Objective : To analyze the trend of lung cancer incidence in Shaoxing, Zhejiang Province from 2014 to 2019, so as to provide the basis for lung cancer prevention and control. Methods : The data of lung cancer were collected through the information management system of chronic disease surveillance in Zhejiang Province.The crude incidence rate, age-standardized incidence rates by Chinese standard population ( ASIRC ) and by world standard population ( ASIRW ), truncated rate ( 35-64 ) years old ), and cumulative rate (0-74 years old) were calculated. The annual percentage change ( APC ) was used to analyze the trend of lung cancer. The annual contribution rate was used to analyze the contribution of the incidence trend with age to the total trend. Results : Totally 22 261 cases of lung cancer were reported in Shaoxing from 2014 to 2019. The crude incidence rate, ASIRC, ASIRW, truncated rate ( 35-64 years old ), and cumulative rate ( 0-74 years old ) were 83.51/100 000, 41.28/100 000, 41.01/100 000, 57.00/100 000 and 5.11%, respectively. The crude incidence rate, ASIRC and ASIRW increased significantly from 2014 to 2019, with the APC values of 8.56%, 6.42% and 6.05%, respectively ( P<0.05 ). The crude incidence rate, ASIRC, ASIRW, truncated rate ( 35-64 years old ), and cumulative rate ( 0-74 years old ) of man were 105.25/100 000, 48.09/100 000, 50.69/100 000, 62.03/100 000 and 6.42%, respectively, which were higher than those of women ( 61.84/100 000, 33.05/100 000, 31.35/100 000, 51.71/100 000 and 3.76% ).The crude incidence rate increased with age. The annual contribution rates of lung cancer incidence in people aged 15-<45 years, 45-<55 years, 55-<65 years and ≥65 years were 51.20%, 30.86%, 15.79% and 2.15%, respectively. The crude incidence rate in people aged 15-<45 years, 45-<55 years and 55-<65 years increased significantly from 2014 to 2019, with the APC values of 23.84%, 13.79% and 6.78%, respectively ( P<0.05 ). Conclusion From 2014 to 2019, the incidence of lung cancer in Shaoxing shows an increasing trend, and the age of onset is getting younger.

We herein overviewed the history,achievement and plan of the twelfth-five program for the development of key medical disciplines in Zhejiang Province.We summarized the practice and characteristics of establishing of the key medical discipline in the Zhejiang Province,and a systemic survey was conducted on the effectiveness of the program.We then proposed several improvements strategies including academic training,multidiscipline coordination,and fund managements to eventually establish the new pattern of discipline development.

Objective:To evaluate the diagnostic performance of probe-based confocal laser endomicroscopy (pCLE) for indeterminate biliary strictures.Methods:Twelve patients with indeterminate biliary strictures who underwent pCLE and brush cytology from April 1, 2013 to December 30, 2016 were enrolled. Clinical data, the results of endoscopic retrograde cholangiopancreatography, pCLE examination and brush cytology were collected. Compared with post-operative pathology and follow-up over 12 months, sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), and accuracy of pCLE and brush cytology of the diagnosis of malignant biliary strictures were analyzed.Results:The final diagnosis were 9 malignant and 3 benign. The sensitivity, specificity, PPV, NPV and accuracy of brush cytology were 3/9, 3/3, 3/3, 3/9 and 50.0%(6/12), respectively. The corresponding indicators of pCLE were 9/9, 2/3, 9/10, 2/2, and 91.7%(11/12), respectively.Conclusion:pCLE can be used for differential diagnosis of indeterminate biliary stricture.

Objective To evaluate the feasibility and safety of performing endoscopic retrograde cholangiopancreatography (ERCP) assisted by single-balloon enteroscopy (SBE) in patients with biliary obstruction after gastrointestinal reconstruction.Methods Clinical data about 7 cases of single-balloon enteroscopy assisted-ERCP (SBE-ERCP) were summarized including the completion of treatment,operation time,and complications for retrospective study.Results The papilla or anastomotic site was reached and therapeutic ERCP were performed successfully in 6 patients.The overall success rate was 85.7％ (6/7),and the mean operation time of SBE-ERCP was 42 min (ranging from 28 to 72 min).The afferent loop and papilla were failed to be confirmed in 1 patient.No complication such as perforation,pancreatitis or bleeding ocurred in all the 7 patients.Conclusion Single-balloon enteroscopy assisted-ERCP (SBE-ERCP) is feasible and relatively safe in postsurgical patients with gastrointestinal reconstruction.

