Case fatality rates of COVID-19 during epidemic periods of variants of concern: A meta-analysis by continents

OBJECTIVES

To calculate the case fatality rates (CFR) of COVID-19 during epidemic periods of different variants of concern (VOC) by continents.

METHODS

We systematically searched five authoritative databases (Web of Science, PubMed, Embase, Cochrane Library, and MedRxiv) for epidemiological studies on the CFR of COVID-19 published between January 1, 2020, and March 31, 2023. After identifying the epidemic trends of variants, we used a random-effects model to calculate the pooled CFRs during periods of different VOCs. This meta-analysis was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered with PROSPERO (CRD42023431572).

RESULTS

There were variations in the CFRs among different variants of COVID-19 (Alpha: 2.62%, Beta: 4.19%, Gamma: 3.60%, Delta: 2.01%, Omicron: 0.70%), and disparities in CFRs also existed among continents. On the whole, the CFRs of COVID-19 in Europe and Oceania were slightly lower than in other continents. There was a statistically significant association between the variant, HDI value, age distribution, coverage of full vaccination of cases, and the CFR.

CONCLUSIONS

The CFRs of COVID-19 varied across the epidemic periods of different VOCs, and disparities existed among continents. The CFR value reflected combined effects of various factors within a certain context. Caution should be exercised when comparing CFRs due to disparities in testing capabilities and age distribution among countries, etc.

Improvement of Cancer Prevention and Control: Reflection on the Role of Emerging Information Technologies

Cancer has become an important public health problem affecting the health of Chinese residents, as well as residents all over the world. With the improvement of cancer prevention and treatment, the growth of the mortality rate of cancers has slowed down gradually, but the incidence rate is still increasing rapidly, and cancers still impose heavy disease and economic burdens. Cancer screening and early cancer diagnosis and treatment are important ways to reduce the burden of cancer-related diseases. At present, various projects for early cancer diagnosis and treatment have been implemented in China. With the expansion of the coverage of these projects, the problems related to project implementation, operation, and management have emerged gradually. In recent years, emerging information technologies have been applied in the field of health and have facilitated health management and clinical decision-making. Meanwhile, China announced multiple policies to encourage and promote the application of information technologies in the field of health. Therefore, combined with the analysis of major problems in cancer prevention and control projects, this paper probes into how to apply information technologies such as biological information mining, artificial intelligence, and electronic information collection technology to various stages of cancer prevention and control. Information technologies realize the integrated management of prevention and control processes, for example, mobilization and preliminary identification, high-risk assessment, clinical screening, clinical diagnosis and treatment, tracking and follow-up, and biological sample management of high-risk groups, and promote the efficient implementation of cancer prevention and control projects in China.

Laser-direct-drive fusion target design with a high-Z gradient-density pusher shell

Laser-direct-drive fusion target designs with solid deuterium-tritium (DT) fuel, a high-Z gradient-density pusher shell (GDPS), and a Au-coated foam layer have been investigated through both 1D and 2D radiation-hydrodynamic simulations. Compared with conventional low-Z ablators and DT-push-on-DT targets, these GDPS targets possess certain advantages of being instability-resistant implosions that can be high adiabat (α≥8) and low hot-spot and pusher-shell convergence (CR_{hs}≈22 and CR_{PS}≈17), and have a low implosion velocity (v_{imp}<3×10^{7}cm/s). Using symmetric drive with laser energies of 1.9 to 2.5MJ, 1D lilac simulations of these GDPS implosions can result in neutron yields corresponding to ≳50-MJ energy, even with reduced laser absorption due to the cross-beam energy transfer (CBET) effect. Two-dimensional draco simulations show that these GDPS targets can still ignite and deliver neutron yields from 4 to ∼10MJ even if CBET is present, while traditional DT-push-on-DT targets normally fail due to the CBET-induced reduction of ablation pressure. If CBET is mitigated, these GDPS targets are expected to produce neutron yields of >20MJ at a driven laser energy of ∼2MJ. The key factors behind the robust ignition and moderate energy gain of such GDPS implosions are as follows: (1) The high initial density of the high-Z pusher shell can be placed at a very high adiabat while the DT fuel is maintained at a relatively low-entropy state; therefore, such implosions can still provide enough compression ρR>1g/cm^{2} for sufficient confinement; (2) the high-Z layer significantly reduces heat-conduction loss from the hot spot since thermal conductivity scales as ∼1/Z; and (3) possible radiation trapping may offer an additional advantage for reducing energy loss from such high-Z targets.

Prevalence, awareness, treatment, and control of dyslipidemia in Chinese adults: a systematic review and meta-analysis

Background

Researchers have conducted a considerable number of epidemiological studies on dyslipidemia in China over recent years. Nevertheless, a representative study to comprehensively appraise for the epidemiological status of dyslipidemia is still lacked. This meta-analysis is intended to explore the pooled prevalence, rates of awareness, treatment, and control of dyslipidemia among adults in Chinese Mainland.

Materials and methods

A systematic review was performed on relevant cross-sectional studies published since January 2012 by searching six authoritative literature databases. Meta-analyses were conducted in included studies based on a random-effect model to summarize the epidemiological status of dyslipidemia in China. A potential source of heterogeneity was detected by subgroup analysis and meta-regression. Publication bias was assessed by Egger's test and funnel plots. A sensitivity analysis was conducted to examine the study quality's influence on the pooled estimate of prevalence and rates of awareness, treatment, and control.

