Provincial Health Commissions Research Articles

Prepackaged foods healthiness ranking index: developing front-of-pack labeling to facilitate the assessment and validation of healthiness rankings of prepackaged foods in China

BackgroundThe Medium and Long-Term Plan for the Prevention and Treatment of Chronic Diseases (2017–2025) in China has highlighted the importance of reducing fat, sodium, and sugar in foods. However, front-of-pack labeling, which enables consumers to assess the health levels of prepackaged foods, is lacking in China. In response to the Zhejiang Provincial Health Commission’s request, we sought to develop a method for efficiently evaluating the health level of prepackaged foods.MethodsThrough a comprehensive literature review, we established a systematic framework: the Prepackaged Foods Healthiness Ranking Index (PHRI). We determined specific threshold values and grading criteria and conducted two rounds of Delphi survey to refine the index. Using a measurement dataset, we aimed to determine the optimal limit values for assessing the health level of prepackaged foods in real-world settings.ResultsAfter two rounds of Delphi surveys, the PHRI underwent multiple revisions until consensus among experts was reached. The final decision regarding the upper limit values set 30% Nutrient Reference Values as the limit for solid foods and 15% Nutrient Reference Values for liquid foods. The calculation of PHRI values was successfully implemented with the dataset, in accord with current nutrition awareness and real-world conditions.ConclusionsThe PHRI provides a valuable tool for assessing the healthiness of prepackaged foods. This front-of-pack labeling system provides a convenient method for evaluating the nutritional quality of prepackaged foods. Ultimately, the PHRI has the potential to contribute to advancements in health policy, practice, and education in China.

Deep radiomics-based fusion model for prediction of bevacizumab treatment response and outcome in patients with colorectal cancer liver metastases: a multicentre cohort study

Accurate tumour response prediction to targeted therapy allows for personalised conversion therapy for patients with unresectable colorectal cancer liver metastases (CRLM). In this study, we aimed to develop and validate a multi-modal deep learning model to predict the efficacy of bevacizumab in patients with initially unresectable CRLM using baseline PET/CT, clinical data, and colonoscopy biopsy specimens. In this multicentre cohort study, we retrospectively collected data of 307 patients with CRLM from the BECOME study (NCT01972490) (Zhongshan Hospital of Fudan University, Shanghai) and two independent Chinese cohorts (internal validation cohort from January 1, 2018 to December 31, 2018at Zhongshan Hospital of Fudan University; external validation cohort from January 1, 2020 to December 31, 2020at Zhongshan Hospital-Xiamen, Shanghai, and the First Hospital of Wenzhou Medical University, Wenzhou). The main inclusion criteria were that patients with CRLM had pre-treatment PET/CT images as well as colonoscopy specimens. After extracting PET/CT features with deep neural networks (DNN) and selecting related clinical factors using LASSO analysis, a random forest classifier was built as the Deep Radiomics Bevacizumab efficacy predicting model (DERBY). Furthermore, by combining histopathological biomarkers into DERBY, we established DERBY+. The performance of model was evaluated using area under the curve (AUC), sensitivity, specificity, positive predictive value, and negative predictive value. DERBY achieved promising performance in predicting bevacizumab sensitivity with an AUC of 0.77 and 95% confidence interval (CI) [0.67-0.87]. After combining histopathological features, we developed DERBY+, which had more robust accuracy for predicting tumour response in external validation cohort (AUC 0.83 and 95% CI [0.75-0.92], sensitivity 80.4%, specificity 76.8%). DERBY+ also had prognostic value: the responders had longer progression-free survival (median progression-free survival: 9.6 vs 6.3 months, p=0.002) and overall survival (median overall survival: 27.6 vs 18.5 months, p=0.010) than non-responders. This multi-modal deep radiomics model, using PET/CT, clinical data and histopathological data, was able to identify patients with bevacizumab-sensitive CRLM, providing a favourable approach for precise patient treatment. To further validate and explore the clinical impact of this work, future prospective studies with larger patient cohorts are warranted. The National Natural Science Foundation of China; Fujian Provincial Health Commission Project; Xiamen Science and Technology Agency Program; Clinical Research Plan of SHDC; Shanghai Science and Technology Committee Project; Clinical Research Plan of SHDC; Zhejiang Provincial Natural Science Foundation of China; and National Science Foundation of Xiamen.

What Makes a Hospital Excellent? A Qualitative Study on the Organization and Management of Five Leading Public Hospitals in China.

