Background and purpose:The colorectal cancer screening program for community residents in Shanghai has been implemented for 12 years since 2013.This study aimed to analyze the impact of screening on the colorectal cancer incidence,stage and survival outcomes based on their screening participation status.Methods:This study used registry-based cohort study method.The registered residents in Shanghai from 2013 to 2017 who met the screening age range were divided into screening group and non-screening group.The data of colorectal cancer cases after being included in groups were obtained from the Population Based Cancer Registry.We calculated age-standardized cumulative incidence and age-group cumulative incidence,diagnosis stage and survival rate of colorectal cancer by gender,age and year of diagnosis.We used the Joinpoint regression method to calculate the annual change percentage for cumulative incidence trend analysis.The life table method and EdererⅡ method were used to calculate the 5-year observed survival rates and expected survival rates of colorectal cancer cases.Finally the 5-year relative survival rates were obtained.Results:The study included 1 687 689 participants aged 50-74 in screening group and 4 713 307 participants in non-screening group.During a 5-year follow-up period,there were 10 333 and 20 904 new cases of colorectal cancer diagnosed in the two groups,respectively.The age-standardized 5-year cumulative incidence in the screening group was 555.33/105,with an average annual increase of 33.32%(P＜0.05).The age-standardized 5-year cumulative incidence in the non-screening group was 529.85/105,with an average annual increase of 48.13%(P＜0.05).There was no statistically significant difference between the screening group and the non-screening group in the age-standardized 5-year cumulative incidence(X=0.25,P=0.804).The lower the age group,the greater the difference between the screening group and the non-screening group in the annual average change percentage of the age-standardized cumulative incidence.The stages 0-Ⅰ of newly diagnosed colorectal cancer cases in the screening group and non-screening group accounted for 14.70%and 7.46%,respectively,with a statistically significant difference in composition between the two groups(P＜0.05).The 5-year relative survival rate of the screening group was 73.94%,while the non-screening group was 59.66%.The survival rate indicators of the former were significantly higher than those of the latter,and the difference was statistically significant.The survival rate of the former was significantly higher than that of the latter(73.94%vs 59.66%),and the difference was statistically significant(P＜0.05).The survival rate of females in both groups of cases was higher than that of males,and the survival rate decreased with increasing age-groups at diagnosis.Conclusion:With the implementation of the colorectal cancer screening program,the growth trend of the incidence rate of colorectal cancer among the screening participants has been curbed,and the early stages of colorectal cancer cases diagnosed and the 5-year survival rate were significantly improved.In order to reduce the incidence rate of colorectal cancer in the whole population,it is necessary to vigorously promote the screening coverage of the appropriate population,especially to increase the proportion of lower age groups participating in screening.We should also pay attention to the screening quality of the elderly groups and improve the compliance of colonoscopy in high-risk participants.At the same time,we should further optimize the refined management of screening for different genders,ages,and risk groups.

Background and purpose:The colorectal cancer screening program for community residents in Shanghai has been implemented for 12 years since 2013.This study aimed to analyze the impact of screening on the colorectal cancer incidence,stage and survival outcomes based on their screening participation status.Methods:This study used registry-based cohort study method.The registered residents in Shanghai from 2013 to 2017 who met the screening age range were divided into screening group and non-screening group.The data of colorectal cancer cases after being included in groups were obtained from the Population Based Cancer Registry.We calculated age-standardized cumulative incidence and age-group cumulative incidence,diagnosis stage and survival rate of colorectal cancer by gender,age and year of diagnosis.We used the Joinpoint