Linxian County in Henan Province, Northern China is known as the region with the highest incidence and mortality rate of esophageal cancer worldwide. Since 1959, the Henan medical team has conducted field work on esophageal cancer prevention and treatment in Linxian. Through three generations of effort exerted by oncologists over 65 years of research on esophageal cancer prevention and treatment in Linxian, the incidence rate of esophageal squamous cell carcinoma in this area has dropped by nearly 50%, and the 5-year survival rate has increased to 40%, reaching the international leading level. This article aims to summarize the history, present opportunities and new challenges, and explore the experience of esophageal cancer prevention and treatment in Linxian (referred to as the “Linxian experience”), providing reference and guidance to cancer prevention and treatment research in China.

BACKGROUND: LY01005 (Goserelin acetate sustained-release microsphere injection) is a modified gonadotropin-releasing hormone (GnRH) agonist injected monthly. This phase III trial study aimed to evaluated the efficacy and safety of LY01005 in Chinese patients with prostate cancer. METHODS: We conducted a randomized controlled, open-label, non-inferiority trial across 49 sites in China. This study included 290 patients with prostate cancer who received either LY01005 or goserelin implants every 28 days for three injections. The primary efficacy endpoints were the percentage of patients with testosterone suppression ≤50 ng/dL at day 29 and the cumulative probability of testosterone ≤50 ng/dL from day 29 to 85. Non-inferiority was prespecified at a margin of -10%. Secondary endpoints included significant castration (≤20 ng/dL), testosterone surge within 72 h following repeated dosing, and changes in luteinizing hormone, follicle-stimulating hormone, and prostate specific antigen levels. RESULTS: On day 29, in the LY01005 and goserelin implant groups, testosterone concentrations fell below medical-castration levels in 99.3% (142/143) and 100% (140/140) of patients, respectively, with a difference of -0.7% (95% confidence interval [CI], -3.9% to 2.0%) between the two groups. The cumulative probabilities of maintaining castration from days 29 to 85 were 99.3% and 97.8%, respectively, with a between-group difference of 1.5% (95% CI, -1.3% to 4.4%). Both results met the criterion for non-inferiority. Secondary endpoints were similar between groups. Both treatments were well-tolerated. LY01005 was associated with fewer injection-site reactions than the goserelin implant (0% vs . 1.4% [2/145]). CONCLUSION: LY01005 is as effective as goserelin implants in reducing testosterone to castration levels, with a similar safety profile. TRIAL REGISTRATION ClinicalTrials.gov, NCT04563936.
Humans ; Male ; Antineoplastic Agents, Hormonal/therapeutic use* ; East Asian People ; Gonadotropin-Releasing Hormone/agonists* ; Goserelin/therapeutic use* ; Prostate-Specific Antigen ; Prostatic Neoplasms/drug therapy* ; Testosterone

