Objective:To analyze the disease burden of colorectal cancer (CRC) among young and middle-aged people in China from 1990 to 2021, and to explore the influence of age, period and cohort on the incidence and mortality of CRC in young and middle-aged people of China.Methods:Data on CRC in patients aged 40-59 years in China from 1990 to 2021 were extracted from the Global Burden of Disease Study 2021 (GBD 2021) database. Statistics such as incidence rate, mortality rate, disability-adjusted life years (DALY), and their corresponding age-standardized rates were calculated to analyze the CRC incidence and mortality in different age and sex groups of young and middle-aged Chinese young people from 1990 to 2021. The Joinpoint regression model was used to analyze the CRC incidence, the mortality and the DALY rate, as well as to calculate the annual percentage change (APC) and the average annual percentage change (AAPC). The effects of three independent factors, namely age, period and cohort, on the incidence and mortality of CRC in young and middle-aged people of China were analyzed and evaluated through the age-period-cohort model.Results:From 1990 to 2021, there was a remarkable upward trend in the incidence, mortality, and DALY of CRC among Chinese young and middle-aged adults. In 2021, the number of incidence cases of CRC among young and middle-aged people in China reached 181 000, and the number of deaths reached 57 900, which were 236.80% and 75.48% higher than those in 1990 (53 800 and 33 000, respectively). During the same period, DALY increased by 62.59%, with the 55-59 age group having the largest increase at 83.35%. From 1990 to 2021, the age-standardized incidence rate (ASIR) increased by 49.04%, rising from 25.51/100 000 to 38.02/100 000, and the age-standardized mortality rate (ASMR) declined by 28.75%, decreasing from 17.01/100 000 to 12.12/100 000, respectively. The increase in ASIR was the greatest among the 40-44 age group, reaching 57.31%, while the decline in ASMR was the most significant among the 50-54 age group, amounting to 30.18%. However, the DALY rate declined by 26.66%, from 673.52/100 000 to 493.94/100 000. The decline in DALY was the greatest among the 50-54 age group, reaching 28.26%. Joinpoint regression model analysis showed that, from 1990 to 2021, the incidence of CRC in Chinese young and middle-aged adults rose on average by 1.32% annually, and the increase was higher in men (1.87%) than that in women (0.36%). The mortality rate showed a downward trend, with an average annual decline of 1.10%, with a higher decline in women than in men (-2.14% vs. -0.50%). The DALY rate showed a downward trend, with an average annual decline of 1.00%, and more decline in women than in men (-2.06% vs. -0.41%). All of these trends were statistically significant (all P<0.001). The age-period-cohort model analysis showed that, the net drift of CRC incidence was 1.21% (1.02%-1.41%) per year among Chinese young and middle-aged adults between 1990 and 2021, while the net drift in mortality was -1.40% (-1.59%--1.21%) per year. The impact of age on CRC incidence and mortality intensified with advancing age. Incidence attributable to age rose from 12.66% (11.90%- 13.46%) in the 40-44 age group to 56.68% (54.37%-59.08%) in the 55-59 age group. Similarly, mortality attributable to age increased from 6.47% (6.12%-6.85%) in the 40-44 age group to 25.74% (24.58%-26.96%) in the 55-59 age group. In all age groups, the role of CRC incidence and mortality attributable to age was higher in men than in women. Period effects on the RR value of CRC incidence showed a declining trend followed by an upward trend, with the highest risk during 2015-2019 ( RR=1.36, 95% CI: 1.28-1.43), using 2000-2004 as the reference. For mortality, period effects exhibited a declining trend, with the highest risk during 1990-1994 ( RR=1.23, 95% CI: 1.15-1.32), using 2000-2004 as the reference. Cohort effects indicated that later birth cohorts had higher incidence risks, with the highest incidence observed in the 1973-1977 birth cohort ( RR=1.30, 95% CI: 1.16-1.45), using the 1953-1957 birth cohort as the reference. Conversely, later birth cohorts had lower mortality risks, with the lowest mortality in the 1973-1977 birth cohort ( RR=0.78, 95% CI: 0.69-0.88), using the 1953-1957 birth cohort as the reference. Conclusions:From 1990 to 2021, the changes in the disease burden of CRC among young and middle-aged people in China are manifested as an increase in standardized incidence rate and a decrease in standardized mortality rate. Meanwhile, there are gender differences in the trend of temporal changes. Age, period and cohort all have a significant impact on the incidence and mortality trends of colorectal cancer in young and middle-aged people. Research on the etiology of CRC should be strengthened, and targeted prevention and control strategies should be formulated.

