Objective To analyze the burden of atherosclerotic cardiovascular disease(ASCVD)attributable to lifestyle and metabolic factors in China from 1990 to 2021 and predict its future trends,providing evidence for public health prevention and control.Methods Based on the Global Burden of Disease(GBD)2021 database,we extracted disability-adjusted life years(DALYs)of ASCVD attributable to 7 key risk factors:dietary,low physical activity,smoking,high body mass index(BMI),high fasting blood glucose,high low-density lipid cholesterol(LDL-C),and hypertension.Age-standardized DALY rates(ASDR)were also calculated to account for variations in age structure,and an ARIMA model was applied to predict future trends.Results ① Overall trend analysis showed the leading risk factor for ischemic heart disease(IHD)shifted from dietary risks in 1990 to hypertension in 2021,while hypertension and smoking remained the primary risk factors for ischemic stroke(IS)and peripheral artery disease(PAD),respectively.② In BRICS nations,hypertension was the dominant risk factor for both IHD and IS,whereas in China,smoking and high fasting blood glucose continued to be the major drivers of PAD burden.③ Sex-specific analysis revealed that hypertension was the leading risk factor for IHD and IS in both males and females.For PAD,smoking was the main risk factor in males,while high fasting blood glucose was for females.Age-stratified analysis revealed that in the 15-49 age group,dietary,high LDL-C and smoking were the primary factor for IHD,IS and PAD,respectively;in the 50-69 group,dietary predominated IHD risk,hypertension IS,and smoking PAD;and among those aged≥70 years,hypertension was the leading risk factor for both IHD and IS,and high fasting blood glucose was for PAD.④ ARIMA model forecasted that by 2035,DALYs for IHD,IS,and PAD will increase to 82.816 million,46.808 million,and 0.192 million person-years,respectively.Conclusion The ASCVD burden attributable to lifestyle and metabolic factors continues to rise in China from 1990 to 2021,and is projected to further increase by 2035.Countermeasures We suggest that current prevention and control priorities are enhanced management of metabolic factors,tailored interventions by sex and age,promotion of healthy lifestyles and tobacco control,and establishment of an integrated system of prevention-treatment-rehabilitation-research.

To analyze the disease burden and trends of motor neuron disease(MND) in China and globally from 1990 to 2021, providing evidence for the formulation of relevant health strategies inChina.

AIM: To study the protective effect of fenofibrate on diabetic retinal neurodegeneration and observe its effect on miR-26a-5p and its target gene PTEN in the retinal of diabetic mice.METHODS: Diabetic mice models were established and they were gavaged by fenofibrate. H& E staining and transmission electron microscopy were used to observe the impairments of retinal neurons. Real-time PCR was used to examine the expression of miR-26a-5p, and Western blotting was employed to measure the expression of phosphatase and tensin homologue(PTEN)in the retina of diabetic mice. The expression level of nuclear factor-κB(NF-κB), interleukin-1β(IL-1β)and the morphology of neural tissues were observed.RESULTS: When compared with the diabetic mice, fenofibrate significantly attenuated the damage to retinal ganglion cells and the atrophy of retinal nerve fiber layer. While the level of miR-26a-5p was increased and the levels of PTEN and inflammatory mediators were significantly decreased in the retina of fenofibrate treated diabetic mice, with significant statistical significance(P<0.05).CONCLUSIONS: Fenofibrate protects against diabetic retinal neurodegeneration by upregulating miR-26a-5p and inhibiting PTEN, attenuating the inflammatory response and alleviating retinal cell injury.

Objective To observe the thickness changes in the peripapillary retinal nerve fiber layer(RNFL)and the ganglion cell-inner plexiform layer(GC-IPL)in the macular region,so as to analyze the pathological rules of retinal nerve injury in diabetes retinopathy(DR)patients and explore the related risk factors.Methods A total of 164 patients(164 eyes)with type 2 diabetes who visited the Department of Ophthalmology and Department of Endocrinology of Shaanxi Pro-vincial People's Hospital from January 1,2017 to January 1,2018 were selected as the subjects.According to the condition of concomitant DR,these subjects were divided into three groups:non-DR(NDR)group(56 eyes of 56 patients),mild non-proliferative DR(NPDR)group(53 eyes of 53 patients)and moderate NPDR group(55 eyes of 55 patients).Healthy individuals who underwent physical examinations in the same period were selected as the control group(50 eyes of 50 pa-tients).Optical coherence tomography and optical coherence tomography angiography were used to measure the peripapil-lary RNFL,macular GC-IPL,and macular vessel density(VD)of all subjects.Comparison among groups and correlation analysis were conducted on the above retinal nerve injury indicators.Results Compared with the control group and NDR group,the average,upper and lower peripapillary RNFL in the mild NPDR group and moderate NPDR group were signifi-cantly thinner,and the differences were statistically significant(all P＜0.05).The differences in macular GC-IPL thickness at the average,upper,upper temporal,lower temporal,lower,lower nasal,and upper nasal regions in all groups were sta-tistically significant(all P＜0.05);pairwise comparisons showed that compared with the control group,the GC-IPL thick-ness in each quadrant of the macular area of patients in the NDR group,mild NPDR group and moderate NPDR group de-creased significantly(all P＜0.05),with the upper GC-IPL thinning being the most significant;compared with the NDR group,the GC-IPL thickness in the upper,average,and upper temporal macular area of patients with mild NPDR decreased significantly(all P＜0.05);compared with the mild NPDR group,the GC-IPL thickness in the upper macular area was thin-ner in the moderate NPDR group,and the difference was statistically significant(P＜0.05).There were statistically signifi-cant differences in the average and inner ring VDs in the macular area among the groups(both P＜0.05).The correlation analysis results showed that there was a significantly positive correlation between the peripapillary RNFL thickness and the average VD in the macular area(r=0.517,P＜0.01),while the average GC-IPL thickness in the macular area was weakly positively correlated with the average VD in the macular area(r=0.279,P＜0.01).Conclusion The peripapillary RNFL thickness objectively reflects the degree of retinal neuron injury,and is a key index to evaluate the degree of retinal nerve injury in diabetes patients.