Results

Forty-one original researches with a total of 1,310,402 Chinese participants were finally included in the meta-analysis. The prevalence, rates of awareness, treatment, and control of dyslipidemia were 42.1%, 18.2%, 11.6%, and 5.4%, respectively. With a pooled prevalence estimate at 24.5%, low HDL-C was the most prevalent among various dyslipidemia types, followed by hypertriglyceridemia (TG) (15.4%), hypercholesterolemia (TC) (8.3%), and high LDL-C (7.1%). The pooled prevalence of elevated serum lipoprotein(a) [Lp(a)] was 19.4%. By gender, the prevalence of dyslipidemia was 47.3% in males and 38.8% in females. Subgroup analyses revealed that the prevalence in southern and urban areas were higher than their counterparts. Females and population in urban areas tended to possess higher rates of awareness, treatment, and control. Meta-regression analyses suggested that the year of screening influenced prevalence estimates for dyslipidemia. The impact of the study's quality on the pooled estimates is insignificant.

Conclusion

Our study suggested a severe epidemic situation of dyslipidemia among adults in Chinese Mainland. More importantly, the awareness, treatment, and control rates were extremely low, revealing that dyslipidemia is a grave health issue. Consequently, we should attach more importance to the management of dyslipidemia, especially in economically underdeveloped areas.

Systematic review registration

PROSPERO [CRD42022366456].

Comparative analysis of prevention and control measures toward COVID-19 epidemic between Shanghai and Beijing

Purpose

By serving and providing a guide for other regional places, this study aims to advance and guide the epidemic prevention and control methods, and practices and strengthen people's ability to respond to COVID-19 and other future potential public health risks.

Design/methodology/approach

A comparative analysis was conducted that the COVID-19 epidemic development trend and prevention and control effects both in Beijing and Shanghai. In fact, regarding the COVID-19 policy and strategic areas, the differences between governmental, social, and professional management were discussed and explored. To prevent and be ready for potential pandemics, experience and knowledge were used and summarized.

Findings

The strong attack of the Omicron variant in early 2022 has posed challenges to epidemic prevention and control practices in many Chinese cities. Shanghai, which had achieved relatively good performance in the fight against the epidemic, has exposed limitations in its epidemic prevention and control system in the face of Omicron. In fact, the city of Beijing has undertaken prompt and severe lockdown measures and achieved rather good results in epidemic prevention and control because of learning from Shanghai's experience and lessons; adhering to the overall concept of "dynamic clearing," implementing precise prevention and monitoring, enhancing community control, and making emergency plans and preparations. All these actions and measures are still essential in the shift from pandemic response to pandemic control.

Research limitations/implications

Different places have introduced different urgent policies to control the spread of the pandemic. Strategies to control COVID-19 have often been based on preliminary and limited data and have tended to be slow to evolve as new evidence emerges. Hence, the effects of these anti-epidemic policies need to be further tested.

Understanding the condition of disease prevention and control workforce by disciplines, duties, and work stress during the COVID-19 pandemic: A case from Beijing disease prevention and control system

Objective

The duties, discipline cross-complementation, and work stress of professional staff during the COVID-19 pandemic are analyzed and summarized to provide a scientific basis for workforce allocation and reserve in respect of infectious disease prevention and control in the disease prevention and control (DPC) system.

Method

The cross-sectional survey was made in April-May 2021 on professional staff in the Beijing DPC system by way of typical + cluster sampling. A total of 1,086 staff were surveyed via electronic questionnaire, which was independently designed by the Study Group and involves three dimensions, i.e., General Information, Working Intensity & Satisfaction, and Need for Key Capacity Building. This paper focuses on the former two dimensions: General Information, Working Intensity, and Satisfaction. The information collected is stored in a database built with Microsoft Excel 2010 and analyzed statistically with SPSS 22.0. The results are expressed in absolute quantities and proportions. Assuming that the overload of work stress is brought by incremental duties and cross-discipline tasks, a binary logistic regression model is constructed.

Results

Among the 1086 staff surveyed, 1032 staff were engaged in COVID-19 prevention and control works, and they can be roughly divided into two groups by their disciplines: Public Health and Preventive Medicine (hereinafter referred to P, 637 staff, as 61.72%) and Non-Public Health and Preventive Medicine (hereinafter referred to N-P, 395 staff, as 38.28%). During the COVID-19 pandemic, the 1,032 staff assumed a total of 2239 duties, that is, 2.17 per person (PP), or 2.45 PP for the P group and 1.72 PP for the N-P group. As to four categories of duties, i.e., Spot Epidemiological Investigation and Sampling, Information Management and Analysis, On-site Disposal, Prevention, Control Guidance, and Publicity, the P group accounts for 76.14, 78.50, 74.74, and 57.66%, respectively, while the N-P group accounts for 23.86, 21.50, 25.26, and 42.34%, respectively. Obviously, the former proportions are higher than the latter proportions. The situation is the opposite of the Sample Detection and Other Works, where the P group accounts for 25.00 and 31.33%, respectively, while the N-P group accounts for 75.00 and 68.67%, respectively. The analysis of work stress reveals that the P group and N-P group have similar proportions in view of full load work stress, being 48.67 and 50.13%, respectively, and the P group shows a proportion of 34.38% in view of overload work stress, apparently higher than the N-P group (24.05%). Moreover, both groups indicate their work stresses are higher than the pre-COVID-19 period levels. According to the analysis of work stress factors, the duty quantity and cross-discipline tasks are statistically positively correlated with the probability of overload work stress.

