Efficacy of Definitive Radiotherapy for Patients with Clinical Stage IIIB or IIIC Lung Adenocarcinoma and Epidermal Growth Factor Receptor (EGFR) Mutations Treated Using First- or Second-Generation EGFR Tyrosine Kinase Inhibitors

Background

The effectiveness of definitive radiotherapy (RT) for patients with clinical stage IIIB or IIIC lung adenocarcinoma and epidermal growth factor receptor (EGFR) mutations who received first- or second-generation EGFR tyrosine kinase inhibitors (TKIs) is unclear.

Methods

Taiwan Cancer Registry data were used in this retrospective cohort study to identify adult patients diagnosed with EGFR-mutated stage IIIB or IIIC lung adenocarcinoma between 2011 and 2020. Patients treated with first- or second-generation EGFR TKIs were classified into RT and non-RT groups. Propensity score (PS) weighting was applied to balance covariates between groups. The primary outcome was overall survival (OS), and the incidence of lung cancer mortality (ILCM) was considered as a supplementary outcome. Additional supplementary analyses were conducted to assess the robustness of the findings.

Results

Among 270 eligible patients, 41 received RT and 229 did not. After a median follow-up of 46 months, PS-weighted analysis showed the PS-weighted hazard ratio of death for the RT group compared to the non-RT group was 0.94 (95% CI: 0.61-1.45, p = 0.78). ILCM rates did not differ significantly between the two groups. Supplementary analyses yielded consistent results.

Conclusion

The addition of definitive RT to first- or second-generation EGFR TKI treatment does not significantly improve OS of patients with EGFR-mutated stage IIIB or IIIC lung adenocarcinoma. NCT03521154NCT05167851.

Neoadjuvant Chemotherapy With/Without Radiotherapy for Locally Advanced Rectal Cancer: A Nationwide Retrospective Cohort Study

BACKGROUND/AIM

The role of neoadjuvant radiotherapy in the management of patients with locally advanced rectal cancer (LARC) who have undergone neoadjuvant systemic therapy has been the subject of recent debate.

PATIENTS AND METHODS

We identified eligible rectal cancer patients diagnosed between 2011 and 2020 using data from the Taiwan Cancer Registry. In our primary analysis, we applied propensity score weighting (PSW) to balance observable potential confounders. We then compared the hazard ratio (HR) of death the neoadjuvant concurrent chemoradiotherapy (nCCRT) group and the neoadjuvant chemotherapy without radiotherapy (nCT) group. Additionally, we conducted a comprehensive assessment of other outcomes and performed various supplementary analyses.

RESULTS

The primary analysis included 2,298 patients. The overall survival did not exhibit statistically significant differences, with a PSW-adjusted HR of 0.72 (95% confidence interval=0.33-1.56, p=0.40) when comparing the nCCRT group to the nCT group. These findings were consistent with those of other long-term outcomes and supplementary analyses.

CONCLUSION

In patients with LARC who have undergone neoadjuvant systemic therapy, the addition of radiotherapy did not yield statistically significant differences in long-term clinical outcomes.

[Study on formulation and revision of standard limits for inhalable particulate matter (PM10) and fine particulate matter (PM2.5) in "Standards for indoor air quality（GB/T 18883-2022）" in China]

The pollution and health effects of indoor inhalable particulate matter (PM10) and fine particulate matter (PM2.5) are increasingly receiving public attention. The"Standards for indoor air quality (GB/T 18883-2022)"has revised the standard limit for PM10 and added the standard limit for PM2.5. This study analyzed and interpreted the relevant technical contents of the revision of the standard limits for two indicators, including the exposure status, health effects, and the basis for the determination of the limit value. It also proposed prospects for the future development and revision of standard limits for indoor particulate matters.

[Analysis of the burden of disease attributable to high temperature exposure in China and globally from 1990 to 2019]

Objective: To analyze the burden of disease attributable to high temperature exposure in China and globally from 1990 to 2019, and to study the current burden of disease in relevant populations. Methods: In October 2021, based on data from the global burden of disease 2019 (GBD 2019) study, population attributable fraction (PAF), number of deaths, mortality, disability-adjusted life year (DALY) and DALY rate of Chinese and global populations with different ages and genders in 1990 and 2019 were extracted and analyzed. The rate of change was calculated, the mortality rate was normalized by the age structure of the world standard population, and the causes of disease burden caused by high temperature exposure of Chinese residents were analyzed. Results: In 2019, compared with 1990, the PAF of Chinese and global population decreased by 43.98% and 12.41% respectively, the number of deaths increased by 29.55% and 49.40% respectively, the crude mortality rate increased by 7.81% and 3.30% respectively, the DALY decreased by 48.12% and 14.41% respectively, and the DALY rate decreased by 56.82% and 40.82% respectively. The mortality rate of the ≥70 age group was higher than that of other groups. The disease burden indicators such as PAF, standardized mortality and DALY attributable to high temperature exposure in men were higher than those in women. In 2019, the main cause of DALY affected by high temperature exposure in Chinese population was ischemic heart disease (84400 person-years), and the main cause of death was ischemic heart disease (4900 cases). Conclusion: The burden of diseases attributable to high temperature exposure is still serious in China and the world at large. Targeted interventions should be formulated for men, the elderly and people with occupational exposure, and a sound surveillance system should be established to reduce the burden of diseases caused by high temperature exposure.

[Efficacy and safety of dexcitabine combined with HAAG regimen in the treatment of recurrent acute myeloid leukemia]

Objective: To investigate the efficacy and safety of dexithabine (DAC) combined with HAAG regimen [harringtonine (HHT), cytarabine (Ara-C), aclarubicin (Acla) and recombinant human granulocyte colony stimulating factor (G-CSF)] in the treatment of acute myeloid leukemia (AML). Methods: The clinical data of 89 AML patients in People's Hospital Affiliated to Shandong First Medical University from January 2019 to January 2021 were retrospectively analyzed. The patients were divided into observation group (n=48) and control group (n=41) according to the treatment plan. The observation group included 25 males and 23 females, aged (44.4±9.3) years old, and was treated with DAC combined with HAAG. The control group included 24 males and 17 females, aged (42.2±10.1) years old, and was treated with DAC regimen. After 3 cycles of treatment, the treatment efficacy of the two groups was judged, including complete remission, partial remission and no remission. The level of serum P-glycoprotein (P-gp) in the two groups was detected by direct immunofluorescence-labeled monoclonal antibody flow cytometry. The enzyme-linked immunosorbent assay was used to detect the level of soluble urokinase-type plasminogen activator receptor (suPAR). Meanwhile, the incidence of adverse reactions such as digestive tract reaction, liver and kidney dysfunction, hemorrhage and infection during treatment were recorded. Results: After 3 cycles of treatment, the observation group had complete remission, partial remission and no remission in 10 cases, 21 cases and 17 cases, respectively, and the control group had 3 cases, 11 cases and 27 cases, respectively. The overall efficacy of the observation group was better than that of the control group (Z=-2.919, P=0.004). The levels of serum P-gp and suPAR in the observation group were (5.2±1.8) % and (464.4±103.4) ng/L, respectively, which were significantly lower than those in the control group [(8.8±1.9) % and (660.6±110.4) ng/L, respectively] (both P<0.05). During the treatment, the incidence of digestive tract reaction, liver and kidney dysfunction, hemorrhage and infection in the observation group was 29.2% (14/48), 22.9% (11/48), 16.7% (8/48) and 33.3% (16/48), respectively, while in the control group was 26.8% (11/41), 21.9% (9/41), 14.6% (6/41) and 24.4% (10/41), respectively, with no statistically significant difference (all P>0.05). Conclusions: The overall efficacy of DAC combined with HAAG in the treatment of AML is better than that of DAC alone. Moreover, the incidence of adverse reactions in DAC combined with HAAG is similar to that of DAC alone, with a high safety profile.

Health Economic Evaluation of Proton Therapy for Lung Cancer: A Systematic Review

BACKGROUND

To our knowledge, there have been no systematic reviews of health economic evaluations of proton therapy specific to lung cancer.

METHODS

We conducted this systematic review according to the predefined protocol [PROSPERO CRD42022365869]. We summarized the results of the included studies via structured narrative synthesis.

RESULTS

We identified four studies (all used passively scattered proton therapy) from 787 searches. Two cost analyses reported that proton therapy was more costly than photon therapy for early- or locally advanced-stage non-small cell lung cancer, one cost-utility analysis reported that proton therapy was dominated by nonproton therapy in early-stage non-small cell lung cancer, and one cost-utility analysis reported that proton therapy was not cost-effective (vs. photon) in locally advanced non-small cell lung cancer.

CONCLUSIONS

Passively scattered proton therapy was more costly and not cost-effective than photon therapy for early- and locally advanced-stage non-small cell lung cancer. Further health economic evaluations regarding modern proton therapy (such as scanning beam) for common radiotherapy indications of lung cancer are eagerly awaited.

