BackgroundThe increasing prevalence of colorectal cancer (CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.MethodsWe conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan (CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup (hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure.ResultsA total of 2356 patients with a mean age of 57.4 years were included, 57.1% of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY. The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage I, II, III, and IV disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3% of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups (P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more, whereas those with a lower household income and those who underwent surgery spent less (all P < 0.05).ConclusionsFor patients in China, direct expenditure for the diagnosis and treatment of CRC seemed catastrophic, and non-medical expenditure was non-ignorable. The financial burden varied among subgroups, especially among patients with different clinical stages of disease, which suggests that, in China, CRC screening might be cost-effective.

Early detection and treatment of breast cancer might be effective for decreasing the economic burden, because costs escalate as the degree of malignancy increases.

Smart contracts have become lucrative and profitable targets for attackers because they can hold a great amount of money. Unfortunately, existing offline approaches for discovering the vulnerabilities in smart contracts or checking the correctness of smart contracts cannot conduct online detection of attacking transactions. Besides, existing online approaches only focus on specific attacks and cannot be easily extended to detect other attacks. Moreover, developing a new online detection system for smart contracts from scratch is time-consuming and requires deep understanding of blockchain internals, thus making it difficult to quickly implement and deploy mechanisms to detect new attacks. In this paper, we propose a novel generic online detection framework named SODA for smart contracts on any blockchains that support Ethereum virtual machine (EVM). SODA distinguishes itself from existing online approaches through its capability, efficiency, and compatibility. First, SODA empowers users to easily develop apps for detecting various attacks online (i.e., when attacks happen) by separating information collection and attack detection with layered design. At the higher layer, SODA provides unified interfaces to develop detection apps against various attacks. At the lower layer, SODA instruments EVM to collect all primitive information necessary to detect various attacks and constructs 11 kinds of structural information for the ease of developing apps. Based on SODA, users can develop new apps in a few lines of code without modifying EVM. Second, SODA is efficient, because we design on-demand information retrieval to reduce the overhead of information collection and adopt dynamic linking to eliminate the overhead of inter-process communication. Such design allows users to develop detection apps using any programming languages that can generate dynamic link libraries. Third, since more and more blockchains adopt EVM as smart contract runtime, SODA can be easily migrated to such blockchains without modifying apps. Based on SODA, we develop 8 detection apps to detect the attacks exploiting major vulnerabilities in smart contracts, and integrate SODA (including all apps) into 3 popular blockchains: Ethereum, Expanse and Wanchain. The extensive experimental results demonstrate the effectiveness and efficiency of SODA and our detection apps.

Background Respiratory function would be impaired during general anesthesia period. Researchers devoted their energies to finding effective strategies for protecting respiratory function. Low tidal volume, positive end-expiratory pressure (PEEP), and lung recruitment maneuvers (LRMs) were recommended for patients under mechanical ventilation. However, based on the current evidence, there was no consensus on whether LRMs should be routinely used for anesthetized patients with healthy lungs, and the benefits of them remained to be determined. Materials and methods To evaluate the benefits of LRMs on patients undergoing surgery with general anesthesia, we searched relevant studies in PubMed, EMBASE, Ovid Medline and the Cochrane Library up to June 30, 2018. The primary outcome was postoperative pulmonary complications (PPCs). Results Twelve trials involving 2756 anesthetized patients were included. The results of our study showed a significant benefit of LRMs for reducing the incidence of PPCs (RR = 0.67; 95%CI, 0.49 to 0.90; P<0.05; Chi 2 = 32.94, p for heterogeneity = 0.0005, I 2 = 67%). After subgroup analyses, we found LRMs combining with lung protective ventilation strategy and sustained recruitment maneuvers were associated with reducing the occurrence of PPCs. The results also revealed that the use of LRMs improved PaO 2 /FiO 2 in non-obese patients, but with extremely high heterogeneity (I 2 = 95%). Conclusion According to the findings from contemporary meta-analysis, LRMs combining with lung protective ventilation strategy may have an association with decreasing in the incidence of PPCs and improvement of oxygenation on non-obese patients. However, the conclusions must be interpreted cautiously as the outcome may be influenced dramatically due to varied LRMs and ventilation patterns.

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