[Purpose]To explore the association between body weight change and long-term risk of esophageal cancer mortality based on Linxian General Population Nutrition Intervention study.[Methods]A total of 21 028 healthy residents aged 40～69 years old at baseline in Linxian of Henan Province were recruited as the study cohort,their body weight were measured in late 1985 and early 1991,and the esophageal cancer mortality was prospectively followed up until March 2016.The cohort was divided into four groups according to weight difference between the two measure-ments,the body weight maintenance group(change＜2 kg)was used as the reference group.The Cox proportional risk model was used to estimate the hazard ratio(HR)and 95％confidence inter-val(CI)for death from esophageal cancer in the weight loss ≥2 kg group,weight gain 2～5 kg group and weight gain ≥5 kg group.[Results]A total of 1 681 esophageal cancer deaths oc-curred during the follow-up after the last weight measurement.After adjusting for baseline age and sex,the risk of esophageal cancer death was 13％(HR=0.87,95％CI:0.77～1.00)and 16％(HR=0.84,95％CI:0.72～1.00)lower in the weight gain 2～5 kg and ≥5 kg groups compared to the weight maintenance group,respectively.The risk of esophageal cancer death was 23％higher in the weight loss ≥2 kg group than in the weight maintenance group(HR=1.23,95％CI:1.09～1.38).After adjusting for age,sex,baseline BMI group,smoking status,alcohol consumption,family history of cancer,education level,commune and nutritional intervention arms,weight loss ≥2 kg was still associated with a significantly increased risk of esophageal cancer death(HR=1.19,95％CI:1.06～1.34).Subgroup analysis showed there was no statistically significant interaction between changes in body weight and age,sex,and baseline BMI status on the risk of esophageal cancer death.[Conclusion]Weight loss is associated with an increased risk of esophageal cancer death.People in the high incidence area of esophageal squamous cell carcinoma should maintain their current weight or gain weight appropriately while maintaining a healthy weight state to reduce the risk of esophageal cancer death.

Malakoplakia is a rare granulomatous inflammatory disease，Almost 75% of cases of malakoplakia mainly affect the genitourinary tracts，and a small proportion affect the intestines. Its occurrence in the adrenal gland is extremely rare. We report a case of adrenal malakoplakia. Who was presented to the hospital for chronic left upper abdominal pain and fever. The patient was admitted to our hospital due to the discovery of a huge mass in the left adrenal gland by CT. Pathological features of Michaelis Gutmann bodies（M-G bodies）were observed through adrenal biopsy，which revealed adrenal Malakoplakia. E. coli was cultured from both blood and the pus in the left renal parenchymal aera. After regular antibiotics treatment，the patient's fever symptoms improved compared to before. CT imaging showed that the adrenal mass had decreased in size，indicating effective treatment. Adrenal malakoplakia is easily misdiagnosed as malignant disease because of its radiological occupying performance. And its gold standard is pathology. For patients with symptoms of infection，we recommend urine，blood，pus in the pararenal area culture tests，and treatment with sensitive antibiotics according to the results of drug sensitivity testing.

