Background:Information on the association between physical activity(PA)and the risk of chronic kidney disease(CKD)is limited.We aimed to explore the associations of total,domain-specific,and intensity-specific PA with...Background:Information on the association between physical activity(PA)and the risk of chronic kidney disease(CKD)is limited.We aimed to explore the associations of total,domain-specific,and intensity-specific PA with CKD and its subtypes in China.Methods:The study included 475,376 adults from the China Kadoorie Biobank aged 30-79 years during 2004-2008 at baseline.An interviewer-administered questionnaire was used to collect the information about PA,which was quantified as metabolic equivalent of task hours per day(MET-h/day)and categorized into 4 groups based on quartiles.Cox regression was used to analyze the association between PA and CKD risk.Results:During a median follow-up of 12.1 years,5415 incident CKD cases were documented,including 1159 incident diabetic kidney disease(DKD)cases and 362 incident hypertensive nephropathy(HTN)cases.Total PA was inversely associated with CKD risk,with an adjusted hazard ratio(HR,95%confidence interval(95%CI))of 0.83(0.75-0.92)for incident CKD in the highest quartile of total PA as compared with participants in the lowest quartile.Similar results were observed for risk of DKD and HTN,and the corresponding HRs(95%CIs)were 0.75(0.58-0.97)for DKD risk and 0.56(0.37-0.85)for HTN risk.Increased nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA were significantly associated with a decreased risk of CKD,with HRs(95%CIs)of 0.80(0.73-0.88),0.85(0.77-0.94),and 0.85(0.76-0.95)in the highest quartile,respectively.Conclusion:PA,including nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA,was inversely associated with the risk of CKD,including DKD,HTN,and other CKD,and such associations were dose dependent.展开更多
Objective To evaluate the impact of major causes of death on changes of life expectancy in China. Methods Life expectancy was calculated by standard life table techniques using mortality data from the national censuse...Objective To evaluate the impact of major causes of death on changes of life expectancy in China. Methods Life expectancy was calculated by standard life table techniques using mortality data from the national censuses in 1990 and 2000 and the 1% National Population Sampling Surveys in 1995 and 2005. Mortality data about the major causes of death from VR-MOH were used as reference values to estimate their death proportions of the specific age groups by sex and regions, as well as all-cause mortality and age-specific mortality rates of major causes of death. Decomposition method was used to quantitatively evaluate the impact. Results Three key findings were identified in our study. First, China's health challenge was shifted from diseases related to living conditions to those related to behavior and lifestyle, with rural areas relatively lagged behind urban areas. Second, the impacts of cardiovascular diseases and neoplasm on the middle aged and elderly population were stressed. Third, compared to the urban population, the rural population tended to have increasing mortality of neoplasm and cardiovascular diseases, especially in adults at the age of 15-39 years. Conclusion Further efforts should be made to reduce the incidence of neoplasm and cardiovascular diseases, especially in rural areas, by promoting healthy behavior and lifestyle and providing appropriate therapies for all patients in need.展开更多
Objective: To redefine overdiagnosis and reestimate the proportion of overdiagnosis of breast cancer caused by screening based on the Surveillance, Epidemiology, and End Results(SEER, 1973-2015) Program data.Methods: ...Objective: To redefine overdiagnosis and reestimate the proportion of overdiagnosis of breast cancer caused by screening based on the Surveillance, Epidemiology, and End Results(SEER, 1973-2015) Program data.Methods: The breast cancer diagnosed before 1977 was defined as the no-screening cohort since America had initiated breast cancer screening from 1977. The breast cancer diagnosed in 1999 was defined as the screening cohort due to no increases in both the proportion of early-stage breast cancer until 1999 and the overall survival of early-stage breast cancer diagnosed over the three years since 1999. The magnitude of overdiagnosis was calculated as the difference in the proportions of