings. We examined the association between sleep duration and hypertension in southwest China. DESIGN: Population-based cross-sectional study. SETTING: This study was part of the baseline survey of a large ongoing prospective cohort study, the China Kadoorie Biobank. Participants were enrolled in 15 townships of Pengzhou city in Sichuan province during 2004-2008. PARTICIPANTS: 55 687 participants aged 30-79 years were included. Sleep duration was assessed by a self-reported questionnaire. MAIN OUTCOME MEASURES: Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg, or prior physician-diagnosed hypertension in hospitals at the township (community) level or above. RESULTS: The prevalence of hypertension was 25.17%. The percentages of subjects with sleep durations of <6, 6, 7, 8 and ≥9 hours were 17.20%, 16.14%, 20.04%, 31.95% and 14.67%, respectively. In multivariable-adjusted analyses, the increased ORs of having hypertension were across those who reported ≥9 hours of sleep (men: 1.16, 95% CI 1.04 to 1.30; women: 1.19, 95% CI 1.08 to 1.32; general population: 1.17, 95% CI 1.08 to 1.26). The odds of hypertension was relatively flat until around 6.81 hours of sleep duration and then started to increase rapidly afterwards in subjects and a J-shaped pattern was observed. There was a U-shaped relationship between sleep duration and hypertension in females. CONCLUSION: Long sleep duration was significantly associated with hypertension and a J-shaped pattern was observed among rural adults in southwest China, independent of potential confounders. However, this association was not obvious between short sleep duration and hypertension.

IDH1 gene mutation activates Smad signaling molecules to regulate the expression levels of cell cycle and biological rhythm genes in human glioma U87­MG cells.

Isocitrate dehydrogenase1 (IDH1) mutation is the most important genetic change in glioma. The most common IDH1 mutation results in the amino acid substitution of arginine 132 (Arg/R132), which is located at the active site of the enzyme. IDH1 Arg132His (R132H) mutation can reduce the proliferative rate of glioma cells. Numerous diseases follow circadian rhythms, and there is growing evidence that circadian disruption may be a risk factor for cancer in humans. Dysregulation of the circadian clock serves an important role in the development of malignant tumors, including glioma. Brain­Muscle Arnt­Like protein 1 (BMAL1) and Circadian Locomotor Output Cycles Kaput (CLOCK) are the main biological rhythm genes. The present study aimed to further study whether there is an association between IDH1 R132H mutation and biological rhythm in glioma, and whether this affects the occurrence of glioma. The Cancer Genome Atlas (TCGA) database was used to detect the expression levels of the biological rhythm genes BMAL1 and CLOCK in various types of tumor. Additionally, U87­MG cells were infected with wild­type and mutant IDH1 lentiviruses. Colony formation experiments were used to detect cell proliferation in each group, cell cycle distribution was detected by flow cytometry and western blotting was used to detect the expression levels of wild­type and mutant IDH1, cyclins, biological rhythm genes and Smad signaling pathway­associated genes in U87­MG cells. TCGA database results suggested that BMAL1 and CLOCK were abnormally expressed in glioma. Cells were successfully infected with wild­type and mutant IDH1 lentiviruses. Colony formation assay revealed decreased cell proliferation in the IDH1 R132H mutant group. The cell cycle distribution detected by flow cytometry indicated that IDH1 gene mutation increased the G1 phase ratio and decreased the S phase ratio in U87­MG cells. The western blotting results demonstrated that IDH1 R132H mutation decreased the expression levels of the S phase­associated proteins Cyclin A and CDK2, and increased the expression levels of the G1 phase­associated proteins Cyclin D3 and CDK4, but did not significantly change the expression levels of the G2/M phase­associated protein Cyclin B1. The expression levels of the positive and negative rhythm regulation genes BMAL1, CLOCK, period (PER s (PER1, 2 and 3) and cryptochrom (CRY)s (CRY1 and 2) were significantly decreased, those of the Smad signaling pathway­associated genes Smad2, Smad3 and Smad2­3 were decreased, and those of phosphorylated (p)­Smad2, p­Smad3 and Smad4 were increased. Therefore, the present results suggested that the IDH1 R132H mutation may alter the cell cycle and biological rhythm genes in U87­MG cells through the TGF­ß/Smad signaling pathway.

Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults.

BACKGROUND: Despite the well-recognised health benefits of fresh fruit consumption, substantial uncertainties remain about its potential effects on incident diabetes and, among those with diabetes, on risks of death and major vascular complications. METHODS AND FINDINGS: Between June 2004 and July 2008, the nationwide China Kadoorie Biobank study recruited 0.5 million adults aged 30-79 (mean 51) y from ten diverse localities across China. During ~7 y of follow-up, 9,504 new diabetes cases were recorded among 482,591 participants without prevalent (previously diagnosed or screen-detected) diabetes at baseline, with an overall incidence rate of 2.8 per 1,000 person-years. Among 30,300 (5.9%) participants who had diabetes at baseline, 3,389 deaths occurred (overall mortality rate 16.5 per 1,000), along with 9,746 cases of macrovascular disease and 1,345 cases of microvascular disease. Cox regression yielded adjusted hazard ratios (HRs) associating each disease outcome with self-reported fresh fruit consumption, adjusting for potential confounders such as age, sex, region, socio-economic status, other lifestyle factors, body mass index, and family history of diabetes. Overall, 18.8% of participants reported consuming fresh fruit daily, and 6.4% never/rarely (non-consumers), with the proportion of non-consumers about three times higher in individuals with previously diagnosed diabetes (18.9%) than in those with screen-detected diabetes (6.7%) or no diabetes (6.0%). Among those without diabetes at baseline, higher fruit consumption was associated with significantly lower risk of developing diabetes (adjusted HR = 0.88 [95% CI 0.83-0.93] for daily versus non-consumers, p < 0.001, corresponding to a 0.2% difference in 5-y absolute risk), with a clear dose-response relationship. Among those with baseline diabetes, higher fruit consumption was associated with lower risks of all-cause mortality (adjusted HR = 0.83 [95% CI 0.74-0.93] per 100 g/d) and microvascular (0.72 [0.61-0.87]) and macrovascular (0.87 [0.82-0.93]) complications (p < 0.001), with similar HRs in individuals with previously diagnosed and screen-detected diabetes; estimated differences in 5-y absolute risk between daily and non-consumers were 1.9%, 1.1%, and 5.4%, respectively. The main limitation of this study was that, owing to its observational nature, we could not fully exclude the effects of residual confounding. CONCLUSION: In this large epidemiological study in Chinese adults, higher fresh fruit consumption was associated with significantly lower risk of diabetes and, among diabetic individuals, lower risks of death and development of major vascular complications.

An oncogenic role of miR-592 in tumorigenesis of human colorectal cancer by targeting Forkhead Box O3A (FoxO3A).

OBJECTIVE: A microRNA (miRNA) that functionally downregulates the expression of tumor suppressors can be defined as an oncomir. Here, we interrogate the biological significance of miR-592 in colorectal cancer (CRC). RESEARCH DESIGN AND METHODS: The expression of miR-592 in CRC tissues and cell lines was ascertained by qRT-PCR assay, and the expression of its target gene was determined by immunohistochemistry staining. The oncogenic role of miR-592 was assessed in terms of cell proliferation, migration, and clonogenicity in vitro, whereas the tumorigenicity was assessed by inhibiting endogenous miR-592 in CRC cells in vivo. RESULTS: A striking upregulation of miR-592 was observed in CRC tissues and cell lines compared to the matched adjacent non-tumor tissues and normal colon cells. Importantly, Forkhead Box O3A (FoxO3A) was identified as a novel target of miR-592. miR-592 inhibitor exhibited a significant reduction of migration, proliferation, and clonogenicity in CRC cells. These cells also displayed a decreased tumorigenicity in SCID mice relative to the control cells. CONCLUSION: These data suggest that miR-592 may promote the progression and metastasis, in part, by targeting FoxO3A in CRC. miR-592 may be a novel target for CRC treatment and antagomir-592 may inhibit the proliferation and metastasis of CRC cells.