OBJECTIVE: To compare the effect on facial acupoint temperature between acupuncture at Houxi (SI 3) and Dazhui (GV 14) so as to verify "Houxi (SI 3) communicating the governor vessel" based on the infrared thermal imaging technology. METHODS: Thirty-five healthy subjects (5 cases dropped off) were collected and before-after study in the same subject was adopted. The subjects were successively assigned into a sham-acupuncture group, a Houxi group, a Wangu group and a Dazhui group. Sham-acupuncture at Houxi (SI 3) on the left, acupuncture at Houxi (SI 3) on the left, Wangu (SI 4) on the left and Dazhui (GV 14) were given respectively. One intervention was given and the needles were retained for 30 min in each group. 30 min before and after acupuncture, the infrared thermal images of the face were collected, and the facial temperature was compared among the following 5 acupoints, i.e. Yintang (GV 24⁺), Suliao (GV 25), Shuigou (GV 26), Duiduan (GV 27) and Chengjiang (CV 24). RESULTS: After acupuncture, the facial temperature at Yintang (GV 24⁺) and Chengjiang (CV 24) was increased compared before acupuncture in the sham-acupuncture group (P<0.01, P<0.05). The facial temperature at Suliao (GV 25) in the Houxi group was reduced after acupuncture (P<0.05). In the Wangu group, the temperature at Yintang (GV 24⁺) was increased compared before acupuncture (P<0.01). The facial temperature was increased at Duiduan (GV 27) and Chengjiang (CV 24) compared before acupuncture in the Dazhui group (P<0.01, P<0.05). The differences of facial temperature at Chengjiang (CV 24) and Suliao (GV 25) after acupuncture were larger than before acupuncture in the Houxi group and the Dazhui group (P<0.01). In comparison with the temperature at Suliao (GV 25) of the same group, the differences of facial temperature before and after acupuncture at Yintang (GV 24⁺), Shuigou (GV 26), Duiduan (GV 27) and Chengjiang (CV 24) were increased in the Houxi group (P<0.01, P<0.05); while, the increase was also obtained at Yintang (GV 24⁺), Shuigou (GV 26), Duiduan (GV 27) and Chengjiang (CV 24) in the Dazhui group (P<0.05, P<0.01). The difference of facial temperature at Yintang (GV 24⁺) before and after acupuncture was increased compared with Suliao (GV 25) in the Wangu group (P<0.05). CONCLUSION Acupuncture at Houxi (SI 3) generates a similar thermal effect as Dazhui (GV 14). It regulates and dissipates the core temperature to "govern the yang qi of the whole body".
Humans ; Acupuncture Therapy ; Acupuncture Points ; Healthy Volunteers ; Needles ; Technology

Background Benzo[a]pyrene (BaP) has neurotoxicity, which can induce the loss of hippocampal neurons in humans and animals and lead to spatial learning and memory dysfunction, but its mechanism is still unclear. Objective To observe the ferroptosis of mouse hippocampal neuron HT22 cells induced by 7,8-dihydroxy-9,10-epoxybenzo[a]pyrene (BPDE), an active metabolite of BaP, and to explore its potential mechanism, so as to provide a basis for the study of BaP neurotoxicity mechanism. Method Mouse hippocampal neuron HT22 cells were selected and divided into four groups: solvent control group and low, medium, and high concentration BPDE exposure groups (0.25, 0.50, and 0.75 μmol·L⁻¹). Cell survival was detected by CCK8 method. Cell morphology and ultrastructure were observed under light and electron microscopes. The levels of reactive oxygen species (ROS) and Fe²⁺ were detected by fluorescence probe method. Iron, 4-hydroxynonenoic acid (4-HNE), malondialdehyde (MDA), glutathione (GSH), and glutathione peroxidase (GSH-PX) levels were detected with commercial kits. The expression levels of acyl-CoA synthase long chain family member 4 (ACSL4), cyclooxygenase 2 (COX2), solute carrier family 7 member 11 (SLC7A11), and glutathione peroxidase 4 (GPX4) were detected by Western blotting. After interventions with ferroptosis inhibitors 20 μmol·L⁻¹ deferoxamine (DFO) and 10 μmol·L⁻¹ ethyl 3-amino-4-cyclohexylaminobenzoate (Fer-1), the cell survival rate of each BPDE exposure group and the changes of the ferroptosis characteristic indicators and protein expression levels were observed. Results With the increase of BPDE concentration, the survival rate of HT22 cells decreased gradually, and the survival rate of each BPDE group was significantly lower than that of the solvent control group (P<0.01). Under light microscope, the number of cells in the high concentration BPDE group was significantly reduced, and atrophic cells and reduced synapses were recorded. Under electron microscope, the HT22 cells in the high concentration BPDE group showed mitochondrial shrinkage, decreased crista, and increased mitochondrial membrane density. Compared with the solvent control group, the levels of intracellular lipid ROS, Fe²⁺, 4-HNE, and MDA significantly increased in the high concentration group (P<0.01), the GSH and GSH-PX levels were significantly decreased (P<0.01), the protein expression levels of ASCL4 and COX2 were significantly increased (P<0.01), and the protein expression levels of SCL7A11 and GPX4 were significantly decreased (P<0.01). The ferroptosis inhibitors DFO and Fer-1 significantly reversed the cell survival rate (P<0.01), the ferroptosis characteristic indicators (ROS, Fe²⁺, 4-HNE, MDA, GSH, and GSH-PX levels) (P<0.01), and the expression levels of ferroptosis-related proteins (ACSL4, COX2, SLC7A11, and GPX4) (P<0.01) in the high concentration BPDE group. Conclusion BPDE can induce ferroptosis in mouse hippocampal neuron HT22 cells, which may be related to the inhibition of SLC7A11/GSH/GPX4 axis and the induction of iron metabolism disorder.