early-stage breast cancer patients with long-time(15-year) survival to all breast cancer patients between two cohorts.Results: Over 23 years before and after widespread screening in America, the proportion of early-stage breast cancer patients increased from 52.1%(16,891/32,443) to 72.7%(16,021/22,025)(P<0.001). The 15-year survival rate of early-stage breast cancer patients increased from 51.1% to 61.5%(P<0.001), while the proportions of earlystage breast cancer patients with long-time survival to all breast cancer patients increased from 26.6%(52.1%×51.1%) to 44.7%(72.7%×61.5%). Assuming no improvements in cancer screening technology and treatment technology, 18.1%(44.7%-26.6%) of breast cancer patients were overdiagnosed associated with screening. The age-specific overdiagnosis rates were 18.9%, 24.7%, 24.5%, 20.5%, and 8.3% for breast cancer patients aged 40-49, 50-59, 60-69, 70-74, and ≥75 years old, respectively.Conclusions: Overdiagnosis caused by mammographic screening is probably overestimated in current screening practices. Further trials with more sophisticated designs and analyses are needed to validate our findings in the future.展开更多
Objective: To investigate and predict the effects of climate change on the potential distribution of the main vector and reservoir hosts of the disease in Yazd province in the future.Methods: Distribution data for vec...Objective: To investigate and predict the effects of climate change on the potential distribution of the main vector and reservoir hosts of the disease in Yazd province in the future.Methods: Distribution data for vector and reservoir hosts of zoonotic cutaneous leishmaniasis in Yazd province were obtained from earlier studies conducted in the area.MaxEnt ecological niche modeling was used to predict environmental suitability.BCC-CSM1-1(m) model and two climate change scenarios, RCP 4.5 and RCP 8.5 were used for horizons 2030 and 2050 climate projections.Future projections were based on data of a regional climate change model.Results: With both scenarios in 2030 and 2050, the results of jackknife test indicated that the mean temperature of wettest quarter and temperature annual range had the greatest effect on the model for the vector and the reservoir hosts, respectively.Conclusions: The climate conditions are the major determinants of zoonotic cutaneous leishmaniasis incidence rate in Yazd Province.These climate conditions provide favorable habitats for ease transmission of zoonotic cutaneous leishmaniasis in this endemic area.Habitats suitability for the vector and reservoir will be expanding in the coming years compared with the current conditions, such that, in horizon 2030 & 2050, the probability of the presence of the vector and reservoir within 38 580 and 37 949 km^2, respectively, from Yazd province is above 60%.Moreover, an increase is predicted in the presence of the vector in the western parts and the reservoir in the northern and central parts of the province in the future.Understanding the role of environmental and bioclimatic factors in zoonotic cutaneous leishmaniasis occurrence can provide a guide for policy-makers in the creation and implementation of more effective policies for prevention and control.展开更多
BACKGROUND Growing evidence have demonstrated that thyroid hormones have been involved in the processes of cardiovascular metabolism.However,the causal relationship of thyroid function and cardiometabolic health remai...BACKGROUND Growing evidence have demonstrated that thyroid hormones have been involved in the processes of cardiovascular metabolism.However,the causal relationship of thyroid function and cardiometabolic health remains partly unknown.METHODS The Mendelian randomization(MR)was used to test genetic,potentially causal relationships between instrumental variables and cardiometabolic traits.Genetic variants of free thyroxine(FT4)and thyrotropin(TSH)levels within the reference range were used as instrumental variables.Data for genetic associations with cardiometabolic diseases were acquired from the genome-wide association studies of the FinnGen,CARDIoGRAM and CARDIoGRAMplusC4D,CHARGE,and MEGASTROKE.This study was conducted using summary statistic data from large,previously described cohorts.Association between thyroid function and essential hypertension(EHTN),secondary hypertension(SHTN),hyperlipidemia(HPL),type 2 diabetes mellitus(T2DM),ischemic heart disease(IHD),myocardial infarction(MI),heart