[Evaluation of the efficacy of medial open wedge high tibial osteotomy combined with anterior cruciate ligament reconstruction in the treatment of varus knee osteoarthritis with anterior cruciate ligament injury]

Objective: To evaluate the efficacy of medial open wedge high tibial osteotomy (MOWHTO) combined with anterior cruciate ligament (ACL) reconstruction in the treatment of varus knee osteoarthritis (OA) with ACL injury. Methods: A follow-up study. The study retrospectively analyzed the patients underwent MOWHTO combined with ACL reconstruction for treatment of varus knee OA with ACL injury in Tianjin Hospital between April 2018 and September 2022. The preoperative and postoperative posterior slope angle (PSA), hip-knee-ankle angle (HKA), visual analog scale (VAS) pain scores, Lysholm score, International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Tegner score were compared. The follow-up indicators were recorded at 6 weeks, 3 months and 1 year after operation, and the complications were recorded. Results: The study included 32 patients (23 males, 9 females) with a mean age of (50.7±8.4) years. The mean follow-up time was (21.2±4.8) months. PSA increased from 9.2°±1.8° preoperatively to 11.1°±2.4° postoperatively, and HKA increased from 168.7°±2.2° to 181.5°±2.2° (both P<0.01). The indicators such as VAS score (6.8±1.1 vs 1.8±0.4), Lysholm score (52.6±7.1 vs 82.0±6.4), IKDC score (64.7±6.2 vs 80.3±10.0), WOMAC score (51.8±6.3 vs 81.8±6.5), and Tegner score (1.9±0.6 vs 5.0±1.0) were all improved after the operation (all P<0.01). Complications occurred in 5 patients (15.6%), including hematomas, sensory abnormalities, intermuscular vein thrombosis and correction angle loss. Conclusion: MOWHTO combined with ACL reconstruction is a safe and effective approach for the treatment of varus knee OA with ACL injury.

Comparison of Survival Outcomes between Adults and Pediatrics with Non-Metastatic Head and Neck Rhabdomyosarcoma: A SEER Database Analysis of 550 Patients

PURPOSE/OBJECTIVE(S)

Despite the long-term survival rate for children with head and neck rhabdomyosarcoma (HNRMS) has improved to over 70-80% due to advancements in therapeutic approaches, the survival outcomes for adult HNRMS have not been thoroughly investigated. Our study aims to compare and analyze the survival outcomes of adult and pediatric patients with non-metastatic HNRMS, with a focus on the effect of different local treatment methods on disease outcomes.

MATERIALS/METHODS

We conducted a retrospective analysis of data from the Surveillance, Epidemiology, and End Results (SEER) database covering the period from 2004 to 2018. Our study population consisted of patients with Head and Neck Rhabdomyosarcoma (HNRMS) who had not developed distant metastases and received at least one local treatment, either radiotherapy or surgery. The comparison of overall survival (OS) and cancer-specific survival (CSS) was performed between the adult and pediatric patient groups, and between patients who received surgery (with or without radiotherapy) and those who received radiotherapy only (non-surgery).

RESULTS

In the study of 550 patients diagnosed with Head and Neck Rhabdomyosarcoma (HNRMS), data was collected from 181 (32.9%) adult and 369 (67.1%) pediatric patients. The results showed that the adult patient group had a significantly worse outcome compared to the pediatric group in terms of 5-year overall survival (OS) rate (34.9% vs 81.6%, P<0.001) and 5-year cancer specific survival (CSS) rate (59.96% vs 87.48%, P<0.001). Of these patients, 308(56%) underwent radical surgery, with 228 (41.5%) receiving a combination of radiation and surgery and the remaining 242 (44%) receiving radiation therapy alone. No significant differences were found in 5-year OS and CSS rates between the surgery and non-surgery (radiation only) groups in adult patients (34.9% vs 35.0%, P = 0.900; 60.2% vs 59.6%, P = 0.988). However, there were slight differences observed in the pediatric patient group, with the 5-year OS and CSS rates being higher for the surgery group compared to the non-surgery group (86.9% vs 75.9%, P = 0.001 and 90.6% vs 84.2%, P = 0.054, respectively).

