Cardiovascular disease (CVD) and environmental degradation are leading global health problems of our time. Recent studies have linked exposure to heavy metals to the risks of CVD and diabetes, ...particularly in populations from low- and middle-income countries, where concomitant rapid development occurs. In this review, we 1) assessed the totality, quantity, and consistency of the available epidemiological studies, linking heavy metal exposures to the risk of CVD (including stroke and coronary heart disease); 2) discussed the potential biological mechanisms underlying some tantalizing observations in humans; and 3) identified gaps in our knowledge base that must be investigated in future work. An accumulating body of evidence from both experimental and observational studies implicates exposure to heavy metals, in a dose-response manner, in the increased risk of CVD. The limitations of most existing studies include insufficient statistical power, lack of comprehensive assessment of exposure, and cross-sectional design. Given the widespread exposure to heavy metals, an urgent need has emerged to investigate these putative associations of environmental exposures, either independently or jointly, with incident CVD outcomes prospectively in well-characterized cohorts of diverse populations, and to determine potential strategies to prevent and control the impacts of heavy metal exposure on the cardiometabolic health outcomes of individuals and populations.
The multi-component nonlinear Schrödinger equations (MNLS) are derived by extending the single-component nonlinear Schrödinger equation to multiple interacting fields. These equations often describe ...the dynamics of wave packets in quantum mechanics or nonlinear optics. In this paper, we investigate MNLS equations via the Lie symmetry method. The Lie infinitesimal symmetries of the MNLS equations are derived by solving recursive determining equations, and the symmetry reductions of the equations are given by using symmetry variables. Moreover, some interesting explicit solutions for the equations are constructed. Finally, the conservation laws of the MNLS equations are obtained utilizing Ibragimov’s method with detailed derivation.
Background
The increasing prevalence of colorectal cancer (CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden ...and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non‐medical expenditure as well as the resulting financial burden of CRC patients in China.
Methods
We conducted a multicenter, cross‐sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan (CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup (hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure.
Results
A total of 2356 patients with a mean age of 57.4 years were included, 57.1% of whom were men; 13.9% of patients had stage I cancer; and the average previous‐year household income was 54,525 CNY. The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage I, II, III, and IV disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non‐medical expenditure accounted for 8.3% of the overall expenditure. The 1‐year out‐of‐pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous‐year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups (P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more, whereas those with a lower household income and those who underwent surgery spent less (all P < 0.05).
Conclusions
For patients in China, direct expenditure for the diagnosis and treatment of CRC seemed catastrophic, and non‐medical expenditure was non‐ignorable. The financial burden varied among subgroups, especially among patients with different clinical stages of disease, which suggests that, in China, CRC screening might be cost‐effective.
Objective
The impact of participating in breast cancer screening programmes on health‐related quality of life (HRQoL)is poorly understood.
Methods
Based on a national breast cancer screening ...programme in China, a multicentre cross‐sectional survey was conducted covering 12 provinces from September 2013 to December 2014. HRQoL of participants in the screening population and general population was evaluated by the three‐levelEuroQol‐five‐Dimensions (EQ‐5D‐3L) instrument, and utility scores were generated through the Chinese value set. Univariate and multivariate regression analyses were performed to explore determinants of utility scores and anxiety/depression problems.
Results
For screening group and general population (n = 4756, mean age = 51.6 year old), the corresponding utility scores were 0.937 (95% CI, 0.933‐0.941) and 0.953 (0.949‐0.957) (P < .001). Pain/discomfort and anxiety/depression were the most common reported in both groups (51.4% and 34.3%, P < .001). Utility scores at prescreening, in‐screening, and postscreening interview timings were 0.928 (0.921‐0.935), 0.958 (0.948‐0.969), and 0.938 (0.933‐0.943), respectively (P < .001); the corresponding proportions of anxiety/depression reporting were 25.9%, 16.3%, and 21.1%, respectively (P = .004). Interview timing, geographical region, and insurance status were associated with HRQoL and anxiety/depression in women at high‐risk of breast cancer.