[Kinetics of SARS-CoV-2-specific antibodies among inactivated COVID-19 vaccine recipients, SARS-CoV-2 natural infection cases, and breakthrough cases]

Between August and September, 2021, this study included 605 SARS-CoV-2 natural infection cases and 589 SARS-CoV-2 breakthrough cases from Nanjing and Yangzhou, as well as 690 inactivated COVID-19 vaccine recipients from Changzhou, China. In SARS-CoV-2 natural infection cases, the age range was 19-91 years (median age: 66 year), and the medians(Q₁,Q₃) of IgG titers were 0.19 (0.06-1.31), 3.70 (0.76-69.48), 15.31 (2.59-82.16), 4.41 (0.99-31.74), 2.31 (0.75-13.83), 2.28 (0.68-9.94) and 2.80 (1.00-9.53) at one to seven weeks after SARS-CoV-2 infection, respectively. In SARS-CoV-2 breakthrough cases, the age range was 18-76 years (median age: 45 year), and the medians(Q₁,Q₃)of IgG titers were 1.93 (0.34-26.67), 38.87 (7.90-121.0), 75.09 (11.85-123.70), 21.97 (5.20-95.58), 13.97 (3.47-46.82), 9.56 (2.48-33.38) and 4.38 (1.87-11.00) at one to seven weeks after SARS-CoV-2 infection, respectively. In inactivated COVID-19 vaccine recipients, the age range was 18-87 years (median age: 47 years), and the medians(Q₁,Q₃)of IgG titers were 16.22 (15.84-33.42), 5.35 (2.96-13.23), 3.30 (2.18-6.18), 3.14 (1.16-5.70), 2.77 (1.50-4.52), 2.72 (1.76-4.36), 2.01 (1.27-3.51) and 1.94 (1.35-3.09) at one to eight months after SARS-CoV-2 infection, respectively. The results suggested that IgG antibodies increased gradually within two weeks after SARS-CoV-2 infection, then declined gradually at three to seven weeks in SARS-CoV-2 natural infection cases. In SARS-CoV-2 breakthrough cases, IgG antibodies increased rapidly within two weeks, then declined gradually at three to seven weeks after SARS-CoV-2 infection. Additionally, IgG antibodies decreased rapidly within three months, then decreased gradually and remained at a low level within three months after immunization.

[Analysis of respiratory syncytial virus infection in hospitalized children with acute lower respiratory tract infection in China from 2017 to 2020]

Objective: To understand the detection rate, epidemic pattern of respiratory syncytial virus (RSV) in hospitalized children with acute lower respiratory tract infection (ALRTI) in China. Methods: From June 2017 to March 2020, a prospective multi-center study on the viral aetiology among hospitalized children with ALRTI was conducted in six pediatrics hospital of North China, Northeast, Northwest, South China, Southeast, and Southwest China. A total of 2 839 hospitalized children with ALRTI were enrolled, and the respiratory specimens were collected from these cases. A multiplex real-time RT-PCR assay were employed to screen the respiratory viruses, and the molecular epidemiological and clinical characteristics of children infected with RSV were analyzed. Results: The positve rate of RSV was 18.6% (528/2 839), and the positive rate of RSV in different regions ranged from 5.5% to 44.3%. The positive rate of RSV in male was higher than that in female (20.2% vs 16.3%), and there was a significant statistically difference between two groups (χ2=6.74, P=0.009). The positive rate of RSV among children under 5 years old was higher than that among children older than 5 years old (22.3% vs 4.5%), and there was a significant statistically difference between two groups (χ2=97.98,P<0.001). The positive rate of RSV among the <6 months age group was higher than that of other age groups (all P<0.05). During January 2018 and December 2019, RSV was detected in almost all through the year, and showed peaks in winter and spring. RSV-positive cases accounted for 17.0% (46/270) among children with severe pneumonia, including 36 cases infected with RSV alone. Conclusion: RSV is an important viral pathogen in children under 5 years old with ALRTI in China. The virus can be detected almost all through the year and reached the peak in winter and spring. RSV could lead to severe pneumonia in children and caused huge threaten to children's health.

High vs. low radiotherapy dose in locally advanced esophageal squamous cell carcinoma patients treated with neoadjuvant concurrent chemoradiotherapy: an endemic area population-based study

BACKGROUND

The optimal radiotherapy dose for locally advanced esophageal squamous cell carcinoma in endemic areas treated with neoadjuvant concurrent chemoradiotherapy is unclear.

METHODS

Eligible patients diagnosed between 2010 and 2019 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders. The hazard ratio (HR) of death was compared between high dose (50-50.4 Gy) and low dose (40-41.4 Gy) radiotherapy. We also evaluated other outcomes and performed supplementary analyses via an alternative approach.

RESULTS

Our study population consisted of 644 patients. The PS weight-adjusted HR of death was 0.92 (95% confidence interval: 0.7-1.19, p = 0.51). There were no statistically significant differences for other outcomes or supplementary analyses.

CONCLUSIONS

In this population-based study from an endemic area, we found no significant difference in overall survival between high vs. low radiotherapy doses.

Consolidative chemotherapy after definitive concurrent chemoradiotherapy for esophageal squamous cell carcinoma patients: a population based cohort study

BACKGROUND

The role of consolidative chemotherapy (CCT) for locally advanced esophageal squamous cell carcinoma (LA-ESCC) patients treated with definitive concurrent chemoradiotherapy (dCCRT) is unclear. We aimed to compare the overall survival (OS) of those treated with vs without CCT via a population based approach.

METHODS

Eligible LA-ESCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between those with vs without CCT. We also evaluated the OS in supplementary analyses via alternative approaches.

RESULTS

Our primary analysis consisted of 368 patients in whom covariates were well balanced after PS weighting. The HR of death when CCT was compared to without was 0.67 (95% confidence interval 0.52-0.86, P = 0.002). The HR of IECM was 0.66 (P = 0.04). The HR of OS remained similarly in favor of CCT in supplementary analyses.

CONCLUSIONS

We found that CCT was associated with significantly improved OS for LA-ESCC patients treated with dCCRT. Randomized controlled trials were needed to confirm this finding.

[The feasibility study of objective evaluation of the severity of motion sickness by quantitative analysis of the facial skin color]

Objective: To explore the feasibility of applying quantitative analysis of the facial skin color to evaluate the severity of motion sickness objectively and to seek objective indicators that can reflect the severity of motion sickness. Methods: Motion sickness was induced in 51 male adult subjects recruited at the Air Force Medical University by Coriolis acceleration stimulation, and facial skin colorimetric values were acquired using a portable spectrophotometer at five time points: before stimulation and at 0 min, 10 min, 20 min and 30 min after the end of stimulation. The Graybiel rating scales were applied to assess the severity of motion sickness in subjects at each time point after stimulation, and the correlation between the magnitude of change in each colorimetric value and the maximum Graybiel's score was analyzed. The ROC curves were used to compare the evaluation performance of colorimetric value indicators which could reflect the severity of motion sickness. Results: Each colorimetric value in the CIE-L^*a^*b^* color system changed significantly after exposure to provocative motion stimuli, and the trend was consistent with the typical sign of pallor in motion sickness. The magnitudes of the increase in the colorimetric value CIE-L^*, the decrease in CIE-a^*, and the increase in CIE-b^* were all significantly and positively correlated with the maximum of Graybiel's scores (r=0.490 0, P=0.000 3; r=0.549 3, P<0.000 1; r=0.540 9, P<0.000 1). Comparing the performance of three colorimetric indicators to assess the severity of motion sickness, CIE-a^* had an area under the ROC curve of 0.875 0, a sensitivity of 85.71%, and a specificity of 87.50%, which was better than CIE-L^* and CIE-b^*. Conclusions: The CIE-L^*a^*b^* colorimeter values can be considered as objective indicators of the severity of motion sickness, among which the colorimetric indicator CIE-a^* has the most diagnostic significance, and the method of quantitative analysis of the facial skin color can provide a new reference for the objective evaluation of the severity of motion sickness.

[Levels and trends of significant injury-caused deaths in the Chinese population, 2010-2019]

Objective: To analyze the level and changing trend of significant injury-caused deaths in the Chinese population from 2010 to 2019 and provide evidence for related intervention. Methods: Data on notable injury-caused deaths in areas under National Disease Surveillance Programs were collected from 2010 to 2019. Crude and standardized mortality rates of four significant injuries were calculated to describe the status of injury-caused deaths. The trend of changes in standardized mortality rates was analyzed using the Joinpoint regression model. Results: The overall trend of standardized mortality rate on an injury during 2010-2019 was consistently decreasing (AAPC=-3.5%, P<0.001) while the general direction of accidental fall standardized mortality rate was increasing (AAPC=1.0%, P=0.104). The standardized mortality rate for significant injuries fluctuated with age, increasing for those aged 50-79 years (AAPC=3.9% for the 50- group, AAPC=5.6% for the 60- group, and AAPC=4.6% for the 70- group, all P<0.001). The standardized mortality rates for all major injuries were higher in males than those in females, with road traffic accidents and drowning declining faster in males than that in females (AAPC=-5.3% in the male road traffic accident group, AAPC=-3.8% in the female road traffic accident group, AAPC=-4.0% in the male drowning group, AAPC=-3.5% in the female drowning group, all P<0.001), and suicide and sequelae declining faster in females than that in males (AAPC=-6.4% in female, AAPC=-4.7% in male, all P<0.001). The standardized mortality rate for significant injuries was higher in rural than that in urban areas and decreased faster than that in urban areas. The central region had the highest standardized mortality rate for suicide and sequelae. The western part had the highest standardized mortality rates for road traffic accidents, accidental falls, and drowning, with the fastest decline in road traffic accidents and drowning (AAPC=-5.3% in the road traffic accident group and AAPC=-5.3% in the drowning group, both P<0.001). Conclusions: The mortality rate from significant injuries in the Chinese population showed a continuous downward trend from 2010 to 2019, with a rebound in the standardized mortality rate from accidental falls in recent years among the elderly, males, rural residents, and central and western regions being the focus of future prevention and control.

