[Purpose]To analyze the incidence and mortality of gastric cancer in Zhejiang cancer registration areas in 2021,and trends from 2000 to 2021.[Methods]The data of gastric cancer were obtained from Zhejiang cancer registration areas.The crude incidence/mortality rates,age-specific rates,and age-standardized incidence/mortality rates by Chinese standard population(ASRC)and the world standard population(ASRW)were calculated.The temporal trends were ana-lyzed by calculating annual percentage change(APC)and average annual percentage change(AAPC).[Results]A total of 7 602 new cases and 4 178 deaths of gastric cancer were reported in 2021.The incidence and mortality rates of gastric cancer in men were significantly higher than those in women;the incidence rate in urban areas was significantly higher than that in rural areas,while the mortality was slightly lower than that in rural areas.From 2000 to 2021,the ASRC of inci-dence rate decreased from 16.80/105 to 16.08/105(without statistical significance):an upward trend was observed from 2000 to 2009,whereas a downward trend became apparent from 2009 to 2021.From 2000 to 2021 the ASRC of mortality rate decreased from 13.59/105 to 8.02/105 with an AAPC of-2.62％(P＜0.001).The decline rate of female mortality rate(AAPC=-2.68％,95％CI:-3.61％～-1.68％,P＜0.001)was slightly higher than that of male(AAPC=-2.44％,95％CI:-3.06％～-1.61％,P＜0.001).[Conclusion]In 2021,both the incidence and mortality rates of gastric can-cer in Zhejiang Province were lower than the national average in China,which ranked 6th and 4th among all types of cancer.From 2000 to 2021,the overall burden of gastric cancer in Zhejiang Province showed a downward trend.

Objective:To investigate the clinical value of changes in serum total cholesterol (TC), chitinase protein-40 (YKL-40), and B7 homolog 4 (B7-H4) levels in patients with severe acute pancreatitis (SAP) complicated with abdominal compartment syndrome (ACS).Methods:A total of 388 SAP patients admitted to the First Affiliated Hospital of Xi'an Medical College from January 2022 to May 2024 were selected as the study group. They were grouped into the ACS group (227 cases) and a non-ACS group (161 cases) based on whether they had concurrent ACS. Another 215 individuals who underwent health check up were selected as the control group. Enzyme linked immunosorbent assay (ELISA) was applied to detect serum levels of TC, YKL-40, and B7-H4. Spearman test was applied to analyze the correlation between serum TC, YKL-40, B7-H4 levels and Acute Physiology and Chronic Health Status Scoring System Ⅱ(APACHE Ⅱ) score and intra-abdominal pressure (IAP)value. Multivariate Logistic regression was applied to analyze the influencing factors of SAP patients complicated ACS. The receiver operating characteristic (ROC) curve was applied to analyze the clinical diagnostic value of serum TC, YKL-40, B7-H4 levels in SAP patientscomplicated with ACS.Results:The serum levels of TC, YKL-40, and B7-H4 in the study group were higher than those in the control group : (5.79 ± 0.81) mmol/L vs. (4.67 ± 0.57) mmol/L, (49.46 ± 7.51) μg/L vs. (36.82 ± 5.93) μg/L, (63.66 ± 11.23) μg/L vs. (52.85 ± 9.21) μg/L, there were statistical differences ( P<0.05). The results of single factor analysis showed that time of stay in intensive care unit (ICU), C-reactive protein (CRP), white blood cell count (WBC), blood amylase (AMY), APACHEⅡ score, IAP value, serum TC, YKL-40, B7-H4 levels and heart rate were the risk factors for ACS in SAP patients ( P<0.05). The results of correlation analysis showed that the levels of serum TC, YKL-40 and B7-H4 were positively correlated with APACHEⅡ score and IAP value (the r value were 0.459, 0.511, 0.445 and 0.742, 0.794, 0.761, P<0.05). Multivariate Logistic regression analysis showed that time of stay in ICU, APACHE Ⅱ score, IAP value and high levels of serum TC, YKL-40 and B7-H4 were independent risk factors for ACS in SAP patients ( P<0.05). ROC curve analysis results showed that the area under the curve(IUC) of serum TC, YKL-40 and B7-H4 predicted SAP patients with ACS was 0.868. Conclusions:The levels of serum TC, YKL-40, and B7-H4 are higher in patients with SAP complicated with ACS, and their combined detection has better clinical value for SAP complicated with ACS patients.