The electrophysiological activity of the gastrointestinal tract and the mechanical anti-reflux structure of the gastroesophageal junction are the basis of the anti-reflux function of the stomach. Proximal gastrectomy destroys the mechanical structure and normal electrophysiological channels of the anti-reflux. Therefore, the residual gastric function is disordered. Moreover, gastroesophageal reflux is one of the most serious complications. The emergence of various types of anti-reflux surgery through the mechanism of reconstructing mechanical anti-reflux barrier and establishing buffer zone, and the preservation of, the pacing area and vagus nerve of the stomach, the continuity of the jejunal bowel, the original gastroenteric electrophysiological activity of the gastrointestinal tract, and the physiological function of the pyloric sphincter, are all important measures for gastric conservative operations. There are many types of reconstructive approaches after proximal gastrectomy. The design based on the anti-reflux mechanism and the functional reconstruction of mechanical barrier, and the protection of gastrointestinal electrophysiological activities are important considerations for the selected of reconstructive approaches after proximal gastrectomy. In clinical practice, we should consider the principle of individualization and the safety of radical resection of tumor to select a rational reconstructive approaches after proximal gastrectomy.
Humans ; Stomach Neoplasms/surgery* ; Gastrectomy ; Gastroesophageal Reflux ; Esophagogastric Junction/surgery* ; Pylorus/pathology*

Objective:To investigate the value of relative lumbar lordosis (RLL) and lumbar distribution index (LDI) in predicting the occurrence of adjacent segment disease (ASDis) after lumbar fusion surgery.Methods:This study retrospectively reviewed 163 consecutive patients (58 males and 105 females) who had undergone lumbar fusion and had been followed over 2 years,with an average age of 58.7 years; among them, 74, 71, and 18 patients had undergone fusion of one-level, two-level, and three-level, respectively. They were divided into the non-ASDis group and ASDis group based on the presence of ASDis or not. Pre- and post-operative spinopelvic parameters were measured on the upright lateral radiographs. RLL was calculated as measured lumbar lordosis (LL) minus ideal LL, and LDI was calculated as the ratio of postoperative low lumbar lordosis (LLL) to LL. Each parameter was stratified into 1 "aligned" subgroup and 3 "disproportioned" subgroups in accordance with values. Cochran-Armitage test of trend andlogistic analysis were performed to investigate the association between these two parameters and the occurrence of ASDis.Results:The average follow-up duration after initial surgery was 46±14 months (range, 25 to 134 months). Twenty-four (14.7%) patients were diagnosed as ASDis. The age ( t=3.13, P=0.002) and the proportion of 2-level and 3-level fusion (χ 2=10.27, P=0.006) in the ASDis group were significantly higher than those in the non-ASDis group ( P<0.05). There were no statistically significant differences between groups with respect to other general data. The ratios of moderate and severe hypolordosis of RLL were significantly higher in the ASDis group than that in the non-ASDis group (χ 2=16.92, P<0.001). There was also a significant linear trend with higher degree of hypolordosis being associated with higher rates of ASDis. However, distribution of four statuses of LDI did not differ statistically between groups. After controlling the confounders, the logistic regression analysis revealed that age, odd ratio ( OR)=1.07, 95% CI: (1.01, 1.13), P=0.018), moderate[ OR=4.34, 95% CI: (1.03, 18.41), P=0.046] and severe hypolordosis [ OR=11.64, 95% CI: (1.30, 104.49), P=0.028] were significantly associated with the occurrence of ASDis. Conclusion:A significant association between postoperative RLL and occurrence of ASDis after lumbar fusion surgery were detected. Setting surgical goals according to RLL may help reduce the ASDis rate. However, LDI is not identified to be predictive factors of the occurrence of ASDis.

