The incidence of thyroid cancer has increased at an alarming rate in both men and women in the United States. The etiology of this epidemic is unclear. We tested the hypothesis that a significant ...component of this epidemic is due to increased detection of occult disease. We examined whether the density of endocrinologists and general surgeons as well as employment of cervical ultrasonography were factors associated with this epidemic.
Thyroid cancer incidence rates by states were obtained from the United States Cancer Statistics 1999-2009 reported by the National Program of Cancer Registries. The densities of endocrinologists and general surgeons and the employment of cervical ultrasonography were calculated on a statewide basis and correlated with the incidence of thyroid cancer.
Age-standardized incidence rates of thyroid cancer have increased in every state in the United States. Significant regional variations were noted, with the highest incidence rates in the northeast and the lowest in the south. The incidence rates were significantly correlated with the density of endocrinologists (r = 0.58, p<0.0001 for males; r = 0.44, p = 0.0031 for females) and the employment of cervical ultrasonography (r = 0.40, p = 0.0091 for males; r = 0.36, p = 0.0197 for females). Both the density of endocrinologists and general surgeons and employment of cervical ultrasonography could explain 57% of the variability in state-level incidence for males and 49% for females.
These data offer evidence to suggest that the epidemic of thyroid cancer is due to increased detection of a reservoir of previously occult disease. The increased detection of thyroid cancer results in therapeutic interventions including surgery and radioactive thyroid treatment that may be of limited benefit.
Hypervirulent Klebsiella pneumoniae (hvKP) is traditionally defined by hypermucoviscosity, but data based on genetic background are limited. Antimicrobial-resistant hvKP has been increasingly ...reported but has not yet been systematically studied. K. pneumoniae isolates from bloodstream infections, hospital-acquired pneumonia, and intra-abdominal infections were collected from 10 cities in China during February to July 2013. Clinical data were collected from medical records. All K. pneumoniae isolates were investigated by antimicrobial susceptibility testing, string test, extended-spectrum β-lactamase (ESBL) gene detection, capsular serotypes, virulence gene profiles, and multilocus sequence typing. hvKP was defined by aerobactin detection. Of 230 K. pneumoniae isolates, 37.8% were hvKP. The prevalence of hvKP varied among different cities, with the highest rate in Wuhan (73.9%) and the lowest in Zhejiang (8.3%). Hypermucoviscosity and the presence of K1, K2, K20, and rmpA genes were strongly associated with hvKP (P < 0.001). A significantly higher incidence of liver abscess (P = 0.026), sepsis (P = 0.038), and invasive infections (P = 0.043) was caused by hvKP. Cancer (odds ratio OR, 2.285) and diabetes mellitus (OR, 2.256) appeared to be independent variables associated with hvKP infections by multivariate analysis. Importantly, 12.6% of hvKP isolates produced ESBLs, and most of them carried blaCTX-M genes. Patients with neutropenia (37.5% versus 5.6%; P = 0.020), history of systemic steroid therapy (37.5% versus 5.6%; P = 0.020), and combination therapy (62.5% versus 16.7%; P = 0.009) were more likely to be infected with ESBL-producing hvKP. The prevalence of hvKP is high in China and has a varied geographic distribution. ESBL-producing hvKP is emerging, suggesting an urgent need to enhance clinical awareness, especially for immunocompromised patients receiving combination therapy.