regression method to calculate the annual change percentage for cumulative incidence trend analysis.The life table method and EdererⅡ method were used to calculate the 5-year observed survival rates and expected survival rates of colorectal cancer cases.Finally the 5-year relative survival rates were obtained.Results:The study included 1 687 689 participants aged 50-74 in screening group and 4 713 307 participants in non-screening group.During a 5-year follow-up period,there were 10 333 and 20 904 new cases of colorectal cancer diagnosed in the two groups,respectively.The age-standardized 5-year cumulative incidence in the screening group was 555.33/105,with an average annual increase of 33.32%(P＜0.05).The age-standardized 5-year cumulative incidence in the non-screening group was 529.85/105,with an average annual increase of 48.13%(P＜0.05).There was no statistically significant difference between the screening group and the non-screening group in the age-standardized 5-year cumulative incidence(X=0.25,P=0.804).The lower the age group,the greater the difference between the screening group and the non-screening group in the annual average change percentage of the age-standardized cumulative incidence.The stages 0-Ⅰ of newly diagnosed colorectal cancer cases in the screening group and non-screening group accounted for 14.70%and 7.46%,respectively,with a statistically significant difference in composition between the two groups(P＜0.05).The 5-year relative survival rate of the screening group was 73.94%,while the non-screening group was 59.66%.The survival rate indicators of the former were significantly higher than those of the latter,and the difference was statistically significant.The survival rate of the former was significantly higher than that of the latter(73.94%vs 59.66%),and the difference was statistically significant(P＜0.05).The survival rate of females in both groups of cases was higher than that of males,and the survival rate decreased with increasing age-groups at diagnosis.Conclusion:With the implementation of the colorectal cancer screening program,the growth trend of the incidence rate of colorectal cancer among the screening participants has been curbed,and the early stages of colorectal cancer cases diagnosed and the 5-year survival rate were significantly improved.In order to reduce the incidence rate of colorectal cancer in the whole population,it is necessary to vigorously promote the screening coverage of the appropriate population,especially to increase the proportion of lower age groups participating in screening.We should also pay attention to the screening quality of the elderly groups and improve the compliance of colonoscopy in high-risk participants.At the same time,we should further optimize the refined management of screening for different genders,ages,and risk groups.

Objective:The study retrospectively analyzed the etiology, clinical manifestations, emergency treatment and etiological treatment of a large sample of cases with hypercalcemic crisis.Methods:The clincial data of patients with hypercalcaemia cirisis who were administered in First Medical Center of Chinese PLA General Hospital from January 2009 to July 2022 were analyzed, inculding the general data, clinical manifestations, etiology, photographic examination, emergency treatment, etiological treatment, serological examination before and after treatment, pathological immunohistochemical findings and prognosis.Results:A total of 143 hypercalcaemia crisis patients(84 males and 59 females) with a mean age of 53.51±16.60 were enrolled. The most common disease was hyperparathyroidism(62/143), followed by solid malignancy(57/143) and multiple myeloma(12/143). Patients presented with digestive system symptoms at 76.91%, followed by neurological symptoms at 63.60%, urinary system symptoms at 58.76%, musculoskeletal symptoms at 55.23%, and cardiovascular system symptoms at 32.91%. After emergency calcium-lowering treatment, the remission rate of hypercalcemic crisis in 143 patients was 100%(143/143), and after etiological treatment, the remission rate of hypercalcemia was 85.31%(122/143).Conclusion:Early identification, emergency treatment and etiology treatment of hypercalcaemia crisis are essential. Effective treament with comprehensive calcium reduction can quickly relieve clinical symptoms and create opportunities for treatment for the cause. Targeted etiological interventions can lead to the correction or long-term remission of hypercalcemia.