Effectiveness evaluation of adjuvant concurrent chemoradiotherapy for patients with positron emission tomography-staged esophageal squamous cell carcinoma after complete resection: A population-based cohort study

Background

The role of adjuvant concurrent chemoradiotherapy (ACCRT) is unclear for patients with esophageal squamous cell carcinoma (ESCC) who receive esophagectomy with clean margins. We compared the survival of the ACCRT versus observation groups for these patients staged with positron emission tomography (PET) via a population‐based approach.

Methods

Eligible patients with locally advanced ESCC diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratios (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between the ACCRT and observation groups. We also evaluated overall survival (OS) in subgroups of either with or without lymph node metastases.

Results

Our primary analysis consisted of 105 patients in whom the covariates were well balanced after PS weighting. The HR for death when ACCRT was compared with observation was 0.58 (95% confidence interval 0.28–1.21, p = 0.15). The results were also not significantly different for IECM or in the subgroup analyses.

Conclusion

We found that for patients with PET‐staged ESCC who received esophagectomy with clean margins, the survival was not statistically different between ACCRT and observation. Further studies (randomized or larger sample size) are needed to clarify this issue.

Adjuvant Concurrent Chemoradiotherapy Versus Adjuvant Chemotherapy Only in Locally Advanced Non-small-cell Lung Cancer With Involved Microscopic Resection Margin: A Population-based Cohort Study

BACKGROUND/AIM

The role of adjuvant concurrent chemoradiotherapy (aCCRT) for locally advanced non-small cell lung cancer (LA-NSCLC) treated with radical surgery, with microscopically involved resection margin, has been debated without there being any direct evidence. In this study, we aimed to compare the outcomes between aCCRT and adjuvant chemotherapy (aCT).

PATIENTS AND METHODS

Eligible patients diagnosed within 2011-2018 with LA-NSCLC were identified via the Taiwan Cancer Registry. We used propensity-score weighting to balance observable potential confounders, and then compared the hazard ratios of death between aCCRT-treated vs. aCT-treated groups. We also performed supplementary analyses using propensityscore matching.

RESULTS

Our main study population consisted of 82 patients. The propensity score weight-adjusted hazard ratio of death for the aCCRT group was 0.74 (95% confidence interval=0.35-1.56, p=0.43). There was also no statistically significant difference in survival between groups in the supplementary analyses.

CONCLUSION

For patients treated with radical but R1 resection for LA-NSCLC, there was no significant OS benefit from the addition of concurrent radiotherapy.

[Analysis of public appeals for vaccination in Guangzhou's Government Hotline from 2018 to 2020]

This study analyzed the characteristics and change trend of Guangzhou citizens' demands related to vaccination through government hotlines 12345 and 12320 from 2018 to 2020. It understood the hotspots and needs of the public for vaccination work, analyzed the problems existing in vaccination work, and provided reference and suggestions for health departments to improve vaccination services and formulate relevant policies: to timely improve the professional ability and knowledge reserve of hotline personnel; to strengthen the construction of vaccination service system;to optimize the appointment vaccination service application; to scientifically purchase HPV vaccine and ensure the production and supply of vaccine.

[Association between urinary arsenic levels and anemia among older adults in nine longevity areas of China]

Objective: To investigate the association between urinary arsenic levels and anemia among older adults in nine longevity areas of China. Methods: A total of 1 896 subjects aged 65 years and above who participated in the Healthy Aging and Biomarkers Cohort Study (HABCS) in 2017-2018 were included. A self-made questionnaire was used to collect demographic characteristics, lifestyle and other information from the subjects. Through physical examination, data including height, weight and blood pressure were determined and body mass index (BMI) was calculated. Blood and urine samples were collected for the detection of hemoglobin (Hb), blood glucose, blood lipids, plasma vitamin B₁₂ and urinary arsenic concentrations. The urinary arsenic levels were divided into four groups according to the quartiles of urinary arsenic concentrations (μg/g creatinine): Q₁ (<18.7), Q₂ (18.7-34.5), Q₃ (34.6-69.5) and Q₄(≥69.6). Multivariate logistic regression model and restricted cubic spline fitting logistic regression model were used to analyze the association between urinary arsenic levels and anemia. Results: The age of the 1 896 subjects (M (Q₁, Q₃)) was 83 (74, 92) years, including 952 females (50.21%), and the concentration of Hb (M (Q₁, Q₃)) was 135 (124, 147)g/L. The prevalence of anemia was 24.89% (472 cases). The geometric mean and M (Q₁, Q₃) of urinary arsenic concentrations were 37.5 and 34.6 (18.7, 69.6)μg/g creatinine, respectively. Multivariate logistic regression model analysis showed that after adjusting for age, gender, BMI, education level, smoking and drinking status, residence, economic level, ethnicity, the status of vitamin B₁₂ deficiency, consumption frequency of aquatic products and meat, the prevalence of hypertension, diabetes and dyslipidemia, urinary arsenic levels were positively associated with anemia (Taking group Q₁ as a reference, OR (95%CI) values in Q₂, Q₃ and Q₄ groups were 1.73 (1.20-2.50), 2.08 (1.43-3.02) and 1.52 (1.02-2.28), respectively). The results of restricted cubic spline fitting logistic regression analysis showed a non-linear association between urinary arsenic concentrations and anemia (P<0.001). Subgroup analysis showed there was a negative multiplicative interaction between the prevalence of chronic diseases and urinary arsenic levels with OR (95%CI) was 0.55 (0.30-0.99), while no multiplicative interaction was found between age, gender, residence, smoking status, drinking status and urinary arsenic levels (P>0.05). There was a positive association between urinary arsenic levels and anemia in participants who were absence of chronic diseases,male, living in rural, smoking and drinking with OR (95%CI) values of 3.62 (1.30-10.06),2.46 (1.34-4.52), 1.70 (1.03-2.80), 2.21 (1.01-4.82) and 2.79 (1.23-6.33), respectively. Conclusion: There is a positive association between urinary arsenic levels and anemia among older adults in nine longevity areas of China.

[One case report of pneumoconiosis in porcelain teeth workers]

Porcelain tooth technology is widely used in the treatment of oral diseases, but there are few reports on the possible occupational hazard factors in the process of porcelain tooth production. Porcelain teeth production will produced a large amount of silica dust and metal dust during the grinding process. The technical workers who have been engaged in this work for a long time are very prone to pneumoconiosis due to their poor personal protection awareness. This paper analyzed the clinical data of a pneumoconiosis patient engaged in porcelain tooth making, and analyzed the possible occupational hazard factors in the process of porcelain teeth production, so as to improve the understanding of relevant enterprises, technical workers and medical personnel on the disease and reduce the risk of porcelain teeth production workers suffering from pneumoconiosis.

Optimal radiotherapy dose in cervical esophageal squamous cell carcinoma patients treated with definitive concurrent chemoradiotherapy: A population based study

BACKGROUND

The optimal radiotherapy dose for locally advanced cervical esophageal squamous cell carcinoma (C-ESqCC) treated with definitive concurrent chemoradiotherapy (dCCRT) is unclear. Here, we aimed to compare the survival of those treated with high dose versus standard dose via a population based approach.

METHODS

Eligible C-ESqCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between high (60-70 Gy) and standard dose (50-50.4 Gy). We also evaluated the outcome in supplementary analyses via alternative approaches.

RESULTS

Our primary analysis consisted of 141 patients in whom covariates were well balanced after PS weighting. The HR of death when high dose was compared with standard dose was 0.65 (95% confidence interval [CI]: 0.4-1.03, p = 0.07). The HR of IECM was 0.74 (p = 0.45). The HR of OS remained similarly insignificant in supplementary analyses.

CONCLUSIONS

We observed a trend in favor of high radiotherapy dose versus standard dose for C-ESqCC treated with dCCRT in this population-based nonrandomized study. Further studies are needed to confirm the findings of the study.

Focal conformal fractionated radiotherapy vs. radiosurgery for lung cancer patients with limited brain metastases

BACKGROUND

For lung cancer (LC) patients with limited brain metastases (LBM), radiosurgery (RS) was the current preferred strategy. We aimed to report our experience regarding an alternative strategy (focal conformal fractionated radiotherapy, FCFRT) for these patients in this cohort study.

METHODS

We identified LC patients with LBM treated with either FCFRT or RS within 2016-2019 without prior brain local treatment via in-house databases. The characteristics of patients, disease, treatment, and outcome were retrospectively obtained via chart review and peer review. The 1st day of FCFRT or RS was the index date. Overall survival (OS) was calculated from the index date to the last date of contact or death via the Kaplan-Meier method. Log-rank test was used in univariate analyses (UVA) whereas Cox regression method was used in the multivariate analyses (MVA). The incidence of local progression (LP) or distal brain metastases (DBM) was estimated by the competing risk approach with death as the competing risk.

RESULTS

We identified 23 eligible patients. The median dose/fractionation for FCFRT was 36 Gy/10 fractions. The median dose for RS was 20 Gy. The Lung-molGPA prognostic groups' distribution for these two groups was not statistically different. After a median follow-up of 8 months (range, 1-38 months), the OS was not statistically different in UVA [P value 0.9]. The adjusted hazard ratio of death was 0.96 when FCFRT was compared to RS in MVA (95% CI, 0.21-5.22). There was also no statistical significant difference in LP (P value 0.79) or DBM (P value 0.88).