Conclusion

The front-line staff in the DPC system involved in the COVID-19 prevention and control primarily fall in the category of Public Health and Preventive Medicine discipline. The P group assumes the most duties, and the N-P group serves as an important cross-complement. The study results indicate that the prevention and control of same-scale epidemic require the duty post setting at least twice than usual. As to workforce recruitment, allocation, and reserve in respect of the DPC system, two solutions are optional: less addition of P staff, or more addition of N-P staff. A balance between P and N-P staff that enables the personnel composition to accommodate both routine DPC and unexpected epidemic needs to be further discussed.

Discussion of the Trust in Vaccination against COVID-19

The COVID-19 pandemic has introduced serious challenges to global public health security, and the benefits of vaccination via public health interventions have been recognized as significant. Vaccination is an effective means of preventing and controlling the spread of COVID-19. However, trust is a major factor that influences vaccine hesitancy; thus, the distrust of vaccination has hindered the popularization of COVID-19 vaccines. This paper aims to discuss the main problems and the role of trust in the vaccination against COVID-19 to effectively promote and implement policy to promote the acceptance of COVID-19 vaccines.

The Running Track of Government Responsibility During the Pandemic, Characteristic Analysis of Policy Documents Relevant to the COVID-19 Pandemic Released by Beijing Municipal Government in 2020

Objective: Provide a reference point for the division of labor during the collaboration of multiple departments and the planning for the prevention and control of the Covid-19 epidemic of departments of the Beijing Municipal Government, from the perspective of policy documents. Methods: Policy documents and daily updates on COVID-19 cases published in 2020 are taken from the official website of Beijing Municipal Government and Beijing Municipal Health Commission. The characteristics of the pandemic situation and the content of relevant documents issued by different departments are described in five stages. Results: There were 988 confirmed cases of COVID-19 in Beijing in 2020, and policy analysis covered 444 documents (257 policy documents and 187 explanations of policy). A total of 153 policy documents were directly issued by the Beijing Municipal Government and its 45 subordinate commissions and bureaus, while others were policy forwarding from the central government and its relevant departments, county-level governments of Beijing and other organizations. Most cases and documents emerged during the initial stage of the pandemic (Level-I of the Emergency Response, which is the most serious). It was found that as many as 109 documents published by Beijing Municipal Government during the Level I emergency response period were relevant to economic and social development, 83 documents were related to disease control and medical services, and the rest were in close relation to the production and daily life of the people. Overall, major policy measures taken were relevant to 7 fields: finance, transportation, economic activities, employment people's lives, epidemic prevention and control and medical insurance. Policy implementation objectives were centered on promoting epidemic prevention and control and maintaining the stability of social production and residents' life. However, there are different emphases in different stages of the epidemic. Conclusion: Beijing municipality realized an effective mode of collaboration among multiple departments and organizations in the prevention and control of the COVID-19 epidemic, which was an example of the practice of "Health in All Policies."

951Can cancer-related health literacy predict cancer preventive behaviours?

Background

Health literacy has direct relevance to outcomes in patients with cancer. An adequate level of health literacy may increase uptake of screening and other supportive cancer prevention programs, which may contribute to improved outcomes. However, existing literature is limited in measuring cancer-specific health literacy and its role in cancer prevention. This study aims to investigate the relationship between cancer-related health literacy and cancer preventive behaviours through a population survey in Beijing, China.

Methods

A cross-sectional design was utilised to collect survey data such as respondents’ sociodemographic characteristics, cancer-related health literacy, cancer status and cancer prevention behaviours. Logistic regression modelling was applied to identify significant sociodemographic predictors for cancer literacy. Multinomial logistic regression analysis was further performed to determine the association between cancer-related health literacy and cancer preventive behaviours after adjusting for effects from sociodemographic variables.

Results

The findings confirmed that cancer-related health literacy was significant in predicting participants’ cancer preventive behaviours, including individual’s cancer information seeking behaviour, intention to participate in cancer screenings, early diagnosis and treatments. In addition, the results also showed that respondents’ gender, age, education, household income, residential region and cancer status were significantly associated with their levels of cancer-related health literacy.

Conclusions/Key messages

The results of this study have provided useful evidence on the importance of applying cancer-related health literacy to predict individual’s cancer preventive behaviours. The study has also identified the variations in cancer literacy between different sub-population groups. Future studies can develop targeted health promotion and education campaigns for more effective cancer prevention.