failure(HF),pulmonary heart disease(PHD),stroke,and non-rheumatic valve disease(NRVD)were examined.RESULTS Genetically predicted FT4 levels were associated with SHTN(odds ratio=0.48;95%CI=0.04−0.82,P=0.027),HPL(odds ratio=0.67;95%CI=0.18−0.88,P=0.023),T2DM(odds ratio=0.80;95%CI=0.42−0.86,P=0.005),IHD(odds ratio=0.85;95%CI=0.49−0.98,P=0.039),NRVD(odds ratio=0.75;95%CI=0.27−0.97,P=0.039).Additionally,genetically predicted TSH levels were associated with HF(odds ratio=0.82;95%CI=0.68−0.99,P=0.042),PHD(odds ratio=0.75;95%CI=0.32−0.82,P=0.006),stroke(odds ratio=0.95;95%CI=0.81−0.97,P=0.007).However,genetically predicted thyroid function traits were not associated with EHTN and MI.CONCLUSIONS Our study suggests FT4 and TSH are associated with cardiometabolic diseases,underscoring the importance of the pituitary-thyroid-cardiac axis in cardiometabolic health susceptibility.展开更多
BACKGROUND AND AIM: Although admission hyperglycemia has been reported to be associated with unfavorable outcomes in acute stroke, little is known about this association in sub-Saharan Africa. Therefore, the aim of th...BACKGROUND AND AIM: Although admission hyperglycemia has been reported to be associated with unfavorable outcomes in acute stroke, little is known about this association in sub-Saharan Africa. Therefore, the aim of the present study was to assess the prognostic significance of admission hyperglycemia in the acute phase of stroke in Congolese patients. METHODS: In a multicenter prospective cohort study, consecutive patients with acute stroke were examined in 5 Emergency Rooms or Intensive Care Units of Kinshasa between July 15th, 2017 and March 15th, 2018. The severity of stroke was assessed at admission using the Glasgow Coma Scale. Stress hyperglycemia was defined as random blood glucose levels at admission > 140 mg/dL in patients without known type 2 diabetes mellitus (T2DM). The endpoint was 10-day all-cause in-hospital mortality. Survival (time-to-death) curves were built using the Kaplan Meier methods. Cox proportional analysis was used to identify predictors of 10-day all-cause in-hospital mortality. The predictive performance of blood glucose level to predict 10-day all-cause in-hospital mortality was assessed using ROC curve analysis. RESULTS: Out of 194 patients (mean age 58.7 ± 13.1 years;64% males, 74.7% light to moderate stroke severity;63.4% ischemic stroke) enrolled, 106 (54.6%) had admission hyperglycemia with 77 (72.6%) having stress hyperglycemia. Ninety four deaths (48.5%);mortality rate of 6 deaths per 100 person-days (95%CI 2.7 - 9.3) occurred during a median follow up time 6 (5 - 7) days equivalent to 1542 person-days. Independent predictors of 10-day all-cause in-hospital mortality were admission hyperglycemia regardless of diabetes status (aHR 3.77;95%CI 1.92 - 7.42;p < 0.001), GCS - 5.23;p = 0.001) and non-use of mechanical ventilation (aHR 1.97;95%CI 1.05 - 3.70;p = 0.034). Blood glucose concentrations (AUC 0.743;95%CI 0.672 - 0.814) had a better predictive performance for 10-day all-cause in-hospital mortality with an optimal value of 154 mg/dL (sensitivity 76.6% and specificity 70%). CONCLUSION: More than half of critically ill stroke patients exhibit admission hyperglycemia that impacts negatively on their survival in the acute phase highlighting thus the need for a better blood glucose control to improve outcomes.展开更多
Cardiovascular disease(CVD)is the leading cause of death in both urban and rural areas of China.The current evidence regarding CVD risk factors was primarily established in Western countries,with limited generalizabil...Cardiovascular disease(CVD)is the leading cause of death in both urban and rural areas of China.The current evidence regarding CVD risk factors was primarily established in Western countries,with limited generalizability to the Chinese population.In China,a growing number of population-based prospective cohort studies have emerged that have yielded substantial research data on CVD risk factors in the past five years.The research studies have covered biological risk factors(e.g.,blood lipids,blood pressure,blood glucose,adiposity),lifestyle risk factors(e.g.,smoking,alcohol,diet,physical activity),environmental risk factors(e.g.,ambient and indoor air pollution),and risk prediction.This study aimed to systematically review the research progress on CVD risk factors in the Chinese population in the past five years.Prospective studies in China have identified biological,lifestyle,and environmental risk factors for CVD and its main subtypes,along with some protective factors unique to the Chinese(e.g.,spicy food and green tea).This review aimed to provide high-quality evidence for achieving the Outline of Healthy China 2030,developing disease prevention guidelines and measures,and deepening efforts for popularization of health knowledge.展开更多