CONCLUSIONS

For LC patients with LBM, the OS was not statistically different for definitive FCFRT or RS. There was also no statistical difference in LP or DBM. Further studies should be considered to clarify the indication of FCFRT.

[A cohort study on plasma uric acid levels and the risk of type 2 diabetes mellitus among the oldest old in longevity areas of China]

Objective: To investigate the effect of plasma uric acid level on the incident risk of type 2 diabetes mellitus (T2DM) among the oldest old (those aged ≥80 years). Methods: Participants were recruited from the Healthy Aging and Biomarkers Cohort Study (HABCS), which conducted a baseline survey in 2008-2009 and follow-up of 3 times in 2011-2012, 2014, and 2017-2018, respectively. A total of 2 213 oldest old were enrolled in this study. The general demographic, socioeconomic, lifestyle and disease data of the oldest old were collected, and physical measurements were made for the oldest old. Fasting venous blood was collected for uric acid and blood glucose detection. Information on the incident and death of T2DM were collected through the follow-up. Cox proportional hazard regression model was used to explore the association of hyperuricemia and plasma uric acid level with the incidence of T2DM. Restricted cubic spline (RCS) function was used to explore the dose-response relationship of plasma uric acid levels with the risk of T2DM. Results: The age of participants was (93.2±7.6) years old, and 66.7% of the participants (1 475) were female. The plasma uric acid level at baseline was (289.1±88.0)μmol/L, and the prevalence of hyperuricemia was 13.3% (294 cases). During 9 years of cumulative follow-up of 7 471 person-years (average of 3.38 years for each), 122 new cases of T2DM occurred and the incidence density was 1 632.98/10⁵ person year. Cox proportional hazards regression analysis showed that per 10μmol/L increase in plasma uric acid level, the risk of T2DM increased by 1.1% [HR (95%CI): 1.011 (1.004, 1.017)]. Compared with the participants with the lowest quintile of plasma uric acid (Q₁), the risk of diabetes increased by 20.7 % among the oldest old with uric acid in the highest quintile (Q₅) [HR (95%CI):1.207 (1.029, 1.416)]. The risk of T2DM was 19.2% higher in the hyperuricemia group than that in the oldest old with normal plasma uric acid [HR (95%CI): 1.192 (1.033, 1.377)]. RCS function showed that the risk of T2DM increased with the increase in plasma uric acid levels in a nonlinear dose-response relationship (P=0.016). Conclusion: The incident risk of T2DM increases with the elevates of plasma uric acid levels in the oldest old.

Effectiveness of Image-Guided Radiotherapy in Adjuvant Radiotherapy on Survival for Localized Breast Cancer: A Population-Based Analysis

Purpose

Image-guided radiotherapy (IGRT) is an advanced radiotherapy technique to improve the radiotherapy delivery. We aimed to compare the overall survival (OS) for localized breast cancer (LBC) patient treated with adjuvant conventional fractionated radiotherapy (CFRT) using IGRT vs those without IGRT via a population-based analysis.

Patients and Methods

Eligible LBC patients diagnosed between 2011 and 2013 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratio (HR) of death and other outcomes were compared between IGRT and non-IGRT. We also evaluated OS in various supplementary analyses.

Results

Our primary analysis included 6490 patients in whom covariates were well balanced after PS weighing. The HR for death when IGRT was compared with non-IGRT was 1.02 (95% confidence interval 0.80–1.31, P = 0.86). There were also no significant differences in the supplementary analyses.

Conclusion

We found that OS of LBC patients treated with adjuvant CFRT was not statistically different between those treated with IGRT versus without IGRT. This was the first study in this regard to our knowledge but randomized controlled trials were needed to confirm our finding.

Safety of image-guided radiotherapy in definitive radiotherapy for localized prostate cancer: a population-based analysis

Objectives:

Image-guided radiotherapy (IGRT) is a recommended advanced radiation technique that is associated with fewer acute and chronic toxicities. However, one Phase III trial showed worse overall survival in the IGRT arm. The purpose of this observational study is to evaluate the impact of IGRT on overall survival.

Methods:

We used the Taiwan Cancer Registry Database to enroll cT1-4N0M0 prostate cancer patients who received definitive radiotherapy between 2011 and 2015. We used inverse probability treatment weighting (IPW) to construct balanced IGRT and non-IGRT groups. We compared the overall survival of those in the IGRT and non-IGRT groups. Supplementary analyses (SA) were performed with alternative covariates in propensity score (PS) models and PS approaches. The incidence rates of prostate cancer mortality (IPCM), other cancer mortality (IOCM), and cardiovascular mortality (ICVM) were also evaluated.

Results:

There were 360 patients in the IGRT arm and 476 patients in the non-IGRT arm. The median follow-up time was 50 months. The 5-year overall survival was 88% in the IGRT arm and 86% in the non-IGRT arm (adjusted hazard ratio [HR] of death = 0.93; 95% CI, 0.61–1.45; p = 0.77). The SA also showed no significant differences in the overall survival between those in the IGRT and non-IGRT arms. Both groups did not significantly differ in terms of IPCM, IOCM, and ICVM.

Conclusions:

The overall survival of localized prostate cancer patients who underwent IGRT was not inferior to those who did not.

Advances in knowledge:

We demonstrated that the overall survival for prostate cancer patients with IGRT was not worse than those who did not undergo IGRT; this important outcome comparison has not been previously examined in the general population.

Chemotherapy alone versus definitive concurrent chemoradiotherapy for cT4b esophageal squamous cell carcinoma: a population-based study

Background

The role of radiotherapy for cT4bNanyM0 esophageal squamous cell carcinoma (ESqCC) is relatively unclear, with both chemotherapy (C/T) alone and definitive concurrent chemoradiotherapy (dCCRT) being treatment options in the current guidelines. We aimed to compare the survival of dCCRT versus C/T for these patients via a population-based approach.

Methods

Eligible cT4b ESqCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance the observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between dCCRT and C/T. We also evaluated OS in subgroups of either low or standard radiotherapy doses.

Results

Our primary analysis consisted of 247 patients in whom covariates were well balanced after PS weighing. The HR for death when dCCRT was compared with C/T was 0.36 (95% confidence interval 0.24–0.53, P < 0.001). Similar results were found for IECM. Statistical significance was only observed in the standard RT dose but not in the low dose in subgroup analyses.

Conclusions

In this population-based nonrandomized study of cT4bNanyM0 ESqCC patients from Asia (Taiwan), we found that the use of radiotherapy with chemotherapy was associated with better overall survival than chemotherapy alone. Further studies (especially RCTs) are needed to confirm our findings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-021-01742-4.

[Association of sleep duration with cognitive impairment among older adults aged 65 years and older in China]

Objective: The study is to examine association of sleep duration and cognitive impairment in the older adults aged 65 years and older in China. Methods: We analyzed data from 2017-2018 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 14 966 participants were included in the analysis. Data with respect to socioeconomic status, community involvement, behavior pattern, diet, life style, family structure, disease condition, mental health and cognitive function were collected. Cognitive function was measured with Mini-mental State Examination (MMSE). We conducted generalized linear mixed models to examine associations of sleep duration with cognitive impairment, and subgroup analyses of sex and age were conducted. Results: Among 14 966 participants, the percentage of participants aged 65 to 79 years, 80 to 89 years, 90 to 99 years and 100 years and older was 5 148 (4.40%), 3 777 (25.24%), 3 322 (22.20%) and 2 719 (18.16%), respectively. A total of 2 704 participants reported sleep duration of 5 h and less, and 3 883 reported 9 h and more, accounting for 18.94% and 27.19%, respectively. In total, 3 748 were defined with cognitive impairment, accounting for 25.04%. The results of generalized linear mixed models showed that both short (≤5 h) and long (≥ 9 h) sleep duration were associated with cognitive impairment compared with sleep duration of 7 h, with OR(95%CI) of 1.35(1.09-1.68) and 1.70(1.39-2.07), respectively. The association of sleep duration with cognitive impairment was more obvious in males and individuals aged 65 to 79 years old. Conclusion: Short or long sleep duration was responsible for increased risk of cognitive impairment in older Chinese.

[Association of blood oxidative stress level with hypertriglyceridemia in the elderly aged 65 years and older in 9 longevity areas of China]

Objective: To investigate the association of blood oxidative stress level with hypertriglyceridemia in the elderly aged 65 years and older in China. Methods: A total of 2 393 participants aged 65 years and older were recruited in 9 longevity areas from Heathy Aging and Biomarkers Cohort Study, during 2017 to 2018. Information on demographics characteristic, life style and health status were collected by questionnaire and physical examination, and venous blood was collected to detect the levels of blood oxidative stress and hypertriglyceridemia. The linear or non-linear association between oxidative stress and hypertriglyceridemia was described by restrictive cubic splines (RCS) fitting multiple linear regression model. The generalized linear mixed effect model was conducted to assess the association between oxidative stress and hypertriglyceridemia. Results: A total of 2 393 participants, mean age was 84.6 years, the youngest was 65 and the oldest was 112, the male was 47.9%(1 145/2 393), the triglyceride level was (1.4±0.8) mmol/L. The hypertriglyceridemia detection rate was 9.99%(239/2 393). The results of multiple linear regression model with restrictive cubic spline fitting showed that MDA level was linear association with triglyceride level; SOD level was nonlinear association with triglyceride level. MDA level had significantly association with hypertriglyceridemia, and the corresponding OR value was 1.063 (95%CI: 1.046,1.081) with 1 nmol/ml increment of blood MDA; SOD level had significantly association with hypertriglyceridemia, and the corresponding OR value was 0.986(95%CI: 0.983,0.989) with 1 U/ml increment of blood SOD. Conclusion: Among the elderly aged 65 and older in 9 longevity areas in China, MDA and SOD levels were associated with the risk of hypertriglyceridemia.