Outcome Assessment for a Telemedicine-Based Second Opinion Program for Midwest China

Through an examination of the records of a telemedicine-based second opinion program in county-level hospitals in central and western China, the impact of this service on the diagnosis and treatment of cancer-related diseases was analyzed and evaluated. In this study, all 135 cancer-related cases were included in the analysis. The basic characteristics of the patients were described, the opinions of the original and second diagnosis and treatment were compared, the rate of consistency between them was calculated, the therapeutic regimens were analyzed and the differences between groups were tested. In 94.07% of the cases, the reason for the doctor's request for second opinion service was to assist in the formulation of therapeutic regimen. 64.44% of cases were confirmed with the diagnosis and 17.78% therapeutic regimen by the second opinion service. 126 cases obtained improved therapeutic regimens, and there were statistically significant differences in treatment methods in the diagnosis changed group. Comparing with other international SO studies, the diagnostic consistency rate obtained in this study was lower but not the lowest. The therapeutic consistency rate was quite low, due to the high proportion of original therapeutic regimens missing. This telemedicine-based second opinion program has brought beneficial improvements to the diagnosis and treatment of cancer-related diseases in county-level hospitals in central and western China.

Health-related quality of life in patients with esophageal cancer or precancerous lesions assessed by EQ-5D: A multicenter cross-sectional study

Background

We aimed to obtain a set of health state utility scores of patients with esophageal cancer (EC) and precancerous lesions in China, and to explore the influencing factors of health‐related quality of life (HRQoL).

Methods

A hospital‐based multicenter cross‐sectional study was conducted. From 2013 to 2014, patients with EC or precancerous lesions were enrolled. HRQoL was assessed using a European quality of life‐5 dimension (EQ‐5D‐3L) instrument. Multivariable linear regression analysis was performed to explore the influencing factors of the EQ‐5D utility scores.

Results

A total of 2090 EC patients and 156 precancer patients were included in the study. The dimension of pain/discomfort had the highest rate of self‐reported problems, 60.5% in EC and 51.3% in precancer patients. The mean visual analog scale (VAS) score for EC and precancer patients were 68.4 ± 0.7 and 64.5 ± 3.1, respectively. The EQ‐5D utility scores for EC and precancer patients were estimated as 0.748 ± 0.009 and 0.852 ± 0.022, and the scores of EC at stage I, stage II, stage III, and stage IV were 0.693 ± 0.031, 0.747 ± 0.014, 0.762 ± 0.015, and 0.750 ± 0.023, respectively. According to the multivariable analyses, the factors of region, occupation, household income in 2012, health care insurance type, pathological type, type of therapy, and time points of the survey were statistically associated with the EQ‐5D utility scores of EC patients.

Conclusions

There were remarkable decrements of utility scores among esophageal cancer patients, compared with precancer patients. The specific utility scores of EC would support further cost‐utility analysis in populations in China.

Cost-utility analysis of screening for colorectal precancerous lesions and cancer in Beijing: A case-control study

Objective

To provide an objective cost-utility evaluation of a colorectal cancer screening program in a hypothetical general population.

Materials and Methods

A cost-utility analysis was conducted comparing screened individuals with the general population. Patients were evaluated as part of the screening program which conducted colorectal cancer risk assessments and performed colonoscopies from October 2012 to May 2013. Data were compared to a hypothetical group of the same size, consisting of the general population in which no cancer screening had been conducted. The cost and utility data have been published previously.

Results

The average cost per quality-adjusted life year (QALY) of colorectal cancer screening population was 84,092 CNY, while the average cost per QALY of the general population was 122,530 CNY. The colorectal cancer screening program saved 43,530 CNY per additional QALY.

Conclusion

The colorectal cancer screening program could improve health-related quality of life and reduce medical expenditure.

Medical expenditures for colorectal cancer diagnosis and treatment: A 10-year high-level-hospital-based multicenter retrospective survey in China, 20022011

Objective

Colorectal cancer (CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China.

Methods

From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan (CNY) using 2011 values.

Results

Of the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stage-I cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval (95% CI): 37,282−38,522], and the annual average increase rate was 9.2% from 2002 to 2011 (P for trend <0.001), with a cumulative increase of 2.4 times (from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages I, II, III and IV were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively (P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion (52.6%).

Conclusions

These conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.

Studying Communication Problems for Emergency Management of SARS and H7N9 in China

BACKGROUND

Severe Acute Respiratory Syndrome (SARS) and Influenza A virus Subtype H7N9 (H7N9) have both had a great impact on China in the 21st century, causing significant negative impacts on health, the economy, and even global security. The control efforts for SARS were heavily criticized, the H7N9 response, 10 years later was acknowledged to be much better.

AIMS

This article explores communication for emergency management of SARS in 2003 and H7N9 in 2013 in China, to provide useful evidence for government and practitioner on management improvement for infectious disease outbreaks response in China and international community in the future.

METHODS

This study uses a qualitative case study approach, including in-depth interviews, literature review, and document, to analysis the emergency management of SARS in 2003 and H7N9 in 2013 in China, identified the problems of communication with the emergency management process for SARS and H7N9.

RESULTS

The control efforts for SARS were slow to be mobilized and were heavily criticized and generally considered to be suboptimal, as the poor handling of SARS exposed serious communication problems in the then emergency management system processes. The H7N9 response, 10 years later, was acknowledged to be much better.

CONCLUSION

Communication is very important in the prevention and control of infectious diseases. From SARS to H7N9, the progress had been made in information disclosure.