Stomach cancer is one of the most common cancers in the world. The relationship between alcohol consumption and the risk of stomach cancer remains unclear. Epidemiology studies investigating this ...relationship have shown inconsistent findings. A meta-analysis was performed to explore the association between alcohol consumption and increased stomach cancer risk. Eighty-one epidemiology studies, including 68 case-control studies and 13 cohort studies, were included in this study. A significant association was found between alcohol consumption and increased risk of stomach cancer (OR = 1.20, 95% CI 1.12–1.27). To explore the source of the significant heterogeneity (p < 0.05, I2 = 86%), analysis was stratified by study type (case-control study and cohort study), control type (hospital-based control and population-based control), gender (male, female, and mix), race (White and Asian), region (United States, Sweden, China, Japan), subsite of stomach cancer, and type of alcohol. The stratified analyses found that region and cancer subsite are major sources of the high heterogeneity. The inconsistent results in different regions and different subsites might be related to smoking rates, Helicobacter pylori infection, obesity, and potential genetic susceptibility. The positive association between drinking and increased risk of stomach cancer is consistent in stratified analyses. The dose-response analysis showed a clear trend that a higher daily intake of alcohol is associated with a higher risk of stomach cancer.
•Alcohol consumption is associated with an increased risk of stomach cancer.•Higher daily intake of alcohol greater risk of stomach cancer.•Alcohol and stomach cancer relationship varies by geographic locations.•Alcohol and stomach cancer relationship also varies by cancer subsites.
This study investigated the accuracy of intraoperative frozen section (FS) diagnosis for predicting the final pathology (FP) of peripheral small-sized lung adenocarcinoma and evaluated its usefulness ...in sublobar resection.
The records of 803 patients with clinical stage I peripheral lung adenocarcinoma who underwent sublobar resection for FS diagnosis to guide surgical strategy were reviewed. The surgical extension was mainly based on FS. The FS were stratified into atypical adenomatous hyperplasia, adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma. The diagnostic accuracy of FS, the reasons for the discrepancy between FS and FP, and the clinical influence of the FS errors were evaluated. To assess the survival of patients with different subtypes after surgery, 301 patients were identified for prognosis evaluation.
The total concordance rate between FS and FP was 84.4%. When atypical adenomatous hyperplasia, AIS, and MIA were classified together as a low-risk group, the concordance rate was 95.9%. Most discrepant cases were the underestimation of AIS and MIA. The diagnostic accuracy of FS for tumors ≤ 1 cm and larger than 1 cm in diameter was 79.6% and 90.8%, respectively (P < .01). The FS errors had significant clinical impact on 0.9% of the 803 patients due to insufficient resection. The 5-year recurrence-free survival rate (100%) was significantly better for the patients with AIS/MIA than for patients with invasive adenocarcinoma (74.1%, P < .01).
Frozen pathology has a high concordance rate with FP. Precise diagnosis by intraoperative FS is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma.
The ever-increasing understanding of the complexity of factors and regulatory layers that contribute to immune evasion facilitates the development of immunotherapies. However, the diversity of ...malignant tumors limits many known mechanisms in specific genetic and epigenetic contexts, manifesting the need to discover general driver genes. Here, we have identified the m
A demethylase FTO as an essential epitranscriptomic regulator utilized by tumors to escape immune surveillance through regulation of glycolytic metabolism. We show that FTO-mediated m
A demethylation in tumor cells elevates the transcription factors c-Jun, JunB, and C/EBPβ, which allows the rewiring of glycolytic metabolism. Fto knockdown impairs the glycolytic activity of tumor cells, which restores the function of CD8
T cells, thereby inhibiting tumor growth. Furthermore, we developed a small-molecule compound, Dac51, that can inhibit the activity of FTO, block FTO-mediated immune evasion, and synergize with checkpoint blockade for better tumor control, suggesting reprogramming RNA epitranscriptome as a potential strategy for immunotherapy.
Short-term exposure to ambient air pollution has been associated with reduced lung function among asthmatic children. However, there is little information about the effects among healthy children, ...especially in areas with relatively high exposure background.
To examine the association between short-term effects of ambient air pollutants and lung function among healthy primary school-aged children in China.
A total of 334 healthy children (7–11 years) from four cities (Chengdu (Southwest China), Guangzhou (Southern China), Wuhan (Central China), and Xi'an (Northwest China)) in China with repeated lung function measurement in 2014–2016 were included. Daily ambient concentrations of PM2.5, PM10, NO2, SO2, mean temperature, and relative humidity data were obtained. Linear mixed model was used to estimate the percent change in lung function associated with per inter-quartile range (IQR) exposure (up to 3 days) increase after adjusting for confounders.