Silencing LncRNA LINC01305 inhibits epithelial mesenchymal transition in lung cancer cells by regulating TNXB-mediated PI3K/Akt signaling pathway

The aim of this study was to investigate whether LINC01305 can regulate TNXB-mediated phosphatidilinositol 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway and therefore affect epithelial mesenchymal transition in lung cancer cells. Quantitative real-time polymerase chain reaction (qRT-PCR) was conducted to detect LINC01305 level in 52 non-small cell lung cancer (NSCLC) tissues and paracancerous normal lung tissues, and the relationship between LINC01305 expression and clinical pathological parameters of these subjects was analyzed. After LINC01305 was knocked down in PC9 cell and overexpressed in A549 cells, qRT-PCR was used to verify the transfection efficiency, and nuclear fractionation technique, cell counting kit-8 (CCK-8), plate cloning assay and Transwell test were used to detect the effect of LINC01305 on cell viability. LINC01305 had an obviously higher expression in NSCLC tissues, and the expression in lung cancer patients with tumor size >3 cm was higher than those with tumor ≤3 cm. LINC01305 expression in tumor tissues in T3-T4 stage was obviously higher than those in T1-T2 stage, and the overall survival rate of lung cancer patients with high expression of LINC01305 was lower than those with low expression. Moreover, clinical analysis revealed that LINC01305 level was related to tumor size, TNM stage and lymph node metastasis of patients with lung cancer, but not related to age or gender. Silencing LINC01305 can inhibit the epithelial mesenchymal transition-induced transformation of lung cancer cells through regulating TNXB-mediated PI3K/Akt signaling pathway, which in turn affects the progression of lung cancer.

Effectiveness of image-guided radiotherapy for locally advanced lung cancer patients treated with definitive concurrent chemoradiotherapy

Background

Image‐guided radiotherapy (IGRT) is an advanced radiotherapy technique to improve the precision and accuracy of treatment delivery. A recent randomized controlled trial (RCT) for prostate cancer patients treated with radiotherapy via either IGRT or routine care reported statistically significantly worse overall survival (OS) for those patients treated with IGRT. This raised the concern regarding the effectiveness of IGRT in definitive concurrent chemoradiotherapy (dCCRT) for locally advanced lung cancer (LALC).

Methods

Eligible LALC patients diagnosed between 2011 and 2016 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratio (HR) of death and other outcomes were compared between IGRT and non‐IGRT. We also evaluated OS in various subgroups.

Results

Our primary analysis consisted of 797 patients in whom covariates were well balanced after PS weighing. The HR for death when IGRT was compared with non‐IGRT was 0.96 (95% confidence interval 0.79–1.15, P = 0.65). There were also no significant differences for most of the other outcomes or subgroup analyses.

Conclusions

In this updated nonrandomized study, we found that OS of LALC patients treated with dCCRT was not statistically different between those treated with IGRT versus non‐IGRT. The results should be interpreted with caution given the nonrandomized design. Studies regarding toxicity, local control, or designed as RCT are needed to clarify the role of IGRT.

Key points

Significant findings of the study

The OS of LALC patients treated with dCCRT was not statistically different between those treated with IGRT versus those without IGRT, although the observed HR for death was less than unity (ie, in favor of IGRT).

What this study adds

In this updated nonrandomized study using real world data with additional potential confounders, our study provided a reasonable tentative evidence in the lack of RCT as suggested in the literature.

Mapping the near-field spin angular momenta in the structured surface plasmon polariton field

Optical spin angular momenta in a confined electromagnetic field exhibit a remarkable difference with their free space counterparts; in particular, the optical transverse spin that is locked with the energy propagating direction lays the foundation for many intriguing physical effects such as unidirectional transportation, quantum spin Hall effects, photonic Skyrmions, etc. In order to investigate the underlying physics behind the spin-orbit interactions as well as to develop the optical spin-based applications, it is crucial to uncover the spin texture in a confined field, yet it faces challenges due to their chiral and near-field vectorial features. Here, we propose a scanning imaging technique which can map the near-field distributions of the optical spin angular momenta with an achiral dielectric nanosphere. The spin angular momentum component normal to the interface can be uncovered experimentally by employing the proposed scanning imaging technique and the three-dimensional spin vector can be reconstructed theoretically with the experimental results. The experiment is demonstrated on the example of surface plasmon polaritons excited with various vector vortex beams under a tight-focusing configuration, where the spin-orbit interaction emerges clearly. The proposed method, which can be utilized to reconstruct the photonic Skyrmion and other photonic topological structures, is straightforward and of high precision, and hence it is expected to be valuable for the study of near-field spin optics and topological photonics.

Clinical Outcomes and Prognostic Factors of Patients With Esophageal Squamous Cell Carcinoma With Oligo-recurrence Treated With Radical Re-irradiation

BACKGROUND

For patients with esophageal squamous cell carcinoma (ESCC) with oligo-recurrence (OR) after previous curative radiotherapy and not eligible for radical resection, the role of radical re-irradiation was not clear. Therefore, we aimed to investigate the outcome and prognostic factors of such patients.

PATIENTS AND METHODS

We identified patients with OR of ESCC after previous curative radiotherapy and were treated with radical re-irradiation within 2012-2018 via an in-house prospectively established database. The characteristics of patients, disease, treatment, and outcome were retrospectively obtained via chart review. The first day of re-irradiation was defined as the index date. Overall survival was calculated via the Kaplan-Meier method. Log-rank test was used for univariate analysis and Cox regression method was used for multivariable analysis.

RESULTS

We identified thirty patients for analyses. After a median follow-up of 9 (range=2-76) months, the 5-year overall survival rate was 21%. Four patients with possible radiotherapy-related complication in need of inpatient care were identified. Gross tumor volume was the only significant prognostic factor in both univariate and multivariable analyses.

CONCLUSION

We found that radical definitive re-irradiation may lead to one-fifth long-term survivors of patients with OR after previous curative radiotherapy for ESCC, and the gross tumor volume was the only significant prognostic factor for these patients. Randomized controlled trials should be considered to compare radical re-irradiation with the current standard of care (systemic therapy) for this population.

[Current advances in research of burning mouth syndrome: biological nerve and social psychology patterns]

Burning mouth syndrome (BMS) is a complex chronic disorder characterized symptomatically by burning sensation mainly localized in the tongue with no specific lesions. Its etiology is not fully understood. Due to the persistent pain and unsatisfactory outcome of treatment, patients with high expectation when seeking medical advice easily feel discontent after treatment, which might cause medical dispute. This review introduces the epidemiology, manifestations, etiology, diagnosis, classification and treatment of BMS. The authors hope the current advances about BMS, mainly focus on the etiology of biological nerve and social psychology, may help the clinicians in treatment of BMS.

Impact of the interval between neoadjuvant concurrent chemoradiotherapy and esophagectomy in the modern era: a population-based propensity-score-matched retrospective cohort study in Asia

Background

Neoadjuvant concurrent chemoradiotherapy (nCCRT) is one of the standard-of-care options for locally advanced esophageal squamous cell carcinoma (LA-ESqCC). The optimal interval between nCCRT and esophagectomy is unknown.

Methods

We constructed a propensity-score-matched [1:1 for long (8–12 weeks) vs short (4–7 weeks) intervals] cohort of LA-ESqCC patients who were diagnosed from 2011 to 2015 and treated with nCCRT via the Taiwan Cancer Registry and related databases. We compared the hazard ratios (HRs) of death using a robust variance estimator. We also evaluated alternative covariables, outcomes, and interval definitions.

Results

Our study population included 80 patients for each group; groups were balanced with respect to the observed covariables. There was no significant difference for the HR of death [1.22; 95% confidence interval 0.78–1.91, P = 0.39] when the long interval group was compared to the short interval group. There were also no significant differences when alternative covariables, outcomes, or interval definitions were evaluated.

Conclusions

In this population-based study in modern Asia, we found that for LA-ESqCC patients treated with nCCRT and esophagectomy, overall survival was similar for either long or short intervals between nCCRT and esophagectomy. Randomized controlled trials are needed to verify this finding.

Comparative effectiveness of simultaneous integrated boost vs sequential intensity-modulated radiotherapy for oropharyngeal or hypopharyngeal cancer patients: A population-based propensity score-matched analysis

There were 2 common radiotherapy dose fractionation strategies in head-and-neck cancer patients (such as oropharyngeal cancer [OPC] or hypopharyngeal cancer [HPC]) treated with radiotherapy: intensity-modulated radiotherapy using simultaneous integrated boost (IMRT-SIB) and sequential IMRT (IMRT-SEQ). There is a lack of high-level clinical evidence to compare IMRT-SIB vs IMRT-SEQ specifically for OPC or HPC patients. The present study investigated the survival outcomes of OPC or HPC patients receiving definite concurrent chemoradiotherapy (CCRT) with either IMRT-SIB or IMRT-SEQ via a population-based propensity score (PS)-based analysis.The localized stage OPC or HPC patients diagnosed between 2011 and 2015 were identified based on the Health and Welfare Data Science Center database in Taiwan. These patients received definitive CCRT with either IMRT-SIB or IMRT-SEQ. We constructed a PS-matched cohort (1:1 for IMRT-SIB vs IMRT-SEQ) to balance observable potential confounders. We compared the hazard ratio (HR) of death between IMRT-SIB and IMRT-SEQ during the entire follow-up period. We also evaluated other disease outcome or subgroups.Our study population constituted 200 patients with well balance in observed covariables. The HR of death when IMRT-SIB was compared to IMRT-SEQ was 1.23 (95% confidence interval 0.84-1.80, P = .29). The results were similar for other disease outcome or subgroups.We found the survival outcome might be comparable for those treated with IMRT-SIB vs those treated with IMRT-SEQ.