Detection of porcine circovirus-like virus P1 in Hebei, China

Porcine circovirus-like virus P1 is a novel unclassified circovirus that was first detected in China and may be associated with post-weaning multisystemic wasting syndrome (PMWS) and congenital tremor. In this study, we detected P1 infection in pigs in Hebei Province, China, in 2017. One hundred and forty of 500 (28.0%) serum samples from 25 pig farms with different PMWS status in seven cities were P1 positive on PCR. Twelve P1 strains were sequenced, and the complete genomes of 11 P1 strains were 648 nucleotides (nt) in length, whereas that of strain ZJK02 was 647 nt, with a G deletion at position of 183 in its genome. The complete genomic and capsid protein sequences of the 12 P1 strains analysed in this study shared 98.8%-100.0% and 86.5%-100.0% identity, respectively. A phylogenetic analysis based on the complete genomic and capsid sequences of 26 P1 strains showed that the 12 P1 sequences from Hebei Province clustered on two small branches. Further studies of the evolution and pathogenesis of P1 are required.

Role of 5 Saponins in Secretion of Cytokines by PRRSV-induced Endothelial Cells

The aim of the research presented here was to investigate the immunoloregulatory effects of 5 saponins: Saikosaponins A (SSA) and D (SSD) from Bupleurum chinese DC (Umbelliferae), Panax Notoginseng Saponin (PNS) and Notoginsenoside R1 from Panax notoginseng (Araliaceae) (SR1), and Anemoside B4 from Pulsatilla chinensis Regel (Ranunculaceae) (AB4). To achieve this, endothelial cells were challenged with 10(5) TCID50/mL PRRSV for 24 h then treated respectively with 5 saponins at 3 concentrations (1, 5 and 10 μg/mL). The cells were incubated at 37°C in a cell incubator for 24 h. The supernatants were collected and analyzed the levels of interleukin-4 (IL-4), IL-10, IL-2, and γ-interferon (IFN-γ) by ELISA kits. The results revealed that PNS and SR1 inhibited the production of IL-4; PNS, SR1 and SSD inhibited the secretion of IL-10; SSA, SSD and AB4 up-regulated IL-2 expression; SSA and SSD increased the level of IFN-γ. All these changes were significant. Taken together, the data suggested that these 5 saponins might effectively regulate immune responses via changes in the levels of these select cytokines.

[Cost analysis of the colorectal neoplasm screen program in Beijing]

OBJECTIVE

To conduct with a cost analysis of the colorectal neoplasm screening program in Beijing, and provide data evidence for decision making.

METHODS

Based on stratified cluster sampling method, we carried out a 2-stage colorectal neoplasm screening program within 6 districts, Dongcheng, Xicheng, Chaoyang, Haidian, Fengtai and Shijingshan, of Beijing city between October, 2012 to May. 2013. The first stage of the program was to conducting a cancer risk level evaluation for community residents who were forty years older and the second stage's task was to providing clinical exam for those high risk people who were selected from the first stage. There were about 12 953 residents were involved in this program. We calculated the main cost of the colorectal neoplasm screen program in Beijing. Then estimate the cost of detecting one Colorectal Neoplasm patient of this program and compare it with the total treatment cost for a patient.

RESULT

2 487 high risk residents were selected by the first stage and 1 055 of them made appointment for the colonoscopy exam but only 375 accepted the exam, participate rate was 35.5%. 9 neoplasm cancer patients and 71 pre-cancer patient were found at the second stage, the detection rate were 69.2/100 000 and 546/100 000, respectively. The direct input for this neoplasm screening program was 227 100 CNY and the transport expense was 4 200 CNY in the calculations. The cost for detecting one cancer patient was about 19 900 CNY. Comparing with the total medical care cost of a cancer patient (1 282 800 CNY), especially for those have been diagnosed as middle to end stage cancer, the screening program (cost 842 800 CNY) might help to reduce the total health expenditure about 128 700 CNY, based on 12 953 local residents age above 40 years old.

CONCLUSION

An colonoscopy based colorectal neoplasm screening program showed its function on medical expenditure saving and might have advantage on health social labor creating.

[Acceptance and willingness-to-pay for colorectal colonoscopy screening among high-risk populations for colorectal cancer in urban China]

OBJECTIVE

To survey the acceptance and willingness-to-pay for colorectal cancer colonoscopy screening among high risk populations in urban China.

METHODS

From 2012 to 2013, a Cancer Screening Program in Urban China (CanSPUC) was initiated in 9 provinces, the current survey was conducted among those participants who were evaluated as "high risk for colorectal cancer" by a risk-factor-evaluation-model (community-based) and then went through a colonoscopy screening procedure (hospital-based). All the data were obtained through a questionnaire-based interview (face-to-face or self-completed), mainly focusing on the acceptance and willingness-to-pay of the participants for colorectal colonoscopy screening.

