OBJECTIVES: To explore the synthesis of high-quality CT (sCT) from cone-beam CT (CBCT) using PE-CycleGAN for adaptive radiotherapy (ART) for nasopharyngeal carcinoma. METHODS: A perception-enhanced CycleGAN model "PE-CycleGAN" was proposed, introducing dual-contrast discriminator loss, multi-perceptual generator loss, and improved U-Net structure. CBCT and CT data from 80 nasopharyngeal carcinoma patients were used as the training set, with 7 cases as the test set. By quantifying the mean absolute error (MAE), peak signal-to-noise ratio (PSNR), structural similarity index (SSIM), as well as the dose gamma pass rate and the relative dose deviations of the target area and organs at risk (OAR) between sCT and reference CT, the image quality and dose calculation accuracy of sCT were evaluated. RESULTS: The MAE of sCT generated by PE-CycleGAN compared to the reference CT was (56.89±13.84) HU, approximately 30% lower than CBCT's (81.06±15.86) HU (P<0.001). PE-CycleGAN's PSNR and SSIM were 26.69±2.41dB and 0.92±0.02 respectively, significantly higher than CBCT's 21.54±2.37dB and 0.86±0.05 (P<0.001), indicating substantial improvements in image quality and structural similarity. In gamma analysis, under the 2 mm/2% criterion, PE-CycleGAN's sCT achieved a pass rate of (90.13±3.75)%, significantly higher than CBCT's (81.65±3.92)% (P<0.001) and CycleGAN's (87.69±3.50)% (P<0.05). Under the 3 mm/3% criterion, PE-CycleGAN's sCT pass rate of (90.13±3.75)% was also significantly superior to CBCT's (86.92±3.51)% (P<0.001) and CycleGAN's (94.58±2.23)% (P<0.01). The mean relative dose deviation of the target area and OAR between sCT and planned CT was within ±3% for all regions, except for the Lens Dmax (Gy), which had a deviation of 3.38% (P=0.09). The mean relative dose deviations for PTVnx HI, PTVnd HI, PTVnd CI, PTV1 HI, PRV_SC, PRV_BS, Parotid, Larynx, Oral, Mandible, and PRV_ON were all less than ±1% (P>0.05). CONCLUSIONS PE-CycleGAN demonstrates the ability to rapidly synthesize high-quality sCT from CBCT, offering a promising approach for CBCT-guided adaptive radiotherapy in nasopharyngeal carcinoma.
Humans ; Cone-Beam Computed Tomography/methods* ; Nasopharyngeal Neoplasms/diagnostic imaging* ; Nasopharyngeal Carcinoma/radiotherapy* ; Radiotherapy Planning, Computer-Assisted/methods* ; Radiotherapy Dosage ; Signal-To-Noise Ratio ; Radiotherapy, Intensity-Modulated

Objective To investigate the status and influencing factors of pressuring feeding style a-mong caregivers in remote rural areas of Sichuan province.Methods Multistage sampling was conducted to select infants of 6-11 months old who had received complementary food and their caregivers in remote rural areas of Si-chuan province.A questionnaire was used to collect sociodemographic characteristics of infants and their caregivers,pressuring feeding behaviors,feeding environment,and caregivers'negative emotions.Quantile regression was em-ployed to analyze the factors influencing pressuring feeding among caregivers of infants.Results A total of 1358 pairs of infants and their caregivers were included,with the pressuring feeding behavior score of 11(8,14).Parity was the protective factor for caregivers'pressuring feeding(β25=-1.17,P＜0.001;β50=-1.40,P=0.002;β75=-2.18,P＜0.001).Whether infants played with toys while eating(β25=1.00,P＜0.001;β50=1.20,P=0.003;β75=1.42,P＜0.001)and whether infants watched TV/mobile phones(β25=0.50,P=0.048;β50=1.07,P=0.004)were the risk factors.At the 75th percentile,caregivers'negative emotions were the risk factor for pressuring feeding(β75=0.94,P=0.015).Caregivers'education background(β25=0.83,P=0.034;β50=0.87,P=0.021)and family income(β75=1.09,P=0.012)were also significantly associated with pressuring feeding scores at different quartile points.Conclusions Pressuring feeding behaviors of caregivers in remote rural areas of Sichuan province need to be improved.Based on the characteristics of infants and their families,guidance should be carried out to improve the feeding environment and the mental health of caregivers,thereby promoting reasonable feeding behaviors among caregivers of infants in rural areas.