Effectiveness of image-guided radiotherapy for locally advanced esophageal squamous cell carcinoma patients treated with definitive concurrent chemoradiotherapy

Background

Image‐guided radiotherapy (IGRT) is an advanced radiotherapy technique to improve the accuracy of treatment delivery. However, a recent randomized controlled trial (RCT) for prostate cancer patients treated with radiotherapy either via IGRT or routine care (no daily IGRT) reported a statistically significant worse overall survival for those treated with IGRT. This raised the concern regarding the effectiveness of IGRT for definitive concurrent chemoradiotherapy (dCCRT) for locally advanced esophageal squamous cell carcinoma (LA‐ESqCC).

Methods

Eligible LA‐ESqCC patients diagnosed between 2011 and 2015 were identified via the Taiwan Cancer Registry. We estimated propensity scores to construct a 1:1 propensity‐score‐matched groups and balance observable potential confounders. The hazard ratio (HR) of death as well as other outcomes was compared between IGRT and non‐IGRT matched groups during the entire follow‐up period. The impact of additional covariables was considered in the sensitivity analysis.

Results

Our study population included 590 patients in the primary analysis. The HR for death when IGRT was compared with non‐IGRT was 0.92 (95% confidence interval 0.77–1.10, P = 0.35). There were also no significant differences for other outcomes or sensitivity analyses.

Conclusions

In this updated nonrandomized study using real world data, we found that the overall survival of LA‐ESqCC patients treated with dCCRT was not statistically different between those treated with IGRT versus those without IGRT, although the hazard ratio was less than unity, ie, in favor of IGRT. The results should be interpreted with caution given the nonrandomized design and RCTs are needed to clarify our findings.

Key points

Significant findings of the study: The OS of LA‐ESqCC patients treated with dCCRT was not statistically different between those treated with IGRT versus those without IGRT, although the hazard ratio was less than unity, ie, in favor of IGRT.

What this study adds: In this updated nonrandomized study using real world data with additional potential confounders, our study provided a reasonable tentative evidence of lack of RCT as suggested in the literature.

Operating behavior of micro-LEDs on a GaN substrate at ultrahigh injection current densities

Near-ultraviolet micro-LEDs with different diameters were fabricated on GaN substrates. The electroluminescence and the light output power-current density and current density-voltage relationships were measured. A saturated current density of 358 kA/cm² was achieved with a 20 µm LED. The ideality factor curves showed steps and peaks when the injection current density was increased from 20 to 150 kA/cm² and an abnormal efficiency increase. The transport and recombination processes of micro-LEDs at high injection current densities were simulated, and the many-body effect and phase space filling in the integrated quantum drift-diffusion model were considered. Serious current crowding was observed above 100 kA/cm², even for the 20 µm LED.

Effectiveness of image-guided radiotherapy for rectal cancer patients treated with neoadjuvant concurrent chemoradiotherapy: A population-based propensity score-matched analysis

AIM

The effects of image-guided radiotherapy (IGRT, an advanced RT technology) have been debated in the literature. We compared the outcomes of locally advanced rectal cancer (LARC) patients treated with neoadjuvant concurrent chemoradiotherapy (NCCRT; with vs without IGRT) in a large population-based propensity score (PS)-matched analysis.

METHODS

We identified LARC patients diagnosed between 2007 and 2015 via the Taiwan cancer registry (TCR) and constructed a PS-matched cohort to balance observable potential confounders. Outcomes (R0 resection, overall survival, incidence of local regional recurrence [ILRR], rectal cancer mortality [IRCM], other cancer mortality [IOCM] and cardiovascular mortality [ICVM]) were obtained from TCR and the national death registry. We compared the hazard ratio (HR) of death and other endpoints between IGRT and non-IGRT groups. We performed supplementary analysis (SA) to evaluate the robustness of these results in a subgroup, taking an additional potential confounder into account.

RESULTS

Our study population comprised of 586 patients that were balanced with regard to observed covariables. There was no significant difference in HR for death (0.99; 95% confidence interval 0.70-1.39; P = 0.94) between IGRT and non-IGRT groups. There were also no significant differences in R0 resection, ILRR, IRCM, IOCM or ICVM. The results of our SA were consistent with these findings.

CONCLUSION

For LARC patients treated with NCCRT, the treatment outcome was not significantly different among patients treated with and without IGRT. Further study is needed to clarify these results with consideration to additional potential confounding factors and toxicity profiles at endpoints.

Detection and analysis of laser driven proton beams by calibrated Gafchromic HD-V2 and MD-V3 radiochromic films

The radiochromic film (RCF) is a high-dose, high-dynamic range dosimetry detection medium. A stack of RCFs can be used to detect both spatial and energetic distribution of laser driven ion beams with a large divergence angle and continuous energy spectrum. Two types of RCFs (HD-V2 and MD-V3, from Radiation Products Design, Inc.) have been calibrated using MeV energy protons and carbon ions produced by using a 2 × 6 MV tandem electrostatic accelerator. The proportional relationship is obtained between the optical density and the irradiation dose. For protons, the responses are consistent at all energies with a variation of about 15%. For carbon ions, the responses are energy related, which should be noted for heavy ion detection. Based on the calibration, the broad energy spectrum and charge distribution of laser accelerated proton beam with energy from 3 to 8 MeV and pC charge were detected and reconstructed at the Compact LAser Plasma Accelerator at Peking University.

[Diagnostic value of endobronchial ultrasonography with guide-sheath combined with virtual bronchoscopy navigation in peripheral lung cancer]

Objective: To explore the diagnostic value and safety of endobronchial ultrasonography with guide-sheath (EBUS-GS) combined with virtual bronchoscopy navigation (VBN) in peripheral lung cancer. Methods: Between Dec. 2015 to Dec. 2016, patients with pulmonary solitary nodule suspected of early lung cancer on computed tomography (CT) in Department of Respiratory, Tangdu Hospital, Fourth Military Medical University were enrolled for this study. The patients underwent EBUS-GS transbronchoscopic lung biopsy (TBLB) with or without VBN. The visibility rate, diagnostic yield, influencing factors, the operation time and complications were evaluated in the 2 groups. The data were compared using independent sample t test or chi-squared test. Results: A total of 134 patients were enrolled and completed this study. Among them 74 were males and 60 were females. There were 64 cases in the group of EBUS-GS with VBN (VBNA), and 70 in the group without VBN (NVBNA). The visibility rate and diagnosis rate of VBNA group were 87.5% (56/64) and 78.1% (50/64), respectively. The mean time of operation and confirming the target lesions were (25±5), (5.8±1.3) min, respectively. The visibility rate and diagnosis rate of NVBNA group were 81.4%(57/70) and 75.7%(53/70), respectively. The mean time of operation and confirming the target lesions were (27±6), (9.8±1.5)min .There was no significant difference in the visibility rate and diagnosis rate between the 2 groups (χ(2)=0.933, P=0.334; χ(2)=0.109, P=0.838). There was no significant difference in the mean operation time between the 2 groups(t=0.633, P=0.524). But the time of confirming the target lesions between the 2 groups was statistically different (t=17.41, P<0.01). EBUS-GS-TBLB was well tolerated. No severe complications such as pneumothorax or chest pain were observed. There were 3 patients in the VBNA group and 7 patients in the NVBNA group experiencing a small amount of biopsy site bleeding. The incidence of complications did not differ between the 2 groups(χ(2)=1.366, P=0.330). Conclusions: VBN could not improve the diagnostic yield of EBUS-GS. However, it could shorten the time needed to confirm the target lesions and did not increase the incidence of EBUS-GS complications, indicating that EBUS-GS with VBN was a safe and effective method.

Outcomes of Localized Esophageal Squamous Cell Carcinoma Patients Treated With Definitive Concurrent Chemoradiotherapy Using Either Standard or High Radiotherapy Dose: A Retrospective Study Controlling for Organ at Risk Dose

BACKGROUND/AIM

The optimal radiotherapy dose for localized esophageal squamous cell carcinoma (ESqCC) patients treated with definitive concurrent chemo-radiotherapy (CCRT) is debated. The aim of our study was to compare patient outcomes using either standard or high radiotherapy dose.

MATERIALS AND METHODS

Eligible patients diagnosed between 2011 and 2015 from the cancer registry of our Institute were identified and a propensity score (PS)-matched cohort (1:1 for high vs. standard dose) was constructed to balance observable potential confounders (including organ at risk dose). The hazard ratio (HR) of death between high and standard dose was compared.

RESULTS

Our study population included 73/36 patients before/after PS matching. The HR of death at the high dose compared to the standard dose was 0.554 (95% confidence interval (CI)=0.308-0.998, p=0.049).