RESULTS

The current analysis included a total of 1 624 participants, with an median age of 55.0 years (P25 = 49.0, P75 = 61.0 years) and an annual income per capita of 17 thousand (range: 10-25 thousand) Chinese Yuan (CNY), 42.8% (695/1 624) of whom were males. Of all the participants, 87.0% (1 414/1 624) could totally or substantially accept the colonoscopy screening, particularly in those at higher education level (junior high school: OR = 0.34, 95% CI: 0.22-0.52; high school OR = 0.41, 95% CI: 0.26-0.66; college or over OR = 0.35, 95% CI: 0.20-0.59). Of all the participants, 13.0% (210/1 624) could not or hardly accept it, particularly in those with older age (60-69 years) (OR = 1.48, 95% CI: 1.06-2.07), not in marriage (OR = 2.15, 95% CI: 1.25-3.70) or with family member(s) to raise (OR = 1.60, 95% CI: 1.17-2.20). 1 388 (85.5%) of all the participants had willingness-to-pay for a long-term colonoscopy screening service, particularly in those working in public (OR = 0.61, 95% CI: 0.44-0.84) or enterprise sectors (OR = 0.60, 95% CI: 0.38-0.94), but 82.3% (1 141/1 386) of whom would only pay less than 100 CNY; 14.5% (236/1 624) of total had no willingness-to-pay, particularly in those living in areas with moderate (OR = 4.08, 95% CI: 2.75-6.33) or high GDP per capita (OR = 3.26, 95% CI: 2.11-4.92), or with an absence of willingness-to-pay for colonoscopy screening (OR = 3.98, 95% CI: 2.81-5.65).

CONCLUSIONS

Although a larger community-based colorectal cancer screening program was warranted to examine the extrapolation of these findings, it suggested that the acceptance for colorectal cancer colonoscopy screening among the selected high-risk populations was considerable. The willing-to-pay was relatively high but the amount of payment was limited, the indicated subgroups with potentially less acceptance or willingness need to be more focused in the future to reach a higher participation rate. The data will also be informative in integrating the screening service into the local health insurance system.

Nanopatterning using a simple bi-layer lift-off process for the fabrication of a photonic crystal nanostructure

A simple and versatile method for fabricating nanopatterns by a lift-off procedure is demonstrated. The technique involves the use of molecular transfer lithography based on water-soluble templates to form a nanopatterned UV-curable material on a PMGI layer, which serves as an underlying resin suitable for lift-off processes. This bi-layer procedure is used for the fabrication of nickel patterns, which are subsequently used as a hard mask for plasma etch processing. Using this procedure, a two-dimensional TiO(2) photonic crystal layer with a 450 nm lattice constant is fabricated on Y(3)Al(5)O(12):Ce(3+) (YAG:Ce) yellow ceramic plate phosphor to enhance its forward emission. The yellow emission in the forward direction is improved by a factor of 3.5 compared to that of a conventional non-scattering YAG:Ce phosphor plate excited by a blue LED.

The hypothesis of an effective strategy for resistance of hepatocellular carcinoma to therapy-autophagy

Hepatocellular carcinoma (HCC) is one of the most common malignant tumours and its five-year survival rate remains low. Autophagy is a catabolic process conserved among all eukaryotes ranging from yeast to mammals. Recently, many studies show that tumour cells can utilize autophagy as a cellular defence mechanism when facing metabolic stress. Thus, we hypothesize that autophagy may play an important role in the resistance of hepatocellular carcinomas to therapy. Although the exact role of autophagy on tumour cells is still complex and further studies are needed to prove the impact of autophagy on HCC, it suggests that autophagy may be a new therapeutic target for the resistance to therapy of HCC.

Efficacy and safety of extended-release niacin/laropiprant plus statin vs. doubling the dose of statin in patients with primary hypercholesterolaemia or mixed dyslipidaemia

BACKGROUND

Co-administration of niacin with statin offers the potential for additional lipid management and cardiovascular risk reduction. However, niacin is underutilised because of the side effects of flushing, mediated primarily by prostaglandin D(2) (PGD(2)). A combination tablet containing extended-release niacin and laropiprant (ERN/LRPT), a PGD(2) receptor (DP1) antagonist, offers improved tolerability. This study assessed the efficacy and safety of ERN/LRPT added to statin vs. doubling the dose of statin in patients with primary hypercholesterolaemia or mixed dyslipidaemia who were not at their National Cholesterol Education Program Adult Treatment Panel III low-density lipoprotein cholesterol (LDL-C) goal based on their coronary heart disease risk category (high, moderate or low).

METHODS

After a 2- to 6-week run-in statin (simvastatin 10 or 20 mg or atorvastatin 10 mg) period, 1216 patients were randomised equally to one of two treatment groups in a double-blind fashion: group 1 received ERN/LRPT (1 g) plus the run-in statin dose and advanced to ERN/LRPT (2 g) after 4 weeks for an additional 8 weeks, with no adjustments to the run-in statin dose; group 2 received simvastatin or atorvastatin at twice their run-in statin dose and remained on this stable dose for 12 weeks.

RESULTS

ERN/LRPT added to statin (pooled across statin and statin dose) significantly improved key lipid parameters vs. the doubled statin dose (pooled): the between-treatment group difference in least squares mean per cent change [95% confidence interval (CI)] from baseline to week 12 in LDL-C (primary end-point) was -4.5% (-7.7, -1.3) and in high-density lipoprotein cholesterol (HDL-C) was 15.6% (13.4, 17.9) and in median per cent change for triglyceride (TG) was -15.4% (-19.2, -11.7). Treatment-related adverse experiences (AEs) related to flushing, pruritis, rash, gastrointestinal upset and elevations in liver transaminases and fasting serum glucose occurred more frequently with ERN/LRPT added to statin vs. statin dose doubled.