Objective: To investigate the incidence, mortality and survival of small intestine cancer in Shanghai from 2002 to 2016. Methods: Data of new small intestine cancer cases and deaths from 2002 to 2016 were obtained from the population-based cancer registry and Vital Statistics System of Shanghai Municipal Center for Disease Control and Prevention. The incidence and mortality of small intestine cancer stratified by year of diagnosis or death, gender and age-group were analyzed. Cases or deaths, proportion, crude rate, age-specific rate, age-standardized rate and others were calculated. Trends of cases or deaths, crude rate, age-specific rate and age-standardized rate of incidence and mortality with follow-up information were estimated. The annual percent change (APC) of age-standardized rates of incidence and mortality was estimated by Joinpoint analysis. The new cases and proportions with selected diagnostic character of small intestine cancer in different diagnosis years were also calculated. Age-standardized rates were calculated using Segi’s 1960 world standard population. The 1- to 5-year observed survival rates were calculated based on the life table. The probabilities of surviving from 0 to 99 years old were estimated according to the Elandt-Johnson model, and then the cumulative expected survival rates were calculated according to the Ederer Ⅱ method. Finally, the 1- to 5-year relative survival rates were calculated. Results: The age-standardized rates of incidence and mortality of small intestine cancer were stable in Shanghai from 2002 to 2016. The new average cases and deaths of small intestine cancer were 280 and 174 per year in Shanghai. The crude rate of incidence was 2.02/105, and the age-standardized rate was 0.96/105. The crude rate of mortality was 1.25/105, and the age-standardized rate was 0.54/105. The age-standardized rates of incidence and mortality in males were higher than those in females. The age-specific cases or deaths and rates of incidence and mortality increased with aging. Duodenum cancer was the dominant anatomical site. Adenocarcinoma was the most histopathological type, and the proportion of gastrointestinal stromal tumors was increasing. The 5-year observed survival rate of small intestine cancer diagnosed from 2002 to 2013 was 36.34% in Shanghai, and the 5-year relative survival rate was 39.98%. All survival rates of male were lower than those of female. The 5-year observed and relative survival rates were stable. And those decreased with the increase of diagnostic years and stages. Relative to other sites, the rates of the duodenum cancer were the lowest. Relative to other histopathological types, those of gastrointestinal stromal tumors were the highest. Conclusions: The diagnostic level of small intestine cancer has been improved in Shanghai, continuously. But the survival rates have not been improved with the times. The proportion of stage Ⅰ was low and without improvement for a long time. This study provides useful information to further research, control and prevention of small intestine cancer. Improvement of the surveillance and research on small intestine cancer will help to promote more efficient control and prevention strategies then decrease cancer burden.

The clinical data, laboratory test, and gene mutations were collected from a family with Liddle syndrome. Literatures on Liddle syndrome published in domestic and abroad since 1994 were reviewed and the types of gene mutations were summarized. The proband was diagnosed with hypertension at the age of 24. Laboratory test showed that serum potassium was 3.65 mmol/L, plasma renin was <0.5 mU/L, and plasma aldosterone was 1.5 ng/dL. Proband′s father was diagnosed with hypertension at the age of 34 with the serum potassium 3.34 mmol/L, plasma renin 3.72 mU/L, and plasma aldosterone 6.04 ng/dL. A nonsense mutation(1724G>A, p.Trp575*) in exon 13 of SCNN1G gene was detected in the proband and his father. In 288 cases from 107 families reported in the review of domestic and foreign literature, the incidence of hypertension, hypokalemia, and low renin/low aldosterone were 95.1%, 55.2%, and 49.6%, respectively. This case suggests that the clinical phenotype of Liddle syndrome is heterogeneous. Patients with early-onset hypertension, regardless of whether they are accompanied by hypokalemia, should be screened for renin-angiotensin-aldosterone and genetic testing related to Liddle syndrome should be further detected in patients with low plasma renin/aldosterone.