Objective To investigate the current status of physical activity and depressive symptoms a-mong middle-aged and older adults in Chengdu,Sichuan and explore the relationship between physical activity and depressive symptoms.Methods Multi-stage proportional stratified random sampling was employed to select middle-aged and older adults aged ≥45 years as the participants,and face-to-face interviews were carried out to collect data.Logistic regression was adopted to explore the relationship between physical activity and depressive symptoms in middle-aged and older adults.The trend test was performed for the relationship between different lev-els of physical activity and depressive symptoms.The subgroup analysis and the test for multiplicative interactions were conducted for the relationship between physical activity and depressive symptoms.Results A total of 4376 middle-aged and older adults were included.Among them,14.58％(638/4376),25.98％(1137/4376),and 27.83％(1218/4376)had depressive symptoms,failed to reach the guideline-recommended standards of physical activity,and were at low levels of physical activity,respectively.There was a negative association be-tween reaching guideline-recommended physical activity standard and depressive symptoms in middle-aged and ol-der adults(OR=0.713,95％CI=0.589-0.861,P＜0.001).In addition,moderate levels(OR=0.714,95％CI=0.586-0.871,P=0.001)and high levels of physical activity(OR=0.705,95％CI=0.548-0.906,P=0.006)had negative associations with the presence of depressive symptoms.The trend test revealed that the negative association between physical activity and depressive symptoms in middle-aged and older adults enhanced as the level of physical activity increased(Pfor trend=0.001).The subgroup analysis and the test for multiplicative interactions revealed that neither reaching guideline-recommended physical activity standards or not nor the physi-cal activity level had an interaction with each of the subgroups(all Pfor interaction＞0.05).Conclusions The current status of depressive symptoms among middle-aged and older adults in Chengdu,Sichuan needs to be ameliora-ted.A negative association existed between reaching the guideline-recommended physical activity standard and pres-ence of depressive symptoms,and the negative association enhanced as the physical activity level elevated.

Background::Non-smokers account for a large proportion of lung cancer patients, especially in Asia, but the attention paid to them is limited compared with smokers. In non-smokers, males display a risk for lung cancer incidence distinct from the females—even after excluding the influence of smoking; but the knowledge regarding the factors causing the difference is sparse. Based on a large multicenter prospective cancer screening cohort in China, we aimed to elucidate the interpretable sex differences caused by known factors and provide clues for primary and secondary prevention.Methods::Risk factors including demographic characteristics, lifestyle factors, family history of cancer, and baseline comorbidity were obtained from 796,283 Chinese non-smoking participants by the baseline risk assessment completed in 2013 to 2018. Cox regression analysis was performed to assess the sex difference in the risk of lung cancer, and the hazard ratios (HRs) that were adjusted for different known factors were calculated and compared to determine the proportion of excess risk and to explain the existing risk factors.Results::With a median follow-up of 4.80 years, 3351 subjects who were diagnosed with lung cancer were selected in the analysis. The lung cancer risk of males was significantly higher than that of females; the HRs in all male non-smokers were 1.29 (95% confidence interval [CI]: 1.20-1.38) after adjusting for the age and 1.38 (95% CI: 1.28-1.50) after adjusting for all factors, which suggested that known factors could not explain the sex difference in the risk of lung cancer in non-smokers. Known factors were 7% (|1.29-1.38|/1.29) more harmful in women than in men. For adenocarcinoma, women showed excess risk higher than men, contrary to squamous cell carcinoma; after adjusting for all factors, 47% ([1.30-1.16]/[1.30-1]) and 4% ([7.02-6.75]/[7.02-1])) of the excess risk was explainable in adenocarcinoma and squamous cell carcinoma. The main causes of gender differences in lung cancer risk were lifestyle factors, baseline comorbidity, and family history.Conclusions::Significant gender differences in the risk of lung cancer were discovered in China non-smokers. Existing risk factors did not explain the excess lung cancer risk of all non-smoking men, and the internal causes for the excess risk still need to be explored; most known risk factors were more harmful to non-smoking women; further exploring the causes of the sex difference would help to improve the prevention and screening programs and protect the non-smoking males from lung cancers.