To summarize the organizational and management experiences and explore the organizational theoretical model of five leading public hospitals in China. Purposive sampling was used to select five leading hospitals in different regions of China under the National Health Commission and Provincial Health Commission as study hospitals for the study. From August 2021 to March 2022, 8 leaders and 39 managers from these hospitals were surveyed using semi-structured interviews. The data and information were analyzed in four dimensions using thematic analysis and grounded theory, focused on summarizing the experiences and practices of China's leading hospitals in organizational system, culture, operations and performance management, and employee development. This study complied with the COREQ guidelines for reporting qualitative research. An organizational system model of the characteristics of hospital excellence was developed using four core attributes: organizational system, organizational culture, operations and performance management, and employee development; the model was named the System-Culture-Operation-Performance-Employee (SCOPE) model. Organization and management among leaders and managers in China's leading hospitals are based on the SCOPE process, resulting in employees' well-being, patients' positive outcomes, and organizational excellence. In terms of hospital culture, while adhering to the Hippocratic Oath, the hospital is deeply influenced by traditional Chinese culture, which emphasizes "benevolence" and "love", leading all staff to adhere to "patient-centered care and service." In terms of operations management, a separate operations management department is responsible for hospital operations and performance assessment. As for employee development, the staff's sense of reverence for their profession is emphasized and a reasonable salary system and good practice environment are established to promote staff motivation. The SCOPE model reveals the perspectives of leaders and managers in China's leading hospitals regarding organization and management under a Chinese cultural background. These findings can complement the existing literature on hospital management systems.

SMOKERS MAY BE SUBJECT TO A HIGHER RISK OF SCHNEIDERIAN MEMBRANE PERFORATION THAN NONSMOKERS DURING MAXILLARY SINUS AUGMENTATION.

Association between smoking and Schneiderian membrane perforation during maxillary sinus floor augmentation: A systematic review and meta-analysis. Wang, X., Ma, S., Lin, L., & Yao, Q. Clinical Implant Dentistry and Related Research. 2022., 25.1: 166-176. National Natural Science Foundation of China, Grant/Award Number: 81801021; Hunan Provincial Health Commission, Grant/Award Number: B202308056991. Systematic review and meta-analysis.

Analgesic efficacy of an opioid-free postoperative pain management strategy versus a conventional opioid-based strategy following open major hepatectomy: an open-label, randomised, controlled, non-inferiority trial

Convincing clinical evidence regarding completely opioid-free postoperative pain management using erector spinae plane block (ESPB) in patients undergoing open major hepatectomy (OMH) is lacking. Herein, we aimed to compare the postoperative analgesic efficacy of the visualised continuous opioid-free ESPB (VC-ESPB) and conventional intravenous opioid-based postoperative pain management in hepatocellular carcinoma (HCC) patients undergoing OMH. This open-label, randomised, controlled, non-inferiority trial enrolled patients with HCC undergone open major hepatectomy in Fujian Provincial Hospital and compared the postoperative analgesic efficacy of VC-ESPB (VC-ESPB group) and conventional intravenous opioid-based pain management regimen (conventional group). Patients were randomly assigned (1:1) to VC-ESPB group and conventional group. Patients were not masked to treatment allocation. The VC-ESPB group was treated with intermittent injections of 0.25% ropivacaine (bilateral, 30mL each side) given every 12h through catheters placed in the space of erector spinae and an opioid-free intravenous pump (10-mg tropisetron diluted to 100mL with 0.9% normal saline [NS]) for postoperative pain management. The conventional group did not receive ESPB and was treated with a conventional intravenous opioid-based pump (2.5-μg/kg sufentanil and 10-mg tropisetron diluted to 100mL with 0.9% NS). Patients in the VC-ESPB group underwent magnetic resonance imaging (MRI) to identify local anaesthetic diffusion after ESPB was performed under ultrasound guidance. The primary outcome was postoperative analgesic efficacy, which was indicated by the cumulative area under the curve (AUC) of the pain visual analogue scale scores (range, 0-10; a higher score indicates more pain) obtained at rest and at movement until 48h postoperatively after leaving the post-anaesthesia care unit (PACU). Herein, an AUC of 26.5 was set as the noninferiority margin, which needed to be satisfied for both cumulative AUCPACU-48h at rest and cumulative AUCPACU-48h at movement. Per protocol participants were included in primary and safety analyses. This trial was registered with ChiCTR.org.cn (ChiCTR1900026583). Between October 30, 2019, and May 1, 2023, 106 patients were enrolled and randomly assigned to the VC-ESPB group (n=53) and the conventional group (n=53). After the dropout (n=5), a total of 101 patients (VC-ESPB group, n=50; conventional group, n=51) were analysed. Both the level of cumulative AUCPACU-48h (at rest: 160.08±38.00 vs. 164.94±31.00; difference [90% CI],-4.861 [-16.308, 6.585]) and cumulative AUCPACU-48h (at movement: 209.64±28.98 vs. 212.59±33.11; difference [90% CI],-2.948 [-13.236, 7.339]) were similar between the VC-ESPB and control groups within the first postoperative 48h. The upper limit of the 90% CIs for the difference in cumulative ACUPACU-48h at rest and at movement did not reach the upper inferiority margin (26.5). During the first postoperative 48h, the rate of nonsteroidal anti-inflammatory drug rescue analgesia was similar between the VC-ESPB group and conventional group (n=16, 32.0% vs. n=11, 21.6%; P=0.236). Treatment-related death was not observed in the VC-ESPB group (n=0, 0%) and conventional group (n=0, 0%). In VC-ESPB group, local site paralysis (n=1, 2.0%) was observed in one patient and rash (n=1, 2.0%) was observed in another patient. One patient in the conventional group was observed with rash preoperatively (n=1, 2.0%). The VC-ESPB group had significantly lower rates of postoperative nausea (n=2, 4.0%, vs. n=9, 17.6%, P=0.028), vomiting (n=1, 2.0% vs. n=8, 15.7%, P=0.031) and lower incidence of major complications (n=4, 8.0% vs. n=6, 11.8%; P=0.033). This study demonstrates the noninferiority of VC-ESPB when compared with the conventional opioid-based approach for postoperative pain management after OMH, suggesting that it is feasible to achieve opioid-free postoperative pain management for OMH. The Joint Funds for the Innovation of Science and Technology, Fujian Province, China; the Youth Scientific Research Project of Fujian Provincial Health Commission; the Fujian Research and Training Grants for Young and Middle-aged Leaders in Healthcare; and the Key Clinical Specialty Discipline Construction Program of Fujian, China.

