Objective To analyze the disease burden of type 2 diabetes mellitus(T2DM)attributable to high body mass index(BMI)in China from 1990 to 2019 in the context of rapid growth in high BMI rates.Methods Data was extracted from GBD 2019,and the disease burden of T2DM attributable to high BMI in China from 1990 to 2019 was analyzed for overall and subgroups defined by age and sex separately and jointly.The joinpoint regression models were used to analyze the trends of standardized death rate and standardized disability-adjusted life year(DALY)rate.Results From 1990 to 2019,the prevalence of T2DM increased from 2928.78 per 100000 to 6328.79 per 100000 in China.The number of T2DM deaths attributed to high BMI increased from 10500 to 47500 and the standardized death rate increased from 1.25 per 100000 to 2.39 per 100000.The attributed DALY increased from 771800 person-years to 3737600 person-years,and the standardized DALY rate increased from 80.21 per 100000 to 181.54 per 100000.Years of life lost(YLL)and years lived with disability(YLD)and their standardized rates also increased.From 1990 to 2019,the annual average percentage change of the standardized death rate and the standardized DALY rate of T2DM attributable to high BMI were 2.28%and 2.81%,respectively,which were statistically significant(P<0.05)and males were both higher than females.The standardized DALY rate and the standardized death rate of males exceeded that of females in 2010 and 2014,respectively.Age-stratified results showed that the burden of T2DM,which is attributed to a high BMI,is even greater in people over 50 years old.The YLD rate attributable to high BMI increased the most among the 15～49 age group,reaching 323.99%.Conclusion From 1990 to 2019,the disease burden of T2DM that can be attributed to high BMI increased significantly in China.It is necessary to strengthen prevention and control efforts,effectively manage population BMI,and adopt key interventions for high-risk groups to reduce the disease burden of T2DM.

Background/Aims: Four-week treatment of linvencorvir (RO7049389) was generally safe and well tolerated, and showed anti-viral activity in chronic hepatitis B (CHB) patients. This study evaluated the efficacy, safety, and pharmacokinetics of 48-week treatment with linvencorvir plus standard of care (SoC) in CHB patients. Methods: This was a multicentre, non-randomized, non-controlled, open-label phase 2 study enrolling three cohorts: nucleos(t)ide analogue (NUC)-suppressed patients received linvencorvir plus NUC (Cohort A, n=32); treatment-naïve patients received linvencorvir plus NUC without (Cohort B, n=10) or with (Cohort C, n=30) pegylated interferon-α (Peg-IFN-α). Treatment duration was 48 weeks, followed by NUC alone for 24 weeks. Results: 68 patients completed the study. No patient achieved functional cure (sustained HBsAg loss and unquantifiable HBV DNA). By Week 48, 89% of treatment-naïve patients (10/10 Cohort B; 24/28 Cohort C) reached unquantifiable HBV DNA. Unquantifiable HBV RNA was achieved in 92% of patients with quantifiable baseline HBV RNA (14/15 Cohort A, 8/8 Cohort B, 22/25 Cohort C) at Week 48 along with partially sustained HBV RNA responses in treatment-naïve patients during follow-up period. Pronounced reductions in HBeAg and HBcrAg were observed in treatment-naïve patients, while HBsAg decline was only observed in Cohort C. Most adverse events were grade 1–2, and no linvencorvir-related serious adverse events were reported. Conclusions 48-week linvencorvir plus SoC was generally safe and well tolerated, and resulted in potent HBV DNA and RNA suppression. However, 48-week linvencorvir plus NUC with or without Peg-IFN did not result in the achievement of functional cure in any patient.