[Objective]To evaluate the role of mature cumulus cells from oocyte-cumulus complex(OCC)in in-vitro maturation(IVM)and establish a new culture technique which is convenient to carry out.[Methods]The cumulus cells of OCC were cut off and dispersed by 1 mL syringe.The cumulus cells were co-cultured with the immature oocytes retrieved from the COH cycles after they adherent to the bottom of the dish.The immature oocytes were experienced IVM procedures in different culture media.They were divided into 3 groups(the oocytes at germinal vesicle stage from one woman were allotted to the same group randomly).Group 1(solution A):basic culture medium+human follicular fluid(hFF);Group 2(solution B):solution A+ cumulus cells(OCC);Group 3(solution C):solution A+ OCC+ follicle stimulating hormone(FSH)+ epidermal growth factor (EGF).Then,the maturation rate,fertilization rate and formation rate of available embryo were observed.[Results]In 113 treatment cycles,298 immature oocytes were performed IVM with solution A,B,and C.The difference for 24 hour maturation rates among 3 groups wag statistically significant(A:45.2%,B:61.7%,C:78.2%,P＜0.05).There was no statistical difference for 25～48 hour maturation rates and normal fertilization rates of mature oocytes.The differences of cleavage rates and rescued embryo rates between group 1 and 2,group 1 and 3 were statistically significant(P＜0.05).The formation rates of available embryo showed an increasing trend from group 1,2,to 3.[Conclusion]After being dispersed by simply beat upon with syringe and adherent culture,the mature cumulus eells from mature OCCs in COH cycles,together with growth factors in the follicular fluid or extraneously supplemented,could promote the IVM of immature oocyte.

Objective To study the efficacy and safety of endobiliary radiofrequency ablation (RFA) with stent placement in treatment of unresectable extrahepatic cholangiocarcinoma (EHCC).Methods The patients with unresectable EHCC in Hangzhou First People's Hospital between October 2013 and January 2015 were enrolled in a prospective, randomized, single-blind cohort study, and were assigned randomly into two groups: RFA+stent group and stent-only group.The jaundice fade time, stent patency period, overall survival rate, and postoperative adverse events were analyzed between two groups.Results Among 59 patients with non-resectable EHCC, 28 were divided into RFA+stent group, and 31 were in stent-only group.There was no statistical difference in preoperative serum total bilirubin between the two groups.Mean serum bilirubin decrease time was significantly lower in the RFA+stent group than that in the stent-only group[17.9 d(7-22 d) VS 29.9 d(10-55 d),P=0.03].The biliary patency period in RFA+stent group was significantly longer than that of stent-only group (8.9 months VS 4.5 months, P=0.02).The mean survival time in RFA+stent group was significantly longer than that of stent-only group[13.3 months(6.2-16.5 months) VS 8.6 months(4.5-11.7 months), P=0.000).Incidence of postoperative adverse events showed no statistical difference between the two groups(P=0.727).Conclusion RFA with stent placement is effective and safe as a palliative measure in the treatment of non-resectable EHCC, and it can significantly shorten the jaundice fade time, prolong the biliary patency period and overall survival, while without increase of the incidence of adverse events.

Objective: To understand clustering of risk factors for chronic diseases among residents aged 60 years or above in Shaoxing，and to provide evidence for prevention of chronic diseases in the elderly. Methods: The data of residents aged 60 years or above in five villages in Donghu Town，Yuecheng District was collected from Zhejiang health surveillance program. The clustering patterns of five common risk factors for chronic diseases in the elderly were analyzed，including smoking，drinking，overweight/obesity，no exercise and sedentary behavior. Results: A total of 1 427 old adults were surveyed. The prevalence of smoking，drinking，overweight/obesity，no exercise and sedentary time more than three hours a day were 15.98%，31.67%，43.73%，73.30% and 41.56%，respectively. About 5.12% of the elderly had none of the above risk factors；24.25% had one risk factor；38.75% had two risk factors，with a clustering of no exercise and overweight/obesity as the most common pattern；31.88% had three to five risk factors，with a clustering of no exercise，overweight/obesity，sedentary time more than three hours a day and/or drinking as the most common pattern. Males，the married，the highly educated and the old people without coronary heart disease had more risk factors（P<0.05）. Conclusion There are clustering of risk factors for chronic diseases among residents aged 60 years or above in Shaoxing. It is common to combine two or three items of no exercise，overweight/obesity and sedentary time more than three hours a day.