CONCLUSION

Definitive CCRT using a high radiotherapy dose showed improved survival outcomes for localized ESqCC patients compared to standard dose.

[Multicenter study of human adenovirus infection in pediatric community-acquired pneumonia in China]

Objective: To investigate the predominant genotypes and epidemiological characteristics of human adenovirus (HAdV) in pediatric community-acquired pneumonia (CAP) in China. Methods: This was a repeated cross sectional study. Between November 2014 and November 2016, nasopharyngeal aspirates (NPAs) or throat swabs from each hospitalized pediatric patients diagnosed as CAP in 12 hospitals in Northern and Southern China were collected. Respiratory specimens were screened for 18 respiratory viruses including HAdV by using Luminex xTAG RVP Fast V2 multiplex Assay. Typing of HAdV and analysis for the epidemiological characteristic of HAdV were performed. Results: (1) A total of 2 723 hospitalized pediatric patients with CAP were enrolled in this study and 156 (5.7%, 156/2 723) respiratory specimens were positive for HAdV, and 74 (6.6%, 74/1 128) and 82 (5.1%, 82/1 595) were in Northern and Southern China, respectively. There was no significant difference in the positive detection rate between the Northern and Southern China. (2) In Northern China, the HAdV positive rate of children at the age of <6 months, 6 months-<1 years, 1-<3 years, 3-<5 years and ≥5 years was 5.9%(6/101), 6.7%(7/104), 10.3%(34/331), 4.1%(11/266) and 4.9%(16/326), respectively, and the incidence of HAdV infection peaked in children aged 1-3 years (χ(2)=11.511, P=0.021). While in Southern China the HAdV positive rate of children at the age of <6 months, 6 months-<1 years, 1-<3 years, 3-<5 years and ≥5 years was 2.2% (7/312), 4.6% (12/259), 6.3% (31/494), 7.3% (18/245) and 4.9%(14/285), respectively. There was no significant difference in the positive detection rate among age groups. (3) In 2015, the highest detection rate of HAdV in northern China was 12.5% (25/200) in winter, and in Southern China was 6.7% (35/525) in spring and 5.3% (19/357) in summer. (4) In 108 cases of HAdV positive specimens typing was done and 80 in cases classification was successfully performed.Totally 7 genotypes of HAdV, including HAdV-3 (n=32), HAdV-7 (n=9), HAdV-1 (n=12), HAdV-2 (n=15), HAdV-5 (n=10), HAdV-6 (n=1) and HAdV-4 (n=1), were detected. The predominant HAdV genotypes were HAdV-3 (30.8%, 8/26) and HAdV-7 (26.9%, 7/26) in Northern China, while HAdV-3 (44.4%, 24/54) and HAdV-2 (22.2%, 12/54) were the most prevalent genotypes in Southern China. Conclusions: HAdV is an important viral pathogen in pediatric CAP. The predominant HAdV genotypes and peak seasons of HAdV infections were different between Northern and Southern China. The predominant HAdV genotypes were HAdV-3 and HAdV-7 in Northern China, while HAdV-3 and HAdV-2 in Southern China. The peak season of HAdV infections was winter in Northern China. However, HAdV infections are more common in spring and summer in Southern China.

Relation between flomoxef minimum inhibitory concentrations and clinical outcomes of patients treated with flomoxef for Enterobacteriaceae bacteremia

Background

Flomoxef is potentially effective against β-lactamase-producing Enterobacteriaceae because limited clinical data demonstrate its effectiveness against Enterobacteriaceae bloodstream infections (BSIs) based on its minimum inhibitory concentrations (MICs). This study was conducted to determine the optimal breakpoints based on the survival of patients with Enterobacteriaceae BSIs treated with flomoxef.

Methods

The 30-day crude mortality rate was analyzed among 224 adults who initiated flomoxef monotherapy for Enterobacteriaceae BSIs at a medical center over a 3-year period, according to the flomoxef MICs of the initial isolates. The outcome was evaluated by classification and regression tree modeling and by logistic regression analysis.

Results

The 30-day crude mortality was approximately two fold greater in patients whose isolates had flomoxef MICs of ≥2 mg/L (54.9% [62/113]) than in those with isolates with MICs of ≤1 mg/L (26.1% [29/111]); the differences were significant in bivariate analysis (P<0.01) and in survival analysis (log-rank test; P<0.001). The classification and regression tree analysis revealed a split between MICs of 1 and 2 mg/L and predicted the same difference in mortality, with a P-value of <0.001. Flomoxef for Enterobacteriaceae BSIs caused by isolates with flomoxef MICs of ≥2 mg/L was an independent predictor of 30-day crude mortality (adjusted OR 3.76, 95% CI 1.94–7.29).

Conclusion

Patients with Enterobacteriaceae bacteremia who received flomoxef had a lower 30-day crude mortality when the flomoxef MICs of the isolates were ≤1 mg/L than those with MICs ≥2 mg/L.

Comparative effectiveness of concurrent chemoradiotherapy versus EGFR-tyrosine kinase inhibitors for the treatment of clinical stage IIIb lung adenocarcinoma patients with mutant EGFR

BACKGROUND

The standard of care for fit locally advanced non-small cell lung cancer (NSCLC) patients is concurrent chemoradiotherapy (CCRT). However, in a subset of patients with lung adenocarcinoma with mutant EGFR (LA-mEGFR), the role of EGFR-tyrosine kinase inhibitors (TKIs) is not clear. We compared CCRT versus TKIs for the treatment of stage IIIb LA-mEGFR in a Taiwanese population.

METHODS

We identified patients from the Taiwan Cancer Registry with good performance status at clinical stage IIIb LA-mEGFR, diagnosed from June 2011 to December 2015 and treated with either TKIs or CCRT. Clinical covariables and survival status were also collected. The Cox regression method was used in the primary analyses and several propensity score methods and alternative study cohort definitions were used in additional analyses.

RESULTS

We compared the data of 177 TKI and 22 CCRT patients and found no statistically significant difference in overall (adjusted hazard ratio of death 0.71, 95% confidence interval 0.34-1.47) or lung cancer-specific survival (hazard ratio 0.65, 95% confidence interval 0.31-1.35). The results of most additional analyses were insignificant.

CONCLUSION

In this population-based study from Taiwan with limited case numbers, no statistical difference in the survival outcomes of patients with clinical stage IIIb LA-mEGFR treated with either EGFR-TKIs or CCRT was determined. Further prospective studies are needed to clarify our findings.

Comparison of intensity-modulated radiotherapy vs 3-dimensional conformal radiotherapy for patients with non-metastatic esophageal squamous cell carcinoma receiving definitive concurrent chemoradiotherapy: A population-based propensity-score-matched analysis

Whether the survival outcome of patients with non-metastatic esophageal squamous cell carcinoma (NM-ESCC) receiving definitive concurrent chemoradiotherapy (CCRT) is better with intensity-modulated radiotherapy (IMRT) or with 3-dimensional conformal radiotherapy (3DCRT) has been debated in the literature. We designed this population-based propensity-score (PS)-matched analysis to address this question. We identified eligible patients diagnosed between 2008 and 2015 from the Taiwan Cancer Registry and constructed a PS-matched cohort (1:1 for IMRT vs 3DCRT) to balance observable potential confounders. We compared the hazard ratio (HR) of death between IMRT and 3DCRT during the entire follow-up period. We also evaluated freedom from local regional recurrence (FFLRR) and esophageal cancer-specific survival (ECSS). Sensitivity analyses (SA) were performed to examine the robustness of our findings. Our study population constituted 558 patients who were well balanced with regard to the measured covariables. The HR of death with IMRT compared to 3DCRT was 0.43 (95% confidence interval 0.35-0.52, P < .001). The results remained significant for FFLRR and ECSS. In SA, our results remained significant when additional covariables were taken into consideration. The survival outcome of patients with NM-ESCC receiving CCRT might be better with IMRT vs 3DCRT. These study results should be interpreted with caution given some possible covariates lacking in the registry. Further studies are needed to clarify this issue.

Clinical benefit of ertapenem compared to flomoxef for the treatment of cefotaxime-resistant Enterobacteriaceae bacteremia

Objectives

Cefotaxime-resistant Enterobacteriaceae (CE) infections are intractable, with limited treatment options. Though carbapenems are frequently prescribed for CE infections, the emergence of carbapenem-resistant Enterobacteriaceae is of huge concern. Flomoxef is effective against CE in vitro, and some clinical data on its demonstrated effectiveness against CE bloodstream infections (BSIs) exists.

Patients and methods

We conducted a retrospective study on adults with BSI caused by flomoxef-susceptible CE to investigate the efficacy of flomoxef compared with that of ertapenem. The outcome was evaluated with propensity score-based matching and logistic regression analysis.

Results

Demographic and clinical characteristics of patients treated with flomoxef (n = 58) or ertapenem (n = 188) were compared. In the multivariate analysis, severe sepsis (adjusted odds ratio [AOR] = 3.84; 95% confidence interval [CI], 1.16–12.78; p = 0.03), high BSI mortality score (AOR = 5.59; 95% CI, 2.37–13.21; p < 0.01), ultimately or rapidly fatal comorbidity (AOR = 10.60; 95% CI, 3.43–32.75; p < 0.01), and pneumonia (AOR = 10.11; 95% CI, 3.43–29.81; p < 0.01) were independently associated with 28-day mortality. Using propensity scores, 58 flomoxef-treated patients were matched to 116 ertapenem-treated patients. There were no intergroup differences in BSI severity, comorbidity, or BSI sources. The 28-day mortality rates (20.7% vs 13.8%, p = 0.28) did not differ significantly. However, hospitalization length was shorter in the ertapenem group (10.2 ± 8.5 vs. 14.6 ± 9.4 days, p < 0.01).