Objective:To investigate Helicobactor pylori (H. pylori) infection status and interfamilial transmission pattern in Zhengzhou area. Methods:A cross-sectional study was conducted from September 2020 to march 2021, among 731 individual from 266 families randomly selected from 9 communities of Zhengzhou area. H. pylori infection status was determined by serum antibody tests, and 13C-urea breath test was performed in the previously eradicated population to clarify the current infection status. The individual and familial infection rate, infection status for couples and children and adolescent were analyzed. Results:Among 731 individuals from 266 families, 397 of them were H. pylori positive. The individual infection rate was 54.31% (397/731); among infected individuals 77.83% (307/397) were infected with type Ⅰ strain, 22.67% (90/397) were infected by type Ⅱ strain. Annual household income ( χ2=0.419, 0.410, 0.213, all P>0.05), smoking history (χ 2=0.071, P>0.05), drinking history ( χ2=0.071, P>0.05), dining place ( χ2=0.009, P>0.05), gastrointestinal symptoms ( χ2=0.047, P>0.05), family history of gastric disease ( χ2=0.069, P>0.05), and history of gastric cancer ( χ2=0.004, P>0.05) had no significant differences between H. pylori-positive and -negative groups, but the infection rate in individuals with higher education level was lower ( χ2=4.449, P<0.05). The infection rate was significantly higher in≥18 age groups compared with<18 age groups ( χ2=6.531, 23.362, 20.671, 24.244, 37.948, 14.597 and 5.170, all P<0.05). The familial H. pylori infection rate was 87.59% (233/266), and in 61 families all member were infected (26.18%, 61/233). The positive rate was 23.08% (6/26) in 50 families with children under 18 years when both parents were infected. Among 231 coupled families, both couples were infected in 78 families (33.76%), one couple was infected in 113 families (48.92%), and both couples were not infected in 40 (17.32%). With the increase of marriage time, the infection rate of both spouses increased significantly ( χ2=7.775, 12.662, 15.487, all P<0.05). Conclusions:The distribution of H. pylori infection presents a family cluster pattern, and intrafamilial infection is an important transmission rout of H. pylori. The type I strain of H. pylori is the dominate strain in this area.

Patients in the intensive care unit (ICU) often need to have various catheters placed on their bodies due to their severe condition. In order to prevent the occurrence of unplanned extubation, patients' hands should be restrained appropriately. The current restraint gloves used in clinical practice have problems such as improper restraint, easy falling off of oxygen saturation monitoring probes, and pressure injury of hands. Therefore, department of critical care medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine designed a wrist restraint glove suitable for restless patients, and obtained the national utility model patent (ZL 2020 2 1612453.7). The device is composed of restraint gloves and restraint rings, which can not only restrain patients, but also continuously monitor the changes of blood oxygen saturation in patients with restfulness. This device is convenient to use, low cost, comfortable to wear, and can prevent the occurrence of device-related pressure injuries, which is suitable for clinical application.
Humans ; Wrist ; Intensive Care Units ; Critical Care ; Hand ; Upper Extremity ; Restraint, Physical

Objective:To analyze clinical characteristics of patients with novel coronavirus Omicron variant of concern infection, and to provide practical data and experience for subsequent clinical treatment.Methods:A retrospective analysis was performed for the clinical data of 5 cases with novel coronavirus Omicron variant of concern infection treated in the First Hospital of Jiaxing from December 18, 2021 to January 28, 2022. The patients' clinical data were recorded, including gender, age, length of hospital stay, vaccination status, clinical symptoms, laboratory indicators [white blood cell count (WBC), lymphocyte count (LYM), eosinophil count (EOS), hypersensitivity C-reactive protein (hs-CRP), novel coronavirus antibody immunoglobulin (IgG and IgM)], chest CT, treatment course and disease outcome.Results:All 5 patients were male, aged 24-37 years old. Four patients were vaccinated with novel coronavirus vaccine (one patient received 3 doses of the vaccine and 3 patients received only the first 2 doses of the vaccine), and no infection was found in chest CT. Laboratory examination showed that WBC, LYM, EOS and hs-CRP levels were normal, and only showed mild symptoms of upper respiratory tract infection. One patient was not vaccinated with novel coronavirus vaccine, and signs of viral pneumonia could be seen in chest CT, laboratory examination showed that WBC and hs-CRP levels increased, suggesting that bacterial infection, fever, cough, sputum and other respiratory symptoms were obvious, and the treatment time was long. All 5 patients were treated with Chinese medicine Lotus antipyretic and Baihu Yinqiao decoction based on routine antiviral therapy.Conclusions:Patients with novel coronavirus Omicron variant of concern infection vaccinated with the novel coronavirus vaccine have milder clinical symptoms, with less obvious chest CT findings and faster recovery. Chinese medicine Lotus antipyretic and Baihu Yinqiao decoction has obvious therapeutic effect on such patients.

