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Lung cancer is the second most common cancer in incidence and the leading cause of cancer deaths worldwide. Meanwhile, lung cancer screening with low-dose CT can reduce mortality. The UK National Screening Committee recommended targeted lung cancer screening on Sept 29, 2022, and asked for more modelling work to be done to help refine the recommendation. This study aims to develop and validate a risk prediction model—the CanPredict (lung) model—for lung cancer screening in the UK and compare the model performance against seven other risk prediction models. For this retrospective, population-based, cohort study, we used linked electronic health records from two English primary care databases: QResearch (Jan 1, 2005–March 31, 2020) and Clinical Practice Research Datalink (CPRD) Gold (Jan 1, 2004–Jan 1, 2015). The primary study outcome was an incident diagnosis of lung cancer. We used a Cox proportional-hazards model in the derivation cohort (12·99 million individuals aged 25–84 years from the QResearch database) to develop the CanPredict (lung) model in men and women. We used discrimination measures (Harrell's C statistic, D statistic, and the explained variation in time to diagnosis of lung cancer [R2 D ]) and calibration plots to evaluate model performance by sex and ethnicity, using data from QResearch (4·14 million people for internal validation) and CPRD (2·54 million for external validation). Seven models for predicting lung cancer risk (Liverpool Lung Project [LLP] v2 , LLP v3 , Lung Cancer Risk Assessment Tool [LCRAT], Prostate, Lung, Colorectal, and Ovarian [PLCO] M2012 , PLCO M2014 , Pittsburgh, and Bach) were selected to compare their model performance with the CanPredict (lung) model using two approaches: (1) in ever-smokers aged 55–74 years (the population recommended for lung cancer screening in the UK), and (2) in the populations for each model determined by that model's eligibility criteria. There were 73 380 incident lung cancer cases in the QResearch derivation cohort, 22 838 cases in the QResearch internal validation cohort, and 16 145 cases in the CPRD external validation cohort during follow-up. The predictors in the final model included sociodemographic characteristics (age, sex, ethnicity, Townsend score), lifestyle factors (BMI, smoking and alcohol status), comorbidities, family history of lung cancer, and personal history of other cancers. Some predictors were different between the models for women and men, but model performance was similar between sexes. The CanPredict (lung) model showed excellent discrimination and calibration in both internal and external validation of the full model, by sex and ethnicity. The model explained 65% of the variation in time to diagnosis of lung cancer R2 D in both sexes in the QResearch validation cohort and 59% of the R2 D in both sexes in the CPRD validation cohort. Harrell's C statistics were 0·90 in the QResearch (validation) cohort and 0·87 in the CPRD cohort, and the D statistics were 2·8 in the QResearch (validation) cohort and 2·4 in the CPRD cohort. Compared with seven other lung cancer prediction models, the CanPredict (lung) model had the best performance in discrimination, calibration, and net benefit across three prediction horizons (5, 6, and 10 years) in the two approaches. The CanPredict (lung) model also had higher sensitivity than the current UK recommended models (LLP v2 and PLCO M2012), as it identified more lung cancer cases than those models by screening the same amount of individuals at high risk. The CanPredict (lung) model was developed, and internally and externally validated, using data from 19·67 million people from two English primary care databases. Our model has potential utility for risk stratification of the UK primary care population and selection of individuals at high risk of lung cancer for targeted screening. If our model is recommended to be implemented in primary care, each individual's risk can be calculated using information in the primary care electronic health records, and people at high risk can be identified for the lung cancer screening programme. Innovate UK (UK Research and Innovation). For the Chinese translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