Objective:To explore the characteristics of the association between the triglyceride glucose (TyG) index and nonfatal cardio-cerebrovascular disease risk in a community population.Method:This was a prospective cohort study. From December 2011 to April 2012, the first investigation was conducted among subjects with more than 40-year old who were from Shijingshan district and Pingguoyuan community in Beijing. The second investigation was conducted from April to October 2015. All the subjects were divided into three groups according to the tertile of the TyG index at baseline. The multivariate Cox proportional risk regression model was established to explore the correlation between the TyG index and nonfatal cardio-cerebrovascular disease risk and the Kaplan-Meier survival curve of the TyG index group was drawn. Subgroup analyses were performed according to age, gender, body mass index, type 2 diabetes mellitus (T2DM), hypertension, and hyperlipidemia to determine the correlation characteristics between the TyG index and nonfatal cardio-cerebrovascular disease among subgroups.Results:A total of 9 577 subjects were finally included to analyze. The mean follow-up time of this study was (34.14±3.84) months. During the follow-up, 363 subjects (3.8%) occurred nonfatal cardio-cerebrovascular disease. The multivariate Cox regression analysis results showed that the hazard ratio ( HR) of nonfatal cardio-cerebrovascular disease in the high TyG index group was 1.54 (95% CI 1.19-1.98), 1.60 (95% CI 1.23-2.10), and 1.57 (95% CI 1.20-2.05) in the three models, compared with the low TyG index group. The Kaplan-Meier analysis showed that the risk of nonfatal cardio-cerebrovascular disease increased from the low-TyG index group to the high-TyG index group ( P=0.015). In the six subgroups analysis, only gender was shown to have a significant interaction effect with the TyG index and nonfatal cardio-cerebrovascular disease risk. In the female population, the risk of nonfatal cardio-cerebrovascular disease is significantly increased with the increase in the TyG index level ( P<0.001). Conclusions:A high TyG index is independently related to the increased risk of nonfatal cardio-cerebrovascular disease in the Beijing community population. Gender has a significant interaction with the TyG index and nonfatal cardio-cerebrovascular disease risk. Therefore, the TyG index may be a useful marker to predict the nonfatal cardio-cerebrovascular disease risk of a community population.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Background and purpose:The Shanghai Municipal Center for Disease Control and Prevention provides annual updates on cancer occurrence and trends in Shanghai.This study aimed to investigate the cancer incidence and mortality in 201 7 and their trends from 2002 to 2017 in Shanghai. Methods:Data of new cancer diagnoses and deaths from 2002 to 2017 were obtained from the Shanghai Municipal Center for Disease Control and Prevention population-based cancer registry and Vital Statistics System.Cancer incidence and mortality stratified by year of diagnosis or death,gender and age group were analyzed.Number,proportion,crude rate,age-specific rate,age-standardized rate and others were calculated.The number,proportion and rates of common cancers in different groups were also calculated.Trends in age-standardized rate of incidence and death rates for all cancers combined and for the common cancer types by gender were estimated by joinpoint analysis and characterized by the annual percent change(APC)and average annual percent change(AAPC).Segi's 1960 world standard population was used for calculating age-standardized incidence and mortality. Results:The new cancer cases and deaths were 79 378 and 37 186 in Shanghai in 2017.The crude rate of incidence was 546.55/105,and the age-standardized rate was 246.31/105.The age-standardized rate of incidence was higher among females than among males.The crude rate of mortality was 256.04/1 05,and the age-standardized rate was 88.41/105.The age-standardized rate of mortality was higher among males than among females.The age-specific numbers and rates of incidence and mortality increased with age.The age-specific number and rate of incidence reached the peak at the age groups of 60-64 years and older than 85 years,and those of mortality among males reached the peak at the age groups of 60-64 years and older than 85 years,and those of mortality among females reached the peak at the age groups of older than 85 years,respectively.The sites of top 10 common cancer types sorted by the number of incidence cases among males were lung,colorectum,stomach,prostate,liver,thyroid,pancreas,bladder,kidney and oesophagus,and among females were lung,breast,thyroid,colorectum,stomach,pancreas,liver,brain,central nervous system(CNS),cervix uteri and gallbladder,the sites of those sorted by the number of deaths among males were lung,stomach,colorectum,liver,pancreas,prostate,oesophagus,bladder,lymphoma and gallbladder,among females were lung,colorectum,breast,stomach,pancreas,liver,gallbladder,brain,CNS,ovary and lymphoma.The top 10 common cancer types stratified by gender and the top 5 common cancer types stratified by common age groups merged of incidence and mortality had wide variations.Overall,the age-standardized rates of incidence were stable from 2002 to 2009,and increased 2.88％on average per year from 2009 to 201 7.The age-standardized rates of mortality were stable from 2002 to 2011,and decreased 2.66％on average per year from 2011 to 201 7.The trends differed by gender and cancer type. Conclusion:Lung cancer,colorectal cancer,pancreatic cancer,thyroid cancer,female breast cancer,cervical cancer and male prostate cancer are the most common cancers in Shanghai,the appropriate screening technical scheme should be formulated according to the current situation of malignant tumors in Shanghai,promote cancer opportunistic screening,promote appropriate technologies for intervention and management of cancer patients in the community,reduce the disease burden of malignant tumors.