Objective:To compare and analyze the image quality, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of T 1WI_Star_VIBE_FS sequence in MRI simulation of neck tumors with different scanning methods, aiming to determine the optimal scanning method. Methods:A retrospective analysis of 78 patients receiving MRI contrast scan was performed. All patients were randomly divided into three groups according to three different scanning methods including bolus mode (group A, n=23), segmentation splicing mode (group B, n=18) and the combination mode (group C, n=37). The image quality, SNR and CNR of the anterior soft tissues of neck were statistically compared. Results:A higher image quality score was obtained in group C. The mean SNR and CNR in three groups were calculated as 214.70±148.78, 91.95±59.26, 307.61±127.80, and 208.74±148.27, 85.79±59.50, 301.58±127.48, respectively. The image quality score, SNR and CNR in group C were significantly better compared with those in group A and B (all P<0.01). Conclusion:Combination of bolus and segmentation splicing modes is a recommended approach in MRI simulation during radiotherapy of neck tumors.

Objective:To understand the components, performance, acceptance test and quality assurance (QA) protocols of the new Varian Halcyon accelerator through the procedures of installation product acceptance (IPA).Methods:Per Varian IPA protocol, TG-142 for LINAC and TG-148 for tomotherapy QA protocols, the software license, safety interlock, mechanical accuracy, dosimetric performance and imager system were checked thoroughly. Some parameters were benchmarked to the conventional TrueBeam system.Results:The system has been fully licensed. Safety interlock was normal. Mechanical accuracy: The maximum deviation of beam stability per gantry rotation was 1.13%. The size of isocenter was>0.59mm. The offsets of MV imager, collimation rotation and absolute gantry rotation were 0.09mm, -0.21° and 0.11°, respectively. The maximum offsets of couch, virtual-to-isocenter were 0.15mm (vertical) and -0.04mm (vertical), respectively. Beam performance: The depth deviation of maximum dose was 0.1cm. The offset of percentage depth dose at 10cm was 0.5%. The maximum deviations of off-axis-intensity, symmetry, and repeatability were 0.9%, 0.94% and -0.44%, respectively. MV imager: The dark field mean pixel value, noise, corrected pixels, defective lines, sensitivity and linearity disparity of dose were 614, 4.4, 3626, 0, 19177, and 0.47%, respectively. All values were within the range of tolerance. Visual check of contrast resolution and small object detection was all satisfactory.Conclusions:Without Halcyon-specific TG report or guidelines, manufacture-provided IPA manual can be helpful with the installation of acceptance and QA protocols. IPA has been successfully performed for Halcyon at Peking University Cancer Hospital. The automated workflow improves the clinical efficiency by simplifying the operations.