Conclusion

Although similar outcomes were observed between the groups, ertapenem therapy was associated with a shorter hospitalization time in adults after CE BSI.

A Population-based Study of the Effectiveness of Stereotactic Ablative Radiotherapy Versus Conventional Fractionated Radiotherapy for Clinical Stage I Non-small Cell Lung Cancer Patients

Background

Stereotactic ablative radiotherapy (SABR) is a promising option for non-operated early-stage non-small cell lung cancer (NSCLC) compared to conventional fractionated radiotherapy (CFRT). However, results from conclusive randomized controlled trials are not yet available. The aim of our study was to explore the effectiveness of SABR vs. CFRT for non-operated early-stage NSCLC.

Patients and methods

We used a comprehensive population-based database to identify clinical stage I non-operated NSCLC patients in Taiwan diagnosed from 2007 to 2013 who were treated with either SABR or CFRT. We used inverse probability weighting and the propensity score as the primary form of analysis to address the nonrandomization of treatment. In the supplementary analyses, we constructed subgroups based on propensity score matching to compare survival between patients treated with SABR vs. CFRT.

Results

We identified 238 patients in our primary analysis. A good balance of covariates was achieved using the propensity score weighting. Overall survival (OS) was not significantly different between those treated with SABR vs. CFRT (SABR vs. CFRT: probability weighting adjusted hazard ratio [HR] 0.586, 95% confidence interval 0.264-1.101, p = 0.102). However, SABR was significantly favored in supplementary analyses.

Conclusions

In this population-based propensity-score adjusted analysis, we found that OS was not significantly different between those treated with SABR vs. CFRT in the primary analysis, although significance was observed in the supplementary analyses. Our results should be interpreted with caution given the database (i.e., nonrandomized) approach used in our study. Overall, further studies are required to explore these issues.

[Characteristics of epidemiology and antimicrobial resistance of gram-negative bacterial bloodstream infections in children]

Objective: To study the epidemiology and antimicrobial resistance of Gram-negative bacterial bloodstream infections in children, and to guide the choice of antimicrobials and the control of nosocomial infection. Method: Clinical data, bacteriology and antimicrobial susceptibility test results were collected retrospectively in hospitalized children who were diagnosed with gram-negative bacterial bloodstream infections in Yuying Children's Hospital of Wenzhou Medical University from January, 2010 to December, 2015. Result: A total of 399 cases (253 male and 146 female) were identified. The age ranged from 16 hours to 16 years (median age 10.1 months). The majority of cases were collected from division of neonatology (n=261, 65.4%), followed by 31 cases (7.8%) from pediatric intensive care unit and 29 cases (7.3%) from Gastroenterology Department; 275 cases (68.9%) had underlying diseases, mainly including preterm birth(n=172), neonatal respiratory distress syndrome(n=67) and newborn asphyxia(n=53). Eighty cases had received invasive procedures and 20 had surgical operation; 149 cases (37.3%) were community-acquired and 250 cases (62.7%) were hospital acquired. Fifty cases had complications, among those, 40 cases had septic shock, 32 cases had multiple organ dysfunction syndrome and 7 cases had disseminated intravascular coagulation; 288 cases were cured, 48 improved, 17 gave up treatment and discharged, and 46 died; totally 408 strains were isolated from 399 children, including Enterobacteriaceae (346, 84.8%), non-fermentative Gram-negative bacteria (49, 12.0%) and other gram-negative bacteria (13, 3.2%). The resistance rates of Escherichia coli (n=175) and Klebsiella pneumoniae (n=106) to carbapenems, β-lactams enzyme and its inhibitors, amikacin and cefoxitin were all lower than 10%. Totally 245 multi-drug resistant strains (60.1%) were isolated, including 225 strains of Enterobacteriaceae and 18 strains of non-fermentative Gram-negative bacteria (P<0.01) . Nine strains of Carbapenem-resistant Enterobacteriaceae were isolated, which were all sensitive to amikacin and the sensitive rates to fluoroquinolone reached 88.9%. Five strains which were detected sensitive to tigecycline were all sensitive. The proportion of Klebsiella sp in Gram-negative bacteria between 2013-2015 and 2010-2012 were 32.9% and 21.2%, respectively. The resistance rates of Escherichia coli and Klebsiella pneumoniae to β-lactams and its enzyme inhibitors and carbapenems had no significant change. Conclusion: Gram-negative bacterial bloodstream infections occur more frequently in newborns. Most children had combined underlying diseases. Escherichia coli and Klebsiella pneumoniae are the most common pathogens. β-Lactams and its enzyme inhibitors and carbapenems are the empirical choice of antimicrobial therapy for severe Enterobacteriaceae bloodstream bacterial infections.

[Clinical and genetic characteristics of Gitelman syndrome in 5 pedigrees]

Objective: To investigate the clinical and genetic characteristics of 5 pedigrees of Gitelman syndrome (GS), and summarize its advances in genetics, diagnosis and management. Methods: Five families with GS were identified and total genome DNA were extracted from the peripheral blood of all the family members. The exons and their flanking introns of SLC12A3 gene were amplified by PCR and screened for mutation using Autoassembler 2.0 software. Results: Six heterozygous SLC12A3 gene mutations were found in the five pedigrees, including two complex combination of deletion and insertion mutation (c.486-490delTACGGinsA and c. 965-1_969delgCGGACinsACCGAAA and c. 976-977delGT). These mutations were predicted to change the normal protein structure. Conclusion: These 6 SLC12A3 mutations are the major cause of the five pedigrees of GS.

Simultaneous detection of respiratory syncytial virus and human metapneumovirus by one-step multiplex real-time RT-PCR in patients with respiratory symptoms

BACKGROUND

Both respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are important viral pathogens causing respiratory tract infection (RTI) in the pediatric population. However, the clinical manifestations of RSV and hMPV infections are similar. Therefore, a reliable and rapid diagnostic tool is needed for diagnostic performance.

METHODS

In order to optimize diagnosis efficiency of RTI, the aim of this study is to establish a rapid and advanced method for simultaneous detecting RSV and hMPV in nasopharyngeal aspirates specimens from patients. We designed a one-step triplex real-time RT-PCR (qRT-PCR) protocol using TaqMan probes for detecting RSV and hMPV. The plasmid clones containing RSV nucleoprotein gene and hMPV fusion gene were established as reference standards. We used virus culture supernatants from 86 known pediatric RTI patient to test the specificity and sensitivity of our assay. Then we used total 222 nasopharyngeal aspirates specimens from pediatric patients hospitalized with respiratory symptoms to evaluate our assay.

RESULTS

Our one-step triplex qRT-PCR assay showed 100% sensitivity and specificity in testing RSV and hMPV in 86 known virus culture supernatants, with excellent linearity (R² > 0.99) and reliable reproducibility (CV lower than 1.04%). This assay has a wide dynamic range 10²-10⁹copies/reaction (limit of detection; LOD = 100 copies/reaction). A total of 222 patients hospitalized with respiratory symptoms were enrolled for clinical evaluation. In these samples, our qRT-PCR assay detected 68 RSV positive and 18 hMPV positive cases. However, standard virus culture only detected 8 RSV positive cases and 0 hMPV cases. Based on this improved triplex qRT-PCR assay, we found that RSV infection was associated with severe inflammation by chest X-ray and occurrence of pneumonia which were not observed previously.

CONCLUSIONS

In summary, we have developed a highly specific and sensitive one-step triplex qRT-PCR assay to detect hMPV and RSV simultaneously. This assay offers a valuable tool for routine diagnosis.

[Influence of extreme weather on years of life lost due to diabetes death in Chongqing and Harbin, China]

Objective: To understand the associations between extremely low and high air temperature and the years of life lost (YLL) due to diabetes deaths in Chongqing and Harbin with different climatic characteristics in China. Methods: A double threshold B-spline distributed lag non-linear model (DLNM) was used to investigate the lag and cumulative effects of extremely low and high air temperature on YLL due to diabetes for lag 0-30 days by using the urban meteorological and diabetes mortality data of Chongqing (2011-2013) and Harbin (2008-2010). The effects were expressed as relative risk (RR). Results: In Chongqing, the cold effects on YLL due to diabetes were delayed by four days and lasted for three days (lag4-6) with the highest RR of 1.304 (95%CI:1.033-1.647) at lag5. The hot effects were delayed by one day (lag1) with RR of 1.321 (95%CI:1.061-1.646). In Harbin, the extreme cold effects on YLL were delayed by four days and lasted for seven days (lag4-10) with the highest RR of 1.309 (95%CI: 1.088-1.575) at lag6. The hot effects were delayed by one day and lasted for four days (lag1-4) with the highest RR of 1.460 (95%CI:1.114-1.915) at lag2. The unit risk for cold and hot effects was 43.7% (P=0.005 5) and 18.0% (P=0.000 2) in Chongqing and 15.0% (P=0.000 8) and 29.5% (P=0.001 2) in Harbin, respectively. Conclusions: Both extremely low air temperature and extremely high air temperature might increase the years of life lost due to diabetes in cities with different climate characteristics. Health education about diabetes prevention should provide information about the effects of extreme weather events.