Background:Although TB health promotion directed at policy makers and healthcare workers(HCWs)is considered important to tuberculosis(TB)control,no indicators currently assess the impact of such promotional activities...Background:Although TB health promotion directed at policy makers and healthcare workers(HCWs)is considered important to tuberculosis(TB)control,no indicators currently assess the impact of such promotional activities.This article is the second in a series of papers that seek to establish a framework of behavioral indicators for outcome evaluation of TB health promotion,using the Delphi method.In the first article,we sought to establish a framework of behavioral indicators for outcome evaluation of TB health promotion among TB suspects and patients.The objective of this second article is to present an indicator framework that can be used to assess behavioral outcomes of TB health promotion directed at policy makers and HCWs.Methods:A two-round,modified Delphi method was used to establish the indicators.Sixteen experts who were knowledgeable and experienced in the field of TB control were consulted in Delphi surveys.A questionnaire was developed following 4 steps,and involved ranking indicators on a five-point Likert scale.The consensus level was 70%.Median,mode,and Coefficient of variation(CV)were used to describe expert responses.An authority coefficient(Cr)was used to assess the degree of each expert’s authority.Results:Consensus was achieved following the two survey rounds and several iterations among the experts.For TB health-promotion activities directed at policymakers,the experts reached consensus on 2 domains(“Resource inputs”and“Policymaking and monitoring behaviors”),4 subdomains(“Human resources”among others),and 13 indicators(“Human resources per 100,000 person”among others).For TB health-promotion activities directed at HCWs,the experts reached consensus on 5 domains(“Self-protective behaviors”among others),6 sub-domains(“Preventing infection”among others),and 15 indicators(“Average hours of daily workplace disinfection by ultraviolet radiation”among others).Conclusions:This study identified a conceptual framework of core behavioral indicators to evaluate TB health-promotion activities directed at policymakers and HCWs involved in TB control.Validation in other parts of the world could lead to global consensus on behavioral indicators to evaluate TB health promotion targeted at policymakers and HCWs.展开更多
Background:Thyroid dysfunction is associated with cardiovascular diseases.However,the role of thyroid function in lipid metabolism remains partly unknown.The present study aimed to investigate the causal association b...Background:Thyroid dysfunction is associated with cardiovascular diseases.However,the role of thyroid function in lipid metabolism remains partly unknown.The present study aimed to investigate the causal association between thyroid function and serum lipid metabolism via a genetic analysis termed Mendelian randomization(MR).Methods:The MR approach uses a genetic variant as the instrumental variable in epidemiological studies to mimic a randomized controlled trial.A two-sample MR was performed to assess the causal association,using summary statistics from the Atrial Fibrillation Genetics Consortium(n=537,409)and the Global Lipids Genetics Consortium(n=188,577).The clinical measures of thyroid function include thyrotropin(TSH),free triiodothyronine(FT3)and free thyroxine(FT4)levels,FT3:FT4 ratio and concentration of thyroid peroxidase antibodies(TPOAb).The serum lipid metabolism traits include total cholesterol(TC)and triglycerides,high-density lipoprotein,and low-density lipoprotein(LDL)levels.The MR estimate and MR inverse variance-weighted method were used to assess the association between thyroid function and serum lipid metabolism.Results:The results demonstrated that increased TSH levels were significantly associated with higher TC(β=0.052,P=0.002)and LDL(β=0.041,P=0.018)levels.In addition,the FT3:FT4 ratio was significantly associated with TC(β=0.240,P=0.033)and LDL(β=0.025,P=0.027)levels.However,no significant differences were observed between genetically predicted FT4 and TPOAb and serum lipids.Conclusion:Taken together,the results of the present study suggest an association between thyroid function and serum lipid metabolism,highlighting the importance of the pituitary-thyroid-cardiac axis in dyslipidemia susceptibility.展开更多