[Display omitted] • The catalytic activity and product selectivity in CO 2 hydrogenation are strongly dependent on the structure of metal-ZnO interfaces. • The catalytic activity in CO 2 hydrogenation is determined by the weak basic sites. • The product selectivity in CO 2 hydrogenation is determined by the strength of adsorbed CO species. • All Ni/ZnO catalysts with weak CO adsorption capacities exhibit high CO selectivity. • CH 4 could be produced on Ru/ZnO catalysts, where more low-coordination Ru species on Ru/p-ZnO induced by stronger MSIs contribute to a higher CH 4 selectivity. Metal-oxide interface is generally regarded as the active sites in CO 2 hydrogenation while their structure–property relationships are hardly identified. Herein, ZnO-supported Ru (Ru/ZnO) and Ni (Ni/ZnO) catalysts were used for CO 2 hydrogenation. Their interfacial structures were finely tuned by altering the nature of supported metal particles and the support morphology, which significantly affect the catalytic activity and product selectivity. Direct evidences indicate that the weak basic sites are responsible for catalytic activity. The catalytic reaction proceeds through the dissociation mechanism involving the key intermediate of adsorbed CO species, whose strength determines product selectivity. A weak CO adsorption capacity on Ni species leads to high CO selectivity on Ni/ZnO catalysts, while CH 4 could be produced on Ru/ZnO catalysts with strong CO binding capacity on low-coordination Ru species. Consequently, more low-coordination Ru species presented on Ru/p-ZnO (nanoplates) induced by stronger metal-support interactions contribute to a higher CH 4 selectivity. These results deepen the understanding of metal-oxide interface in CO 2 hydrogenation and broaden the concept of morphology-dependent catalysis of oxide-based catalysts. [ABSTRACT FROM AUTHOR]

[Display omitted] • CeO 2 -supported single Pd atoms are the most intrinsically active in CO oxidation. • The CO reaction rate on isolated Pd sites is exclusively promoted by H 2. • The oxidation of CO proceeds through a Langmuir-Hinshelwood mechanism. • The decomposition of formate species contribution dominantly in CO oxidation. • A stronger H-spillover effect was observed on isolated Pd sites. • Bridged-OH contributes to the consumptions of bicarbonate and formate species. Supported metal catalysts are the most widely used in industrial processes and the metal particle size plays a crucial factor in determining the catalytic performance. Herein, CeO 2 -supported Pd catalysts with different Pd size regimes ranging from single atoms, to nanoclusters (1–2 nm), and to nanoparticles (>2 nm) were used for both CO oxidation and preferential oxidation of CO in H 2 (CO-PROX). Compared to Pd nanoclusters and nanoparticles, CeO 2 -supported single Pd atoms (Pd SA /CeO 2) are the most intrinsically active in CO oxidation, with an apparent activation energy of ca. 40 kJ mol−1. Results of kinetic investigations and in situ diffuse reflectance infrared Fourier transformed spectroscopy demonstrate the CO oxidation proceeding through a Langmuir-Hinshelwood mechanism with the decomposition of formate species acting dominantly as the rate-determining step. The CO reaction rate is exclusively promoted on Pd SA /CeO 2 catalysts for the CO-PROX reaction, which could be ascribed to a stronger H-spillover effect on isolated Pd sites to produce bridged-OH on CeO 2 surface, simultaneously facilitating the consumptions of bicarbonate and formate species. There results greatly deepen the fundamental understanding of the Pd size regimes over Pd/CeO 2 catalysts for the oxidation of CO. [ABSTRACT FROM AUTHOR]

[Display omitted] • Pd/TiO 2 {100} is highly active and stable for CO 2 hydrogenation into formate. • The activity is benefit from the moderate basic site and metallic Pd species. • Higher density of moderate basicity over Pd/TiO 2 {100} favors for CO 2 activation. • More metallic Pd species over Pd/TiO 2 {100} contributes to H 2 activation. • The stability is benefit from strong Pd-TiO 2 interactions. • The oxygen vacancy in the TiO 2 {100} promote the Pd-TiO 2 interactions. Pd supported on different anatase TiO 2 nanocrystals predominantly exposing either {1 0 0}, {1 0 1}, or {0 0 1} facets were tested for CO 2 hydrogenation into formate. Remarkable morphology-dependent catalysis was observed. Compared to 