Background::Non-smokers account for a large proportion of lung cancer patients, especially in Asia, but the attention paid to them is limited compared with smokers. In non-smokers, males display a risk for lung cancer incidence distinct from the females—even after excluding the influence of smoking; but the knowledge regarding the factors causing the difference is sparse. Based on a large multicenter prospective cancer screening cohort in China, we aimed to elucidate the interpretable sex differences caused by known factors and provide clues for primary and secondary prevention.Methods::Risk factors including demographic characteristics, lifestyle factors, family history of cancer, and baseline comorbidity were obtained from 796,283 Chinese non-smoking participants by the baseline risk assessment completed in 2013 to 2018. Cox regression analysis was performed to assess the sex difference in the risk of lung cancer, and the hazard ratios (HRs) that were adjusted for different known factors were calculated and compared to determine the proportion of excess risk and to explain the existing risk factors.Results::With a median follow-up of 4.80 years, 3351 subjects who were diagnosed with lung cancer were selected in the analysis. The lung cancer risk of males was significantly higher than that of females; the HRs in all male non-smokers were 1.29 (95% confidence interval [CI]: 1.20-1.38) after adjusting for the age and 1.38 (95% CI: 1.28-1.50) after adjusting for all factors, which suggested that known factors could not explain the sex difference in the risk of lung cancer in non-smokers. Known factors were 7% (|1.29-1.38|/1.29) more harmful in women than in men. For adenocarcinoma, women showed excess risk higher than men, contrary to squamous cell carcinoma; after adjusting for all factors, 47% ([1.30-1.16]/[1.30-1]) and 4% ([7.02-6.75]/[7.02-1])) of the excess risk was explainable in adenocarcinoma and squamous cell carcinoma. The main causes of gender differences in lung cancer risk were lifestyle factors, baseline comorbidity, and family history.Conclusions::Significant gender differences in the risk of lung cancer were discovered in China non-smokers. Existing risk factors did not explain the excess lung cancer risk of all non-smoking men, and the internal causes for the excess risk still need to be explored; most known risk factors were more harmful to non-smoking women; further exploring the causes of the sex difference would help to improve the prevention and screening programs and protect the non-smoking males from lung cancers.

Objective:Based on the data of Global Burden of Disease 2019 data, to analyze the past, current, and future burden of disability-adjusted life years (DALYs) in China and compare with the international status.Methods:The total number of DALYs, age-standardized DALY rate, and the composition of different subgroups were extracted and described to analyze the time trend in 2000-2019 and the current situation in 2019 for Chinese female breast cancer. The burden of DALYs in 2050 was predicted by Joinpoint using average annual percent change (AAPC).Results:In 2000-2019, the ranking of DALYs caused by female breast cancer in China rose from the fourth to the second in all female cancers. The total DALYs increased by 48.4%, of which the years lived with disability increased from 4.8% to 8.8%. The age-standardized DALY rate only slightly decreased (AAPC=-0.3%; which increased during 2016-2019, AAPC=1.6%). In 2019, the age-standardized DALY rate for breast cancer in China was 278.0/100 000. The DALYs were 2.88 million (accounting for 14.2% of the global burden and 12.1% of all female cancers burden in China), 26.5% of which attributed known risk factors (overweight and obesity were the largest: 0.34 million DALYs, but some common breast cancer risk factors were not available on the platform, such as menstruation and fertility). In 2050, the prediction suggests that the total DALYs caused by female breast cancer in China will reach 3.80 million person-years-5.16 million person-years, increasing 32.1%-79.4% over 2019. From 2000 to 2019, the peak age of DALYs and DALY rate became older, and the DALYs among females aged 65 years and above increased faster than those younger than 65 years (AAPC were 4.8% and 1.3%, respectively). In 2019, females aged 45-74 (the starting age recommended by local guidelines for breast cancer screening) contributed 74.3% of the total DALYs.Conclusions:Over the past 20 years, the age-standardized DALY rate for breast cancer in female populations in China has not changed obviously. Without the continuous expansion of effective intervention and population aging, the burden of DALYs for female breast cancer in China will increase. DALYs for breast cancer attributed leading risk factors were still limited.