Purpose::Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury(ASOI).The purpose of this study was to investigate the correlation of ASOI with ...Purpose::Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury(ASOI).The purpose of this study was to investigate the correlation of ASOI with the number,location,and involved segments of rib fracture(s)in blunt chest trauma.Methods::This retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years,who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020.After ethic committee approval,a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected.Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age,gender,injury severity score,trauma mechanism,number and sides of the fractured ribs(left/right/bilateral),rib fracture segments(upper,middle,lower zone)and results of chest and abdominal spiral CT scan were recorded.The correlation between ASOI and the sides,segments and number of rib fracture(s)was assessed by Pearson's correlation coefficient.Results::Altogether 1056 patients with rib fracture(s)were included.The mean age was(42.76±13.35)years and 85.4%were male.The most common mechanism of trauma was car accident(34.6%).Most fractures occurred in the middle rib zone(60.44%)and the most commonly involved ribs were the 6th and 7th ones(15.7%and 16.4%,respectively).Concurrent abdominal injuries were observed in 103 patients(34.91%)and were significantly associated with middle zone rib fractures.Conclusion::There is a significant relationship between middle zone rib fractures and ASOI.Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.展开更多
The main goal of this paper is to employ longitudinal trajectories in a significant number of sub-regional brain volumetric MRI data as statistical predictors for Alzheimer's disease(AD)clas-sification.We use logi...The main goal of this paper is to employ longitudinal trajectories in a significant number of sub-regional brain volumetric MRI data as statistical predictors for Alzheimer's disease(AD)clas-sification.We use logistic regression in a Bayesian framework that includes many functional predictors.The direct sampling of regression Coefficients from the Bayesian logistic model is dif-ficult due to its complicated likelihood function.In high-dimensional scenarios,the selection of predictors is paramount with the introduction of either spike-and-slab priors,non-local priors,or Horseshoe priors.We seek to avoid the complicated Metropolis-Hastings approach and to develop an easily implementable Gibbs sampler.In addition,the Bayesian estimation provides proper estimates of the model parameters,which are also useful for building inference.Another advantage of working with logistic regression is that it calculates the log of odds of relative risk for AD compared to normal control based on the selected longitudinal predictors,rather than simply classifying patients based on cross-sectional estimates.Ultimately,however,we com-bine approaches and use a probability threshold to classify individual patients.We employ 49 functional predictors consisting of volumetric estimates of brain sub-regions,chosen for their established clinical significance.Moreover,the use of spike and slab priors ensures that many redundant predictors are dropped from the model.展开更多
The purpose of this study was to develop a tool for community-based health organisations(CBHOs)to evaluate the preparedness in biohazards concerning epidemics or bioterrorism.We searched concepts on partnerships of CB...The purpose of this study was to develop a tool for community-based health organisations(CBHOs)to evaluate the preparedness in biohazards concerning epidemics or bioterrorism.We searched concepts on partnerships of CBHOs with health systems in guidelines of the Centers for Disease Control and Prevention and literature.Then,we validated the researcher-made tool by face validity,content validity,exploratory factor analysis(EFA),confirmatory factor analysis(CFA)and criterion validity.Data were collected by sending the tool to 620 