Conclusions
Utility scores of screening participants were significantly lower than that of general population in China, but the difference may be clinically insignificant. Further cohort studies using HRQoL measurements are needed.
Haliotid herpesvirus-1 (HaHV-1) is the first identified gastropod herpesvirus, causing a highly lethal neurologic disease of abalone species. The genome of HaHV-1 has been sequenced, but the ...functions of the putative genes and their roles during infection are still poorly understood. In the present study, transcriptomic profiles of
at 0, 24 and 60 h post injection (hpi) with HaHV-1 were characterized through high-throughput RNA sequencing. A total of 448 M raw reads were obtained and assembled into 2.08 × 10
unigenes with a mean length of 1486 bp and an N50 of 2455 bp. Although we detected increased HaHV-1 DNA loads and active viral expression at 24 hpi, this evidence was not linked to significant changes of host transcriptomic profiles between 0 and 24 hpi, whereas a rich immune-related gene set was over-expressed at 60 hpi. These results indicate that, at least at the beginning of HaHV-1 infection, the virus can replicate with no activation of the host immune response. We propose that HaHV-1 may evolve more effective strategies to modulate the host immune response and hide during replication, so that it could evade the immune surveillance at the early stage of infection.
Aim
We aimed to assess economic burden of breast cancer (BC) diagnosis and treatment in China through a multicenter cross‐sectional study, and to obtain theoretical evidence for policy‐making.
...Methods
This survey was conducted in 37 hospital centers across 13 provinces in China from September 2012 to December 2014. We collected information on the subject characteristics. We then assessed the medical and non‐medical expenditure for BC diagnosis and treatment, factors influencing the average case expense, variations between medical and non‐medical expenditure at different clinical stages, economic impact of overall expenditure in newly diagnosed course after reimbursement to the patient's family, composition of non‐medical expenditure and time loss for the patient and family.
Results
Among 2746 women with BC (72.6% were admitted to specialized hospitals), the overall average expenditure was US $8450 (medical expenditure: $7527; non‐medical expenditure: $922). Significant differences were found among the overall expenditure in the four clinical stages (P < 0.0001); the expenditure was higher in stages III and IV than that in stages I and II, whereas the stage IV was the highest (P < 0.0001). Moreover, a higher self‐reported predicted reimbursement ratio was associated with a less economic impact on the patient's family, and the average time lost was estimated as $1529.
Conclusions
Early detection and treatment of breast cancer might be effective for decreasing the economic burden, because costs escalate as the degree of malignancy increases.
Some studies found out that TC/HDL-C ratio is a predictor of Cardiovascular disease (CVD) and Nonalcoholic fatty liver (NAFLD) is related to CVD. And some researches have already studied that ...Apolipoprotein B to Apolipoprotein A1 ratio (ApoB/ApoA1) and Triglyceride to High-density lipoprotein cholesterol ratio (TG/HDL-C) were both related with CVD and NAFLD, but few studied the association between TC/HDL-C ratio and NAFLD. So, we suspected the ratio was also related to NAFLD. The research aims to study the predictive value of TC/HDL-C to NAFLD and to help the early detection of NAFLD.
Based on the Jinchang Cohort, the study contained 32,121 participants. We assessed the incidence of NAFLD by the quartiles of TC, HDL-C and TC/HDL-C. Then, the does-response relationship between these indicators and the risk of NAFLD was obtained. Finally, the receiver operator characteristic curve (ROC) was applied to decide the predictive value of TC/HDL-C.
Among the study participants, the cumulative incidence of NAFLD was 6.30% and the rate of dyslipidemia was 40.37%. The biochemical indicators of NAFLD had a difference with general population. The incidence of NAFLD raised with the quartiles of TC, TG and LDL-C raising, while decreased with the HDL-C' quartiles raising. After controlling confounding factors, TC and TC/HD-C had a positive relationship with NAFLD, while HDL-C had the opposite. Finally, the ROC analysis showed the area under the curve (AUC) of TC/HDL-C (0.645) was greater than TC (0.554), HDL-C (0.627) and Apolipoprotein B to Apolipoprotein A1 (ApoB/ApoA1) (0.613).