Objective:To evaluate the quality of the published breast cancer screening guidelines to provide a reference for domestic studies in the future.Methods:PubMed, Embase, Cochrane Library, Web of Science, SinoMed, China National Knowledge Infrastructure, VIP, and Wanfang Data were searched to identify breast cancer screening guidelines on until August 2020. Two reviewers screened literature and extracted data independently. The Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREEⅡ) and Reporting Items for Practice Guidelines in Healthcare(RIGHT) tools were used to evaluate the quality of the included guidelines.Results:A total of 15 breast cancer screening guidelines were included, of which seven were published in the United States, with publication years focusing on 2015 to 2019, and 11 guidelines had updated versions. "Rigour of development" (47.0%±22.1%) and "Applicability" (44.0%±15.1%) of AGREEⅡ scored lower than other domains. "Review and quality assurance" (46.7%±39.9%) and "Funding, declaration, and management of interests" (41.7%±24.4%) of RIGHT were reported poorer than others. There were six guidelines recommended and another nine recommended with modifications based on the overall AGREEⅡ score. There were four guidelines with a good level, and another 11 were with a moderate level of RIGHT. The National Comprehensive Cancer Network published the best overall quality guidelines in 2018 (AGREEⅡ: 83.3%, RIGHT: 80.0%) and by the American Cancer Society in 2015 (AGREEⅡ: 83.3%, RIGHT: 85.7%).Conclusion:The quality of breast cancer screening guidelines was predominantly of moderate quality, and greater attention should be paid to the guideline development process and quality control of the guidelines.

Objective:To systematically evaluate the methodology and reporting quality of colorectal cancer (CRC) screening guidelines/consensus and provide lights for drafting CRC screening guidelines in China.Methods:The literature retrieval for all the Chinese and English guidelines published before September 1 st, 2020 was conducted by using Chinese/English databases, such as China National Knowledge Infrastructure, Wanfang Data, VIP, SinoMed, PubMed, Embase, Web of Science, Cochrane Library, Guideline International Network, and supplement with the official website of multiple regions, such as the U.S. Preventive Services Task Force and American Cancer Society. We utilized The Appraisal of Guidelines for Research & Evaluation Ⅱ (AGREE Ⅱ) and Reporting Items for Practice Guidelines in Healthcare (RIGHT) approaches to assess the quality of CRC screening guidelines/consensus comprehensively. Results:After quality control, a total of 19 guidelines/consensus released by the United States, China, Australia, Canada, Britain, South Korea, and International organizations are successfully included, and strikingly, most of those belong to the United State(7). The results of the AGREE Ⅱ quality evaluation show that the average scores of scope and purpose (87.5%) and clarity of presentation (89.6%) are high. In contrast, there are deficient in stakeholder involvement (47.0%), the rigor of development (42.3%), applicability (47.5%), and editorial independence (50.2%). Among all the guidelines, there are 12 with an overall score of 50 or more, 13 with a recommendation level of "A", 2 with a rating of "B" and 4 with a rating of "C". Additionally, the RIGHT evaluation revealed that the average report rate in each field is necessary information (76.3%), background (77.0%), evidence (55.8%), recommendations (59.4%), review and quality assurance (26.3%), funding and declaration and management of interests (43.4%), other information (49.1%). Among all the guidelines, six have good reporting quality, whereas the additional 13 have general or weak evidence. Furthermore, subgroup analysis indicates that the quality of guidelines in developed countries is superior to that of China.Conclusion:The number of CRC screening guidelines/consensus is increasing gradually, and the overall quality of those is high, but the normative nature is warranted to be strengthened.

Objective:To investigate the relationship between metabolic syndrome (MS) and the risk of breast cancer in Chinese females.Methods:From May 2006 to December 2015, based on the Kailuan Women′s Dynamic Cohort,a total of 25 618 female employees and retirees of the Kailuan Group were included and followed. Questionnaire surveys, physical measurements and laboratory tests were used to collect baseline sociodemographic characteristics, height, weight, blood glucose, blood lipids, blood pressure, tumor incidence and outcome information. Cox proportional hazards regression models were used to analyze the relationship between MS and its components (body mass index, blood pressure, blood glucose and blood lipid) and the risk of breast cancer in females.Results:The age of 25 618 women was (47.65±12.02) years old and median follow-up time was 8.78 years; 235 new cases of breast cancer were detected, and the incidence density was 113.19/100 000 person-years. After adjusting for age, education, income, smoking status, drinking status and other factors, people who were overweight or obese had a higher risk of breast cancer, with HR (95% CI) about 1.47 (1.12-1.93), than those with normal body mass index. Compared with those without MS abnormal components, women with two MS abnormal components had an increased risk of breast cancer ( HR=1.70, 95% CI: 1.16-2.50). With the increase of the number of MS abnormal components, the risk of breast cancer increased gradually ( Ptrend value<0.05). Conclusion:Overweight/obesity and the number of abnormal components of MS can increase the risk of breast cancer in women.