Ambient PM2.5 and PM10 exposure were associated with decrements in lung function measurements. The moving average exposures generally showed stronger effect estimates than the single lag day exposures. An IQR increase in two-day average (lag01 day) PM10 exposure (IQR, 144 μg/m3) was significantly associated with 2.56% decrease in FVC, 5.46% in FEV1, 4.23% in PEF, and 7.35% in FEF25%, respectively. The effect estimates were stronger after adjusting for gaseous pollutants in particulate matter (PM) models. The strengths of these associations were stronger in girls than those in boys.
Short-term exposure to PM was associated with reduced lung function in healthy children. The estimated adverse effects were greater in girls than in boys.
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•Short-term effects of air pollutants and lung function among healthy children were assessed.•PM2.5 and PM10 exposure were associated with decrements in lung function.•The effects were stronger after adjusting SO2 and NO2 in particulate matter (PM) models.•The estimated adverse effects were greater in girls than in boys.
Carbapenem-resistant
(CRE) infection is highly endemic in China, but estimates of the infection burden are lacking. We established the incidence of CRE infection from a multicenter study that covered ...25 tertiary hospitals in 14 provinces. CRE cases defined as carbapenem-nonsusceptible
,
,
, or
infections during January to December 2015 were collected and reviewed from medical records. Antimicrobial susceptibility testing and carbapenemase gene identification were performed. Among 664 CRE cases, most were caused by
(73.9%), followed by
(16.6%) and
(7.1%). The overall CRE infection incidence per 10,000 discharges was 4.0 and differed significantly by region, with the highest in Jiangsu (14.97) and the lowest in Qinghai (0.34). Underlying comorbidities were found in 83.8% of patients; the median patient age was 62 years (range, 45 to 74 years), and 450 (67.8%) patients were male. Lower respiratory tract infections (65.4%) were the most common, followed by urinary tract infection (16.6%), intra-abdominal infection (7.7%), and bacteremia (7.7%). The overall hospital mortality rate was 33.5%. All isolates showed nonsusceptibility to carbapenems and cephalosporins. The susceptibility rate of polymyxin B was >90%. Tigecycline demonstrated a higher susceptibility rate against
than against
(90.9% versus 40.2%). Of 155 clinical isolates analyzed, 89% produced carbapenemases, with a majority of isolates producing KPC (50%) or NDM (33.5%)-type beta-lactamases among
and
The incidence of CRE infection in China was 4.0 per 10,000 discharges. The patient-based disease burden in tertiary hospitals in China is severe, suggesting an urgent need to enhance infection control.
Edges tend to be over-smoothed in total variation (TV) regularized under-sampled images. In this paper, symmetric residual convolutional neural network (SR-CNN), a deep learning based model, was ...proposed to enhance the sharpness of edges and detailed anatomical structures in under-sampled cone-beam computed tomography (CBCT). For training, CBCT images were reconstructed using TV-based method from limited projections simulated from the ground truth CT, and were fed into SR-CNN, which was trained to learn a restoring pattern from under-sampled images to the ground truth. For testing, under-sampled CBCT was reconstructed using TV regularization and was then augmented by SR-CNN. Performance of SR-CNN was evaluated using phantom and patient images of various disease sites acquired at different institutions both qualitatively and quantitatively using structure similarity (SSIM) and peak signal-to-noise ratio (PSNR). SR-CNN substantially enhanced image details in the TV-based CBCT across all experiments. In the patient study using real projections, SR-CNN augmented CBCT images reconstructed from as low as 120 half-fan projections to image quality comparable to the reference fully-sampled FDK reconstruction using 900 projections. In the tumor localization study, improvements in the tumor localization accuracy were made by the SR-CNN augmented images compared with the conventional FDK and TV-based images. SR-CNN demonstrated robustness against noise levels and projection number reductions and generalization for various disease sites and datasets from different institutions. Overall, the SR-CNN-based image augmentation technique was efficient and effective in considerably enhancing edges and anatomical structures in under-sampled 3D/4D-CBCT, which can be very valuable for image-guided radiotherapy.