[Characteristics of hypertension prevalence and related factors in rural area in Sichuan].

OBJECTIVE: To understand the prevalence, awareness, treatment and control of hypertension in rural area in Sichuan province. METHODS: The cross-sectional data of 55 687 subjects who were enrolled into the China Kadoorie Biobank study from Pengzhou in southwestern China were used to analyze the prevalence, awareness, treatment and control of hypertension among local residents. RESULTS: The prevalence of hypertension among population aged 30-79 years old was 25.2%. The awareness rate of self hypertension status, the treatment rate and the control rate of hypertension were 24.7%, 14.7% and 3.7%, respectively. The prevalence of hypertension, the awareness rate of self hypertension status, the treatment rate and the control rate of hypertension were associated with the socio-demographic characteristics of the subjects. The prevalence of hypertension in winter (70%-80%) was higher than that in summer, while the awareness rate, the treatment rate and the control rate of hypertension in winter were much lower than those in summer. Among the hypertension patients, the rates of smoking and alcohol use were high, the dietary habit was bad, physical activities were less and the prevalence of obesity was higher. The lifestyles of the hypertension patients were improved in those who know about their disease status. CONCLUSION: The prevalence of hypertension was high, but the awareness rate of self hypertension status, the treatment rate and the control rate of hypertension were low in rural area in Sichuan. It is necessary to strengthen the health education in young population and the treatment and control of hypertension in old population. Meanwhile, the management of hypertension patients should be standardized.

Patterns and socio-demographic correlates of domain-specific physical activities and their associations with adiposity in the China Kadoorie Biobank study.

BACKGROUND: Domain-specific physical activities may have different correlates and health effects, but few large studies have examined these questions, especially their separate associations with adiposity. METHODS: We analysed cross-sectional data of 466 605 adults without any prior chronic diseases, enrolled during 2004-8, from 10 diverse localities across China. Physical activity level in each of 4 domains (occupation, commuting, household, and active-recreation), calculated as metabolic equivalent (MET)-hr/day, was related to social-demographic factors and measures of adiposity (body mass index [BMI], waist circumference [WC], and bio-impedance derived percentage body fat), using multivariable linear and logistic regression models. RESULTS: The overall mean age was 50.8 years. The mean total physical activity was 21.7 MET-hr/day, mainly from occupation (62%) and household chores (26%), but little from active-recreation (4%), with women having a much higher household activity than men. Older participants had a lower level of occupational activity but a higher level of household and active-recreational activity, particularly after retirement. There was no linear association of occupational activity with adiposity, but working women tended to have a lower adiposity (e.g. 1.0 cm WC) than non-working women. In men, there was an inverse and apparently linear association between adiposity and levels of both commuting-related and household activities, with 3 MET-hr/day associated with -0.11 and -0.13 kg/m(2) BMI, -0.42 and -0.62 cm WC, and -0.28 and -0.33 percentage points of body fat, respectively. In women, only household activity showed a linear, but weaker, association with adiposity. A higher adiposity was observed among men and women with higher levels of active-recreational activity. CONCLUSIONS: In Chinese adults, physical activity mainly involves occupation and housework, with little from active-recreational activity. Domain-specific physical activities varied by socio-demographic factors and had different associations with adiposity.

Prevalence and treatment gap of active convulsive epilepsy: a large community-based survey in rural West China.

PURPOSE: Active convulsive epilepsy (ACE) impacts patients greatly, especially in low-income countries where patients do not receive appropriate treatment. In the present study, we measured the prevalence and treatment gap (TG) of ACE in rural West China. METHODS: Six rural areas in West China that have a total population of 3,541,319 were selected to conduct prevalence and TG estimates of ACE via a clue survey from 2007 to 2009. Clue survey here is a community-based screening strategy among defined population which requires employed well-trained local physicians//health workers to collect all clues available to discover/identify/recruit patients within a study period. Questionnaire-based interviews were used for the identification of ACE patients, and information was obtained during the survey. Prevalence and TG of ACE were calculated. RESULTS: A total of 6547 patients with ACE were identified. The estimated prevalence of ACE was 1.8 per 1000 in the general population, with the prevalences in males and females determined to be 2.0 and 1.7, respectively (p<0.001). The TG in the general population was 66.3%, and it was 66.6% and 66.0% in males and females, respectively (p>0.05). The TG figures dropped with advancing age and increased above 30 years of age. Patients aged 60 years or older had the largest TG (77.8%); those with disease course less than 10 years showed a larger TG and those who experienced two to five seizures annually had a significantly larger TG (70.6%). Additionally, only 63.9% of the ACE patients included in the study were aware of the disease and had consulted a doctor. CONCLUSIONS: There exists a large TG of ACE in West China rural areas. Majority of those ever consulted a doctor but failed to receive or adhere to an appropriate treatment program. Management including public education as well as training of local physicians were necessary to fill that gap.