The TC/HDL-C ratio has significant predictive value to NAFLD.
Background and Aim
This study aimed to clarify health‐related quality of life (HRQoL) of patients with colorectal precancer and colorectal cancer (CRC) in China and to better understand related ...utility scores.
Methods
A hospital‐based cross‐sectional survey was conducted in precancer and CRC patients from 2012 to 2014, covering 12 provinces in China. HRQoL was assessed with EuroQol 5‐Dimensions 3‐Levels. Utility scores were derived using Chinese value set. A multivariate regression model was established to explore potential predictors of utility scores.
Results
A total of 376 precancer (mean age 58.7 years, 61.2% men) and 2470 CRC patients (mean age 58.6 years, 57.6% men) were included. In five dimensions, there was a certain percentage of problem reported among precancer (range: 12.0% to 36.7%) and CRC (range: 32.4% to 50.3%) patients, with pain/discomfort being the most serious dimension. Utility scores of precancer and CRC patients were 0.870 (95% confidence interval CI, 0.855–0.886) and 0.751 (95% CI, 0.742–0.759), both of which were lower than those of general Chinese population (0.960 95% CI, 0.960–0.960). Utilities for patients at stage I to stage IV were 0.742 (95% CI, 0.715–0.769), 0.722 (95% CI, 0.705–0.740), 0.756 (95% CI, 0.741–0.772), and 0.745 (95% CI, 0.742–0.767), respectively. Multivariate analysis showed that therapeutic regimen, time point of the interview, education, occupation, annual household income, and geographic region were associated with utilities of CRC patients.
Conclusion
Health‐related quality of life of both precancer and CRC patients in China declined considerably. Utility scores differed by sociodemographic and clinical characteristics, and findings of these utilities may facilitate implementation of further cost–utility evaluations.
Breast cancer is the most common cancer among women in China; however, a routine screening programme is currently not available. The aim of this study was to develop a novel model to estimate the ...effectiveness and cost-effectiveness of several screening strategies for women living in urban areas.
We developed a state-transition natural history model of breast cancer and validated the model with multiple outcomes for Chinese women living in urban areas. A total of 23 screening scenarios were considered with different screening techniques, ages, and frequencies. We evaluated the reduction of breast cancer mortality for each screening scenario compared with no screening. By integrating population-specific cost and utility scores, we calculated the incremental cost-effectiveness ratio (ICER) in terms of the cost per quality-adjusted life-year gained.
In the natural history model, the breast cancer incidence rate was estimated as 36·0 cases per 100 000 women and breast cancer mortality rate as 6·8 deaths per 100 000 women, which approximated reported rates from national cancer registries (incidence 34·9–36·5 cases per 100 000 women and 6·8–7·0 deaths per 100 000 women). Meanwhile, the modelled stage distribution and life expectancy were substantially similar to reported values. Compared with no screening, the breast cancer mortality of all screening scenarios decreased by 4·1–53·6%. The ICERs of 16 of the 23 scenarios was lower than the triple of the GDP per capita of China in 2018 (193 932 Chinese Yuan), indicating cost-effectiveness. At the national level, the biennial series-parallel strategy (ultrasound, followed by the mammography when suspected for women aged 40–44 years, and ultrasound combined with mammography for women aged 45–69 years) was the most cost-effective strategy, while the optimal screening interval differed with economic development at the provincial level.
We developed a well calibrated natural history model of breast cancer for Chinese women living in urban areas. Generally, breast cancer screening is cost-effective in urban China. The biennial series-parallel strategy is recommended at the national level, but at the provincial level, the optimal strategy should be determined by balancing health gains and resources.
National Natural Science Foundation of China (81773521 and 81402740) and National Health Commission of the People's Republic of China.
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