Objective:To explore the feasibility and optimization effect of modifying the Henry Ford Hospital (HFHS) RapidPlan model for stereotactic body radiation therapy planning based on local requirements.Methods:The following changes were made based on Henry Ford Health System(HFHS) Rapid Plan Lung SBRT model, taking the latest clinical guideline evidence and local clinical practice into account: Internal gross target volume(IGTV) and organ at risk(OAR) structure, lung, were added and set corresponding parameters.The upper value of planning target volume (PTV) was adjusted from 109% to 125%. The original training library was replaced with 73 local historical simultaneous integrated boosting plans, and statistical verification and outlier cleaning of the initial trained model were performed using Model Analytics software. Totally 10 cases not included in the model library were selected for independent verification, and automatic optimization result of the models before and after modifying were compared under the same beam condition. The following dosimetric parameters were compared after target dose normalization: conformal index (CI) of target volume, the mean doses, maximum doses and dose-volume parameters of OARs.Results:The " tail" of the PTV′s DVH and the " shoulder" and " tail" of the IGTV′s DVH of model M (local) validation plan (M (local)_P) performs higher than the original model HFHS (HFHS_P). The PTV_CI (1.07±0.13) of M local_P were significantly smaller than HFHS_P (1.25±0.24) ( Z=-2.497, P<0.05). Except for Heart_ D15 cm 3 and Heart_ Dmax, most of the M local_P dosimetric parameters of OARs were lower than HFHS_P, and the standard deviation was smaller. However, the difference of between two plans was no more than 3.06%. 10 HFHS_P plans don′t satisfy dose parameters requirement, two of which PTV_CI values are 1.52 and 1.74, far beyond the clinically acceptable range. Conclusions:Commercial model HFHS could be localized by replacing training library and adjusting parameters. Moreover, plans optimized by the modified model are local clinical acceptable in the aspects of target volume conformity and hotspots, and have a better performance in terms of OAR sparing and plan consistency.

Objective:To characterize the key dose response properties of the novel presage sheet dosimeters for radiotherapy dose verification, including absorption spectra, linearity, dose range and stability.Methods:The same batch of presage sheet dosimeters were irradiated by a radiotherapy linac. The absorption spectra within 400-700 nm were read out with a spectrophotometer, and the R-G-B3 absorption changes read out with a film flatbed scanner was compared before and after irradiation.Results:An absorption peak was clearly identified at 628 nm, where absorptions change in high linearity with delivered doses ( R2=0.9999). A flat valley region is identified around 490 nm, where dose induced absorption changes were negligible. The readout sensitivity of the R-channel of the flatbed scanner was higher than both in green and blue channels. In the dose range below 10 Gy, the R-channel absorptions are in significant linearity with doses ( R2=0.9999), with absorptions change in an obvious quadratic trend in the range beyond 10 Gy ( R2=0.9999). The dose range of presage sheets was more than 94.6 Gy. The absorptions were well preserved within 1 h post-irradation, and then are shown to increase gradually, where the increase speeds are dose-related. The post-irradiation integrity of dose falloff gradients are shown with negligible gradient blurring. Conclusions:The novel presage sheets shown to have reasonable dose response linearity, large dose range, desirable post-irradiation dose gradient integrity and negligible fractionation effect, which indicates its great potentials in integral dose verification of high-dose and multiple target radiotherapy deliveries.

Objective:To establish a new model for the prediction of severe outcomes of COVID-19 patients and provide more comprehensive, accurate and timely indicators for the early identification of severe COVID-19 patients.Methods:Based on the patients’ admission detection indicators, mild or severe status of COVID-19, and dynamic changes in admission indicators (the differences between indicators of two measurements) and other input variables, XGBoost method was applied to establish a prediction model to evaluate the risk of severe outcomes of the COVID-19 patients after admission. Follow up was done for the selected patients from admission to discharge, and their outcomes were observed to evaluate the predicted results of this model.Results:In the training set of 100 COVID-19 patients, six predictors with higher scores were screened and a prediction model was established. The high-risk range of the predictor variables was calculated as: blood oxygen saturation <94 %, peripheral white blood cells count >8.0×10 9, change in systolic blood pressure <-2.5 mmHg, heart rate >90 beats/min, multiple small patchy shadows, age >30 years, and change in heart rate <12.5 beats/min. The prediction sensitivity of the model based on the training set was 61.7 %, and the missed diagnosis rate was 38.3 %. The prediction sensitivity of the model based on the test set was 75.0 %, and the missed diagnosis rate was 25.0 %. Conclusions:Compared with the traditional prediction (i.e. using indicators from the first test at admission and the critical admission conditions to assess whether patients are in mild or severe status), the new model’s prediction additionally takes into account of the baseline physiological indicators and dynamic changes of COVID-19 patients, so it can predict the risk of severe outcomes in COVID-19 patients more comprehensively and accurately to reduce the missed diagnosis of severe COVID-19.