Objective To investigate the effect of facet joint asymmetry on lumbar biomechanics in normal and patients with adolescent lumbar disc hemiation (ALDH). Methods Mimics 21.0, 3-Matic Medical 13.0, Geomagic Wrap 2017, HyperMesh 2019 and finite element software ABAQUS 2021 were combined to establish three-dimensional finite element models of nonnal lower lumbar spine and adolescent lumbar disc hemiation. According to the difference between the left and right facet joints, three cases of nonnal and ALDH patients aged 13-18 years old were selected, with a total of 6 cases. The stress of intervertebral disc under different torque loads (neutral position, lateral flexion and rotation) was analyzed and compared. Results 1. Three dimensional finite element models of L3-L, segments were established in 6 male nonnal and adolescent patients with lumbar disc herniation, and the stress and displacement nephogram of lumbar disc hemiation in nonnal neutral position, flexion, extension, lateral flexion and rotation were obtained; 2. The stress of L4_, annulus fibrosus increased when the facet joint angle of nonnal adolescents was symmetrical in the neutral position; 3. The stress of annulus fibrosus was greater than that of nucleus pulposus under different conditions, and the stress of annulus fibrosus was flexion > neutral position > extension; 4. In patients with ALDH, the left side of the facet joint was larger than the right 10 ° model, and the stress in the posterior side of the annulus fibrosus of L4_, segment increased significantly under extension condition. Under lateral flexion condition, the left stress of the left annulus fibrosus was compared with the right stress of the right annulus fibrosus, t = l. 575, P<0. 05, the difference was statistically significant, the right stress of the right annulus fibrosus was greater than the left stress of the left annulus fibrosus. Under the rotating condition, the stress on the left and right sides of the fiber ring was greater than that on the back side. Conclusion 1. Compared with nonnal and patients with ALDH, the stress of intervertebral disc increases under different postures, which ma)' increase the shear load of intervertebral disc and aggravate the process of intervertebral disc degeneration; 2. When the degree of left-right asymmetry of facet joint is more than 10 degrees, the stress on the side with small degree is greater. Facet joint asymmetry can lead to the overload of vertebral bod)' and intervertebral disc, leading to spinal instability; 3. The stress of intervertebral disc in extension is less than that in neutral position and flexion. Extension can relieve the pressure of intervertebral disc and play an auxiliary role in the recovery of patients with ALDH.

