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Zhang J.,Chinese Academy of Medical Sciences
Zhonghua nei ke za zhi [Chinese journal of internal medicine] | Year: 2011

To investigate the effect and safety of early intervention and delayed intervention therapy on elderly patients and younger patients with non-ST segment elevation acute coronary syndrome. The patients with non-ST segment elevation acute coronary syndrome were randomly divided into early intervention group (coronary angiography taken within 24 hours after grouping) and delayed intervention group (coronary angiography taken after 36 hours after grouping). The primary endpoint was a composite endpoint of death, myocardial infarction and stroke during 180 days follow-up. A total of 815 patients were enrolled, including 198 elderly patients aged 75 years and above, and 617 younger patients aged below 75 years. The elderly patients had a greater incidence of the primary endpoint than that of younger patients (P = 0.00). The primary endpoint of early intervention group were obviously lower than that of delayed intervention group of younger patients (P = 0.01). There was no significant difference in primary endpoint incidence of early intervention group and delayed intervention group of the elderly patients (P = 0.39). The elderly patients with non-ST segment elevation acute coronary syndrome who underwent intervention had greater incidence of death and myocardial infarction. Early intervention reduced the rate of myocardial infarction for the younger patients. There was no significant difference in primary endpoint incidence between early intervention and delayed intervention among elderly patients.

Aschebrook-Kilfoy B.,Yale University | Aschebrook-Kilfoy B.,U.S. National Institutes of Health | Aschebrook-Kilfoy B.,U.S. National Cancer Institute | Zheng T.,Yale University | And 9 more authors.
Journal of Cancer Survivorship | Year: 2012

Introduction: Cytokines play a critical role in regulating the immune system. In the tumor microenvironment, they influence survival, proliferation, differentiation, and movement of both tumor and stromal cells, and regulate tumor interactions with the extracellular matrix. Given these biologic properties, there is reason to hypothesize that cytokine activity influences the pathogenesis of non-Hodgkin lymphoma (NHL). Methods: We investigated the effect of genetic variation in cytokine genes on NHL prognosis and survival by evaluating genetic variation in individual SNPs as well as the combined effect of multiple deleterious genotypes. Survival information from 496 female incident NHL cases diagnosed during 1996-2000 in Connecticut were abstracted from Connecticut Tumor Registry in 2008. Survival analyses were conducted by comparing Kaplan-Meier curves and hazard ratios (HR) were computed using Cox proportional hazard models adjusting for demographic and tumor characteristics for genes that were suggested by previous studies to be associated with NHL survival. Results: We found that the variant IL6 genotype is significantly associated (HR = 0. 42; 95%CI: 0. 23-0. 77) with a decreased risk of death, as well as relapse and secondary cancer occurrence, among those with NHL. We also found that risk of death, relapse, and secondary cancers varied by specific SNPs for the follicular, DLBCL, and CLL/SLL histologic types. We identified combinations of polymorphisms whose combined deleterious effect significantly alter overall NHL survival and disease-free survival. Conclusion: Our study provides evidence that the identification of genetic polymorphisms in cytokine genes may help improve the prediction of NHL survival and prognosis. © 2010 Springer Science+Business Media, LLC (Outside the USA).

News Article
Site: www.technologyreview.com

Backed by rich private investors, proton therapy, a highly precise but expensive form of radiation used to treat cancer, is booming in China. The country has gone from having no operating proton therapy centers two and a half years ago to having two in operation today plus at least 43 more proton projects in various stages of development, according to China Particle Therapy News, an industry newsletter. “Proton therapy is going into overdrive,” says Zeng Xianwen, a leading radiation oncologist with 60 years of experience in the field. Zeng is positive on the development but cautions that the treatment is not a cure-all. Advocates hold that proton-beam therapy is better than conventional radiation treatment based on X-rays because protons release most of their energy on the tumor and then stop, causing less damage to nearby healthy tissue. And researchers, including Zeng, are looking for ways to further improve the therapy by minimizing its impact on skin and other tissue the radiation travels through to reach the tumor. But studies of proton therapy have been limited, and their authors say more work in this area is needed. For example, a 2014 study of childhood brain tumor survivors supports the idea that proton therapy may lead to a better quality of life for patients when compared to conventional radiation, but its authors say more study is needed to prove that. Another paper published earlier this year concludes that despite its higher cost, proton therapy “offers promising cost-effectiveness” for childhood brain tumors and some types of breast, lung, and head and neck cancer. This study, however, was based on limited data, and its authors warn that the conclusion could change as more evidence becomes available. Proton centers are far more expensive to build than conventional radiation suites. Traditionally centers cost hundreds of millions of dollars to build. Even new, more compact designs cost between $25 million and $30 million per system. Rather than stemming from demand from the medical community, this building spree in China originates from the country’s shifting economic winds. Chinese investors have seen returns from traditionally lucrative stakes in manufacturing and real estate decline in recent years, and that has made investment in medical centers, particularly ones focused on a cutting-edge technology, an area of increasing popularity, says Yu Hongxia, general manager of APH Medical, a subsidiary of a medical supplies company that is investing 1.6 billion yuan ($240 million) in a proton center in southeastern China. Further encouraging this interest is a 2015 decision by the government to relax restrictions on the importing of medical equipment. That made it easy to purchase proton-beam systems from foreign manufacturers. Some worry these centers could further worsen the existing disparity of health care between what the rich and well-connected receive and the average citizen. Although detailed pricing information for the new centers is not yet available, it is certain to be expensive. The going rate for an average treatment at a proton center in Shanghai, one of two operating today, is 278,000 yuan ($41,636). Patients pay for that out of their own pocket. No insurance policy covers proton therapy in China today. Others question whether China has the medical expertise needed to staff so many centers. Some of the hospitals that have teamed up with private investors to build proton centers have never had radiation oncology departments, and there are few professionals experienced with providing proton therapy. As a result, Hu Yimin, chief medical physicist at Cancer Hospital Chinese Academy of Medical Sciences, worries that patients may suffer. “We should develop proton therapy, but not in such haste,” he says. Chao, a 28-year-old who underwent proton therapy treatment two years ago, would argue the centers can’t open quickly enough. In early 2014, when a doctor told her that a rare cancerous tumor nestled at the base of her skull had begun to grow again after two surgeries, Chao, who declined to have her full name published in order to protect her privacy, says she didn’t know what to do. A second doctor suggested proton therapy, but it wasn’t then available in China. That fall, her family scratched together 200,000 yuan ($29,954) and took her to a cancer center in Japan for treatment. “I was lucky,” says Chao, seated recently in her brightly lit office in Beijing. Her tumor is no longer growing, and she’s working full-time again.