Objective:To investigate the effects of hip replacement on human β-defensin 3 (HBd-3) and N-arachidonoylethanolamine (AEA) levels in older adult patients with intertrochanteric femoral fractures.Methods:This study was a retrospective analysis. A total of 110 older adult patients with intertrochanteric femoral fractures who received treatment at Xi'an Labor Union Hospital from March 2021 to December 2023. Based on the different treatment methods, patients were assigned to either the hip replacement group ( n = 55, hip replacement) or the control group ( n = 55, intramedullary nail fixation). The operation time, postoperative bed rest duration, hospital stay, and weight-bearing time were recorded for both groups. The levels of malondialdehyde, aldosterone, tumor necrosis factor-alpha, HBd-3, AEA, and calcitonin gene-related peptide were measured before and 3 days after surgery. Behaviors were evaluated using the 6-point behavioral rating scale before and 14 days after surgery. Hip function was evaluated using the Mayo hip function score before and 3 months after surgery. Complications were recorded for both groups. Results:The operation time in the hip replacement group was significantly longer than that in the control group [(75.58 ± 7.19) minutes vs. (60.03 ± 5.75) minutes, t = -12.53, P < 0.001]. However, postoperative bed rest duration, hospital stay, and weight-bearing time in the hip replacement group were (8.35 ± 1.63) days, (13.18 ± 2.32) days, and (6.19 ± 1.51) days, respectively, which were significantly shorter than those in the control group [(16.28 ± 2.02) days, (15.65 ± 3.15) days, (42.21 ± 6.67) days, t = 22.68, 4.68, 39.06, all P < 0.001]. The levels of malondialdehyde and aldosterone in the hip replacement group were (14.89 ± 3.06) U/L and (37.80 ± 3.80) ng/L, respectively, which were significantly lower than those in the control group [(16.73 ± 3.42) U/L, (40.85 ± 4.24) ng/L, t = 2.97, 3.97, both P < 0.05]. Additionally, the levels of tumor necrosis factor-α and HBd-3 in the hip replacement group were (18.85 ± 3.25) ng/L and (0.93 ± 0.15), respectively, which were significantly lower than those in the control group [(24.40 ± 4.43) ng/L, (1.22 ± 0.30), t = 7.49, 6.41, both P < 0.001]. The level of calcitonin gene-related peptide in the hip replacement group was significantly lower than that in the control group [(73.81 ± 12.26) ng/L vs. (89.39 ± 14.43) ng/L, t = 6.40, P < 0.001]. The level of anandamide in the hip replacement group was significantly higher than that in the control group [(112.65 ± 18.35) ng/L vs. (95.28 ± 14.07) ng/L, t = -5.57, P < 0.001]. The 6-point behavioral rating scale score in the hip replacement group was significantly lower than that in the control group [(1.05 ± 0.32) vs. (2.28 ± 0.67), t = 12.29, P < 0.05]. The Mayo hip function score for patients in the hip replacement group was significantly higher than that in the control group [(85.12 ± 4.33) vs. (79.38 ± 4.12), t = 7.12, P < 0.001]. The incidence of complications in the hip replacement group was significantly lower than that in the control group [1.82% (1/55) vs. 14.55% (8/55), χ2 = 4.36, P < 0.05]. Conclusions:Hip replacement therapy for older adult patients with intertrochanteric femoral fractures can shorten hospital stays, promote the reduction of postoperative stress responses and inflammation, downregulate HBd-3 and AEA levels, facilitate early functional rehabilitation, improve hip function, reduce complications, and enhance prognosis.