Objective:To describe the prevalence of preserved ratio impaired spirometry (PRISm) in participants from the China Kadoorie Biobank (CKB) and explore the influencing factors.Methods:The CKB project conducted the baseline survey, the first and the second resurvey in 2004-2008, 2008, and 2013-2014, respectively. Based on the lung function tests, the participants were categorized into three groups: regular, PRISm, and airflow obstruction. The prevalence of PRISm was reported by gender, age, and region at the baseline survey. The secular trend in the prevalence of PRISm was described during the three surveys. Finally, we used the multiple logistic regression model to examine the factors related to PRISm in the baseline survey.Results:After standardization for gender, age, and region according to the sixth national census data in 2010, the overall prevalence of PRISm and airflow obstruction among the 434 760 participants at baseline was 24.8% and 6.1%, respectively. The prevalence of PRISm was higher in rural (25.4%) than that in urban areas (24.3%). Of the 10 study regions, Gansu had the highest prevalence of PRISm (56.0%), while Henan had the lowest (15.4%). After standardization for gender, age, and region according to the baseline population, the prevalence of PRISm decreased from 24.9% at baseline to 15.7% in the second resurvey, and the prevalence of airflow obstruction increased from 5.9% to 21.4%. Unmarried status, current smoking, using solid fuels for cooking, low body weight, being overweight, obesity, and central obesity were associated with an increased risk of PRISm. In contrast, higher education attainments, increased household income, and maintaining a specific degree of physical activity were associated with a reduced risk of PRISm.Conclusions:The prevalence of PRISm was high in adults aged 40 years and above in China, and it varied by sociodemographic and lifestyle factors.

Objective:To explore the prospective association between physical activity level and mor-tality risk in Chinese adults with chronic obstructive pulmonary disease(COPD).Methods:Based on the China Kadoorie Biobank(CKB)who had COPD at the baseline survey,this study employed the Cox proportional hazards regression model to estimate the prospective associations between the overall physical activity,different intensities(low-level,moderate-to-vigorous-level),and types(occupational,non-occupational)of physical activity level and the risks of all-cause and cause-specific mortality,such as vascular diseases,cancer,and respiratory diseases.Based on the quintiles of physical activity level,par-ticipants were divided into five groups(Q1-Q5),with the lowest quintile group(Q1)as the reference group.Hazard ratio(HR)and 95％confidence interval(95％CI)were calculated for the remaining.In our study,we also performed sensitivity and subgroup analyses,including age,gender,self-rated health status,severity of COPD,etc.Results:Among 33 588 COPD patients at the baseline survey,8 314(22.2％)deaths were documented during an average follow-up of(11.1±3.1)years.Negative linear associations between the overall physical activity level and mortality risk from all-cause,vascular,and respiratory diseases were observed(P trend for linear correlation being＜0.001,0.002,＜0.001).Compared with the lowest quintile group of total physical activity(Q1),the hazard ratios(HR)and 95％confidence intervals(CI)for all-cause mortality,vascular disease mortality,and respiratory disease mortality in the highest quintile group(Q5)were 0.77(0.70,0.85),0.77(0.65,0.91),and 0.58(0.48,0.71),respectively.The low-level and moderate-to-vigorous-level physical activity were nega-tively associated with all-cause mortality in the COPD patients(P trend for linear correlation:0.002,＜0.001,respectively).Compared with the lowest quintile group of low-intensity and moderate-to-vigorous intensity physical activity(Q1),the HRs(95％CI)for all-cause mortality in the highest quintile group(Q5)were 0.89(0.82,0.97)and 0.79(0.72,0.87),respectively.The occupational and non-occupational physical activity were also found to have a linear inverse association with all-cause mortality risk among the COPD patients(P trend＜0.001 and 0.015,respectively).Compared with the lowest quintile group of occupational and non-occupational physical activity(Q1),the HR(95％CI)for all-cause mortality in the highest quintile group(Q5)were 0.69(0.61,0.78)and 0.91(0.84,0.98),respectively.The associations between overall physical activity and all-cause mortality risk were stronger for patients aged 60 and above,female,and who reported poor health status(P for interaction:0.028,0.012,0.010).The protective effect of total physical activity was also applicable to the COPD patients of varying severity.Conclusion:Physical activity could reduce the mortality risk in a dose-response relationship among COPD patients,regardless of its intensity and type,especially among indi-viduals aged 60 and above,females,and those with poor self-report health status.