PURPOSE: Rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone administered every 3 weeks (R-CHOP-21) is the standard care for diffuse large B-cell lymphoma (DLBCL). It is unknown whether the dose-dense R-CHOP (R-CHOP-14) could improve the outcome of the disease in Asian population. MATERIALS AND METHODS: Newly diagnosed DLBCL patients were centrally, randomly assigned (1:1) to receive R-CHOP-14 or R-CHOP-21. R-CHOP-14 was administered every 2 weeks, and R-CHOP-21 was administered every 3 weeks. Primary end point was disease-free survival (DFS). Secondary end points included overall survival (OS), progression-free survival (PFS), response rate and toxicities. RESULTS: Seven hundred and two patients were randomly assigned to receive R-CHOP-14 (n=349) or R-CHOP-21 (n=353). With a median follow-up of 45.6 months, the two groups did not differ significantly in 3-year DFS (79.6% for R-CHOP-14 vs. 83.2% for R-CHOP-21, p=0.311), 3-year OS (77.5% for R-CHOP-14 vs. 77.6% for R-CHOP-21, p=0.903), or 3-year PFS (63.2% for R-CHOP-14 vs. 66.1% for R-CHOP-21, p=0.447). Patients with an International Prognostic Index (IPI) score ≥ 2 had a poorer prognosis compared to those with an IPI score < 2. Grade 3/4 hematologic and non-hematologic toxicities were manageable and similar between R-CHOP-14 and R-CHOP-21. CONCLUSION: R-CHOP-14 did not improve the outcome of DLBCL compared to R-CHOP-21 in Asian population. With manageable and similar toxicities, both of the two regimens were suitable for Asian DLBCL patients. For high-risk patients with IPI ≥ 2, new combination regimens based on R-CHOP deserve further investigation to improve efficacy.
Asian Continental Ancestry Group ; B-Lymphocytes ; Cyclophosphamide ; Disease-Free Survival ; Doxorubicin ; Follow-Up Studies ; Humans ; Lymphoma, B-Cell ; Prednisone ; Prognosis ; Rituximab ; Vincristine

Background and purpose:Intensity-modulated radiation therapy (IMRT) enables the delivery of higher radiation dose to the primary tumor target, while sparing the organs and tissues at risk (OARs). Chemotherapy is an effective means to prevent distant metastasis. The purpose of this study was to observe clinical effect of concurrent intensity-modulated radiation therapy and chemotherapy for advanced esophageal carcinoma. Methods: A total number of 62 cases of advanced esophageal carcinoma were divided into two groups. There were 32 cases in concurrent chemoradiotherapy group, and 30 cases were in radiotherapy alone group. The patients in two groups were both used IMRT radiotherapy, while the patients of concurrent chemoradiotherapy group were plused adjuvant chemotherapy. The chemotherapy regimen was TP. Twenty-eight days was a treatment cycle, 2 treatment cycles were lasted during chemoradiotherapy.After that, recent curative effect and toxicside reaction were compared between two groups. Results: The total relief rate (CR+PR) in concurrent chemoradiotherapy group was 93.8%. The total relief rate in radiotherapy alone group was 76.7%. There were signiifcant differences between the two groups (P<0.05). One-year local response rate(84.4%) and 2-year local response rate (59.4%) in concurrent chemoradiotherapy group were both higher than those (70.0%, 36.7%) in radiotherapy alone group (P<0.05), while the survival rate was similar between the two groups (P>0.05). Toxicside reaction in concurrent chemoradiotherapy group, including leucocytes decrease, radioactive esophagitis andⅢ,Ⅳtoxicity, were higher than those in radiotherapy alone group (P<0.05). Conclusion:After treating advanced esophageal carcinoma with concurrent intensity-modulated radiation therapy and chemotherapy, the recent curative effect and the local response were ifne, while toxicity was more serious.