Objective To evaluate the efficacy and safety of rabbit anti-human thymocyte immuneglobulin(rATG)induction therapy in kidney transplant recipients from donation after cardiac death in China.Methods This was a prospective,multicenter,single-arm and interventional study conducted in China(NCT03099122).Adult patients who underwent kidney transplantation from donation after cardiac death and received rATG induction therapy(cumulative dose of 5 mg/kg)were included.Univariate and multivariate logistic regression analyses were used to identify factors associated with acute rejection(AR),delayed graft function(DGF),graft failure and patient death.The occurrence of adverse events was also analyzed.Results A total of 115 adult patients were enrolled in the study,of whom 107 were evaluable for efficacy.The incidence of biopsy-proven acute rejection(BPAR)and acute rejection(AR)was 2.8%(95%confidence interval 0.6%-8.0%)and 4.7%(95%confidence interval 1.5%-10.6%),respectively.The incidence of delayed graft function(DGF)was 13.1%(95%confidence interval 7.3%-21.0%).Graft and patient survival rates were 97.2%(95%confidence interval 92.0%-99.4%)and 99.1%(95%confidence interval 94.9%-100%),respectively.Multivariate logistic regression analysis showed that donor serum creatinine and recipient panel reactive antibodies were risk factors for DGF(both P<0.05).Common treatment-emergent adverse events(incidence>5%)included anemia(8.7%),infectious pneumonia(8.7%),and urinary tract infection(8.7%).Conclusions Standard-dose rATG induction therapy demonstrates low incidences of BPAR,AR,and DGF,and good safety in kidney transplant recipients from donation after cardiac death in China.

Objective:To investigate the characteristics of cardiopulmonary exercise testing and risk factors for decreased aerobic capacity in children with non-acute asthma exacerbations, to assess their cardiopulmonary health and to provide a basis for improvement.Methods:A case-control study.Sixty-one children with non-acute asthma exacerbations treated at the Outpatient Department of Children′s Hospital of Soochow University from October 2022 to December 2023 and 22 control children during the same period were included.Binary Logistic regression was employed to assess risk factors for decreased aerobic capacity in children with asthma.Results:Among the included 61 children with non-acute asthma exacerbations, there were 33 cases in the chronic persistent phase (chronic persistent phase group) and 28 in the clinical remission phase(clinical remission group).There were 22 children in the control group.During the peak exercise phase of the cardiopulmonary exercise testing, the mean kilogram body weight oxygen uptake (VO 2/kg), the percentage of predicted kilogram body weight oxygen uptake, and metabolic equivalents (Met) in the chronic persistent phase group were lower than those in the control and clinical remission phase groups.The mean VO 2/kg recovery from the cardiopulmonary exercise testing in the first minute in the chronic persistent phase group was lower than that in the control and clinical remission phase groups.The median Met and ventilation per minute recovery in the chronic persistent phase group were lower than those in the control group.The median heart rate recovery in asthma children was lower than that in control children.The percentage of cardiopulmonary exercise testing abnormalities was higher in asthma children with symptoms after excise than that in asthma children without symptoms after excise.The percentage of decreased ventilation efficiency in asthma children with symptoms after excise was higher than that in asthma children without symptoms after excise.Multivariate regression analysis showed that a higher body mass index (BMI) ( OR=1.577, 95% CI: 1.113-2.235, P=0.010) and a higher peak respiratory reserve ( OR=1.103, 95% CI: 1.018-1.195, P=0.017) were risk factors of decreased aerobic capacity.The risk of decreased aerobic capacity in the chronic persistent phase was 7.949 times higher than that in the clinical remission phase ( OR=7.949, 95% CI: 1.290-48.996, P=0.025). Conclusions:The aerobic capacity is decreased and ventilatory recovery is slower in children with chronic persistent asthma than those in healthy children.The heart rate recovery in asthma children is slower than that in healthy children.A high BMI, a high peak respiratory reserve, and chronic persistence of asthma are independent risk factors for decreased aerobic capacity in children with non-acute asthma exacerbations.asthma.