Objective:To investigate the survival of cancer cases diagnosed during 2002-2013 in Shanghai. Methods:Data on new cancer cases with dead and follow-up information were obtained from the population-based cancer registry and vital statistics system of Shanghai Municipal Center for Disease Control and Prevention.Survival indicators stratified by year of diagnosis,gender,site and age were analyzed.Number of cases and proportion were calculated.The observed survival rates were calculated based on the life table.The probabilities of surviving from 0 to 99 years old were estimated according to the Elandt-Johnson model,and then the cumulative expected survival rates were calculated according to the Ederer Ⅱ method.Finally,the relative survival rates and average annual percent changes of their trends were calculated.The age-standardized relative survival rates adjusted by International Cancer Survival Standard weights were calculated. Results:Total 644 520 new cancer cases were diagnosed during 2002-2013 in Shanghai,accounting for 643 545(99.85％)cases included in the observed cohort for survival analysis.The 5-year observed survival rate increased from 37.61％to 46.47％.The 5-year relative survival rate increased from 42.1 8％to 51.11％.The 5-year age-standardized relative survival rate increased from 40.57％to 49.80％.Among the 5-year relative survival rates of cases diagnosed during 2011 to 2013,99.43％of thyroid cancer was the highest,followed by female breast cancer(88.35％)and corpus uteri cancer(85.56％);5.87％of pancreas cancer was the lowest,followed by gallbladder cancer(13.64％)and oesophagus cancer(17.72％).the rate of lung cancer with the largest number of cases was 23.59％,followed by colorectal cancer(59.82％)and stomach cancer(38.65％).The 5-year relative survival rate of total cases of all sites increased from 40.55％in 2002 to 52.77％in 2013,with an average annual percent change of 2.40％.13 cancer types showed increasing trends,such as liver cancer and lung cancer,while the trends of other cancer types were not statistically significant,such as pancreatic cancer and gallbladder cancer. Conclusion:The diagnostic levels and survival rates of cancer cases have been improved continuously in Shanghai.The trends of different cancer types were varied.

Objective:To investigate the lung cancer incidence and mortality in 2016 and their trends from 2002 to 2016 in shanghai. Methods:The data of incidence and death on lung cancer in shanghai from 2002 to 2016 were obtained from the Shanghai Municipal Center for Disease Control and Prevention population-based cancer registry and Vital Statistics System.Lung Cancer incidence and mortality stratified by age of diagnosis or death,gender and age-group were analyzed.The number of cases and deaths,proportion,crude rates,age-specific rates,age-standardized rates,corresponding truncated age-standardized rates(35-64 years)and cumulative rates were calculated.Segi's 1960 world standard population was used for calculating age-standardized rates of incidence and mortality as well as truncated age-standardized rates.Trends in age-standardized rates of incidence and death for lung cancer in Shanghai from 2002-2016 were estimated by Joinpoint analysis and characterized by the annual percent change(APC). Results:The new lung cancer cases and deaths were 14 395 and 9 170 in Shanghai in 2016.The crude rate of incidence was 99.41/105,and the age-standardized rate of incidence was 39.76/105.New cases of lung cancer accounted for 19.34％of all malignant tumors in shanghai,ranking the first in the incidence spectrum of malignant tumors.The crude rate of mortality was 63.33/105,and the age-standardized rate was 21.57/105.Deaths of lung cancer accounted for 24.78％of all malignant tumor deaths in shanghai,ranking the first in the mortality spectrum of malignant tumors.The age-standardized rates of incidence and mortality for males were higher than those for females.The age-specific numbers and rates of incidence and mortality increased with age.The age-specific number and rate of incidence reached the peak at the age group of 60-64 years and 80-84 years respectively,and those of mortality peaked at the age group of 80-84 years and older than 85 years respectively.The incidence of lung cancer increased from 33.70/105 in 2002 to 39.76/1 05 in 2016 in Shanghai.Joinpoint analyses showed that the age-standardized rate of lung cancer incidence remained stable from 2002 to 2010(APC=-0.79,t=-1.46,P=0.175)but showed a significant upward trend with an average annual increase rate of 5.12％from 2010 to 2016(APC=5.12,t=6.97,P＜0.001).The standardized mortality showed a downward trend with an average annual decrease rate of 0.87％from 2002 to 2016(APC=-0.87,t=-2.87,P=0.013). Conclusion:The incidence of lung cancer in Shanghai during 2002-2016 presented an upward trend while the mortality of lung cancer showed a gradual downward trend.There are differences in the incidence and mortality of lung cancer among different gender and age groups.