Background and purpose:The application of intensity-modulated radiotherapy (IMRT) has improved the local control rate of nasopharyngeal carcinoma greatly, which changed the predictive value of T classiifca-tions of TNM staging system. This study aimed to validate the predictive effect of T classiifcations in the 7th Union for International Cancer Control (UICC) staging system and discuss the simpliifcation of T classiifcations.Methods:We retrospectively reviewed the clinical data of 641 primary nasopharyngeal carcinoma patients at our center from January 2007 to June 2011. We evaluated the predictive effect of T classiifcations by Kaplan-Meier method and Cox regression model.Results:The 5-year overall survival (OS), local relapse-free survival (LRFS), progression-free survival (PFS) and distant metastasis free survival (DMFS) were 85.4%, 88.5%, 78% and 87.1%, respectively. The 5-year OS of T1, T2, T3 and T4 categories were 91.6%, 85.3%, 90.1% and 76.5%, respectively; LRFS were 93%, 85.3%, 91.5% and 84.4%; PFS were 88.2%, 77.3%, 80.8% and 70.9%; DMFS were 95.1%, 88.9%, 88.2% and 81.3%, respectively. The difference in survival curves between T1, T2 and T3 were not signiifcant (P>0.05). However, several prognostic indexes were signiifcantly different between T4 and T1, T2, T3. We merged the T1, T2 and T3 classiifcations as new T1, and the T4 classiifcation as new T2. The 5-year OS of new T1 and T2 were 89.1% and 76.5% (P=0.001); LRFS were 90.1% and 84.4% (P=0.028); PFS were 81% and 70.9% (P=0.001); DMFS were 90.8% and 81.2% (P=0.002). The survival curves were substantially separated. The simpliifed T classiifcations had obvious advantages when separately analyzed in different N stages.Conclusion:In the era of IMRT, the predictive effect of T classiifcations of the 7th UICC staging system has diminished. The simpliifcation of T classiifcations can ift with the new treatment and provide a better surviv-al prediction.

Objective To investigate the differences of HCV infection rates among blood donors of different Chinese nationalities.Methods Anti-HCV results from more than 300000 blood donors of 41 nationalities from 8 provinces or autonomous regions were investigated and analyzed.Serum anti-HCV antibody was tested by ELISA.Results(1)The anti-HCV prevalence rate was 0.98%(676/68782) among first time blood donors;0.71%(1750/245137) among repeated donors;and the overall anti-HCV prevalence rate among all the blood donors was 0.77%(2426/313919).The anti-HCV prevalence rate was higher among first time donors,compared to repeated donors(P

Objective:To evaluate the efficacy and safety of endoscopic papillectomy (EP) combined with endobiliary radio frequency ablation (RFA) for duodenal papilla tumor with intraductal biliary infiltration.Methods:Data of 12 patients with histologically confirmed duodenal papilla tumor combined with intraductal biliary infiltration treated by EP with RFA from February 2013 to February 2019 were retrospectively analyzed. Clinical characteristics,endoscopic features, treatment efficacy and postoperative complications of patients were reviewed and recurrence was followed up.Results:The median diameter of lesions measured by endoscopic ultrasound was 18.5 mm×15.5 mm, and the length of intrabiliary invasion was 14.1±5.8 mm. EP combined with RFA was successfully performed in all patients with a technical success rate of 100%. Postoperative pathology showed adenocarcinoma in 5 patients, adenoma with high-grade intraepithelial neoplasia in 6 patients, and adenoma with low-grade intraepithelial neoplasia in 1 patient. Patients received mean 4.1±1.6 times of ERCP with intraductal biopsy during a mean follow-up period of 28.5±10.4 months. Recurrence occurred in 2 patients at 14 and 20 months respectively, both were adenocarcinoma.Conclusion:EP combined with RFA is effective and safe for duodenal papilla tumor with intraductal biliary infiltration. However, given the risk of recurrence, close surveillance is recommended.