Objective:To explore the prospective association between physical activity level and mor-tality risk in Chinese adults with chronic obstructive pulmonary disease(COPD).Methods:Based on the China Kadoorie Biobank(CKB)who had COPD at the baseline survey,this study employed the Cox proportional hazards regression model to estimate the prospective associations between the overall physical activity,different intensities(low-level,moderate-to-vigorous-level),and types(occupational,non-occupational)of physical activity level and the risks of all-cause and cause-specific mortality,such as vascular diseases,cancer,and respiratory diseases.Based on the quintiles of physical activity level,par-ticipants were divided into five groups(Q1-Q5),with the lowest quintile group(Q1)as the reference group.Hazard ratio(HR)and 95％confidence interval(95％CI)were calculated for the remaining.In our study,we also performed sensitivity and subgroup analyses,including age,gender,self-rated health status,severity of COPD,etc.Results:Among 33 588 COPD patients at the baseline survey,8 314(22.2％)deaths were documented during an average follow-up of(11.1±3.1)years.Negative linear associations between the overall physical activity level and mortality risk from all-cause,vascular,and respiratory diseases were observed(P trend for linear correlation being＜0.001,0.002,＜0.001).Compared with the lowest quintile group of total physical activity(Q1),the hazard ratios(HR)and 95％confidence intervals(CI)for all-cause mortality,vascular disease mortality,and respiratory disease mortality in the highest quintile group(Q5)were 0.77(0.70,0.85),0.77(0.65,0.91),and 0.58(0.48,0.71),respectively.The low-level and moderate-to-vigorous-level physical activity were nega-tively associated with all-cause mortality in the COPD patients(P trend for linear correlation:0.002,＜0.001,respectively).Compared with the lowest quintile group of low-intensity and moderate-to-vigorous intensity physical activity(Q1),the HRs(95％CI)for all-cause mortality in the highest quintile group(Q5)were 0.89(0.82,0.97)and 0.79(0.72,0.87),respectively.The occupational and non-occupational physical activity were also found to have a linear inverse association with all-cause mortality risk among the COPD patients(P trend＜0.001 and 0.015,respectively).Compared with the lowest quintile group of occupational and non-occupational physical activity(Q1),the HR(95％CI)for all-cause mortality in the highest quintile group(Q5)were 0.69(0.61,0.78)and 0.91(0.84,0.98),respectively.The associations between overall physical activity and all-cause mortality risk were stronger for patients aged 60 and above,female,and who reported poor health status(P for interaction:0.028,0.012,0.010).The protective effect of total physical activity was also applicable to the COPD patients of varying severity.Conclusion:Physical activity could reduce the mortality risk in a dose-response relationship among COPD patients,regardless of its intensity and type,especially among indi-viduals aged 60 and above,females,and those with poor self-report health status.

Objective:To describe the prevalence of preserved ratio impaired spirometry (PRISm) in participants from the China Kadoorie Biobank (CKB) and explore the influencing factors.Methods:The CKB project conducted the baseline survey, the first and the second resurvey in 2004-2008, 2008, and 2013-2014, respectively. Based on the lung function tests, the participants were categorized into three groups: regular, PRISm, and airflow obstruction. The prevalence of PRISm was reported by gender, age, and region at the baseline survey. The secular trend in the prevalence of PRISm was described during the three surveys. Finally, we used the multiple logistic regression model to examine the factors related to PRISm in the baseline survey.Results:After standardization for gender, age, and region according to the sixth national census data in 2010, the overall prevalence of PRISm and airflow obstruction among the 434 760 participants at baseline was 24.8% and 6.1%, respectively. The prevalence of PRISm was higher in rural (25.4%) than that in urban areas (24.3%). Of the 10 study regions, Gansu had the highest prevalence of PRISm (56.0%), while Henan had the lowest (15.4%). After standardization for gender, age, and region according to the baseline population, the prevalence of PRISm decreased from 24.9% at baseline to 15.7% in the second resurvey, and the prevalence of airflow obstruction increased from 5.9% to 21.4%. Unmarried status, current smoking, using solid fuels for cooking, low body weight, being overweight, obesity, and central obesity were associated with an increased risk of PRISm. In contrast, higher education attainments, increased household income, and maintaining a specific degree of physical activity were associated with a reduced risk of PRISm.Conclusions:The prevalence of PRISm was high in adults aged 40 years and above in China, and it varied by sociodemographic and lifestyle factors.