CONCLUSIONS

The addition of ERN/LRPT to ongoing statin treatment produced significantly improved lipid-modifying benefits on LDL-C, HDL-C and TG and all other lipid parameters compared with doubling the statin dose in patients with primary hypercholesterolaemia or mixed dyslipidaemia. The types of AEs that occurred at a greater frequency in the ERN/LRPT group were those typically associated with niacin.

Quantitative study on socioeconomic determinants of life expectancy in Beijing, China

OBJECTIVE

To explore the socioeconomic factors associated with life expectancy in Beijing, and to predict future trends.

METHODS

The linear stepwise regression model was used to construct the relationship between life expectancy and socioeconomic factors.

RESULTS

The model showed that there were four factors associated with life expectancy in Beijing. Floor space available per rural resident (P = 0.000) and GDP per capita (P = 0.022) correlated positively with life expectancy, while the rural population proportion (P = 0.010) and illiteracy rate (P = 0.001) correlated negatively with life expectancy.

CONCLUSION

There is a close relationship between life expectancy and socioeconomic factors. The constructed model can be used as a rapid tool to project life expectancy in Beijing. It is possible to improve life expectancy continuously with sustained development of socioeconomic conditions in Beijing, China.

A semi-automated method for measuring the potential for protein covalent binding in drug discovery

INTRODUCTION

Covalent protein binding of metabolically reactive intermediates of drugs has been implicated in drug toxicity including the occurrence of idiosyncratic drug toxicity. Investigators therefore would prefer to avoid developing compounds that produce significant amounts of reactive metabolites. By incubating the radiolabeled drug of interest with liver microsomes it is possible to evaluate the propensity of a drug candidate to covalently bind to proteins.

METHODS

Here we present a semi-automated method in which a Brandel cell harvester is used to collect and wash proteins that have been incubated with radiolabeled drug. This method utilizes glass fiber filter paper to capture precipitated protein, rather than the more traditional exhaustive extraction/centrifugation approach. Using model compounds (including [14C]diclofenac, [3H]imipramine, [14C]naphthalene, and [14C]L-746530) we compare the covalent binding results obtained using this method to results generated using the traditional method and we performed cross-laboratory testing of assay reproducibility.

RESULTS

It was found that results from new method correlated highly with the traditional method (R2=0.89). The cross-laboratory testing of the method showed an average interlaboratory coefficient of variation of only 18.4%.

DISCUSSION

This method provides comparable results to the more traditional centrifugation-based method with considerable time and labor savings.

Species and gender differences in the formation of an active metabolite of a substituted 2,4-thiazolidinedione insulin sensitizer

1. The metabolism of a substituted 2,4-thiazolidinedione (P1) with dual PPARalpha/gamma activity was evaluated in male and female rats, dogs and monkeys. A para-hydroxylated metabolite (M1) with potent PPARgamma-selective agonist, was a major circulating drug-related component in female rats, dogs and monkeys, but not in male rats (M1-to-P1 exposure ratio of <1, 3-5, 5 and 5-11 in male rat, monkey, female rat, and dog, respectively). 2. M1 (%) formed in vitro (5, 53, 57-65, 67 and 67% in male rat, monkey, female rat, dog, and human liver microsomes, respectively), rank ordered with M1 (%) formed in vivo (24-45, 53-57, 78, 75-85%, for male rat, monkey, female rat and dog, respectively, after oral administration of P1). 3. The plasma clearance of M1 was higher in male rats (32 ml min(-1) kg(-1) compared with 6, 7 and 2 ml min(-1) kg(-1) in female rat, male monkey and male dogs, respectively). 4. The low amounts of M1 observed in male rats, with the appearance of products of the cleavage of the propyl group between the phenyl groups was probably due to the presence of the sex-specific CYP2C11, which cleaves P1 at the propyl bridge. None of the CYPs present in female rats cleaved P1 at this site and M1 was only produced by CYP2C6. In humans, only CYP2C8 and the polymorphic CYP2C19 produced M1.

Use of on-line hydrogen/deuterium exchange to facilitate metabolite identification

Biotransformation studies performed on an investigational compound (I, represented by R1-CH(NH(2))-CO-N(R2)-CH(2)-S-R3) led to the identification of five metabolites (M1-M5). Based on LC/MS (liquid chromatography/mass spectrometry) analysis which included the use of H(2)O and D(2)O in the mobile phases, they were identified as the sulfoxide (M1), sulfone (M2), carbamoyl glucuronide (M3), N-glucuronide (M4), and N-glucoside (M5) metabolites, respectively. The structure of M3, a less commonly seen carbamoyl glucuronide metabolite, was established using on-line H/D (hydrogen/deuterium) exchange experiments conducted by LC/MS. H/D exchange experiments were also used to distinguish the S-oxidation structures of M1 and M2 from hydroxylation. Herein, the application of deuterium oxide as the LC/MS mobile phase for structural elucidation of drug metabolites in biological matrices is demonstrated.