2%Pd/TiO 2 {1 0 1} and 2%Pd/TiO 2 {0 0 1} catalysts, 2%Pd/TiO 2 {1 0 0} is highly active and stable, affording an unprecedented turnover frequency of ca. 1369 h−1 and keeping stable after 6 cycles at 313 K. This can be associated with, on the one hand, higher density of moderate basic site and relatively more Pd(0) species over 2%Pd/TiO 2 {1 0 0} contribute to the activations of CO 2 and H 2 , respectively, favorable for the activity; On the other hand, higher oxygen vacancy concentrations in the TiO 2 {1 0 0} promote the Pd-TiO 2 interactions and result in the formation and stability of flat Pd particles over 2%Pd/TiO 2 {1 0 0}, beneficial to the stability. These results highlight the importance of oxide morphology in formate formation and open up possibilities of oxide morphology engineering for developing efficient Pd-based catalysts for CO 2 hydrogenation. [ABSTRACT FROM AUTHOR]

Background: Pancreatic cancer has the worst survival rate among all cancers. Almost 70% of patients in the UK were diagnosed at Stage IV.Aim: This study aimed to investigate the symptoms associated with the diagnoses of pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine neoplasms (PNEN), and comparatively characterise the symptomatology between the two tumour types to inform earlier diagnosis.Design and Setting: A nested case-control study in primary care was conducted using data from the QResearch® database. Patients aged ≥25 years and diagnosed with PDAC or PNEN during 2000 to 2019 were included as cases. Up to 10 controls from the same general practice were matched with each case by age, sex, and calendar year using incidence density sampling.Method: Conditional logistic regression was used to investigate the association between the 42 shortlisted symptoms and the diagnoses of PDAC and (or) PNEN in different timeframes relative to the index date, adjusting for patients' sociodemographic characteristics, lifestyle, and relevant comorbidities.Results: A total of 23 640 patients were identified as diagnosed with PDAC and 596 with PNEN. Of the symptoms identified, 23 were significantly associated with PDAC, and nine symptoms with PNEN. The two alarm symptoms for both tumours were jaundice and gastrointestinal bleeding. The two newly identified symptoms for PDAC were thirst and dark urine. The risk of unintentional weight loss may be longer than 2 years before the diagnosis of PNEN.Conclusion: PDAC and PNEN have overlapping symptom profiles. The QCancer® (pancreas) risk prediction model could be updated by including the newly identified symptoms and comorbidities, which could help GPs identify high-risk patients for timely investigation in primary care. [ABSTRACT FROM AUTHOR]

Background: Offering free glasses can be important to increase children’s wear. We sought to assess whether “Upgrade glasses” could avoid reduced glasses sales when offering free glasses to children in China. Methods: In this cluster-randomized, controlled trial, children with uncorrected visual acuity (VA)< = 6/12 in either eye correctable to >6/12 in both eyes at 138 randomly-selected primary schools in 9 counties in Guangdong and Yunnan provinces, China, were randomized by school to one of four groups: glasses prescription only (Control); Free Glasses; Free Glasses + offer of $15 Upgrade Glasses; Free Glasses + offer of $30 Upgrade Glasses. Spectacle purchase (main outcome) was assessed 6 months after randomization. Results: Among 10,234 children screened, 882 (8.62%, mean age 10.6 years, 45.5% boys) were eligible and randomized: 257 (29.1%) at 37 schools to Control; 253 (28.7%) at 32 schools to Free Glasses; 187 (21.2%) at 31 schools to Free Glasses + $15 Upgrade; and 185 (21.0%) at 27 schools to Free Glasses +$30 Upgrade. Baseline ownership among these children needing glasses was 11.8% (104/882), and 867 (98.3%) children completed follow-up. Glasses purchase was significantly less likely when free glasses were given: Control: 59/250 = 23.6%; Free glasses: 32/252 = 12.7%, P = 0.010. Offering Upgrade Glasses eliminated this difference: Free + $15 Upgrade: 39/183 = 21.3%, multiple regression relative risk (RR) 0.90 (0.56–1.43), P = 0.65; Free + $30 Upgrade: 38/182 = 20.9%, RR 0.91 (0.59, 1.42), P = 0.69. Conclusions: Upgrade glasses can prevent reductions in glasses purchase when free spectacles are provided, providing important program income. Trial registration: ClinicalTrials.gov Identifier: . Registered on 31 August 2014. [ABSTRACT FROM AUTHOR]