BACKGROUND: Extensive-stage small cell lung cancer (ES-SCLC) is a malignant tumor with remarkable proliferative and invasive ability, which has very poor clinical prognosis due to lack of effective treatments. This study aims to evaluate the efficacy and synergistic effects of radiotherapy (RT) combined with immunotherapy (IT) and chemotherapy (CT) in patients with ES-SCLC. METHODS: A retrospective analysis was performed on 145 ES-SCLC patients treated with first-line CT. Kaplan-Meier analysis and Log-rank tests were used to evaluate survival outcomes, while propensity score matching (PSM) was applied to reduce confounding factors. RESULTS: The median overall survival (mOS) and median progression-free survival (mPFS) for the entire cohort were 15.7 and 6.9 mon, respectively. The IT+CT group had a significantly longer mOS compared to the CT group (17.2 vs 13.5 mon, P=0.047). Similarly, the RT+CT group demonstrated superior mOS (18.5 vs 12.3 mon, P<0.001) and mPFS (7.1 vs 6.2 mon, P=0.006) compared to the CT group. Multivariate analysis identified RT, IT, and Eastern Cooperative Oncology Group performance status (ECOG PS) as independent prognostic factors for mOS (P<0.05), while gender and ECOG PS were independent predictors for mPFS (P<0.05). Following PSM, the RT+CT group continued to exhibit significant advantages in mOS (18.0 vs 12.1 mon, P<0.001) and mPFS (7.1 vs 5.5 mon, P=0.037) compared to the CT group. Notably, the RT+IT+CT group achieved a markedly longer mOS than the IT+CT group (28.5 vs 15.8 mon, P=0.017). Grade 3-4 adverse events occurred in 27.6% of patients, with no grade 5 adverse events reported. CONCLUSIONS The combination of RT, IT, and CT significantly enhances the prognosis of ES-SCLC patients. RT plays a key role in their synergistic effects and demonstrates good safety, warranting further research and clinical application.
Humans ; Small Cell Lung Carcinoma/mortality* ; Male ; Female ; Middle Aged ; Lung Neoplasms/mortality* ; Retrospective Studies ; Aged ; Immunotherapy ; Prognosis ; Combined Modality Therapy ; Adult ; Neoplasm Staging ; Aged, 80 and over

Objectives To understand the quality status of disinfection products in the market in Shaanxi Province, and to provide a basis for taking targeted management measures. Methods From 2020 to 2023, in accordance with the national disinfection product management regulations and standards, the physicochemical and microbial tests of disinfection products in Shaanxi Province were carried out through supervised sampling, and the test results were analyzed according to the active ingredients, illegal addition, stability, and bactericidal or bacteriostatic performance. Results The overall qualification rate of the active ingredient content of disinfectants sampled in Shaanxi Province was 90.48%, with the lowest qualification rate in 2023 (84.38%). The overall qualification rate of quantitative sterilization test of disinfectants was 90.12%, showing a decreasing trend year by year (P=0.272). The overall qualification rate of anti-bacterial products was 88.59%, and the bactericidal test results of 20 antibacterial products were all qualified. The overall qualification rate of bacteriostatic performance testing for bacteriostatic products was 86.17%, with the pass rate of bacteriostatic product germicidal efficacy testing of different components in descending order being quaternary ammonium salt/silver ion > guanidine > others > lysozyme, and there was statistically significant difference (P=0.004). The detection rate of illegal additives in antimicrobial products was 7.07%, with the main detection indicators being miconazole nitrate, clobetasol propionate, and dexamethasone acetate. Conclusion The qualified rate of disinfection products in Shaanxi Province is relatively high, but there is a downward trend. It is necessary to continue to strengthen the daily supervision and product testing of disinfection product manufacturers, and promote the continuous improvement of disinfection product quality.