CONCLUSION

The results of this cohort study indicate that age plays a crucial role in predicting survival outcomes in patients diagnosed with Head and Neck Rhabdomyosarcoma (HNRMS). The findings highlight the need for age-specific treatment strategies for HNRMS patients. While the data suggests that radiotherapy may be a viable first-line option for non-metastatic adult HNRMS patients, additional research is required to validate these trends.

Prospective Efficacy of Two Cycles Toripalimab Plus Induction Chemotherapy in T4 or N3 Locoregionally Advanced Nasopharyngeal Carcinoma: A Retrospective and Mechanistic Study

PURPOSE/OBJECTIVE(S)

Gemcitabine-cisplatin (GP) as the most commonly used induction chemotherapy is the standard first-line systemic treatment for advanced nasopharyngeal carcinoma. However, the toxicity of three cycles induction chemotherapy following on chemoradiotherapy remains a pertinent issue. Additional monoclonal antibody against human programmed death-1 (PD-1) has shown promising efficacy in recurrent or metastatic nasopharyngeal carcinoma.

MATERIALS/METHODS

In this study, we compared three cycles of gemcitabine and cisplatin as classical induction chemotherapy with two cycles of induction chemotherapy plus toripalimab, and then both groups treated with the similar concurrent chemoradiotherapy. Patients with locoregionally advanced nasopharyngeal carcinoma staging T4 or N3 were randomly assigned in a 1:1 ratio to receive gemcitabine (at a dose of 1 g per square meter of body-surface area on days 1 and 8) plus cisplatin (80 mg per square meter on day 1-3), administered every 3 weeks for three cycles, or GP combined with toripalimab (at a dose of 240mg) for two cycles. The primary end point was recurrence-free survival (i.e., freedom from disease recurrence [distant metastasis or locoregional recurrence] or death from any cause) in the intention-to-treat population. Secondary end points included overall survival, treatment adherence, and safety.

RESULTS

A total of 60 patients were included in the trial (30 patients in the toripalimab combined induction chemotherapy group and another 30 in the standard-therapy group). Among 60 patients evaluable for response assessment after induction therapy, all patients had overall response in combined group, including 10 patients (30%) with complete response (CR) in the primary tumor site. 21 patients (70%) were evaluated as partial response (PR) in the standard induction chemotherapy, and another 9 patients were assessed as SDa. At a median follow-up of 27.6 months, the 6-months, 1-, 2-year recurrence-free survival was 100% vs 86.7%, 100% vs 80%, 93% vs 70% in the toripalimab combined induction chemotherapy group and standard-therapy group (stratified hazard ratio for recurrence or death, 0.62; 95% confidence interval [CI], 0.38 to 0.87; P = 0.001). Overall survival at 2 years was 93.3% and 100%, respectively (stratified hazard ratio for death, 0.53; 95% CI, 0.29 to 0.79). The incidence of acute adverse events of grade 3 or 4 was 76.8% in the standard-induction chemotherapy group and 56% in the standard-therapy group, with a higher incidence of neutropenia, thrombocytopenia, anemia, nausea, and vomiting in the induction chemotherapy group. The incidence of grade 3 or 4 late toxic effects was 10.2% in the induction chemotherapy group and 10.4% in the combined-therapy group.

CONCLUSION

Two cycles of toripalimab combined with induction chemotherapy of and CCRT shows excellent distant metastatic control with acceptable safety, which is a new promising and effective systemic therapy regimen for high-risk of metastatic NPC patients.

Combining Radiotherapy with Chemotherapy and Immunotherapy as First-Line Treatment for De Novo Metastatic Nasopharyngeal Carcinoma: A Dual-Center Retrospective Analysis

PURPOSE/OBJECTIVE(S)

Local regional radiotherapy combined with systemic chemotherapy significantly improves the prognosis of patients with metastatic nasopharyngeal carcinoma (NPC). Immunochemotherapy has become the first-line treatment for initial metastatic NPC. This study evaluated the safety and efficacy of local regional radiotherapy combined with immunochemotherapy as the first-line treatment of metastatic NPC.

MATERIALS/METHODS

Patients with histologically proven de novo metastatic NPC who received immunotherapy and chemotherapy followed by local-regional radiotherapy were included from 2 cancer centers. Toxicity and treatment response were assessed using CTCAE 5.0 and RECIST 1.1, respectively. Overall survival (OS) and progression free survival (PFS) were analyzed using the Kaplan-Meier method.