Biorhythm is a fundamental property of human physiology. Changes in the extracellular space induced by cell swelling in response to the neural activity enable the in vivo characterization of cerebral microstructure by measuring the water diffusivity using diffusion tensor imaging (DTI). To study the diurnal microstructural alterations of human brain, fifteen right-handed healthy adult subjects were recruited for DTI studies in two repeated sessions (8∶30 AM and 8∶30 PM) within a 24-hour interval. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial (λ//) and radial diffusivity (λ⊥) were compared pixel by pixel between the sessions for each subject. Significant increased morning measurements in FA, ADC, λ// and λ⊥ were seen in a wide range of brain areas involving frontal, parietal, temporal and occipital lobes. Prominent evening dominant λ⊥ (18.58%) was detected in the right inferior temporal and ventral fusiform gyri. AM-PM variation of λ⊥ was substantially left side hemisphere dominant (p<0.05), while no hemispheric preference was observed for the same analysis for ADC (p = 0.77), λ// (p = 0.08) or FA (p = 0.25). The percentage change of ADC, λ//, λ⊥, and FA were 1.59%, 2.15%, 1.20% and 2.84%, respectively, for brain areas without diurnal diffusivity contrast. Microstructural variations may function as the substrates of the phasic neural activities in correspondence to the environment adaptation in a light-dark cycle. This research provided a baseline for researches in neuroscience, sleep medicine, psychological and psychiatric disorders, and necessitates that diurnal effect should be taken into account in following up studies using diffusion tensor quantities. [ABSTRACT FROM AUTHOR]

[Display omitted] • The CO oxidation catalyzed by various CuO-CeO 2 interfacial sites involves a typical Mars-van Krevelen mechanism. • The CuO-CeO 2 interfaces in the CeO 2 -CuO/c-Cu 2 O (cubes) nanocomposites are more intrinsically active at CeO 2 loadings no less than 0.75 wt%. • The higher activity is relevant to lower coordinated oxygen ions and thus better CO reactivity for the CeO 2 -CuO/c-Cu 2 O nanocomposites. • The active oxygen species on CuO-CeO 2 interface in catalyzing CO oxidation should come from CuO rather than CeO 2. • A highly active 13.2 %CeO 2 -CuO/c-Cu 2 O(s) (small) catalyst with high density of active sites for CO oxidation is realized on fine Cu 2 O cubes. Several CeO 2 -CuO/Cu 2 O nanocomposites with different CuO structures were used to identify the structure sensitivity of CuO in the CeO 2 -CuO/Cu 2 O catalyzed CO oxidation. The CO oxidation catalyzed by various CuO-CeO 2 interfacial sites involves a typical Mars-van Krevelen mechanism, in which the CuO-CeO 2 interfaces in the CeO 2 -CuO/c-Cu 2 O (cubes) nanocomposites are more intrinsically active, exhibiting ca. 15 kJ mol−1 lower activation energy than those in the CeO 2 -CuO/o-Cu 2 O (octahedra) and CeO 2 -CuO/d-Cu 2 O (rhombic dodecahedra) nanocomposites at CeO 2 loadings no less than 0.75 wt%. The higher activity is relevant to lower coordinated oxygen ions on CuO/c-Cu 2 O surface and thus better CO reactivity for the CeO 2 -CuO/c-Cu 2 O nanocomposites, which therefore indicates that the active oxygen species on CuO-CeO 2 interface should come from CuO rather than CeO 2. Moreover, a highly active 13.2 %CeO 2 -CuO/c-Cu 2 O(s) catalyst for CO oxidation is realized on fine Cu 2 O cubes, which thus has high density of active sites. [ABSTRACT FROM AUTHOR]

Background: Liver cancer has one of the fastest rising incidence and mortality rates among all cancers in the UK, but it receives little attention. This study aims to understand the disparities in epidemiology and clinical pathways of primary liver cancer and identify the gaps for early detection and diagnosis of liver cancer in England., Methods: This study used a dynamic English primary care cohort of 8.52 million individuals aged ≥25 years in the QResearch database during 2008-2018, followed up to June 2021. The crude and age-standardised incidence rates, and the observed survival duration were calculated by sex and three liver cancer subtypes, including hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (CCA), and other