The aim of this study was to assess the ability of electronic tongue system TS-5000Z to evaluate meat quality based on flavor assessment, recognition and correlation with the meat chemical ...composition. Meat was sampled from eighteen beef cattle including 6 Wagyu breed cattle, 6 Angus breed cattle and 6 Simmental breed cattle. Chemical composition including dry matter, crude protein, fat, ash, cholesterol and taurine and flavor of the meat were measured. The results showed that different breed cattle had different chemical compositions and flavor, which contains sourness, umami, saltiness, bitterness, astringency, aftertaste from astringency, aftertaste from bitterness and aftertaste from umami, respectively. A principal component analysis (PCA) showed an easily visible separation between different breeds of cattle and indicated that TS-5000Z made a rapid identification of different breeds of cattle. In addition, TS-5000Z seemed to be used to predict the chemical composition according to its correlation with the flavor. In conclusion, TS-5000Z would be used as a rapid analytical tool to evaluate the beef quality both qualitatively and quantitatively, based on flavor assessment, recognition and chemical composition according to its correlation with flavor.
Maternal exposure to ambient air pollution has been associated with preterm birth (PTB), however, entire pregnancy or trimester-specific associations were generally reported, which may not ...sufficiently identify windows of susceptibility. Using birth registry data from Guangzhou, a megacity of southern China (population ~14.5 million), including 469,975 singleton live births between January 2015 and July 2017, we assessed the association between weekly air pollution exposure and PTB in a retrospective cohort study. Daily average concentrations of PM2.5, PM10, NO2, SO2, and O3 from 11 monitoring stations were used to estimate district-specific exposures for each participant based on their district residency during pregnancy. Distributed lag models (DLMs) incorporating Cox proportional hazard models were applied to estimate the association between weekly maternal exposure to air pollutant and PTB risk (as a time-to-event outcome), after controlling for temperature, seasonality, and individual-level covariates. We also considered moderate PTB (32–36 gestational weeks) and very PTB (28–31 gestational weeks) as outcomes of interest. Hazard ratios (HRs) and 95% confidential intervals (95% CIs) were calculated for an interquartile range (IQR) increase in air pollutants during the study period. An IQR increase in PM2.5 exposure during the 20th to 28th gestational weeks (27.0 μg/m3) was significantly associated with PTB risk, with the strongest effect in the 25th week (HR = 1.034, 95% CI:1.010–1.059). The significant exposure windows were the 19th–28th weeks for PM10, the 18th–31st weeks for NO2, and the 23rd–31st weeks for O3, respectively. The strongest associations were observed in the 25th week for PM10 (IQR = 37.0 μg/m3; HR = 1.048, 95% CI:1.034–1.062), the 26th week for NO2 (IQR = 29.0 μg/m3; HR = 1.060, 95% CI:1.028–1.094), and in the 28th week for O3 (IQR = 90.0 μg/m3; HR = 1.063, 95% CI:1.046–1.081). Similar patterns were observed for moderate PTB (32–36 gestational weeks) and very PTB (28–31 gestational weeks) for PM2.5, PM10, NO2 exposure, but the effects were greater for very PTB. We did not observe any association between pregnancy SO2 exposure and the risk of PTB. Our results suggest that middle to late pregnancy is the most susceptible air pollution exposure window for air pollution and PTB among women in Guangzhou, China.
•Limited studies identified susceptible windows for prenatal air pollution and preterm birth at a weekly level.•Prenatal PM2.5, PM10, NO2, and O3 exposure is associated with preterm birth.•The most susceptible exposure window for each pollutant is gestational weeks 18–31.•Distributed lag models are applicable for identifying the susceptible windows.
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