Objective:To analyze the compliance and related factors of low-dose computed tomography (LDCT) screening among the high-risk population of lung cancer in three provinces participating in the cancer early diagnosis and early treatment program in urban areas of China.Methods:From October 2017 to October 2018, 17 983 people aged between 40 and 74 years old at high risk of lung cancer were recruited from Zhejiang, Anhui and Liaoning provinces. The basic demographic characteristics, living habits, history of the disease and family history of cancer were collected by using a cancer risk assessment questionnaire, and the data of participants examined by LDCT were obtained from the hospitals participating in the program. The screening compliance was quantified by the screening participation rate, and it was calculated as the proportion of participants completing LDCT scan among high-risk population. The related factors of LDCT screening compliance were analyzed by using a multivariate logistic regression model.Results:The age of 17 983 participants was (56.52±8.22) years old. Males accounted for 51.9% (N=9 332), and 69.5% (N=12 495) had ever smoked, including former smokers and current smokers. A total of 6 269 participants were screened by LDCT, and the screening participation rate was 34.86%. The results of multivariate logistic regression analysis showed that the age group of 50 to 69 years old, female, passive smokers, alcohol consumption, family history of lung cancer and history of chronic respiratory diseases were more likely to be screened by LDCT, while the compliance of LDCT screening in current smokers was low.Conclusions:The LDCT screening compliance of the high-risk population of lung cancer in urban areas of China still needs to be improved. Age, sex, smoking, drinking, family history of lung cancer and history of chronic respiratory disease are associated with screening compliance.

Objective:To investigate the relationship between metabolic syndrome (MS) and the risk of breast cancer in Chinese females.Methods:From May 2006 to December 2015, based on the Kailuan Women′s Dynamic Cohort,a total of 25 618 female employees and retirees of the Kailuan Group were included and followed. Questionnaire surveys, physical measurements and laboratory tests were used to collect baseline sociodemographic characteristics, height, weight, blood glucose, blood lipids, blood pressure, tumor incidence and outcome information. Cox proportional hazards regression models were used to analyze the relationship between MS and its components (body mass index, blood pressure, blood glucose and blood lipid) and the risk of breast cancer in females.Results:The age of 25 618 women was (47.65±12.02) years old and median follow-up time was 8.78 years; 235 new cases of breast cancer were detected, and the incidence density was 113.19/100 000 person-years. After adjusting for age, education, income, smoking status, drinking status and other factors, people who were overweight or obese had a higher risk of breast cancer, with HR (95% CI) about 1.47 (1.12-1.93), than those with normal body mass index. Compared with those without MS abnormal components, women with two MS abnormal components had an increased risk of breast cancer ( HR=1.70, 95% CI: 1.16-2.50). With the increase of the number of MS abnormal components, the risk of breast cancer increased gradually ( Ptrend value<0.05). Conclusion:Overweight/obesity and the number of abnormal components of MS can increase the risk of breast cancer in women.

Objective:To analyze the compliance and related factors of low-dose computed tomography (LDCT) screening among the high-risk population of lung cancer in three provinces participating in the cancer early diagnosis and early treatment program in urban areas of China.Methods:From October 2017 to October 2018, 17 983 people aged between 40 and 74 years old at high risk of lung cancer were recruited from Zhejiang, Anhui and Liaoning provinces. The basic demographic characteristics, living habits, history of the disease and family history of cancer were collected by using a cancer risk assessment questionnaire, and the data of participants examined by LDCT were obtained from the hospitals participating in the program. The screening compliance was quantified by the screening participation rate, and it was calculated as the proportion of participants completing LDCT scan among high-risk population. The related factors of LDCT screening compliance were analyzed by using a multivariate logistic regression model.Results:The age of 17 983 participants was (56.52±8.22) years old. Males accounted for 51.9% (N=9 332), and 69.5% (N=12 495) had ever smoked, including former smokers and current smokers. A total of 6 269 participants were screened by LDCT, and the screening participation rate was 34.86%. The results of multivariate logistic regression analysis showed that the age group of 50 to 69 years old, female, passive smokers, alcohol consumption, family history of lung cancer and history of chronic respiratory diseases were more likely to be screened by LDCT, while the compliance of LDCT screening in current smokers was low.Conclusions:The LDCT screening compliance of the high-risk population of lung cancer in urban areas of China still needs to be improved. Age, sex, smoking, drinking, family history of lung cancer and history of chronic respiratory disease are associated with screening compliance.