Enhancing medical compliance of patients with convulsive epilepsy in rural community: a randomized intervention trial.

PURPOSE: This randomized intervention trial was to determine whether the implementation of a practical intervention was effective in enhancing medical compliance and improving seizure control among patients with convulsive epilepsy in rural communities in western China. METHODS: Two of four areas were randomly selected for this study and assigned to be the intervention group (IG) and the control group (CG), respectively. An intervention package with four components (intensive education, consultation services, maintenance of an epilepsy tracking card, and repeated reminders) was formulated. Medical compliance included antiepileptic drug (AED) adherence and lifestyle; each was graded on a 6-point scale with possible scores. Medical compliance and seizure control were measured and compared between the groups before and after the intervention. In addition, correlation of both changes in medical compliance and seizure frequency were investigated. KEY FINDINGS: After 1-year follow-up, 183 patients in the IG (105 male) and 177 in the CG (99 male) remained for the analysis. At the end of the study, the average number of seizures in the IG declined 18.3% compared to that prior to the intervention (after 6-month phenobarbital monotherapy), nearly twice as much as in CG (9.1%) with statistical difference (p = 0.023). The proportion of patients with a reduction in seizures >50% (including those who were seizure-free) rose to 79.8% in the IG compared to 61.0% in the CG (p < 0.05). With regard to medical compliance, the majority of the IG members were rated as excellent or very good, but medical compliance remained nearly unchanged for the CG. A moderate correlation was found between the changes in AED adherence and seizure control (r = 0.4, p < 0.05), and a weaker correlation was found between lifestyle and seizure control (r = 0.328, p < 0.05). SIGNIFICANCE: This intervention package proved to be efficient in enhancing medical compliance and improving seizure control in rural communities of resource-poor areas.

Cancer stem cell marker Bmi-1 expression is associated with basal-like phenotype and poor survival in breast cancer.

BACKGROUND: The purpose of present study was to examine the expression of cancer stem cell marker Bmi-1 in breast cancer tissue and to evaluate the clinical implication of Bmi-1 expression for these patients. METHODS: A total of 171 breast cancer patients who received surgical treatment in our hospital were enrolled in this study. Bmi-1 expression in breast cancer tissue was assayed by immunohistochemistry. Statistical analyses were applied to test the relationship between expression of Bmi-1 and clinicopathologic features and patient survival. The relationship between Bmi-1 and the basal-like phenotype of breast cancer also was analyzed in this study. RESULTS: Positive Bmi-1 expression was detected in 89 of 171 (52%) invasive breast cancers patients. The Bmi-1 status was significantly correlated to histological grade III (p = 0.001) and basal-like phenotype (p < 0.001). The 5 year overall survival of the patients with Bmi-1-positive and -negative cancers were 78 and 91.9%, respectively (p = 0.03). Histological grade (p = 0.046) and Bmi-1 status (p = 0.012) were detected as the independent prognostic factors in the Cox regression test. CONCLUSIONS: Bmi-1 status is an independent prognostic factor, which also is associated with tumor histological grade and basal-like phenotype. The high proportions of positive Bmi-1 expression in basal-like breast cancer may be related to the high aggressiveness behavior of this subtype of breast cancer.

Overexpression of minichromosome maintenance 2 predicts poor prognosis in patients with gastric cancer.