Human infection of avian influenza A H3N8 virus and the viral origins: a descriptive study

The H3N8 avian influenza virus (AIV) has been circulating in wild birds, with occasional interspecies transmission to mammals. The first human infection of H3N8 subtype occurred in Henan Province, China, in April, 2022. We aimed to investigate clinical, epidemiological, and virological data related to a second case identified soon afterwards in Hunan Province, China. We analysed clinical, epidemiological, and virological data for a 5-year-old boy diagnosed with H3N8 AIV infection in May, 2022, during influenza-like illness surveillance in Changsha City, Hunan Province, China. H3N8 virus strains from chicken flocks from January, 2021, to April, 2022, were retrospectively investigated in China. The genomes of the viruses were sequenced for phylogenetic analysis of all the eight gene segments. We evaluated the receptor-binding properties of the H3N8 viruses by using a solid-phase binding assay. We used sequence alignment and homology-modelling methods to study the effect of specific mutations on the human receptor-binding properties. We also conducted serological surveillance to detect the H3N8 infections among poultry workers in the two provinces with H3N8 cases. The clinical symptoms of the patient were mild, including fever, sore throat, chills, and a runny nose. The patient's fever subsided on the same day of hospitalisation, and these symptoms disappeared 7 days later, presenting mild influenza symptoms, with no pneumonia. An H3N8 virus was isolated from the patient's throat swab specimen. The novel H3N8 virus causing human infection was first detected in a chicken farm in Guangdong Province in December, 2021, and subsequently emerged in several provinces. Sequence analyses revealed the novel H3N8 AIVs originated from multiple reassortment events. The haemagglutinin gene could have originated from H3Ny AIVs of duck origin. The neuraminidase gene belongs to North American lineage, and might have originated in Alaska (USA) and been transferred by migratory birds along the east Asian flyway. The six internal genes had originated from G57 genotype H9N2 AIVs that were endemic in chicken flocks. Reassortment events might have occurred in domestic ducks or chickens in the Pearl River Delta area in southern China. The novel H3N8 viruses possess the ability to bind to both avian-type and human-type sialic acid receptors, which pose a threat to human health. No poultry worker in our study was positive for antibodies against the H3N8 virus. The novel H3N8 virus that caused human infection had originated from chickens, a typical spillover. The virus is a triple reassortment strain with the Eurasian avian H3 gene, North American avian N8 gene, and dynamic internal genes of the H9N2 viruses. The virus already possesses binding ability to human-type receptors, though the risk of the H3N8 virus infection in humans was low, and the cases are rare and sporadic at present. Considering the pandemic potential, comprehensive surveillance of the H3N8 virus in poultry flocks and the environment is imperative, and poultry-to-human transmission should be closely monitored. National Natural Science Foundation of China, National Key Research and Development Program of China, Strategic Priority Research Program of the Chinese Academy of Sciences, Hunan Provincial Innovative Construction Special Fund: Emergency response to COVID-19 outbreak, Scientific Research Fund of Hunan Provincial Health Department, and the Hunan Provincial Health Commission Foundation.

400.9: The First Independent Provincial OPO in China: Shanxi Experience

Introduction: While the reform of organ transplantation in China has achieved success, the organ procurement model for different regions in the country varies. Starting from a hospital-based organ procurement organization (OPO), Shanxi OPO was established as the first independent non-profit provincial OPO in China, which covers a donation area of 37.29 million population and serves 6 transplant hospitals in the region. Shanxi OPO was established in 2018 under the supervision of Shanxi provincial health commission. This study compares results before and after the establishment in regard to the quantity, quality and efficiency of organ donation and transplantation (OD & OT) within Shanxi Province, aiming at exploring a feasible and up-to-date procurement management mode in China. Method: From the point of organizational structure, personnel composition, equipment management and core quality indicators, we analyze the data from 2015 to 2021 and compare the results before and after the establishment of the provincial OPO. Results: In the past two years, a professional team with 7 departments has been built. Besides, advanced facilities like those for donor maintenance and information collection are equipped. Then in 2020, an ethics and scientific committee have been founded to guide scientific research and supervise ethical norm compliance. Through analyzing the quality control indicators, the number of OD has increased from 35 cases (PMP: 0.99) in 2015 to 126 cases (PMP: 3.61) in 2021, with an increase rate of 260%. The growth trend remains within Shanxi Province even under the influence of COVID-19 pandemic in 2020, while the case number of the country decreased. Since 2018, the number of organs procured from per donor and the organ utilization rate of Shanxi OPO have risen year by year, reaching 3.02 and 98.7% respectively in 2021. Moreover, the DBD rate has increased from 1.1% in 2019 to 20.63% in 2021, though there is still a gap compared to the national and international level. These positive changes indicate that the quality of our service in organ viability assessment, donor maintenance, organ recovery and coordination have been gradually improved. Conclusion: Efficiency and quality of the organ procurement and allocation have been greatly improved in the past few years because of the establishment of Shanxi OPO. This kind of provincial OPO also provides a solution, which will lead a clear direction for the standardization of organ procurement in China.