Mycophenolic acid (MPA), the active moiety of both mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS), serves as a primary immunosuppressant for maintaining solid organ transplants. Therapeutic drug monitoring (TDM) enhances treatment outcomes through tailored approaches. This study aimed to develop an evidence-based guideline for MPA TDM, facilitating its rational application in clinical settings. The guideline plan was drawn from the Institute of Medicine and World Health Organization (WHO) guidelines. Using the Delphi method, clinical questions and outcome indicators were generated. Systematic reviews, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence quality evaluations, expert opinions, and patient values guided evidence-based suggestions for the guideline. External reviews further refined the recommendations. The guideline for the TDM of MPA (IPGRP-2020CN099) consists of four sections and 16 recommendations encompassing target populations, monitoring strategies, dosage regimens, and influencing factors. High-risk populations, timing of TDM, area under the curve (AUC) versus trough concentration (C₀), target concentration ranges, monitoring frequency, and analytical methods are addressed. Formulation-specific recommendations, initial dosage regimens, populations with unique considerations, pharmacokinetic-informed dosing, body weight factors, pharmacogenetics, and drug‍-‍drug interactions are covered. The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy, promoting standardization of MPA TDM, and enhancing treatment efficacy and safety.
Mycophenolic Acid/administration & dosage* ; Drug Monitoring/methods* ; Humans ; Organ Transplantation ; Immunosuppressive Agents/administration & dosage* ; Delphi Technique

Objective To analyze the nonlinear relationship between hypothermic machine perfusion (HMP) parameters and delayed graft function (DGF) and optimize the construction of a predictive model for DGF. Methods The data of 923 recipients who underwent kidney transplantation from deceased donors were retrospectively analyzed. According to the occurrence of DGF, the recipients were divided into DGF group (n=823) and non-DGF group (n=100). Donor data, HMP parameters and recipient data were analyzed for both groups. The nonlinear relationship between HMP parameters and the occurrence of DGF was explored based on restricted cubic splines (RCS). Over-sampling, under-sampling and balanced sampling were used to address the imbalance in the proportion of DGF to construct logistic regression predictive models. The area under the curve (AUC) of each model was compared in the validation set, and a nomogram model was constructed. Results Donor BMI, cold ischemia time of the donor kidney, and HMP parameters (initial and final pressures, resistance, and perfusion time) were significantly different between the DGF and non-DGF groups (all P<0.05). The RCS analysis revealed a threshold-like nonlinear relationship between HMP parameters and the risk of DGF. Among the models constructed using different sampling methods, the balanced sampling model had the highest AUC. Using this model, a nomogram was constructed to stratify recipients based on risk scores. Recipients in the high-risk group had higher serum creatinine levels at 1, 6, and 12 months after kidney transplantation compared to those in the low-risk group (all P<0.05). Conclusions There is a nonlinear relationship between HMP parameters and the risk of DGF, and the threshold is helpful for organ quality assessment and monitoring of graft function after transplantation. The predictive model for DGF constructed on the base of balanced sampling algorithms helps perioperative decision-making and postoperative graft function monitoring of kidney transplantation.

OBJECTIVES: To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and. RESULTS: Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications. CONCLUSIONS The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

Objective To evaluate the efficacy and safety of rabbit anti-human thymocyte immuneglobulin(rATG)induction therapy in kidney transplant recipients from donation after cardiac death in China.Methods This was a prospective,multicenter,single-arm and interventional study conducted in China(NCT03099122).Adult patients who underwent kidney transplantation from donation after cardiac death and received rATG induction therapy(cumulative dose of 5 mg/kg)were included.Univariate and multivariate logistic regression analyses were used to identify factors associated with acute rejection(AR),delayed graft function(DGF),graft failure and patient death.The occurrence of adverse events was also analyzed.Results A total of 115 adult patients were enrolled in the study,of whom 107 were evaluable for efficacy.The incidence of biopsy-proven acute rejection(BPAR)and acute rejection(AR)was 2.8%(95%confidence interval 0.6%-8.0%)and 4.7%(95%confidence interval 1.5%-10.6%),respectively.The incidence of delayed graft function(DGF)was 13.1%(95%confidence interval 7.3%-21.0%).Graft and patient survival rates were 97.2%(95%confidence interval 92.0%-99.4%)and 99.1%(95%confidence interval 94.9%-100%),respectively.Multivariate logistic regression analysis showed that donor serum creatinine and recipient panel reactive antibodies were risk factors for DGF(both P<0.05).Common treatment-emergent adverse events(incidence>5%)included anemia(8.7%),infectious pneumonia(8.7%),and urinary tract infection(8.7%).Conclusions Standard-dose rATG induction therapy demonstrates low incidences of BPAR,AR,and DGF,and good safety in kidney transplant recipients from donation after cardiac death in China.