We examined the expression of minichromosome maintenance 2 (MCM2) in gastric cancer and adjacent normal tissues and estimated the possible value of MCM2 as a novel prognostic marker. Using real-time PCR, western blotting and immunohistochemistry, we examined the expression of MCM2 in gastric carcinoma and paired normal gastric mucosa. Statistical analysis of the expression of MCM2 mRNA and protein in gastric cancer and normal tissues was performed to evaluate the relationship between MCM2 expression and clinicopathological characteristics in gastric cancer. The expression of MCM2 mRNA and protein in gastric carcinomas was significantly higher compared to that in normal gastric mucosa (P=0.04). Immunohistochemistry analysis showed that MCM2 expression was significantly up-regulated in tumor and metastastic lymph node tissues compared with the corresponding non-cancerous mucosa (P<0.05). Positive expression of MCM2 was significantly associated with patient age, T category and the presence of lymph node metastasis (P<0.05). There were no differences between MCM2 expression and gender, tumor size, tumor location, M category, International Union Against Cancer (UICC) stage, vessel invasion and tumor differentiation. Patients with negative tumor MCM2 expression displayed a better survival time than those with positive MCM2 expression (P<0.05). Survival analysis showed that positive MCM2 expression (P<0.05), T stage (P<0.05) and N stage (P<0.05) were independent prognostic factors for disease-free survival (DFS) and overall survival (OS). Our data suggest that MCM2 could serve as a novel prognostic biomarker in gastric carcinoma.

The operational model of a network for managing patients with convulsive epilepsy in rural West China.

OBJECTIVE: To establish an operational model of a network for managing patients with convulsive epilepsy in rural areas of West China. METHODS: The network is under unified leadership of the public health administration departments, who liaised with medical institutions and disease control and prevention organizations to foster local communities to participate. Patients with convulsive epilepsy were treated with phenobarbital. Trained local primary health care physicians carried out screening, treatment, and follow-up. Political, financial, and technological support was incrementally provided through the network. Efficacy was assessed as the percentage reduction in seizure frequency and the retention of patients on treatment. RESULTS: Two thousand five hundred fourteen patients with active convulsive epilepsy were enrolled. After more than 1 year of treatment, 78.4% of the patients had a 50% or greater reduction in seizure frequency and 43.3% remained seizure free. Probability of retention was 85.8% at 750 days. Nearly 20% patients withdrew from the project, and most of them migrated out of the study areas. Some regular training and educational programs were also carried out. CONCLUSION: This pragmatic procedure suggests that the network could be suitable for managing convulsive epilepsy in resource-poor regions. Such a network could depend on existing primary health services to ensure its sustainability.

Epidemiological analysis of pulmonary tuberculosis in Sichuan Province, China, 2000-2006.

OBJECTIVES: To investigate the epidemiological features of pulmonary tuberculosis in Sichuan Province, China, for the period 2000-2006. MATERIALS AND METHODS: Data from the China Information System for Disease Control and Prevention, the World Health Organization, and the high caseload provinces in China were collected. This was a descriptive study, and the Besag and Newell method was applied. RESULTS: From 2000 to 2006, the incidence rate of pulmonary tuberculosis increased from 54 to 103/100,000, the mortality rate increased from 0.02 to 0.30/100,000, and the case-fatality rate increased from 0.04% to 0.29%. The age groups 20-24, 65-69, and 70-74 years had higher incidences. There were more cases and deaths in males compared to females. Peasants contributed the most to caseloads (64%) and deaths (69%) in the total population. The north and west regions of Sichuan Province had higher incidences. Sichuan had a higher incidence, mortality rate, and case-fatality rate than both the national level and Henan Province between 2001 and 2003. It also had a higher prevalence of active tuberculosis and smear-positive pulmonary tuberculosis than the national level and Guangdong Province after 1990. Multidrug-resistant tuberculosis is a major problem in China compared to India and Indonesia. CONCLUSIONS: Sichuan should be the most important province in China with regard to tuberculosis prevention and control, especially for male peasants from the north and west regions and the active pulmonary tuberculosis and sputum smear-positive cases. The major challenge is multidrug-resistant tuberculosis.