Objective: To analyze the epidemiology and spatial-temporal distribution characteristics of hand, foot and mouth disease (HFMD) in Shanxi province. Methods: The data of HFMD in Shanxi province from 2009 to 2020 were collected from notifiable disease management information system of Chinese information system for disease control and prevention and analyzed by descriptive epidemiology, Joinpoint regression, spatial autocorrelation analysis and spatio- temporal scanning analysis. Results: A total of 293 477 HFMD cases were reported in Shanxi province from 2009 to 2020, with an average annual incidence of 67.64/100 000 (293 477/433 867 454), severe disease rate of 5.36/100 000 (2 326/433 867 454), severe disease ratio of 0.79%(2 326/293 477), mortality of 0.015/100 000 (66/433 867 454), and fatality rate of 22.49/100 000 (66/293 477). The reported incidence rate, severe disease rate, mortality rate and fatality rate of HFMD showed decreasing trends. The main high-risk groups were scattered children and kindergarten children aged 0-5. The incidence of HFMD had obvious seasonal variation, with two peaks every year: the main peak was during June-July, the secondary peak was during September-October and the peak period is from April to November. A total of 13 942 laboratory cases were confirmed, with a diagnosis rate of 4.75% (13 942/293 477), including 4 438 (35.11%, 4 438/293 477) Enterovirus A71 (EV-A71) positive cases, 4 609 (33.06%, 4 609/293 477) Coxsackievirus A16 (CV-A16) positive cases, and 4 895 (31.83%, 4 895/293 477) other enterovirus positive cases. There was a spatial positive correlation (Moran's I ranged from 0.12 to 0.58, all P<0.05) and the spatial clustering was obvious. High-risk regions were mainly distributed in Taiyuan in central Shanxi province, Linfen and Yuncheng in southern Shanxi province, and Changzhi in southeastern Shanxi province. Spatial-temporal scanning analysis revealed 1 the most likely cluster and 8 secondary likely clusters, of which the most likely cluster (RR=2.65, LLR=22 387.42, P<0.001) located in Taiyuan and Jinzhong city, Shanxi province, including 12 counties (districts), and accumulated from April 1, 2009 to November 30, 2018. Conclusions: There was obvious spatial-temporal clustering of HFMD in Shanxi province, and the epidemic situation was in decline. The key areas were the districts in urban areas and the counties adjacent to it. Meanwhile, the monitoring and classification of other enterovirus types of HFMD should be strengthened.
Child ; Humans ; Hand, Foot and Mouth Disease/epidemiology* ; Spatial Analysis ; Enterovirus Infections ; Spatio-Temporal Analysis ; Cluster Analysis

OBJECTIVE: To evaluate the effect of general anesthesia on postoperative melatonin secretion in 4-to 6-year-old children with snoring. METHODS: Twenty children with snoring aged 4-6 years of either gender (ASA grade Ⅰ and Ⅱ) were selected for adenoidectomy.Before, during and 3 days after the operation, salivary melatonin levels of the children were measured at 11 selected time points (T1-T11).The illumination intensity and body temperature of the children were recorded at each time point of measurement.The sleep time of the children in 3 days after the operation was recorded, and postoperative pain scores (FLACC) and Riker and Rehabilitation Quality Rating Scale-15(QoR-15) scores were assessed.Sleep Apnea Life Quality Evaluation Questionnaire (OSA-18) was used to evaluate postoperative recovery of the children at 28 days after the operation.The incidence of major adverse events of the children during hospitalization was recorded. RESULTS: No significant difference was found in baseline salivary melatonin level among the 20 children before the operation.Salivary melatonin level at 7 am after the operation (T8) was significantly lowered as compared with that before the surgery (T4)( CONCLUSIONS In preschool children with snoring, general anesthesia affects but does not inhibit melatonin secretion on the first night after surgery, and minor surgeries under general anesthesia in the morning do not cause significant changes in melatonin secretion to cause disturbance of the circadian rhythm in these children.
Anesthesia, General/adverse effects* ; Bodily Secretions ; Child ; Child, Preschool ; Circadian Rhythm ; Humans ; Melatonin ; Snoring

With the popularization of minimally invasive concept in the treatment of lumbar degenerative disease,minimally invasive lumbar interbody fusion has gradually developed into the mainstream technique of lumbar fixation and fusion.At present,there are many types of minimally invasive lumbar interbody fusion. In this paper, four kinds of minimally invasive lumbar interbody fusion (anterior lumbar interbody fusion,minimally invasive transforaminal lumbar interbody fusion,extreme lateral interbody fusion,oblique lumbar interbody fusion),which are widely used in clinical practice,are systematically described from the aspects of indication selection,technical characteristics, clinical efficacy and prevention of complications.In order to obtain the best treatment effect with the least trauma,it is necessary for the surgeons to formulate detailed surgical strategies on the basis of strictly grasping the indications,and choose the operation according to their own clinical experience and skills,so as to maximize the advantages of different minimally invasive lumbar interbody fusion.