Subtyping of metastatic breast cancer based on plasma circulating tumor DNA alterations: An observational, multicentre platform study.

SummaryBackgroundAfter multiple lines of therapies, no guideline or consensus is currently available for the treatment of patients with metastatic breast cancer. This study aims to evaluate the efficacy of a novel re-subtyping and treatment strategy based on ctDNA alterations.MethodsThis observational, multicentre study recruited 223 patients with metastatic breast cancer intending to receive late-line therapy from Dec 1, 2016, to June 31, 2019. This study took place in Hunan Cancer Hospital, the Forth Hospital of Changsha and Zhuzhou Central Hospital in China. ctDNA alterations were assessed by next-generation sequencing (NGS). Patients with druggable ctDNA alterations were treated with corresponding targeted drugs which are clinically available. Other patients received physician-chosen treatment. This study was registered with ClinicalTrials.gov, NCT05079074.FindingsThe progression-free survival (hazard ratio: 0.45, 95% Confidence Interval (CI): 0.33-0.62, P < 0.0001) and disease control rate (89.4% vs. 65.9%, P < 0.0001) were significantly improved in patients who received druggable ctDNA alteration-guided therapy compared with those of patients who received physician-chosen treatment. ctDNA alterations with top rank and high clustering scores were classified into four subtypes based on their functions as follows: 1) extracellular function (ECF), 2) cell proliferation (CP), 3) nuclear function (NF), and 4) cascade signaling pathway (CSP). A significant benefit from ctDNA alteration-guided treatment was observed in patients with NF and CSP ctDNA alterations, with hazard ratios of 0.39 (95% CI: 0.24-0.65, P = 0.0003) and 0.14 (95% CI: 0.04-0.46, P < 0.0001), respectively.InterpretationAfter multiline traditional pathological HR/HER2 subtype-guided therapies, ctDNA testing could identify druggable ctDNA alterations to guide late-line therapy for patients with metastatic breast cancer.FundingThis work was supported by Key Grants of Research and Development in Hunan Province (2018SK2124, 2018SK2120), Natural Science Foundation of Hunan (2019JJ50360), Hunan Provincial Health Commission Project (B2019085, B2019089 and C2019070), and Changsha Science and Technology Project (kq2004125 and kq2004137).

Targeting Depth of Anesthesia to Prevent Delirium: Comment

Brown et al.1 nicely described their work comparing spinal anesthesia with targeted sedation based on Bispectral Index values compared with general anesthesia (masked Bispectral Index) and the outcome of delirium. Intraoperative hypotension has been associated with delirium.2,3 The adjusted hazard ratio associated with a 1-mmHg increase in time-weighted average of mean arterial pressure less than 65 mmHg was 1.11 (95% CI, 1.03 to 1.20).2 The study by Brown et al.1 found that the lowest mean arterial pressure was similar in both groups (general anesthesia, 59 [51 to 64] vs. spinal anesthesia, 60 [52 to 64]); however, the relationship between intraoperative hypotension and the subsequent development of delirium might be more of a cumulative exposure response than a single threshold. It would be of interest to know the hypotension exposure by time under the 65- or 60-mmHg threshold and to consider that in a treatment-by-covariate interactions analysis. In short, we appreciate Brown et al. for their great contributions to this important topic.Supported by grant No. (2018)5779-51 from the Academic New Seedling Cultivation and Innovation Exploration Special Project of Guizhou Medical University (Guiyang, China) in 2018 and grant No. gzwjkj2020-1-132 from the Science and Technology Foundation of Guizhou Provincial Health Commission (Guiyang, China).The authors declare no competing interests.

Clinical data mining reveals Gancao-Banxia as a potential herbal pair against moderate COVID‐19 by dual binding to IL-6/STAT3