RESULTS

From 2019 to 2021, a total of 16 patients were retrospectively analyzed. The median age was 44.5-year-old (range 16-76). Patients with ≥3 metastatic lesions accounts for 58.8%. Bone metastasis was the most common metastatic site. The chemotherapy regimens were paclitaxel/gemcitabine and cisplatin. Toripalimab, camrelizumab and sintilimab were used for immunotherapy. All patients completed the local regional radiotherapy with 69.96Gy for primary nasopharyngeal tumor and positive lymph nodes, 60.06Gy for high-risk region and 50ཞ54.45Gy for low-risk region. Seven patients underwent radiotherapy for metastatic lesions. The median follow-up was 20.5 months (range 6-38 months). Two-year OS was 100%. Three patients experienced distant progression. One-year and 2-year PFS rate was 93.8% and 76.7%, respectively. After combination of chemotherapy and immunotherapy, the overall response rate (ORR) was 93.7% with a complete response (CR) of 6.3%. At the end of radiotherapy, the ORR was 100%. Nine patients (56.3%) achieved CR. Radiotherapy related acute severe (grade 3 or higher) toxicity was dermatitis (1/16, 6.3%) and mucositis (2/16, 12.5%). Immunotherapy related hypophysitis and capillary hyperplasia was 6.3% and 6.3%, respectively. No long-term toxicity was observed.

CONCLUSION

Loco-regional radiotherapy provided a promising efficacy with modest toxicity for patients with metastatic nasopharyngeal carcinoma who received immunochemotherapy.

[Access to breast cancer screening among females in China: a focus report on screening rate and composition]

Objective: To systematically integrate and analyze the breast cancer screening rates among females in China and to estimate the composition of different screening service types. Methods: Based on core literature, relevant official websites, projects/survey reports, and information on breast cancer screening rates of Chinese females were extracted and analyzed, and the screening rates for 40-69 years old and 35-64 years old were standardized and compared using 2010 China's population structure. The literature review method was used to retrieve the journal literature related to the composition of breast cancer screening services types (organized screening, physical examination and opportunistic screening). The number of detected literature and the median sample size of individual screening people of the three screening service types were analyzed, and used them as weights to estimate the composition of screening service types. Results: A total of 6 related national surveys on breast cancer screening rate were identified, including 2 from the National Health Service Surveys (broader definition of "breast screening" in 2013, 2018) and 4 from the chronic disease monitoring system of China CDC (the exact definition of "breast cancer screening" in 2010, 2013 and twice in 2015). The age-standardized analysis indicated that 1-year, 2-year and 3-year breast cancer screening rates in 2015 among females in China aged 40-69 years old were 16.9%, 20.2% and 21.4%, respectively. The ever-breast cancer-screened rates were 21.1% in 2013 and 23.5% in 2015 among females aged 40-69, and the corresponding rates were 23.3% and 25.7%, respectively, among females aged 35-64. When taking the literature published in 2015 for further literature review, 130 articles were included, in which the proportions of numbers of reports on organized screening, physical examination, and opportunistic screening were 71.0%, 23.7%, and 5.3%, respectively. Along with the extracted data on median sample sizes (shown in the main text) by breast cancer screening types, it was estimated that the individual service volume of corresponding screening types accounted for 88.0%, 11.2% and 0.8% among all the screened females in China in 2015. Conclusions: The breast cancer screening rates among females of appropriate age in China in 2015 are higher than those in 2013. The literature review analysis preliminarily suggested that the current breast cancer screening service type in China is mainly organized screening service.

[Comparison of three different measurement methods to determine resting energy expenditure in patients with decompensated hepatitis B cirrhosis]

