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Humans can be exposed to multiple pollutants in the air and surface water. These environments are non-static, trans-boundary and correlated, creating a complex network, and significant challenges for research on environmental hazards, especially in real-world cancer research. This article reports on a large study (377 million people in 30 provinces of China) that evaluated the combined impact of air and surface water pollution on cancer. We formulate a spatial evaluation system and a common grading scale for co-pollution measurement, and validate assumptions that air and surface water environments are spatially connected and that cancers of different types tend to cluster in areas where these environments are poorer. We observe "dose–response" relationships in both the number of affected cancer types and the cancer incidence with an increase in degree of co-pollution. We estimate that 62,847 (7.4%) new cases of cancer registered in China in 2016 were attributable to air and surface water pollution, and the majority (69.7%) of these excess cases occurred in areas with the highest level of co-pollution. The findings clearly show that the environment cannot be considered as a set of separate entities. They also support the development of policies for cooperative environmental governance and disease prevention. Dissecting the associations between exposure to environmental pollution and cancer risk remains crucial. Here, the authors evaluate the impact of air and water pollution on cancer incidence in China using a spatial evaluation system and show that most excess cancer cases occurred in areas with the highest level of co-pollution. [ABSTRACT FROM AUTHOR]

Little is known about the association between surface water quality and cancer incidence, especially in China. Drinking water quality has been linked to the incidence of several cancers in individual-level studies. However, few studies have attempted to examine multiple pollutants and multiple cancers at population level. This study used water monitoring and population-level cancer data from across China to examine spatial associations between water pollutants and types of cancer. We found a "dose–response" relationship between the number of pollutants present at high levels and cancer incidence. These results provide evidence of a nationwide spatial association between water quality and cancer in China. The precise relationship varies with cancers and pollutants. However, the overall consistency of the "dose–response" relationship suggests that surface water quality is an important factor in cancer incidence. Our findings highlight new issues such as the changing effects when different pollutants co-exist and an increasing number of new cancer cases partially attributable to poor water quality. Our work also points to some ways to deal with these challenges. [ABSTRACT FROM AUTHOR]

Complicated relationships exist in both occurrence and progression of surgical complications, which are difficult to account for using a separate quantitative method such as prediction or grading. Data of 51,030 surgical inpatients were collected from four academic/teaching hospitals in a prospective cohort study in China. The relationship between preoperative factors, 22 common complications, and death was analyzed. With input from 54 senior clinicians and following a Bayesian network approach, a complication grading, cluster-visualization, and prediction (GCP) system was designed to model pathways between grades of complication and preoperative risk factor clusters. In the GCP system, there were 11 nodes representing six grades of complication and five preoperative risk factor clusters, and 32 arcs representing a direct association. Several critical targets were pinpointed on the pathway. Malnourished status was a fundamental cause widely associated (7/32 arcs) with other risk factor clusters and complications. American Society of Anesthesiologists (ASA) score ⩾3 was directly dependent on all other risk factor clusters and influenced all severe complications. Grade III complications (mainly pneumonia) were directly dependent on 4/5 risk factor clusters and affected all other grades of complication. Irrespective of grade, complication occurrence was more likely to increase the risk of other grades of complication than risk factor clusters. [ABSTRACT FROM AUTHOR]

These authors contributed equally: Dengyuan Liu, Peng Wu, Wentao Gu Dear Editor, More than 2 years have passed since the World Health Organization (WHO) announced the global pandemic of coronavirus disease 2019 (COVID-19). These studies suggest that ARBs might be a broad-spectrum treatment drug for patients with all-cause severe pneumonia in whom the renin-angiotensin system (angiotensin II is the biomarker) is altered, such as patients with COVID-19[6]. Although currently not recommended, RCTs of angiotensin II receptor blocker (ARB) drugs telmisartan and losartan have demonstrated a significant reduction in the mortality rate among hospitalized patients with COVID-19 and those in the intensive care unit (ICU), respectively. [Extracted from the article]