Fossilized high pressure from the Earth's deep interior: the coesite-in-diamond barometer

Mineral inclusions in diamonds provide an important source of information about the composition of the continental lithosphere at depths exceeding 120-150 km, i.e., within the diamond stability field. Fossilized high pressures in coesite inclusions from a Venezuela diamond have been identified and measured by using laser Raman and synchrotron x-ray microanalytical techniques. Micro-Raman measurements on an intact inclusion of remnant vibrational band shifts give a high confining pressure of 3.62 (+/-0.18) GPa. Synchrotron single-crystal diffraction measurements of the volume compression are in accord with the Raman results and also revealed direct structural information on the state of the inclusion. In contrast to olivine and garnet inclusions, the thermoelasticity of coesite favors accurate identification of pressure preservation. Owing to the unique combination of physical properties of coesite and diamond, this "coesite-in-diamond" geobarometer is virtually independent of temperature, allowing an estimation of the initial pressure of Venezuela diamond formation of 5.5 (+/-0.5) GPa.

Pressure-enhanced ortho-para conversion in solid hydrogen up to 58 GPa

We measured the ortho-para conversion rate in solid hydrogen by using Raman scattering in a diamond-anvil cell, extending previous measurements by a factor of 60 in pressure. We confirm previous experiments that suggested a decrease in the conversion rate above about 0.5 GPa. We observe a distinct minimum at 3 GPa followed by a drastic increase in the conversion rate to our maximum pressure of 58 GPa. This pressure enhancement of conversion is not predicted by previous theoretical treatments and must be due to a new conversion pathway.

Slow deformation and lower seismic hazard at the new madrid seismic zone

Global Positioning System (GPS) measurements across the New Madrid seismic zone (NMSZ) in the central United States show little, if any, motion. These data are consistent with platewide continuous GPS data away from the NMSZ, which show no motion within uncertainties. Both these data and the frequency-magnitude relation for seismicity imply that had the largest shocks in the series of earthquakes that occurred in 1811 and 1812 been magnitude 8, their recurrence interval should well exceed 2500 years, longer than has been assumed. Alternatively, the largest 1811 and 1812 earthquakes and those in the paleoseismic record may have been much smaller than typically assumed. Hence, the hazard posed by great earthquakes in the NMSZ appears to be overestimated.

Space geodetic observations of nazca-south america convergence across the central andes

Space geodetic data recorded rates and directions of motion across the convergent boundary zone between the oceanic Nazca and continental South American plates in Peru and Bolivia. Roughly half of the overall convergence, about 30 to 40 millimeters per year, accumulated on the locked plate interface and can be released in future earthquakes. About 10 to 15 millimeters per year of crustal shortening occurred inland at the sub-Andean foreland fold and thrust belt, indicating that the Andes are continuing to build. Little (5 to 10 millimeters per year) along-trench motion of coastal forearc slivers was observed, despite the oblique convergence.

Transient loss of dopamine autoreceptor control in the presence of highly potent dopamine agonists

The concentrations of endogenous ligands generally remain in a bounded range around a basal level, a manifestation of control. The dopaminergic system is an excellent example of a control system in which a negative feedback signal is associated with receptor occupancy of a D2-like dopamine autoreceptor. A consequence of the control theory is that autoreceptor occupancy by an agonist results in dopamine levels below the basal, whereas similar stimulation by a dopamine competitive antagonist results in an increase of dopamine to levels above the basal. These consequences of control theory were tested and verified in the rat striatum by infusing graded doses of either the agonist, quinpirole, or the antagonist, sulpiride, into the rat striatum via a microdialysis probe and sampling dopamine and metabolite levels at various times after the start of infusion. Control was maintained even at the very highest doses of these compounds, i.e., striatal dopamine concentration rose in response to the antagonist and fell in response to the agonist. In contrast, administration of each of two high affinity dopamine agonists, 7-OH-DPAT and PPHT showed dose-dependent control only up to certain doses. Above these doses the dopamine concentration actually increased to levels well above basal, an indication of loss of control. These findings suggest that the control of this endogenous ligand does not extend to the very highest levels of autoreceptor occupancy.

Interaction of echicetin with a high affinity thrombin binding site on platelet glycoprotein GPIb

Echicetin, a protein isolated from Echis carinatus snake venom, inhibited platelet aggregation and secretion induced by low concentrations of thrombin ( < 0.2 U/ml), by binding to platelet glycoprotein Ib (GPIb). The inhibition was not observed when the platelets were stimulated with higher concentrations of thrombin ( > 0.2 U/ml). Echicetin competed with thrombin for binding to the high affinity site on GPIb. Thrombin also inhibited 50% of the binding of 125I-echicetin to the platelets.

The relationship between vessel wall tension and the magnitude and frequency of oscillation in rat aorta

Aortic rings from adult normotensive rats display spontaneous rhythmic activity that is enhanced by vasoconstricting agents. Graded doses of norepinephrine as well as combinations of norepinephrine and vasodilators produced levels of tension that were inversely related to the magnitude of oscillation and directly related to the frequency. A similar result occurred with KCl stimulation. Oscillations were only slightly affected by removal of the endothelium. These results, when combined with other reported studies, suggest that the oscillations in rat aorta are a manifestation of feedback control that may involve the cyclic release of one or more agents affecting calcium channels.