Objective: To compare the differences to determine resting energy expenditure (REE) measured with indirect calorimetry and REE predicted by formula method and body composition analyzer in patients with decompensated hepatitis B cirrhosis, so as to provide theoretical guidance for the implementation of precision nutrition intervention. Methods: Patients with decompensated hepatitis B cirrhosis who were admitted to Henan Provincial People's Hospital from April 2020 to December 2020 were collected. REE was determined by the body composition analyzer and the H-B formula method. Results: were analyzed and compared to REE measured by the metabolic cart. Results A total of 57 cases with liver cirrhosis were included in this study. Among them, 42 were male, aged (47.93 ± 8.62) years, and 15 were female aged (57.20 ± 11.34) years. REE measured value in males was (1 808.14 ± 201.47) kcal/d, compared with the results calculated by the H-B formula method and the measured result of body composition, and the difference was statistically significant (P = 0.002 and 0.003, respectively). REE measured value in females was (1 496.60 ± 131.28) kcal/d, compared with the results calculated by the H-B formula method and the measured result of body composition, and the difference was statistically significant (P = 0.016 and 0.004, respectively). REE measured with the metabolic cart had correlation with age and area of visceral fat in men (P = 0.021) and women (P = 0.037). Conclusion: Metabolic cart use will be more accurate to obtain resting energy expenditure in patients with decompensated hepatitis B cirrhosis. Body composition analyzer and formula method may underestimate REE predictions. Simultaneously, it is suggested that the effect of age on REE in H-B formula should be fully considered for male patients, while the area of visceral fat may have a certain impact on the interpretation of REE in female patients.

Characterization data of reference materials used for phase II of the priority program DFG SPP 2005 "Opus Fluidum Futurum - Rheology of reactive, multiscale, multiphase construction materials"

A thorough characterization of base materials is the prerequisite for further research. In this paper, the characterization data of the reference materials (CEM I 42.5 R, limestone powder, calcined clay and a mixture of these three components) used in the second funding phase of the priority program 2005 of the German Research Foundation (DFG SPP 2005) are presented under the aspects of chemical and mineralogical composition as well as physical and chemical properties. The data were collected based on tests performed by up to eleven research groups involved in this cooperative program.

[Thirty-year changes in disability adjusted life years for colorectal cancer in China: a screening perspective analysis]

Objective: From a screening-focused perspective, to analyze the 30-year changes in disability adjusted life years (DALYs) caused by colorectal cancer (CRC) in China and in some other selected populations, to inform extent of burden of CRC and future related prevention and control in populations in China. Methods: Based on the data of Global Burden of Disease 2019 (GBD 2019), the DALYs, world standardized DALY rate, and the composition of different subgroups in China were collected. Joinpoint regression model was used to analyze the trend during 1990-2019, and comparison was made with the international data and population screening situation. The trend of DALY burden caused by CRC in China was predicted. Results: In 2019, the DALYs due to CRC in China was 6.395 million person-years, accounting for 26.3% of the global burden and 9.5% of all cancers burden in China; the DALYs in men accounted for 65.2%, in those aged ≥65 years old accounted for 44.8%, in the age group recommended by local screening guidelines (40-75 years) accounted for 73.7%. The years lived with disability accounted for 4.8%. Compared with 1990, the CRC-caused DALYs in China increased by 181.5% in 2019. Factors with the largest increase in the attributable percentage were high Body Mass Index (151.1%), diet high in red meat (86.4%) and diet high in processed meat (78.8%), etc. For DALY rate, it was 245.6/100 000 in 1990 and 320.6/100 000 in 2019, an increase of 30.5%. For reference, Australia (began in 2006), the UK (2006), and Japan (1992), where CRC population-wide screening has been conducted, had decreases in DALY rate of 36.0%, 28.6%, and 17.8%, respectively. The predication of DALYs suggested that without continued expansion of population-based screening, the DALYs in China would reach 7.7 million person-year-9.1 million person-year by 2030, an increase of 19.9%-41.8% compared with 2019. Conclusions: The burden of CRC-caused DALYs in China increased over the past 30 years, and would become more serious because of population aging and the concomitant disability problem. The age range recommended by the current local screening guideline could theoretically include 70% of the population from which the DALYs burden originates, however, the real-world population screening coverage is still limited. The observed decline in CRC-related DALY rate in selected countries was substantially due to the implementation of mass screening, indicating the importance of speedily expanding the population coverage of CRC screening in China.