specified/unspecified primary liver cancer. Regression models were used to investigate factors associated with an incident diagnosis of liver cancer, emergency presentation, late stage at diagnosis, receiving treatments, and survival duration after diagnosis by subtype., Findings: 7331 patients were diagnosed with primary liver cancer during follow-up. The age-standardised incidence rates increased over the study period, particularly for HCC in men (increased by 60%). Age, sex, socioeconomic deprivation, ethnicity, and geographical regions were all significantly associated with liver cancer incidence in the English primary care population. People aged ≥80 years were more likely to be diagnosed through emergency presentation and in late stages, less likely to receive treatments and had poorer survival than those aged <60 years. Men had a higher risk of being diagnosed with liver cancer than women, with a hazard ratio (HR) of 3.9 (95% confidence interval 3.6-4.2) for HCC, 1.2 (1.1-1.3) for CCA, and 1.7 (1.5-2.0) for other specified/unspecified liver cancer. Compared with white British, Asians and Black Africans were more likely to be diagnosed with HCC. Patients with higher socioeconomic deprivation were more likely to be diagnosed through the emergency route. Survival rates were poor overall. Patients diagnosed with HCC had better survival rates (14.5% at 10-year survival, 13.1%-16.0%) compared to CCA (4.4%, 3.4%-5.6%) and other specified/unspecified liver cancer (12.5%, 10.1%-15.2%). For 62.7% of patients with missing/unknown stage in liver cancer, their survival outcomes were between those diagnosed in Stages III and IV., Interpretation: This study provides an overview of the current epidemiology and the disparities in clinical pathways of primary liver cancer in England between 2008 and 2018. A complex public health approach is needed to tackle the rapid increase in incidence and the poor survival of liver cancer. Further studies are urgently needed to address the gaps in early detection and diagnosis of liver cancer in England., Funding: The Early Detection of Hepatocellular Liver Cancer (DeLIVER) project is funded by Cancer Research UK (Early Detection Programme Award, grant reference: C30358/A29725)., Competing Interests: JH-C is an unpaid director of QResearch, a not-for-profit organisation in a partnership between the University of Oxford and EMIS Health, who supply the QResearch database for this work. JH-C is a founder and shareholder of ClinRisk Ltd and was its medical director until 31 May 2019. ClinRisk Ltd produces open and closed source software to implement clinical risk algorithms into clinical computer systems. EB contributed to patents on imaging technologies that are owned by Perspectum Diagnostics, an imaging spin-out company of the University of Oxford, and holds shares of Perspectum Diagnostics. EB received honoraria from Roche Diagnostics for a presentation at a symposium and for contributions/evaluations of a manuscript. PJ received research funding from Novo Nordisk Foundation as a Borregaard Clinical Ascending Investigator (grant reference number NNF19OC0054612). The funder had no role in this study. The University of Oxford received funding from GSK, which partly contributed to a DPhil studentship for CC in HBV and HCC epidemiology. The DeLIVER consortium has Roche, Perspectum Diagnostics, and Oncimmune as industry partners. WL, CACC, and HI have no interests to declare for this work., (© 2023 University of Oxford.)

Three-dimensional cell culture technology (3DCC) sits between two-dimensional cell culture (2DCC) and animal models and is widely used in oncology research. Compared to 2DCC, 3DCC allows cells to grow in a three-dimensional space, better simulating the in vivo growth environment of tumors, including hypoxia, nutrient concentration gradients, micro angiogenesis mimicism, and the interaction between tumor cells and the tumor microenvironment matrix. 3DCC has unparalleled advantages when compared to animal models, being more controllable, operable, and convenient. This review summarizes the comparison between 2DCC and 3DCC, as well as recent advances in different methods to obtain 3D models and their respective advantages and disadvantages., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zhang, Liao, Chen, Chen, Cheng, Lu and Ma.)