Objective:To analyze the characteristics of electroencephalogram (EEG) and clinical manifestations of children with moyamoya disease (MMD), and to explore the value of EEG in the clinical diagnosis of childhood MMD.Methods:Twelve children indicated as cerebrovascular diseases by EEG and later diagnosed with MMD by head magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2012 to June 2019 were enrolled in this study.Their EEG and clinical data were retrospectively analyzed.Results:Nine cases were male and 3 cases were female, with the onset age of 3.0-8.7 years old.Ten cases were taken to the hospital because of paroxysmal limb weakness on one side or both sides, 1 case was because of paroxysmal fall, and 1 case was because of paroxysmal posture abnormalities.EEG background activities of 12 cases were normal.Interictal EEG was normal in 8 cases, borderline in 1 case, and abnormal in 3 cases (1 case had many slow waves in bilateral anterior head, and its number significantly increased during the awakening period; 1 case had a great many irregular delta slow waves on bilateral prefrontal cortex, showing significant aggravation during the awakening period; 1 case had many multifocal delta slow waves especially in the right frontopolar region). The hyperventilation (HV) induction test was abnormal, and rebuild-up of slow waves was noted in 4 cases.The focal delta slow waves (especially in the anterior head) developed to diffuse slow waves after stopping HV for 0.5 to 1.0 minutes, and lasted for 5 to 9 minutes after relief of symptoms.The delayed disappearance of asymmetric focal slow waves was noted in 8 cases.Focal slow waves (especially in anterior head) developed to diffuse slow waves at 1.5 to 2.0 minutes after HV initiation, and lasted for 5 to 10 minutes in total.Among them, 1 case pre-sented no obvious accompanying symptoms during HV, while 11 cases showed transient ischemic symptoms that were basically consistent with the chief complaint.The duration of symptoms was much shorter than the appearance of slow waves in EEG.Besides, brain MRI of 3 cases suggested local malacia lesions or abnormal signals, especially in parietal and basal ganglia areas.The high signal shadow was observed in the sulcus of bilateral cerebral hemispheres on the fluid attenuating inversion recovery sequence of one case.All of 12 cases were proved to MMD by head MRA.Conclusions:Clinical symptoms of children with MMD are paroxysmal limb weakness.Rebuild-up of slow waves or the delayed disappea-rance of focal slow waves is highly suggestive of MMD.These 2 kinds of abnormal EEG patterns sustain over long periods of time.Focal slow waves (especially in anterior head) develop to diffuse slow waves, and lastly decrease to focal slow waves in anterior head.

Objective To investigate the relationship between the serum level of vancomycin and its clinical efficacy as well as adverse reactions in adult patient so as to provide recommendations for clinical management. Methods An open observational research was performed from 1st July 2013 to 31st December 2017 in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, which recruited the adult patients who were infected with Gram positive (G+) bacteria and treated with vancomycin. The initial dose was decided by the patient's creatinine clearance rate, and the treating dose was directed by the serum drug concentration and the patient's clinical response. By recording the associated clinical information (pathogen eradication, blood test results, adverse reactions, etc.), the clinical outcome and adverse reactions for vancomycin to treat G+bacterial infections were analyzed. Results Eighty-nine cases who meet research standards were finally recruited, with 67.42% of male patients, and an average age of (50.5±17.9) years. The most common type of infection was bloodstream infection (61.80%), followed by low respiratory infection (17.98%). Infections caused by Staphylococcus aureus accounted for 39.33%. The bacterial eradication rate was 89.89% (80/89) and the total effective rate was 77.53% (69/89). The effective rate was 80.30% (53/66) with minimum inhibitory concentration (MIC) < 2 mg/L vs. 69.57% (16/23) with MIC ≥ 2 mg/L, the difference was not statistically significant (χ2= 1.129, P = 0.288). The effective rate was 72.92% (35/48) with trough levels <10 mg/L vs. 82.93% (34/41) with trough levels ≥ 10 mg/L, the difference was not statistically significant (χ2= 1.272, P = 0.259). There were 4 cases of vancomycin associated nephrotoxicity, the incidence of nephrotoxicity was 4.49%, and the vancomycin serum trough levels were 17.22-28.53 mg/L. There were 33 cases of liver dysfunction, and elevated γ-glutamine transferase, alkaline phosphatase and aspartate aminotransferase were most common. There were 2 cases of neutropenia and 2 patients appeared rash during vancomycin period. Conclusions Treatment outcomes were similar regardless of vancomycin MIC and serum trough level. The incidence of vancomycin associated nephrotoxicity rises apparently when serum trough level is over 15 mg/L. Clinical Trial Registry Chinese Clinical Trail Registry, ChiCTR-OPC-16007920.

Objective To explore the prognostic factors in Guillain Barre syndrome (GBS) in children. Methods A total of 125 children with GBS were included and grouped according to their independent walking at two and six months after discharge, and their clinical data were analyzed. Results In 125 children (74 males, 51 females) the average age was 84.49±25.32 months, and 41 were under 6 years old. 102 children had a history of prodromal infections. 32 children had cranial nerve involvement and 35 had autonomic nerve involvement. 12 children need assisted respiration. At 2 and 6 months after discharge, when compared with children who could walk independently, the rates of functional score > 3, cranial nerve involvement, and neuroelectrophysiology as denervation potential were higher in children who could not walk independently, and the differences were statistically significant (P all<0.05). Conclusions The factors that affect the short-term prognosis are denervation potential in neuroelectrophysiology, cranial nerve involvement, and functional score > 3. Early identification of uniqueness in patients and subsequent development of targeted rehabilitation training should be carried out to improve the prognosis.