Smoothed Nested Testing on Directed Acyclic Graphs

We consider the problem of multiple hypothesis testing when there is a logical nested structure to the hypotheses. When one hypothesis is nested inside another, the outer hypothesis must be false if the inner hypothesis is false. We model the nested structure as a directed acyclic graph, including chain and tree graphs as special cases. Each node in the graph is a hypothesis and rejecting a node requires also rejecting all of its ancestors. We propose a general framework for adjusting node-level test statistics using the known logical constraints. Within this framework, we study a smoothing procedure that combines each node with all of its descendants to form a more powerful statistic. We prove a broad class of smoothing strategies can be used with existing selection procedures to control the familywise error rate, false discovery exceedance rate, or false discovery rate, so long as the original test statistics are independent under the null. When the null statistics are not independent but are derived from positively-correlated normal observations, we prove control for all three error rates when the smoothing method is arithmetic averaging of the observations. Simulations and an application to a real biology dataset demonstrate that smoothing leads to substantial power gains.

Resveratrol modulates the gut microbiota of cholestasis in pregnant rats

This study aims to investigate the effect of resveratrol on intrahepatic cholestasis of pregnancy (ICP) and its effect on the gut microbiome profiles, thus contributing to the potential therapeutic strategies for ICP. ICP rat models were established by injecting 17α-ethinylestradiol (EE) subcutaneously from the thirteenth day of gestation for four days and then treated with EE (D group, n=5), resveratrol (R group, n=5), or ursodeoxycholic acid (UDCA; U group, n=5) from the seventeenth to the twentieth day of gestation. Fecal samples were analyzed with 16S ribosomal RNA (rRNA) sequencing. In results: the gut microbiota of pregnant rats was characterized with reduced alpha diversity (Chao1 index), and significant variation in the microbiota structure (ANOSIM) was also observed after being treated with EE. The richness of four phyla and ten genera was upregulated, and five phyla and ten genera were downregulated by EE treatment. The dysbiosis of Bilophila, Ruminococcus, and Actinobacteria caused by EE treatment was reversed by resveratrol administration. There was a correlation between total bile acid and alanine aminotransferase in ICP rats. The Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis results suggested that the secondary bile acid biosynthesis was decreased, and the alanine, aspartate, and glutamate metabolism was increased after being treated with EE in pregnant rats. In conclusion, EE treatment could lead to gut microbiome dysbiosis and bile acid metabolism dysregulation in pregnant rats. Resveratrol could partially rescue gut microbiota dysbiosis and improve the biochemical characteristics caused by EE treatment.

[Research progress in pathogenesis and control of Enterococcus faecalis with persistent infection in root canals]

Root canal therapy is the common treatment for endodontic infections. Successful root canal therapy depends on favorable root canal preparation, root canal medication and three-dimensional obturation of the root canal system. The key to successful root canal therapy is to prevent re-infection of the highly complex root canal systems by removing infecious biofilms and bacterial toxins in the root canal system. The present paper reviews the pathogenic mechanism of the Enterococcus faecalis in the harsh environment of root canal system, the inflammation and immunity of refractory periapical periodontitis and the progress of infection control methods.

[DALYs for breast cancer in China, 2000-2050: trend analysis and prediction based on GBD 2019]

Objective: Based on the data of Global Burden of Disease 2019 data, to analyze the past, current, and future burden of disability-adjusted life years (DALYs) in China and compare with the international status. Methods: The total number of DALYs, age-standardized DALY rate, and the composition of different subgroups were extracted and described to analyze the time trend in 2000-2019 and the current situation in 2019 for Chinese female breast cancer. The burden of DALYs in 2050 was predicted by Joinpoint using average annual percent change (AAPC). Results: In 2000-2019, the ranking of DALYs caused by female breast cancer in China rose from the fourth to the second in all female cancers. The total DALYs increased by 48.4%, of which the years lived with disability increased from 4.8% to 8.8%. The age-standardized DALY rate only slightly decreased (AAPC=-0.3%; which increased during 2016-2019, AAPC=1.6%). In 2019, the age-standardized DALY rate for breast cancer in China was 278.0/100 000. The DALYs were 2.88 million (accounting for 14.2% of the global burden and 12.1% of all female cancers burden in China), 26.5% of which attributed known risk factors (overweight and obesity were the largest: 0.34 million DALYs, but some common breast cancer risk factors were not available on the platform, such as menstruation and fertility). In 2050, the prediction suggests that the total DALYs caused by female breast cancer in China will reach 3.80 million person-years-5.16 million person-years, increasing 32.1%-79.4% over 2019. From 2000 to 2019, the peak age of DALYs and DALY rate became older, and the DALYs among females aged 65 years and above increased faster than those younger than 65 years (AAPC were 4.8% and 1.3%, respectively). In 2019, females aged 45-74 (the starting age recommended by local guidelines for breast cancer screening) contributed 74.3% of the total DALYs. Conclusions: Over the past 20 years, the age-standardized DALY rate for breast cancer in female populations in China has not changed obviously. Without the continuous expansion of effective intervention and population aging, the burden of DALYs for female breast cancer in China will increase. DALYs for breast cancer attributed leading risk factors were still limited.