Background: Radiomics-based image metrics are not used in the clinic despite the rapidly growing literature. We selected eight promising radiomic features and validated their value in decoding lung cancer heterogeneity. Methods: CT images of 236 lung cancer patients were obtained from three different institutes, whereupon radiomic features were extracted according to a standardized procedure. The predictive value for patient long-term prognosis and association with routinely used semantic, genetic (e.g., epidermal growth factor receptor (EGFR)), and histopathological cancer profiles were validated. Feature measurement reproducibility was assessed. Results: All eight selected features were robust across repeat scans (intraclass coefficient range: 0.81–0.99), and were associated with at least one of the cancer profiles: prognostic, semantic, genetic, and histopathological. For instance, "kurtosis" had a high predictive value of early death (AUC at first year: 0.70–0.75 in two independent cohorts), negative association with histopathological grade (Spearman's r: − 0.30), and altered expression levels regarding EGFR mutation and semantic characteristics (solid intensity, spiculated shape, juxtapleural location, and pleura tag; all p < 0.05). Combined as a radiomic score, the features had a higher area under curve for predicting 5-year survival (train: 0.855, test: 0.780, external validation: 0.760) than routine characteristics (0.733, 0.622, 0.613, respectively), and a better capability in patient death risk stratification (hazard ratio: 5.828, 95% confidence interval: 2.915–11.561) than histopathological staging and grading. Conclusions: We highlighted the clinical value of radiomic features. Following confirmation, these features may change the way in which we approach CT imaging and improve the individualized care of lung cancer patients. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether smoking, in any form, is a risk factor in the development of cervical cancer (CC) among urban Chinese women. Methods: We ascertained retrospectively the smoking habits of 1,865 women (aged 35+) who had died from CC (cases) and 48,781 who had died from causes unrelated to smoking (controls) in 24 cities using data from a large national survey of smoking and mortality in 1989-1991. We assessed the risk of smoking on CC mortality with and without considering passive smoke exposure from a spouse using a proportional mortality study design. Results: Overall, there was a 51.0 % excess risk of death from CC among smokers. When the spouse's exposure was further considered, the RR (95 % CI) for exposed versus unexposed women was 1.28 (1.04-1.57) for passive smokers, 1.49 (1.02-2.20) for active smokers, and 1.69 (1.27-2.26) for women with both exposures (all p < 0.001). Significant dose-response associations were observed between smoking and CC for all categories of exposure. For example, individuals with both smoking exposure had the highest risk of CC mortality with moderate [RR = 1.67 (1.18-2.38)] and high [RR = 1.88 (1.04-3.41)] daily cigarette consumption, and they also had the highest risk with ≤15 years exposure [RR = 1.73 (1.19-2.52)] and >15 years exposure [RR = 1.95 (1.15-3.32)], compared with the active and passive groups ( p for trend <0.001). Conclusions: Younger trend of CC death and the rapid increase in smoking among young women may have a profound impact on future incidence of CC. Our findings emphasize the need for preventive efforts among both women and men in China. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the influence of depressive symptoms on the prevalence of physical disability in a cohort study of Beijing elderly (1992--2000) and analyses the role of some confounding variables in this relationship.Methods: A cohort of 1828 elderly aged 55 and older who were initially free of any physical disability was followed up for 8 years. Baseline depression was assessed by the Center for Epidemiological Studies Depression Scale. Disability on activities of daily living (BADL and IADL) was measured in 1994, 1997, and 2000 respectively.Results: The cumulative percentages of persons who developed BADL disability and IADL disability during each follow-up interview was significantly greater among depressed than non-depressed individuals. Compare with the 1525 non-depressed individuals, the 303 depressed individuals had a relative risk (95% confidence interval) of 2.52 (2.02, 4.82) for BADL disability and 4.98 (2.46, 10.09) for IADL disability, respectively. Although adjustment for confounding factors reduced the risk to 2.20 (1.33, 3.62) and 4.29 (2.08, 8.86), the detrimental effect of depression on disability remained significant. The items of IADL which connected physical activity had higher impairment among depressed individuals.Conclusions: Depression in elderly persons may increase the risk for prevalent disability. It is very important for elders to prevent and reduce depression for improving the quality of their life and physical function. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the association between body mass index (BMI) and blood pressure. Two sets of cross-sectional data were obtained from annual health examinations for adults aged 40 years and over (n=1,327 in 1993; n=1,302 in 2000) in Tsunagi area of Kumamoto Prefecture, Japan. BMI was associated with mean blood pressure and with prevalence of hypertension both in 1993 and 2000. The association was independent of age, smoking status and alcohol consumption. A significant increase in risk of hypertension was found in most categories of BMI 25.0 and above, and a greater than three fold increase in those with BMI of 27 and above compared with those with BMI of 18.5–22.9. Although mean blood pressure and prevalence of hypertension sharply decreased in 2000 compared with that in 1993, BMI was positively and independently associated with increased blood pressure. [ABSTRACT FROM AUTHOR]