Objective To analyze the colorectal cancer screening of community residents in Pudong New Area in Shanghai and provide reference for the promotion and strategy optimization of colorectal cancer screening programs. Methods Residents aged 50-74 years in the colorectal cancer screening project of Pudong New Area in Shanghai from 2013 to 2023 were recruited in this analysis. The situation of primary screening and colonoscopy in the community was described, and results of different age groups in primary screening and colonoscopy surveys were evaluated. Chi-square test was used to determine differences between groups. Results From 2013 to 2023, 907 030 residents were screened in Pudong New Area, of which 183 724 residents were positive, and the positive rate was 20.3%. The positive rate was the lowest in the 50-54 age group and the highest in the 70-74 age group. The positive rate was higher in men than in women. The overall colonoscopy rate was 27.1%, with the highest rates in the 50-54 age group in men and the 55-59 age group in women, respectively. The participation rate of colonoscopy increased with the increase of the year. A total of 19 094 cases of intestinal lesions were found by colonoscopy. Among these lesions, 1 147 cases were colorectal cancer, accounting for 6.0%, and the population detection rate was 126.5/100 000. In addition, 4 751 cases of precancerous lesions were found, accounting for 24.9%, and the detection rate was 523.8/100 000. Conclusion Colorectal cancer screening improves the detection rate of precancerous lesions and early cancer and is of great significance for reducing the incidence and mortality of colon cancer. Measures should be taken to optimize the screening strategy based on age differences and increase the participation rate of primary screening and colonoscopy to achieve the best effect of local colorectal cancer prevention and treatment.

Objective To investigate the significance of spread through air spaces (STAS) in early-stage non-small cell lung cancer (NSCLC) patients undergoing either sublobar resection or lobectomy by pooling evidence available, and to assess the accuracy of frozen sections in determining types of resection among patients with suspected presence of STAS. Methods Studies were identified by searching databases including PubMed, EMbase, Web of Science, and The Cochrane Library from inception to July 2022. Two researchers independently searched, screened, evaluated literature, and extracted data. Statistical analysis was conducted using RevMan 5.4 and STATA 15.0. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the study. Results A total of 26 studies involving 23 surgical related studies (12 266 patients) were included, among which, 11 compared the outcomes of lobectomy with sublobar resection in the STAS-positive patients. NOS score≥6 points. Meta-analysis indicated that presence of STAS shortened patients' survival in both lobectomy group and sublobar resection group (RFS: HR=2.27, 95%CI 1.96-2.63, P＜0.01; OS: HR=2.08, 95%CI 1.74-2.49, P＜0.01). Moreover, lobectomy brought additional survival benefits to STAS-positive patients compared with sublobar resection (RFS: HR=1.97, 95%CI 1.59-2.44, P＜0.01; OS: HR=1.91, 95%CI 1.47-2.48, P＜0.01). Four studies were included to assess the accuracy of identifying presence of STAS on intraoperative frozen sections, of which the pooled sensitivity reached 55% (95%CI 45%-64%), the pooled specificity reached 92% (95%CI 77%-97%), and the pooled area under the curve was 0.68 (95%CI 0.64-0.72) based on the data available. Conclusion This study confirms that presence of STAS is a critical risk factor for patients with early-stage NSCLC. Lobectomy should be recommended as the first choice when presence of STAS is identified on frozen sections, as lobectomy can prolong patients' survival compared with sublobar resection in STAS-positive disease. The specificity of identifying STAS on frozen sections seems to be satisfactory, which may be helpful in determining types of resection. However, more robust methods are urgently in need to make up for the limited sensitivity and accuracy of frozen sections.

Objective To investigate whether adjuvant therapy can bring survival benefits to patients with esophageal squamous cell carcinoma (ESCC) who have received neoadjuvant therapy plus esophagectomy. Methods Studies were identified by searching databases including PubMed, EMbase, Web of Science, The Cochrane Library and CNKI from inception to November 2022 to collect studies which conformed to the objective of this study. Clinical outcomes including overall survival (OS) and recurrence-free survival (RFS) were extracted from eligible studies after screening. RevMan 5.4 and Stata 14.0 were used to perform the meta-analysis. Results A total of 9 studies were selected including 1 340 patients. Compared with the neoadjuvant therapy plus surgery (NS) group, the neoadjuvant therapy plus surgery+adjuvant therapy (NS+A) group had no significant benefit in the OS [HR=0.88, 95%CI (0.75, 1.02), P=0.09], but had remarkable benefit in the RFS [HR=0.75, 95%CI (0.58, 0.97), P=0.03]. Subgroup analysis by nodal status showed that adjuvant therapy could improve the RFS of patients with node-positive disease. Prolonged OS was observed in the patients with both positive and negative nodes but not in the patients with only positive nodes. In terms of the subgroup analysis by prescription, it revealed that triple agents exhibited advantages in improving RFS but not OS. However, dual agents did not bring additional survival benefits to the NS+A group compared with the NS group. Subgroup analysis by adjuvant therapy indicated that neither postoperative chemoradiotherapy nor chemotherapy improved OS, whereas postoperative chemoradiation elongated RFS. Conclusion Adjuvant therapy can improve the prognosis of patients with ESCC after neoadjuvant therapy followed by esophagectomy.