[Practice of laparoscopic anatomical adrenalectomy]

On the basis of existing laparoscopic transabdominal adrenalectomy, this article described a safe and reliable surgical method for the treatment of small adrenal lesions-laparoscopic anatomical adrenalectomy (LAA), and retrospectively analyzed the clinical data of 74 patients who had undergone LAA. All patients had no signs of recurrence on imaging. LAA has high safety and feasibility, clear intraoperative anatomical layers, good spatial operability, and low postoperative complications. LAA provides a more reliable option for the treatment of small adrenal diseases.

[Research advances in the relationship of dietary factors and prostate cancer risk]

Prostate cancer is the second most common malignancy in men worldwide. An increasing trend for prostate cancer incidence was observed in China. Enormous studies have been conducted to investigate the association between dietary factors and prostate cancer, however conflicted results were obtained. Red meat, processed meat, and dairy products consumption were reported to be associated with the increased prostate cancer risk, while tomatoes, soybeans and green tea might reduce the risk of prostate cancer occurance. However, no consensus could be reached without strong evidence. Furthermore, further studies are needed to investigate the association between vitamin and mineral supplements and prostate cancer risk. Some studies reported that men with higher dietary inflammatory index scores increased prostate cancer risk. There may be a long susceptible period when dietary factors affect prostate cancer risk, which poses challenges for collecting exposure and the follow-up. Measure bias and detection bias are the main reasons which impair the authenticity of studies on the relationship of dietary factors and prostate cancer risk. Researchers should apply various methods to measure participants' dietary consumption levels and ascertain essential outcomes, such as prostate cancer death. This article reviews updated epidemiological evidences on the association of dietary factors and prostate cancer, aims to benefit future nutritional epidemiology studies focus on the prostate cancer prevention.

[Association between blood pressure control and characteristics of green space among hypertensive patients in Shenzhen]

Objective: To explore the influence of characteristics of green space on blood pressure control. Methods: Hypertensive patients who were managed by community health centers for one year and aged 35 years old and above were selected as the study subjects in Shenzhen. Multi-stage random sampling method was applied to select a representative sample of 1 200 patients. A total of 1 116 valid questionnaires were collected, with a response rate of 93.0%. From November 2019 to January 2020, well-structured questionnaire, physical examination and laboratory biochemical test were applied for information collection among the 1 116 participants. Binary logistic regression model was used to analyze the relationship between characteristics of green space and blood pressure control. Results: The rate of blood pressure control was 67.8%. Results of binary logistic regression analysis showed that after adjusting confounding factors, health supporting elements, such as fitness areas (OR=1.678, 95%CI:1.231-2.288), collective exercise venues(OR=1.373, 95%CI:1.020-1.848), health knowledge promotion areas (OR=1.416, 95%CI: 1.049-1.911) in green space, were significantly correlated with blood pressure control. Green space safetiness (OR=1.010, 95%CI: 1.000-1.019), comfortableness (OR=1.011, 95%CI: 1.001-1.021) and maintenance status (OR=1.011, 95%CI: 1.001-1.021) also played a role. The rate of blood control among patients with exclusive green space was higher than that of patients without exclusive green space (OR=1.333, 95%CI: 1.009-1.762). Conclusion: Health supporting elements, safety, comfort, maintenance of green space and exclusive green space play an important role in blood pressure controlling.