Objective To investigate the characteristics of ictal and interictal electroencephalogram (EEG) and clinical manifestation in children with startle epilepsy. Methods The age of onset, inducing factors, the types of attacks, EEG features, cognitive function, treatment and prognosis were retrospectively analyzed in 8 cases of children with startle epilepsy from June 6, 2012 to March 2016. Results In 8 cases, 3 cases were male and 5 were female. The onset age was from 2.3 to 8.1 years old. The forms of onset were varied from generalized (tonic, myoclonic, atonic) to partial seizures (the asymmetry of posture rigidity, spasm). The most common ictal EEG finding was a diffuse electrodecremental pattern (5 cases), and the interictal EEG showed a large number of multifocal, generalized spines, slow waves and multiple spinous waves. There was one case with no history of brain injury while the other 7 cases had a history of brain injury. There were 7 cases with imaging abnormality, and the lesions of the frontal, parietal and temporal regions were indicated with a partial cerebral softening and brain atrophy. In 7 cases, all children had abnormal mental and motor development, and 1 case had normal cognitive function. The 7 cases with shock epilepsy showed no obvious response to the treatment of multiple antiepileptic drugs, and 1 case had no clinical onset after 2 months of treatment with VPA. Conclusions Startle epilepsy is mostly symptomatic, and few are non-symptomatic. The former had history of brain structure abnormalities, certain degree of motor retardation and mental disability, and no clinical response to antiepileptic drug therapy. The latter had basically normal cognitive function, and antiepileptic drug VPA treatment is effective. The degree of interictal epileptic was not an indicator of cognitive impairment and prognosis in children with startle epilepsy.

This paper introduces the failure phenomenon, failure analysis, maintenance process and method of SIEMENS PRIMUS linear accelerator.
Particle Accelerators ; Radiotherapy Dosage

Objective To evaluate the feasibility of the three-dimensional brain artery vessel wall imaging technology reverse rotation angle of fast spin echo (T1 W-SPACE)in the diagnosis of ischemic cerebrovascular disease by comparing it with TOF vascular imaging in magnetic resonance. Methods Patients undergoing stroke but stable condition,including 50,patients with transient cerebral ischemia (TIA)or a history of stroke,examined by TOF-MRA and routine MRI sequence first,then followed by T1 W-SPACE.Results In 43 of 50 cases,conventional MRI sequences detectiog was positive,TOF-MRA found the vascular stenosis in 76 branches,T1 W-SPACE found the vascular stenosis in 73 branches,there was no difference between the two groups(χ2 =0.625,P >0.05);Conventional TOF-MRA cannot detect the vascular wall, T1 W-SPACE found that arterial wall thickening,plaque in 48 branches.Conclusion Compared with the TOF-MRA,T1 W-SPACE can not only detect the vessel stenosis,but also the vessel wall and plaque,and can also type on plaque from pathology angle,has im-portant clinical significance for early prevention and treatment of stroke.

Objective To evaluate the efficacy and safety of therapeutic drug monitoring (TDM ) based vancomycin dose adjustment in patients with gram‐positive infections .Methods A cohort study was designed with 128 inpatients undergoing TDM in Huashan Hospital from January 2005 to September 2014 .The clinical data of these patients were used to analyze the efficacy and safety of vancomycin therapy by Cox model and survival analysis .Results The patients undergoing TDM‐based dose adjustment had a higher daily dose and blood trough concentration ,which may lead to better bacteriological efficacy and overall efficacy .Cox proportional hazards model analysis showed that TDM‐based dose adjustment is a protective factor .No safety‐related risk factor was found .Conclusions TDM‐based vancomycin dose adjustment is important for patients to achieve better outcomes in fighting gram‐positive infections .

Objective To evaluate the efficiency of long-term video electro-encephalography(VEEG) monitoring in neonatal seizure.Methods The medical records of 36 neonates recruited and performed with long-term VEEG in the neonatal intensive care units in hospital from Jun.2011 to Jun.2012 were collected.The medical records included age,gender,diagnosis,VEEG background,epileptiform activity,epileptic seizures (electrographic seizures,electroclinical seizures or both),and nonepilepic events.Informations on prognosis and therapy was also obtained.Results Among the 36 neonates,the neonates with normal,or mildly,moderately,and severely abnormal VEEG were 3 (8.3％),9 (25.0％),16 (44.4％) and 8 (22.2％) neonates,respectively.Children with normal electro-encephalography (EEG) developed normally.The percentage with developmental delay in children with mildly,moderately,and severely abnormal EEG were 1 1.1％,37.5％ and 62.5％,respectively and abnormal VEEG was significantly associated with developmental delay(x2 =13.8,P =0.003).Among these 36 neonates,21 cases had neonatal seizures (58.3％),including 14 (66.7％) cases with epileptic seizures and 6(28.6％) cases with nonepileptic seizures and 1 case with both.In addition,13 (61.9％) cases out of 21 cases with neonatal seizures developed abnormally (including developmental delay and death),and there was no significant association between neonatal seizure and development (x2 =0.206,P =0.65).Conclusions Neonatal seizure is very common,but electroclinical dissociation is an outstanding feature of neonatal seizures.Long-term VEEG monitoring is a valuable tool and may aid in the early identification and management of patients who are more likely to develop epilepsy.