The goal of the present study was to describe the changes in activities of daily living (ADL) of community-dwelling Beijing elderly people (n=3,257), observed for 8 years, and to identify the demographic characteristic that predict the functional change. Two sets of interview data (1992 and 2000) were used to evaluate changes among the elderly in reports of limitation in ADL management. The prevalence of disability increased over 8 years both in IADL and BADL disability. The patterns of ADLs change were bi-directional. A large proportion (74.7%) of the elderly were found to remain active in their functional states, 20.4% of the elderly declined, 3.4% of the elderly remained disabled, and 1.5% showed improvement in functional states. The transition rates from non-disability and disability states to various functional states showed different characteristic, a high disability rate accompanied a high mortality rate. The demographic factors that affected the level of disability among different kinds of population manifested similar trends. Age was the most significant predictor for functional limitations. In addition, demographic variables played an important role in estimating functional outcomes. It is recommended that the demarcation factor for the evaluation of ADLs should be 75 years of age. [ABSTRACT FROM AUTHOR]

The purpose of this study was to test the hypothesis that ADL disability affects the risk of onset of depressive symptoms and the role of possible confounding variables in this relation. The data was obtained from the Beijing Longitudinal Study of Aging, a community-based cohort study of 3,257 elderly, aged 55 through 99 years, who were assessed four time at an 8-year interval. ADL disability and depressive symptoms were assessed by self-reported measures. Compared with non-disabled persons, the disabled persons were associated with an increased risk of onset depression (RR=7.28 for urban, R=2.22 for non-urban). Although an adjustment for possible confounders reduced the risk for depression association with the disability, the detrimental effect of disability remained significantly present. This excess risk is partly explained by the lower satisfation with economy and poor perceived health status of the disabled elderly. Disability among elderly may significantly increase the risk for depressive symptoms. [ABSTRACT FROM AUTHOR]

Hypertension is a leading cause of death worldwide; data on hypertension among ethnic minorities in China are sparse. This study aimed to estimate hypertension prevalence, awareness, treatment, and control in a Kazakh population, and to assess the association between salt intake and the above measures. A cross-sectional survey was conducted among Kazakh adults (≥30 years old) in the town of Hongdun, Altay, Xinjiang. Survey procedures included a questionnaire, physical measurement, and laboratory tests. Of 1805 eligible individuals, 1668 (92.4%) were included in the analysis. After adjustment for gender, age, and occupation, prevalence of hypertension was 45.5%. The proportions with awareness, treatment, control, or medication-control were 61.0%, 28.8%, 2.9% and 10.1%, respectively. Higher prevalence was seen among nomads and farmers (50.7% and 44.6%, respectively). However, the proportions with treatment or control were lower than seen among urban citizens. Hypertension prevalence was higher in those with higher salt intake (p = 0.0008). In contrast, the proportions with awareness (p = 0.0389), treatment (p = 0.0010), control (p = 0.0503), and medication-control (p = 0.2012) reduced as salt intake increased. In conclusion, hypertension prevalence is high in this population, but the proportions with awareness, treatment, or control are sub-optimal. Public health interventions that improve hypertension prevention and control, particularly among nomads, is needed. [ABSTRACT FROM AUTHOR]

An association between passive smoking and stroke is unclear in China, particularly the association with hemorrhagic stroke. This study included 16205 deaths due to stroke aged ≥30 years and 16205 non-stroke controls randomly selected and frequency-matched to cases on gender and age. Smoking of spouses, defined as ≥1 cigarette per day for up to 1 year, was taken as a measure of exposure to passive smoking of subjects that was retrospectively ascertained by interviewing surviving spouses. After adjustment for variables, passive smoking increased the risk of death by 10% (odds ratio (OR), 1.10; 95% confidence interval (CI), 1.05-1.16) for all strokes, by 10% (OR, 1.10; 95% CI, 1.04-1.16) for hemorrhagic stroke, and by 12% (OR, 1.12; 95% CI, 1.03-1.23) for ischemic stroke, compared with non-exposure. This finding was highly consistent in men or women and in smokers or non-smokers, and was generally consistent among zones of China despite geographic diversity. The risk significantly increased with exposure-years and quantity of cigarettes smoked daily by spouses. This study indicated that passive smoking is associated with deaths from all-type strokes. It is highly advisable for the government to promote strong tobacco prevention and cessation programs and smoke-free environments. [ABSTRACT FROM AUTHOR]