BackgroundCoronavirus disease 2019 (COVID-19) keeps spreading globally. Chinese medicine (CM) exerts a critical role for the prevention or therapy of COVID-19 in an integrative and holistic way. However, mining and development of early, efficient, multisite binding CMs that inhibit the cytokine storm are imminent. MethodsThe formulae were extracted retrospectively from clinical records in Hunan Province. Clinical data mining analysis and association rule analysis were employed for mining the high-frequency herbal pairs and groups from formulae. Network pharmacology methods were applied to initially explore the most critical pair's hub targets, active ingredients, and potential mechanisms. The binding power of active ingredients to the hub targets was verified by molecular docking. ResultsEight hundred sixty-two prescriptions were obtained from 320 moderate COVID-19 through the Hunan Provincial Health Commission. Glycyrrhizae Radix et Rhizoma (Gancao) and Pinelliae Rhizoma (Banxia) were used with the highest frequency and support. There were 49 potential genes associated with Gancao-Banxia pair against moderate COVID-19 patients. The Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) indicated that Gancao-Banxia might act via inflammatory response, viral defense, and immune responses signaling pathways. IL-6 and STAT3 were the two most hub targets in the protein-protein interaction (PPI) network. The binding of five active ingredients originated from Gancao-Banxia to IL-6-STAT3 was verified by molecular docking, namely quercetin, coniferin, licochalcone a, Licoagrocarpin and (3S,6S)-3-(benzyl)-6-(4-hydroxybenzyl)piperazine-2,5-quinone, maximizing therapeutic efficacy. ConclusionsThis work provided some potential candidate Chinese medicine formulas for moderate COVID-19. Among them, Gancao-Banxia was considered the most potential herbal pair. Bioinformatic data demonstrated that Gancao-Banxia pair may achieve dual inhibition of IL-6-STAT3 via directly interacting with IL-6 and STAT3, suppressing the IL-6 amplifier. SARS-CoV-2 models will be needed to validate this possibility in the future.

A CT-based deep learning radiomics nomogram for predicting the response to neoadjuvant chemotherapy in patients with locally advanced gastric cancer: A multicenter cohort study

SummaryBackgroundAccurate prediction of treatment response to neoadjuvant chemotherapy (NACT) in individual patients with locally advanced gastric cancer (LAGC) is essential for personalized medicine. We aimed to develop and validate a deep learning radiomics nomogram (DLRN) based on pretreatment contrast-enhanced computed tomography (CT) images and clinical features to predict the response to NACT in patients with LAGC.Methods719 patients with LAGC were retrospectively recruited from four Chinese hospitals between Dec 1st, 2014 and Nov 30th, 2020. The training cohort and internal validation cohort (IVC), comprising 243 and 103 patients, respectively, were randomly selected from center I; the external validation cohort1 (EVC1) comprised 207 patients from center II; and EVC2 comprised 166 patients from another two hospitals. Two imaging signatures, reflecting the phenotypes of the deep learning and handcrafted radiomics features, were constructed from the pretreatment portal venous-phase CT images. A four-step procedure, including reproducibility evaluation, the univariable analysis, the LASSO method, and the multivariable logistic regression analysis, was applied for feature selection and signature building. The integrated DLRN was then developed for the added value of the imaging signatures to independent clinicopathological factors for predicting the response to NACT. The prediction performance was assessed with respect to discrimination, calibration, and clinical usefulness. Kaplan-Meier survival curves based on the DLRN were used to estimate the disease-free survival (DFS) in the follow-up cohort (n = 300).FindingsThe DLRN showed satisfactory discrimination of good response to NACT and yielded the areas under the receiver operating curve (AUCs) of 0.829 (95% CI, 0.739–0.920), 0.804 (95% CI, 0.732–0.877), and 0.827 (95% CI, 0.755–0.900) in the internal and two external validation cohorts, respectively, with good calibration in all cohorts (p > 0.05). Furthermore, the DLRN performed significantly better than the clinical model (p < 0.001). Decision curve analysis confirmed that the DLRN was clinically useful. Besides, DLRN was significantly associated with the DFS of patients with LAGC (p < 0.05).InterpretationA deep learning-based radiomics nomogram exhibited a promising performance for predicting therapeutic response and clinical outcomes in patients with LAGC, which could provide valuable information for individualized treatment.

Integrative analysis from multi-center studies identities a consensus machine learning-derived lncRNA signature for stage II/III colorectal cancer.

SummaryBackgroundLong non-coding RNAs (lncRNAs) have recently emerged as essential biomarkers of cancer progression. However, studies are limited regarding lncRNAs correlated with recurrence and fluorouracil-based adjuvant chemotherapy (ACT) in stage II/III colorectal cancer (CRC).Methods1640 stage II/III CRC patients were enrolled from 15 independent datasets and a clinical in-house cohort. 10 prevalent machine learning algorithms were collected and then combined into 76 combinations. 109 published transcriptome signatures were also retrieved. qRT-PCR assay was performed to verify our model.FindingsWe comprehensively identified 27 stably recurrence-related lncRNAs from multi-center cohorts. According to these lncRNAs, a consensus machine learning-derived lncRNA signature (CMDLncS) that exhibited best power for predicting recurrence risk was determined from 76 kinds of algorithm combinations. A high CMDLncS indicated unfavorable recurrence and mortality rates. CMDLncS not only could work independently of common clinical traits (e.g., AJCC stage) and molecular features (e.g., microsatellite state, KRAS mutation), but also presented dramatically better performance than these variables. qRT-PCR results from 173 patients further verified our in-silico findings and assessed its feasible in different centers. Comparisons of CMDLncS with 109 published transcriptome signatures further demonstrated its predictive superiority. Additionally, patients with high CMDLncS benefited more from fluorouracil-based ACT and were characterized by activation of stromal and epithelial-mesenchymal transition, while patients with low CMDLncS suggested the sensitivity to bevacizumab and displayed enhanced immune activation.InterpretationCMDLncS provides an attractive platform for identifying patient at high risk of recurrence and could optimize precision treatment to improve the clinical outcomes in stage II/III CRC.FundingThis study was supported by the National Natural Science Foundation of China (81,972,663); Henan Province Young and Middle‐Aged Health Science and Technology Innovation Talent Project (YXKC2020037); and Henan Provincial Health Commission Joint Youth Project (SB201902014).