Objective To investigate the incidence of pancreatic cancer-related depression in Guangzhou,China.Methods A multicenter,prospective survey was conducted,50 patients with pancreatic cancer,60 with liver cancer,50 with esophageal cancer,50 with gastric cancer,52 with colorectal cancer were enrolled from 4 hospitals in Guangzhou between June 2007 and June 2009.Hamilton Rating Scale for Depression-24 (HAMD-24) questionnaire was used to assess the degree of depression.Results The incidence of depression in pancreatic cancer patients was 78% (39/50),which was significantly higher than that among liver cancer patients (60% ,36/60),gastric cancer patients (36%,18/50),esophageal cancer patients(24%,12/50),and colorectal cancer patients(19.2%,10/52,P＜0.05 ).Twelve of 50 patients in pancreatic cancer were reported to have severe depression (24%),which was significantly more than that in liver cancer (10%,6/60),gastric cancer (4%,2/50),esophageal and colorectal cancer (0,P ＜0.05).In pancreatic cancer patients,the incidence of depression was significantly higher in patients with advanced stage (94.3%) than that in early stage (46.7%,P＜0.05).Patients who underwent chemotherapy had high incidence of depression(92.3%)than that of patients who underwent operation (62.5%,P＜0.05 ).Conclusions Compared with other cancers of digestive tract,the incidence of pancreatic cancer-related depression was higher,and its degree was more severe than that of other cancers.

Objective To investigate the prevalence and the clinical features of pancreatic cancer pain in a Chinese patient population.Methods The study was carried out in 415 cages of pancreatic cancer which were admitted to the First Municipal people's Hospital of Guangzhou Medical college and the Second Affiliated Hospital of Sun Yat-sen University from 1999 to 2007.The prevalence,clinical features of pancreatic cancer pain and its correlations with the cancer site and the clinical staging were analyzed.Results Of the 415 patients.the prevalence of pain wag 65.1%and 60.5%of all the patients presented pain as the initial symptom;the incidence of pain in pancreatic body/tail cancer patients was 80.7%.while it was 71.4%in total pancreatic cancer patients.and the incidence was 58.2%in pancreatic head cancer patients;the incidence between pancreatic body/tail cancer and pancreatic head cancer patients was statistically different (P＜0.05).The incidence of pain in patients with stage Ⅰ,Ⅱ,Ⅲ,and Ⅳ was 28.6%,58.1%,66.2%and 78.6%.and the difference was statistically significant(P＜0.01).The incidence of moderate to severe degree of pain in patients with stage Ⅰ,Ⅱ,Ⅲ,and Ⅳ was 18.8%,44.4%,53.1%and 68.2%,and the differenee was statistically significant(P＜0.01).Conclusions Pain was very common in patients with advanced pancreatic cancer.The incidence and severity of pain increased with the progression of pancreatic cancer.

Objective To compare the clinical efficacy of gemcitabine arterial infusion chemotherapy with intravenous chemotherapy in the management of patients with advanced pancreatic cancer and to evaluate the efficacy and safety of gemcitabine arterial infusion chemotherapy. Methods 43 patients with advanced pancreatic cancer were included in this study, of whom 21 patients received arterial infusion chemotherapy (Group A) and the other 22 were treated by intravenous chemotherapy (Group B), gemcitabine combined with 5-FU chemotherapy was administrated in both groups. The main outcomes were clinical benefit response (CBR), tumor response rate and toxicity. Results Compared with Group B, there was a significant improvement of CBR in group A (81% vs 50%, P =0.033) ; there was also significant improvement of pain control in group A (76.2% vs 45.5%, P =0.039). There was no significant difference in the tumor response rate between two groups (33.3% vs 22.7%, P =0.498). No significant increase of side effects was observed in both groups. Conclusions In the management of advanced pancreatic cancer, the arterial infusion method may be more favorable than intravenous approach in improving clinical benefits with mild toxicity and well tolerability.

[Objective] To investigate the efficacy of Xiangsha Yangwei Wan (XYW) on the inhibition of chemotherapy-induced chemical gastritis and upper gastrointestinal symptoms. [Methods] A randomized controlled trial (RCT) was carried out in 87 cases of maligant tumor confirmed by histopathological and cytological examination. All the cases were treated with chemotherapy regimen of adriamycin ( ADM) , adcarbazine ( DTIC) , platinum-based agents, irinotecan (CPT-11) and fluorouraeil (5-FU). Meanwhile, 41 cases in group A were also treated with dexamethason and 5-HT3 receptor antagonist as an essential anti-emesis and with XYW to regulate gastrointestinal function; other 46 cases in group B were given dexamethason and 5-HT3 receptor antagonist only. Seven days after treatment, incidences of chemical gastritis and upper gastrointestinal symptoms were observed and compared between the two groups. [Results] Seven days after chemotherapy, upper gastrointestinal symptoms and signs were relieved in 95.1% (39/41) of the patients of group A and in 76.1 % (35/46) of group B; the occurring rate of chemical gastritis with symptoms was 2.4% (1/41) in group A and 19.6% (9/46) in group B, the differences being significant statistically between the two groups( P - 0.0122) . [ Conclusion ] XYW has an inhibitory effect on chemotherapy-induced chemical gastritis and upper gastrointestinal symptoms.