Objective:To investigate the dosimetric characteristics of intensity modulated proton therapy (IMPT) and intensity modulated radiation therapy (IMRT) for lung cancers.Methods:Three lung cancer patients (central-lower, central, and peripheral types) admitted to Shandong Cancer Hospital and Institute from January 2024 to May 2024 were selected as the research subjects. IMPT and IMRT plans were designed for each case based on the anatomical location of the clinical target volume and the dose constraints for organs at risk (OARs). Dosimetric parameters, including conformity index (CI), homogeneity index (HI), and gradient index (GI) for target coverage, as well as OARs dosimetric parameters were evaluated. The volume of additional dose deposition in the body was compared by assessing regions receiving 10%, 30%, and 50% of the prescription dose.Results:For all three cases, IMRT plans demonstrated higher CI values (0.80, 0.60, and 0.79) compared to IMPT plans (0.61, 0.57, and 0.34). IMPT plans yielded lower HI values (0.07, 0.06, and 0.06) than IMRT plans (0.09, 0.15, and 0.09) and lower GI values (2.84, 2.47, and 4.56 vs. 4.91, 3.09, and 4.99 for IMRT plans). Compared with the IMRT plans, the low-dose region in the ipsilateral lung was significantly reduced in IMPT plans (V 5 of the IMPT plans were 20.59%, 46.29%, 10.94%, respectively; V 5 of the IMRT plans were 48.91%, 60.63%, 19.92%, respectively), but there was no significant advantage in the high-dose region compared to IMRT plans (V 20 of the IMPT plans were 12.88%, 34.75%, 5.21%, respectively; V 20 of the IMRT plans were 21.70%, 36.50%, 5.31%, respectively). The dose to the contralateral lung and heart was significantly reduced in IMPT plans [the D mean of the contralateral lung in the IMPT plans were 0.08, 0.04, and 0.00 Gy (RBE), respectively, and those in the IMRT plans were 3.25, 1.18, and 0.55 Gy, respectively; the heart D mean in the IMPT plans were 6.23, 7.04, and 0.00 Gy (RBE), respectively, while those of the IMRT plans were 18.33, 10.27, and 0.08 Gy, respectively). IMPT plans significantly reduced the volumes receiving 10% of the prescription dose by 65.94%, 25.57% and 72.47%, respectively, compared to IMRT plans. The volumes IMPT plans occupied by 30% of the prescription dose area in the body were reduced by 54.97%, 26.47% and 39.04%, respectively, compared to the IMRT plans. The volumes IMPT plans occupied by 50% of the prescription dose area in the body were reduced by 54.49%, 30.43% and 28.89%, respectively, compared to the IMRT plans. Conclusions:IMPT plan significantly reduces the V 5 of the ipsilateral lung, the D mean of the contralateral lung and the heart, while maintaining target coverage compared with IMRT plan for lung cancers. However, IMPT plan does not show much more advantage than IMRT plan in the ipsilateral lung V 20. IMPT can reduce the additional exposure volume within the body.

[Purpose]To explore the association between body weight change and long-term risk of esophageal cancer mortality based on Linxian General Population Nutrition Intervention study.[Methods]A total of 21 028 healthy residents aged 40～69 years old at baseline in Linxian of Henan Province were recruited as the study cohort,their body weight were measured in late 1985 and early 1991,and the esophageal cancer mortality was prospectively followed up until March 2016.The cohort was divided into four groups according to weight difference between the two measure-ments,the body weight maintenance group(change＜2 kg)was used as the reference group.The Cox proportional risk model was used to estimate the hazard ratio(HR)and 95％confidence inter-val(CI)for death from esophageal cancer in the weight loss ≥2 kg group,weight gain 2～5 kg group and weight gain ≥5 kg group.[Results]A total of 1 681 esophageal cancer deaths oc-curred during the follow-up after the last weight measurement.After adjusting for baseline age and sex,the risk of esophageal cancer death was 13％(HR=0.87,95％CI:0.77～1.00)and 16％(HR=0.84,95％CI:0.72～1.00)lower in the weight gain 2～5 kg and ≥5 kg groups compared to the weight maintenance group,respectively.The risk of esophageal cancer death was 23％higher in the weight loss ≥2 kg group than in the weight maintenance group(HR=1.23,95％CI:1.09～1.38).After adjusting for age,sex,baseline BMI group,smoking status,alcohol consumption,family history of cancer,education level,commune and nutritional intervention arms,weight loss ≥2 kg was still associated with a significantly increased risk of esophageal cancer death(HR=1.19,95％CI:1.06～1.34).Subgroup analysis showed there was no statistically significant interaction between changes in body weight and age,sex,and baseline BMI status on the risk of esophageal cancer death.[Conclusion]Weight loss is associated with an increased risk of esophageal cancer death.People in the high incidence area of esophageal squamous cell carcinoma should maintain their current weight or gain weight appropriately while maintaining a healthy weight state to reduce the risk of esophageal cancer death.