[Quality assessment of global prostate cancer screening guidelines]

Objective: To systematically review the quality of clinical practice guidelines for prostate cancer screening to serve as a reference for developing prostate cancer screening guidelines in China. Methods: We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, and SinoMed with the term "prostate cancer" "prostate carcinoma" "prostate tumor" "screening" "early detection" "guideline" "recommendation" as keywords. The Appraisal of Guidelines for Research & Evaluation (AGREE) Ⅱ instrument and Reporting Items for Practice Guidelines in Healthcare (RIGHT) were used for critical appraisal. Results: A total of thirteen guidelines were included in this review. Evaluated by the AGREE Ⅱ instrument, ten were considered as A level. Two guidelines scored B level, and one was considered C level. Lowest mean domain scores were for stakeholder involvement (52.1%) and applicability (34.0%). Using the RIGHT checklist, we found that the low reporting quality of the thirteen guidelines could be attributable to incomplete disclosure of evidence (64.6%), funding, declaration and management of interest (44.2%), or other information (46.2%). Conclusions: No guidelines for prostate cancer screening was developed in China. The methodological quality of the guidelines in prostate cancer screening was good, which set a tone for the development of Chinese guidelines. However, all guidelines showed poor reporting quality.

Effects of targeted hydration on risk of major adverse renal and cardiac events: a systematic review and meta-analysis of randomized controlled trials

Background

Inconsistent results have been published that have evaluated the preventive effect of targeted hydration in major adverse renal and cardiac events among patients exposed to contrast agents.

Methods

Online databases were searched up to October, 2019, for randomized controlled trials (RCTs). The primary outcome was the incidence of contrast-induced acute kidney injury (CI-AKI), and the secondary outcomes were all-cause in-hospital mortality, all-cause long-term mortality, requirement for dialysis, acute pulmonary edema and stroke/transient ischemic attack (TIA).

Results

9 high quality trials were identified including 2424 patients. Overall, compared with general hydration, targeted hydration significantly reduced the incidence of CI-AKI by 58% (RR 0.42; 95% CI: 0.33–0.54, p&lt;0.01), the requirement for dialysis by 68% (RR 0.32, 95% CI: 0.17–0.62, p&lt;0.01) and the all-cause long-term mortality by 55% (RR 0.45; 95% CI: 0.26–0.76, p&lt;0.01). The effect on all-cause in-hospital mortality was not statistically significant. The effect on acute pulmonary edema and stroke/TIA also showed no difference between two groups (RR: 0.54, 95% CI: 0.28–1.03, p=0.18; RR: 0.61, 95% CI: 0.14–2.61, p=0.49, respectively). Trial sequential analysis confirmed that an additional 3900 study participants would need to be recruited to demonstrate a statistically significant improvement for all-cause in-hospital mortality.

Conclusions

Targeted hydration likely reduces the incidence of CI-AKI, dialysis and all-cause long-term mortality in patients exposed to contrast agents. However, further independent high-quality RCTs should elucidate the effectiveness and safety of this prophylactic strategy in interventional cardiology.

Funding Acknowledgement

Type of funding source: None

Association of high-sensitivity C-reactive protein and long-term mortality may differ from lipoprotein(a) levels among patients undergoing coronary angiography

Background

The use of high-sensitivity C-reactive protein (hs-CRP) as an inflammation biomarker in predicting long-term mortality remains controversial. We aimed to investigate whether the association of hs-CRP with long-term mortality differs from another inflammation biomarker, lipoprotein(a), in patients undergoing coronary angiography (CAG).

Methods

A total of 2422 patients undergoing CAG were included in the final analysis from a prospective, observational study. We divided them into 4 groups according to hs-CRP level (high ≥4.8 mg/l, low &lt;4.8 mg/l) and lipoprotein(a) level (high ≥17 mg/dl, low &lt;17 mg/dl).

Results

The overall incidence of all-cause long-term mortality was 133/2422 (5.5%). In the high lipoprotein(a) group, after adjusting for LDL-cholesterol concentration (LDL-C), age, sex, smoking status, diabetes mellitus and estimated glomerular filtration rate (eGFR), a high hs-CRP level was an independent predictor of all-cause long-term mortality (hazard ratio: 2.01; 95% CI: 1.13–3.54; p=0.02). In the low lipoprotein(a) group, a similar result was not found (hazard ratio: 1.42; 95% CI: 0.92–2.01; p=0.24).

Conclusions

Our data suggested that the association of hs-CRP with all-cause long-term mortality may differ from lipoprotein(a) levels among patients undergoing CAG. In addition to hs-CRP, a high lipoprotein(a) level might be a simultaneous intervention target for improving long-term prognosis in the future.