Associations of Monocytes and the Monocyte/High-Density Lipoprotein Ratio With Extracranial and Intracranial Atherosclerotic Stenosis.

Background: Although the monocyte/high-density lipoprotein ratio (MHR) has been shown to be a potential marker of inflammatory of cardiovascular and cerebrovascular diseases, there are few studies on its relationships with the degree of intracranial and extracranial atherosclerotic stenosis and the stenosis distribution.Methods: In total, 271 patients were admitted for digital subtraction angiography (DSA) examination and were classified into a non-stenosis group and a stenosis group. (1) The two groups were compared and the arteries were categorized according to the degree of intracranial or extracranial atherosclerotic stenosis (if ≥two branches were stenotic, the artery with the most severe stenosis was used). (2) Clinical baseline data and laboratory indexes of patients grouped according to stenosis location (intracranial vs. extracranial) were collected.Results: (1) MHR × 102 [odds ratio (OR) = 1.119, p < 0.001], age (OR = 1.057, p = 0.007), and lymphocyte count (OR = 0.273, p = 0.002) significantly affected the presence of cerebral atherosclerotic stenosis, with an MHR area of 0.82 under the receiver operating characteristic (ROC) curve (AUC) and an optimal diagnostic value of 0.486. Analyses of the moderate, mild, and severe stenosis groups showed that MHR × 102 (OR = 1.07, p < 0.001) significantly affected the severity of stenosis in patients. (2) In the analysis of stenosis at different sites, the rate of extracranial artery stenosis in patients who smoked (OR = 3.86, p = 0.023) and had a reduced lymphocyte level (OR = 0.202, p = 0.001) was remarkably greater than that in patients who smoked (OR = 3.86, p = 0.023). With increasing age, the rate of extracranial artery stenosis raised sharply. With the increase in the MHR level, the stenosis rate of each group was highly greater than that of the non-stenosis group.Conclusion: The MHR has a predictive value for the diagnosis of extracranial and intracranial atherosclerotic stenosis and is correlated with the degree and distribution of stenosis.Trial Registration: Clinical Medical Research Center Project of Qinghai Province (2017-SF-L1). Qinghai Provincial Health Commission Project (Grant #2020-wjzdx-29).

Use of public data to describe COVID-19 contact tracing in Hubei Province and non-Hubei provinces in China between 20 January and 29 February 2020.

ObjectiveContact tracing has been used in China and several other countries in the WHO Western Pacific Region as part of the COVID-19 response. We describe COVID-19 cases and the number of contacts traced and quarantined per case as part of COVID-19 emergency public health response activities in China.MethodsWe abstracted publicly available, online aggregated data published in daily COVID-19 situational reports by China’s National Health Commission and provincial health commissions between 20 January and 29 February 2020. The number of new contacts traced by report date was computed as the difference between total contacts traced in consecutive reports. A proxy for the number of contacts traced per case was computed as the number of new contacts traced divided by the number of new cases.ResultsDuring the study period, China reported 80 968 new COVID-19 cases and 659 899 contacts. In Hubei Province, there were 67 608 cases and 264 878 contacts, representing 83% and 40% of the total, respectively. Non-Hubei provinces reported tracing 1.5 times more contacts than Hubei Province; the weekly number of contacts traced per case was also higher in non-Hubei provinces than in Hubei Province and increased from 17.2 in epidemiological week 4 to 115.7 in epidemiological week 9.DiscussionMore contacts per case were reported from areas and periods with lower COVID-19 case counts. With other non-pharmaceutical interventions used in China, contact tracing and quarantining large numbers of potentially infected contacts probably contributed to reducing SARS-CoV-2 transmission.

Predicting Stroke Risk in a Chinese Hypertensive Population Using Machine Learning