Objective: Prior studies identified clinical factors associated with increased risk of pancreatic ductal adenocarcinoma (PDAC). However, little is known regarding their time-varying nature, which could inform earlier diagnosis. This study assessed temporality of body mass index (BMI), blood-based markers, comorbidities and medication use with PDAC risk ., Design: We performed a population-based nested case-control study of 28 137 PDAC cases and 261 219 matched-controls in England. We described the associations of biomarkers with risk of PDAC using fractional polynomials and 5-year time trends using joinpoint regression. Associations with comorbidities and medication use were evaluated using conditional logistic regression., Results: Risk of PDAC increased with raised HbA1c, liver markers, white blood cell and platelets, while following a U-shaped relationship for BMI and haemoglobin. Five-year trends showed biphasic BMI decrease and HbA1c increase prior to PDAC; early-gradual changes 2-3 years prior, followed by late-rapid changes 1-2 years prior. Liver markers and blood counts (white blood cell, platelets) showed monophasic rapid-increase approximately 1 year prior. Recent diagnosis of pancreatic cyst, pancreatitis, type 2 diabetes and initiation of certain glucose-lowering and acid-regulating therapies were associated with highest risk of PDAC., Conclusion: Risk of PDAC increased with raised HbA1c, liver markers, white blood cell and platelets, while followed a U-shaped relationship for BMI and haemoglobin. BMI and HbA1c derange biphasically approximately 3 years prior while liver markers and blood counts (white blood cell, platelets) derange monophasically approximately 1 year prior to PDAC. Profiling these in combination with their temporality could inform earlier PDAC diagnosis., Competing Interests: Competing interests: JH-C reports grants from National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford, grants from John Fell Oxford University Press Research Fund, grants from Cancer Research UK (CR-UK) grant number C5255/A18085, through the Cancer Research UK Oxford Centre, grants from the Oxford Wellcome Institutional Strategic Support Fund (204826/Z/16/Z) and other research councils, during the conduct of the study. JH-C is an unpaid director of QResearch, a not-for-profit organisation which is a partnership between the University of Oxford and EMIS Health who supply the QResearch database used for this work. JH-C is a founder and shareholder of ClinRisk ltd and was its medical director until 31st May 2019. ClinRisk Ltd produces open and closed source software to implement clinical risk algorithms (outside this work) into clinical computer systems. AC reports consulting fees from Mendelian, outside the scope of the current work. RB-R is a cofounder of Alchemab Therapeutics and consultant for Alchemab Therapeutics and GSK. PST reports previous consultation with AstraZeneca and Duke-NUS outside the current work., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background: Heterogeneous disease trajectories of mild cognitive impairment (MCI) and dementia are frequently encountered in clinical practice, but there is still insufficient knowledge to understand the reasons and mechanisms causing this heterogeneity. In addition to correlates of the disorder, patient characteristics such as their health status, social environment, comorbidities and frailty may contribute to variability in trajectories over time. The current paper outlines the study design and the study population of and provides an overview of the data collected in the Clinical Course of Cognition and Comorbidity in Mild Cognitive Impairment (4C-MCI cohort, n = 315) and Dementia (4C-Dementia cohort, n = 331) Study., Methods: The two complementary longitudinal cohorts part of the 4C study began enrolment in March 2010. Participants were prospectively recruited from three collaborating Dutch Alzheimer Centers, with three annual follow-up assessments after baseline. Extensive neuropsychological assessments, and detailed profiling of comorbidities, health and frailty at each follow up were the key features of the 4C study. As such, the 4C study was designed to study if and how patients' comorbidities and frailty are associated with the course of MCI and dementia measured with a comprehensive and multidimensional set of outcomes including cognition, daily functioning, quality of life, behavioral disturbances, caregiver burden, institutionalization and death and whether the effects of medical health and frailty differ between MCI and dementia stages of cognitive disorders., Conclusion: Sampled in a clinical setting, the 4C study complements population-based studies on neurodegenerative disorders in terms of the type of assessment (e.g. comorbidity, frailty, and functional status were repeatedly assessed). The 4C study complements available clinical cohorts of MCI and dementia patients, because the exclusion criteria were kept to a minimum, to obtain a sample that is representative for the average patient visiting a memory clinic.