Yu S.,Peking University | Yang C.S.,Rutgers University | Li J.,Chinese Academy of Medical Sciences | You W.,Peking University | And 4 more authors.
Cancer Prevention Research | Year: 2015

Although cancer incidence and mortality rates in the United States and some European countries have started to decrease, those in developing countries are increasing. China, the most populous developing country, is facing a serious challenge from cancer. Cancer incidence has been increasing for decades, and cancer is the leading cause of death in China. In 2012, the cancer incidence was 174.0 per 100,000, and the cancer mortality was 122.2 per 100,000 in China. In addition to the still-prevalent traditional Chinese cancers of the stomach, liver, esophagus, cervix, and nasopharynx, the incidence of "Western" cancers such those of the lung, breast, and colorectum has increased alarmingly in recent years. These increases are likely due to the lifestyle and environmental changes associated with rapid economic development and population aging. More importantly, a large portion of these cancers are preventable. Researchers in China have made important contributions to cancer prevention research, especially in the traditional Chinese cancers. More cancer prevention research and measures, especially on the major emerging cancers, are urgently needed. This review article highlights some of the past achievements and present needs in cancer prevention research in China and suggests important areas for future studies. ©2015 AACR.

Chen Z.,University of Oxford | Peto R.,University of Oxford | Zhou M.,Chinese Center for Disease Control and PreventionBeijing | Iona A.,University of Oxford | And 16 more authors.
The Lancet | Year: 2015

Background Chinese men now smoke more than a third of the world's cigarettes, following a large increase in urban then rural usage. Conversely, Chinese women now smoke far less than in previous generations. We assess the oppositely changing effects of tobacco on male and female mortality. Methods Two nationwide prospective studies 15 years apart recruited 220 000 men in about 1991 at ages 40-79 years (first study) and 210 000 men and 300 000 women in about 2006 at ages 35-74 years (second study), with follow-up during 1991-99 (mid-year 1995) and 2006-14 (mid-year 2010), respectively. Cox regression yielded sex-specific adjusted mortality rate ratios (RRs) comparing smokers (including any who had stopped because of illness, but not the other ex-smokers, who are described as having stopped by choice) versus never-smokers. Findings Two-thirds of the men smoked; there was little dependence of male smoking prevalence on age, but many smokers had not smoked cigarettes throughout adult life. Comparing men born before and since 1950, in the older generation, the age at which smoking had started was later and, particularly in rural areas, lifelong exclusive cigarette use was less common than in the younger generation. Comparing male mortality RRs in the first study (mid-year 1995) versus those in the second study (mid-year 2010), the proportional excess risk among smokers (RR-1) approximately doubled over this 15-year period (urban: RR 1·32 [95% CI 1·24-1·41] vs 1·65 [1·53-1·79]; rural: RR 1·13 [1·09-1·17] vs 1·22 [1·16-1·29]), as did the smoking-attributed fraction of deaths at ages 40-79 years (urban: 17% vs 26%; rural: 9% vs 14%). In the second study, urban male smokers who had started before age 20 years (which is now typical among both urban and rural young men) had twice the never-smoker mortality rate (RR 1·98, 1·79-2·19, approaching Western RRs), with substantial excess mortality from chronic obstructive pulmonary disease (COPD RR 9·09, 5·11-16·15), lung cancer (RR 3·78, 2·78-5·14), and ischaemic stroke or ischaemic heart disease (combined RR 2·03, 1·66-2·47). Ex-smokers who had stopped by choice (only 3% of ever-smokers in 1991, but 9% in 2006) had little smoking-attributed risk more than 10 years after stopping. Among Chinese women, however, there has been a tenfold intergenerational reduction in smoking uptake rates. In the second study, among women born in the 1930s, 1940s, 1950s, and since 1960 the proportions who had smoked were, respectively, 10%, 5%, 2%, and 1% (3097/30 943, 3265/62 246, 2339/97 344, and 1068/111 933). The smoker versus non-smoker RR of 1·51 (1·40-1·63) for all female mortality at ages 40-79 years accounted for 5%, 3%, 1%, and <1%, respectively, of all the female deaths in these four successive birth cohorts. In 2010, smoking caused about 1 million (840 000 male, 130 000 female) deaths in China. Interpretation Smoking will cause about 20% of all adult male deaths in China during the 2010s. The tobacco-attributed proportion is increasing in men, but low, and decreasing, in women. Although overall adult mortality rates are falling, as the adult population of China grows and the proportion of male deaths due to smoking increases, the annual number of deaths in China that are caused by tobacco will rise from about 1 million in 2010 to 2 million in 2030 and 3 million in 2050, unless there is widespread cessation. © 2015 Chen et al.

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