Malakoplakia is a rare granulomatous inflammatory disease，Almost 75% of cases of malakoplakia mainly affect the genitourinary tracts，and a small proportion affect the intestines. Its occurrence in the adrenal gland is extremely rare. We report a case of adrenal malakoplakia. Who was presented to the hospital for chronic left upper abdominal pain and fever. The patient was admitted to our hospital due to the discovery of a huge mass in the left adrenal gland by CT. Pathological features of Michaelis Gutmann bodies（M-G bodies）were observed through adrenal biopsy，which revealed adrenal Malakoplakia. E. coli was cultured from both blood and the pus in the left renal parenchymal aera. After regular antibiotics treatment，the patient's fever symptoms improved compared to before. CT imaging showed that the adrenal mass had decreased in size，indicating effective treatment. Adrenal malakoplakia is easily misdiagnosed as malignant disease because of its radiological occupying performance. And its gold standard is pathology. For patients with symptoms of infection，we recommend urine，blood，pus in the pararenal area culture tests，and treatment with sensitive antibiotics according to the results of drug sensitivity testing.

Background::Whether the dynamic weight change is an independent risk factor for mortality remains controversial. This study aimed to examine the association between weight change and risk of all-cause and cause-specific mortality based on the Linxian Nutrition Intervention Trial (NIT) cohort.Methods::Body weight of 21,028 healthy residents of Linxian, Henan province, aged 40-69 years was measured two times from 1986 to 1991. Outcome events were prospectively collected up to 2016. Weight maintenance group (weight change <2 kg) or stable normal weight group was treated as the reference. Cox proportional hazard model was performed to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) to estimate the risk of mortality.Results::A total of 21,028 subjects were included in the final analysis. Compared with the weight maintenance group, subjects with weight loss ≥2 kg had an increased risk of death from all-cause (HR All-cause = 1.14, 95% CI: 1.09-1.19, P <0.001), cancer (HR Cancer = 1.12, 95% CI: 1.03-1.21, P = 0.009), and heart disease (HR Heart diseases = 1.21, 95% CI: 1.11-1.31, P <0.001), whereas subjects with weight gain ≥5 kg had 11% (HR Cancer = 0.89, 95% CI: 0.79-0.99, P = 0.033) lower risk of cancer mortality and 23% higher risk of stroke mortality (HR Stroke = 1.23,95% CI: 1.12-1.34, P <0.001). For the change of weight status, both going from overweight to normal weight and becoming underweight within 5 years could increase the risk of total death (HR Overweight to normal = 1.18, 95% CI: 1.09-1.27; HR Becoming underweight = 1.35, 95% CI: 1.25-1.46) and cancer death (HR Overweight to normal = 1.20, 95% CI: 1.04-1.39; HR Becoming underweight = 1.44, 95% CI: 1.24-1.67), while stable overweight could increase the risk of total death (HR Stable overweight = 1.11, 95% CI: 1.05-1.17) and death from stroke (HR Stable overweight = 1.44, 95% CI: 1.33-1.56). Interaction effects were observed between age and weight change on cancer mortality, as well as between baseline BMI and weight change on all-cause, heart disease, and stroke mortality (all Pinteraction <0.01). Conclusions::Weight loss was associated with an increased risk of all-cause, cancer, and heart disease mortality, whereas excessive weight gain and stable overweight were associated with a higher risk of stroke mortality. Efforts of weight management should be taken to improve health status.Trial registration::https://classic.clinicaltrials.gov/, NCT00342654.