Background: Stroke is a major global health concern, and risk prediction is essential for primary prevention of stroke. However, uncertainty remains about the optimal methodology for analyzing stroke risk. In this study, we aim to determine the most effective stroke prediction method in a targeted population using machine learning and establish a general pipeline for future analysis. Method: Training set included 70% of data (n=14491) from China Stroke Primary Prevention Trial (CSPPT), a randomized, double-blind, multicenter clinical trial. Internal validation was processed with the rest 30% of CSPPT data (n=6211), and external validation was conducted using a Nested case-control (NCC) dataset (n=2568). Total analyzed participants were hypertensive adults who without prior history of stroke (n=23270). The primary outcome was first stroke. Four received analysis methods were processed and compared: logistic regression (LR), stepwise logistic regression (SLR), extreme gradient boosting (XGBoost), and random forest (RF). Population characteristic data with inclusion and exclusion of laboratory variables were separately analyzed. Accuracy, sensitivity, specificity, kappa, and area under receiver operating characteristic curves (AUCs) were used to make model assessments with AUCs the top concern. Data balancing techniques including random under sampling (RUS) and synthetic minority over sampling technique (SMOTE) were applied to process this unbalanced training set. Findings: Best model performance was observed in RUS applied RF model with laboratory variables. Compared with null models (sensitivity = 0, specificity = 100, mean AUCs = 0·643), data balancing techniques improved overall performance with RUS demonstrated a more satisfactory effect in current study (RUS: sensitivity = 63·9; specificity = 53·7; AUCs = 0.624 (mean). Adding laboratory variables improved performance of analysis methods. All results were reconfirmed in validation sets. The top 10 important variables were determined by the analysis method with the best performance. Interpretation: Among tested methods, the most effective stroke prediction model in targeted population is RUS applied RF. From the insights current study revealed, we provided general frameworks of building machine learning based prediction models. Funding Information: The study was supported by funding from the following: Jiangxi Outstanding Person Foundation [20192BCBL23024]; Key RD the National Natural Science Foundation of China [81960074, 81730019, 81973133]; Jiangxi Provincial Health Commission [202130440]; the National Key Research and Development Program [2016YFE0205400, 2018ZX09739010, 2018ZX09301034003], the Science and Technology Planning Project of Guangzhou, China [201707020010]; the Science, Technology and Innovation Committee of Shenzhen [JSGG20170412155639040, GJHS20170314114526143, JSGG20180703155802047]; the Economic, Trade and Information Commission of Shenzhen Municipality [20170505161556110, 20170505160926390]; the Research Fund Program of Guangdong Provincial Key Laboratory of Renal Failure Research, Clinical Innovation Research Program of Guangzhou Regenerative Medicine and Health Guangdong Laboratory [2018GZR0201003]. Declaration of Interests: Dr. Xiao Huang reports grants from Jiangxi Outstanding Person Foundation [20192BCBL23024], Key RD Jiangxi Provincial Health Commission [202130440]; Dr. Xiping Xu reports grants from the National Key Research and Development Program [2016YFE0205400, 2018ZX09739010, 2018ZX09301034003], the Department of Science and Technology of Guangdong Province [2020B121202010], the Science and Technology Planning Project of Guangzhou, China [201707020010], the Science, Technology and Innovation Committee of Shenzhen [GJHS20170314114526143, JSGG20180703155802047], the Economic, Trade and Information Commission of Shenzhen Municipality [20170505161556110, 20170505160926390, 201705051617070]. Dr. Xianhui Qin reports grants from the National Natural Science Foundation of China [81730019, 81973133]; the Research Fund Program of Guangdong Provincial Key Laboratory of Renal Failure Research, Clinical Innovation Research Program of Guangzhou Regenerative Medicine and Health Guangdong Laboratory [2018GZR0201003]. No other disclosures were reported. Ethics Approval Statement: Two data sets with similar baseline characteristics investigated by the same team were selected and analyzed in our study: The China Stroke Primary Prevention Trial (CSPPT) data set and the nested case-control (NCC) data set which is a subset from the H-type Hypertension and Stroke Prevention and Control Project (HSPCP). Both studies were approved by the Ethics Committee of the Institute of Biomedicine, Anhui Medical University, Hefei, China and all participants from both studies provided written informed consent.

Effect of Emerging Major Infectious Diseases on Sleep Quality of Medical Workers: Findings from Medical Workers Providing Support During the COVID-19 Pandemic.

BackgroundThe coronavirus disease 2019 (COVID-19) outbreak has exerted immense pressure on medical systems in China and abroad. This study aimed to compare the sleep quality of medical personnel conscripted to the Wuhan Union Cancer Centre to offer support during the early stages of the COVID-19 pandemic to the sleep quality of those who remained at Anhui Medical University Hospital and to determine the role of interventions in improving sleep quality.Material/MethodsQuestionnaires were completed by 369 individuals who were conscripted to support Wuhan (N=137) and others who were not (the control group; N=232). The Pittsburgh Sleep Quality Index (PSQI) was used to measure the duration and quality of sleep. The Anhui Provincial Health Commission organized a comprehensive intervention, consisting of physical-psychological-social dimensions, over the course of 2 weeks.ResultsOnly 34.21% of the Wuhan support workers reported better sleep quality, as opposed to the 55.60% of the control group at stage 1 (t/χ2=14.005, P<.001). Furthermore, despite the Wuhan support group being more prone to poor sleep quality, their sleep quality significantly improved after the interventions.ConclusionsThe findings from this study showed that medical staff who were conscripted to offer support during the early stages of the COVID-19 pandemic suffered from impaired quality of sleep. The use of questionnaire-based sleep assessments may provide individualized approaches to supporting medical personnel during future epidemics and pandemics. Furthermore, our results indicate that relevant interventions can significantly improve sleep quality, while a prolonged break after interventions does not affect sleep quality.

A Heterogeneous Branching Process with Immigration Modeling for COVID-19 Spreading in Local Communities in China

The COVID-19 pandemic spread catastrophically over the world since the spring of 2020. In this paper, a heterogeneous branching process with immigration is established to quantify the human-to-human transmission of COVID-19 in local communities, based on the temporal and structural transmission patterns extracted from public case disclosures by four provincial Health Commissions in China. With proper parameter settings, our branching model matches the actual transmission chains satisfactorily and, therefore, sheds light on the underlying COVID-19 spreading mechanism. Moreover, based on our branching model, the efficacy of home quarantine and social distancing are explored, providing a reference for the effective prevention of COVID-19 worldwide.