Funding Acknowledgement

Type of funding source: None

Global risk factors of contrast-induced acute kidney injury: systematic review and meta-analysis

Background

Administration of iodinated contrast is common but may be associated with contrast-induced acute kidney injury (CI-AKI), particularly in at-risk patients. There is no recent systematic review of potentially modifiable risk factors.

Methods

We searched MEDLINE, Embase and the Cochrane Database of Systematic Reviews (to 30 th June 2019) for observational studies assessing risk factors associated with CI-AKI. Twelve potentially modifiable risk factors were finally included in this thematic review and meta-analysis. Random or fixed meta-analysis was performed to derive the adjusted odds ratio (aOR), and the population attributable risk (PAR) was calculated for each risk factor globally and by region.

Findings

We included 157 studies (2,297,863 participants). The global incidence of CI-AKI was 5.4%. The potentially modifiable risk factors included high contrast volume (PAR 33%), eight cardiovascular risk factors (diuretic use, multivessel coronary artery disease, acute coronary syndrome, hypertension, hypotension, heart failure, reduced left ventricular ejection fraction and intra-aortic balloon pump use) (combined PAR 76.2%) and three noncardiovascular risk factors (renal dysfunction, diabetes mellitus and anaemia) (combined PAR 47.4%) with geographical differences.

Bubble chart of the 12 risk factors

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): National Science Foundation of China

Identifying the value of RVEF for the prediction of major cardiovascular outcomes: a study of 7,131 patients undergoing cardiovascular magnetic resonance imaging

Background

Right ventricular (RV) function remains poorly recognized for its value in predicting cardiovascular events at a population level. Cardiovascular Magnetic Resonance (CMR) imaging is the gold standard for RV assessment.

Purpose

To define the independent prognostic value of RVEF for the prediction of major adverse cardiovascular events (MACE) as primary outcome in patients with known or suspected cardiovascular disease.

Methods

Data was obtained from the Cardiovascular Imaging Registry of Calgary (CIROC). Patients underwent standardized CMR imaging protocols and analysis. Clinical events were identified from administrative data.

Results

7,131 patients were included. 870 primary outcome events occurred over 2.5 years follow-up. RVEF provided equivalent predictive utility versus LVEF (Table 1). There was an increase in events with worsening severity of RVEF (Figure 1), with a significant “threshold-effect” at an RVEF of 40%.

Conclusions

RVEF is a strong and independent predictor of MACE at a population level.

Figure 1

Funding Acknowledgement

Type of funding source: None

A simple nomogram to predict contrast-induced acute kidney injury in patients with congestive heart failure undergoing coronary angiography

Background

Patients with congestive heart failure (CHF) are vulnerable to contrast-induced acute kidney injury (CI-AKI), but few prediction models are currently available.

Objectives

We aimed to establish a simple nomogram for CI-AKI risk assessment for patients with CHF undergoing coronary angiography.

Methods

A total of 1876 consecutive patients with CHF (defined as New York Heart Association functional class II-IV or Killip class II-IV) were enrolled and randomly (2:1) assigned to a development cohort and a validation cohort. The endpoint was CI-AKI defined as serum creatinine elevation of ≥0.3 mg/dL or 50% from baseline within the first 48–72 hours following the procedure. Predictors for the nomogram were selected by multivariable logistic regression with a stepwise approach. The discriminative power was assessed using the area under the receiver operating characteristic (ROC) curve and was compared with the classic Mehran score in the validation cohort. Calibration was assessed using the Hosmer–Lemeshow test and 1000 bootstrap samples.

Results

The incidence of CI-AKI was 9.06% (n=170) in the total sample, 8.64% (n=109) in the development cohort and 9.92% (n=61) in the validation cohort (p=0.367). The simple nomogram including four predictors (age, intra-aortic balloon pump, acute myocardial infarction and chronic kidney disease) demonstrated a similar predictive power as the Mehran score (area under the curve: 0.80 vs 0.75, p=0.061), as well as a well-fitted calibration curve.

Conclusions

The present simple nomogram including four predictors is a simple and reliable tool to identify CHF patients at risk of CI-AKI, whereas further external validations are needed.

Figure 1

Funding Acknowledgement

Type of funding source: None