Objective:To summarize the trend of disease burden of esophageal cancer in 4 countries with high incidence of esophageal cancer and analyse the proportion of death attribution of three common risk factors, which helps to provide reference for the prevention and control of esophageal cancer.Methods:Based on the 2019 Global Burden of Disease Study (GBD2019) database and visualization platform, the absolute number and age-standardized rates of incidence, mortality and disability adjusted life years (DALY) of esophageal cancer in 4 countries with high incidence of esophageal cancer (China, Iran, Russia and South Africa) from 1990 to 2019 were described. The Joinpoint regression model was used for time trend analysis, and the annual percentage change (APC) and average annual percentage change (AAPC) of age-standardized incidence, age-standardized mortality, and age-standardized DALY rate of esophageal cancer were calculated. The proportion of death attribution of three common risk factors (smoking, alcohol consumption and low fruit intake) in 2019 was compared, and the differences in the population attributable fraction (PAF) for risk factors globally and in 4 countries were analyzed. The incidence and mortality of esophageal cancer under different socio-demographic index (SDI) were analyzed by drawing fitting curves.Results:From 1990 to 2019, the age-standardized incidence, mortality and DALY rates of esophageal cancer showed an overall decreasing trend globally and in 4 countries with high incidence of esophageal cancer. The age-standardized incidence rate of esophageal cancer in China decreased from 21.0/100 000 to 13.9/100 000 (AAPC = -1.4%, 95% CI -1.3% - -1.1%), the age-standardized mortality rate decreased from 22.1/100 000 to 13.1/100 000 (AAPC = -1.8%, 95% CI -1.9% - -1.7%), and the age-standardized DALY rate decreased from 507.0/100 000 to 227.5/100 000 (AAPC = -2.1%, 95% CI -2.2% - -1.9%). These rates in China had been decreasing at a much faster rate than the other 3 countries. Both Chinese men and Russian men had higher rates of esophageal cancer deaths due to smoking and alcohol consumption than the global average (PAF smoking: 59.2%, 56.7% vs. 51.2%; PAF alcohol consumption: 29.7%, 38.3% vs. 28.4%). The proportion of alcohol-related esophageal cancer deaths in Russian women was higher than the global average for women (PAF: 14.9% vs. 7.3%). Attributing low fruit intake to esophageal cancer deaths in South African men and women were higher than the global average for men and women (PAF men: 20.8% vs. 9.8%; PAF women: 21.3% vs. 11.7%). The age-standardized incidence and mortality rates in China and South Africa were consistently higher than would be expected for the same level of SDI, while those in Iran were consistently lower than would be expected, and Russia was broadly in line with expectation. Conclusions:Although the disease burden of countries with high incidence of esophageal cancer in the world has been effectively controlled, the disease burden of esophageal cancer in China is still higher than that in other countries. Targeted prevention measures should be made according to the epidemiological characteristics of esophageal cancer in Chinese population.

Esophageal cancer (EC) is one of the most fatal cancers worldwide. According to GLOBOCAN 2020, it was estimated that there were 600, 000 new EC cases and 540 000 EC deaths, while nearly half of all newly diagnosed cases of EC and associated deaths worldwide occurred in China. The annual incidence and mortality of EC have been reduced in the last 20 years in China. However, the early symptoms and signs of EC are not easily distinguished and the disease tends to be within the middle and late stage of pathogenesis when identified, leading to its low 5-year survival rate. Therefore, it could help effectively reduce the burden of EC by clarifying its etiology and risk factors, as well as taking preventive and early diagnosis measures. This article reviews the epidemiology, etiology, screening and early diagnosis of EC in China, to provide systematic references for EC prevention and control.

Pancreatic cancer (PC) is one of most fatal cancers worldwide. According to the 2020 cancer registry data, PC was the 12th common cancer and the 7th leading cause of cancer deaths globally. PC is a rare cancer, but the 5-year survival is very low because of its rapid progress and poor prognosis. The disease burden of PC in China is quite different from western countries, indicating that the distribution of genetic factors, lifestyle and environmental factors varies from different regions. This article reviews the epidemiology, etiology and screening of PC in China, to provide systematic references for PC prevention and control.

Objective:To investigate the long-term risk of esophageal cancer from fresh fruit consumption. Methods:In 1985, a total of 29,479 participants aged between 40 and 69 years old were recruited for this study. Demographic characteristics, lifestyle, history of diseases, and food intake frequency were surveyed at the baseline and were then followed up. Through December 31, 2015, a median of 31.79 years of observation was obtained. The primary endpoint was death from esophageal cancer. The hazard ratio and 95%confi-dence intervals for fresh fruit consumption were calculated using a Cox proportional hazard model. Results:Overall, 31.09%of partici-pants reported consuming fresh fruit more than once every week. Compared with participants who never or rarely consumed fresh fruit, those who consumed fresh fruit more than once a week had a lower long-term risk of esophageal cancer. Death rate decreased to 7%among those who ate fresh fruit more than once a week, especially among males (11%) and those with positive smoking history (13%). Conclusion:Fresh fruit consumption is associated with a lower risk of death from esophageal cancer, but the etiological mecha-nism needs to be investigated further.