Quality Requirements for the Release of COVID-19 Data and Further Regulatory Suggestions

To surveil the development of COVID-19 is a complex and challenging issue. The foundation of such surveillance is timely and accurate epidemic data. Therefore, quality control for releasing COVID-19 data is very important, accounting for the releasing agent, the content to release, and the impact of the released data. We suggest that the quality requirements for the release of COVID-19 data be based on the global perspective that the goal of open epidemic data is to create a valuable ecological chain in which all stakeholders are involved. As such, the collection, aggregation, and release process of the COVID-19 data should meet not only the data quality standards of official statistics and health statistics, but also the characteristics of the epidemic statistics and the needs of pandemic prevention. The quality requirements should follow the unique characteristics of the epidemic and be scrutinized by the public. We integrate the perspectives of official statistics, health statistics, and open government data, proposing five quality dimensions for releasing COVID-19 data: accuracy, timeliness, systematicness, userfriendliness and security. Through case studies on the official websites of Chinese provincial health commission, we report the quality problems in the current data releasing process and suggest improvements.

Forecasting of COVID-19 onset cases: a data-driven analysis in the early stage of delay.

The outbreak of COVID-19 has become a global public health event. Many researchers have proposed many epidemiological models to predict the outbreak trend of COVID-19, but all use confirmed cases to predict “onset cases.” In this article, a total of 5434 cases were collected from National Health Commission and other provincial Health Commission in China, spanning from 1 December 2019 to 23 February 2020. We studied the delayed distribution of patients from onset to be confirmed. The delay is divided into two stages, which takes about 15 days or even longer. Therefore, considering the right truncation of the data, we proposed a “predict-in-advance” method, used the number of “visiting hospital cases” to predict the number of “onset cases.” The results not only show that our prediction shortens the delay of the second stage, but also the predicted value of onset cases is quite close to the real value of onset cases, which can effectively predict the epidemic trend of sudden infectious diseases, and provide an important reference for the government to formulate control measures in advance.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11356-020-11859-w.

Risk-Grade Classification of Progress of Disease in Patients Undergoing Multimodality Treatments for Recurrent or Metastatic HNSCC

Objective: Neither the factors that affect prognosis for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) is not well investigated, nor are comparative efficacy of salvage treatments well assessed. To determine factors predicting the outcome after multimodality of treatments for R/M HNSCC, we classified the R/M HNSCC into three risk-grades based on progress-free survival time and investigated the tumor factors and treatments. Methods: A retrospective analysis was conducted at head and neck center of Sir Run Run Shaw hospital of clinical and follow-up data for 152 R/M HNSCC patients who underwent salvage surgery with or without microvascular flap reconstruction, salvage radiation, systemic treatments after prior unsuccessful cancer treatment using surgery, radiation, or chemotherapy. Results: According to the progress-free survival (PFS). 116 (76.3%) recurrence or metastasis HNSCC with progress of disease (PD) divided into 4 grades: 15 (12.9%) in every low-risk of PD, 19 (16.4%) in low-risk of PD, 38 (32.8%) in middle-risk of PD, 44 (37.9%) in high-risk of PD. The proportion of cigarettes in the high-risk of PD was significantly higher than other grades (60.00%, 73.68%, 60.53% and 86.36%, respectively, p=0.0431). The distribution of primary pathological differentiation, T stage, N stage was significantly different among four grades. The most predominant R/M or second malignance lesion of low-risk and every low-risk of PD was larynx (73.33%, 57.89%, 7.89%, and 9.09%, respectively, p<0.0001). Prior surgery followed with adjuvant chemoradiation in high-risk of PD were significantly higher than those in low-risk and every-low risk of PD (6.67%, 0.00%, 34.21% and 47.73%, respectively; P=0.0004). Notably, salvage surgeries without microvascular reconstruction apparently improved survival and were the main salvage treatments of low-risk and very low-risk patients (73.33%, 57.89%, 31.58%, and 13.64%, respectively; P=0.0138). Importantly, the short PFS did not significantly correspond to short DFS. Conclusions: The risk-grade classification may favor strategies for predict prognosis of R/M patients and identification likely to benefit from salvage treatments. Due to our risk classification, asymptomatic and local regional recurrence conferred decreased risk of PD for aggressive-recurrence patients. Radical surgical salvage remains the critical strategy for resectable disease, although proper patient selection for microvascular reconstruction is essential. For second R/M disease, patients with low-risk of PD would be possibility benefit from supportive care rather than aggressive re-salvage treatments. Funding: This work was supported by the National Natural Science Foundation of China (No. 62071415), Natural Science Foundation of Zhejiang Province (No. LY21H160031), Medical Health Science and Technology Project of Zhejiang Provincial Health Commission Grants (No. 2019336033 and No. 2020367813). Declaration of Interest: The authors declare that they have no competing interests. Ethical Approval: According to the protocol approved by the Ethical Review Committee of the Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University.