CBHOs serving under supervision of Iran’s ministry of health.Opinions of health professionals and stakeholders in CBHOs were used to assess face and content validity.Factor loads in EFA were based on three-factor structure that verified by CFA.We used SPSS V.18 and Mplus7 software for statistical analysis.About 105 health-based CBHOs participated.After conducting face validity and calculating content validity ratio and content validity index,we reached 54 items in the field of planning,training and infrastructure.We conducted construct validity using 105 CBHOs.Three items exchanged between the fields according to factor loads in EFA,and CFA verified the model fit as Comparative Fit Index,Tucker-Lewis index and root mean square error of approximation were 0.921,0918 and 0.052,respectively.The Cronbach’s of the whole tool was 0.944.Spearman correlation coefficient confirmed criterion validity as coefficient was 0.736.Planning,training and infrastructure fields are the most important aspects of preparedness in health-based CBHOs.Applying the new assessment tool in future studies will show the weaknesses and capabilities of health-based CBHOs in biohazard and clear necessary intervention actions for health authorities.展开更多
Objective.The strongest locus which associated with type 2 diabetes(T2D)by the common variant rs7903146 is the transcription factor 7-like 2 gene(TCF7L2).We aimed to quantify the interaction of diet/lifestyle interven...Objective.The strongest locus which associated with type 2 diabetes(T2D)by the common variant rs7903146 is the transcription factor 7-like 2 gene(TCF7L2).We aimed to quantify the interaction of diet/lifestyle interventions and the genetic effect of TCF7L2 rs7903146 on glycemic traits,body weight,or waist circumference in overweight or obese adults in several randomized controlled trials(RCTs).Methods.From October 2016 to May 2018,a large collaborative analysis was performed by pooling individualparticipant data from 7 RCTs.These RCTs reported changes in glycemic control and adiposity of the variant rs7903146 after dietary/lifestyle-related interventions in overweight or obese adults.Gene treatment interaction models which used the genetic effect encoded by the allele dose and common covariates were applicable to individual participant data in all studies.Results.In the joint analysis,a total of 7 eligible RCTs were included(n=4,114).Importantly,we observed a significant effect modification of diet/lifestyle-related interventions on the TCF7L2 variant rs7903146 and changes in fasting glucose.Compared with the control group,diet/lifestyle interventions were related to lower fasting glucose by-3.06(95%CI,-5.77 to-0.36)mg/dL(test for heterogeneity and overall effect:I^(2)=45:1%,p<0:05;z=2:20,p=0:028)per one copy of the TCF7L2 T risk allele.Furthermore,regardless of genetic risk,diet/lifestyle interventions were associated with lower waist circumference.However,there was no significant change for diet/lifestyle interventions in other glycemic control and adiposity traits per one copy of TCF7L2 risk allele.Conclusions.Our findings suggest that carrying the TCF7L2 T risk allele may have a modestly greater benefit for specific diet/lifestyle interventions to improve the control of fasting glucose in overweight or obese adults.展开更多
Background:Most lung cancer risk prediction models were developed in European and North-American cohorts of smokers aged≥55 years,while less is known about risk profiles in Asia,especially for never smokers or indivi...Background:Most lung cancer risk prediction models were developed in European and North-American cohorts of smokers aged≥55 years,while less is known about risk profiles in Asia,especially for never smokers or individuals aged<50 years.Hence,we aimed to develop and validate a lung cancer risk estimate tool for ever and never smokers across a wide age range.Methods:Based on the China Kadoorie Biobank cohort,we first systematically selected the predictors and explored the nonlinear association of predictors with lung cancer risk using restricted cubic splines.Then,we separately developed risk prediction models to construct a lung cancer risk score(LCRS)in 159,715 ever smokers and 336,526 never smokers.The LCRS was further validated in an independent cohort over a median follow-up of 13.6 years,consisting of 14,153 never smokers and 5,890 ever smokers.Results:A total of 13 and 9 routinely available predictors were identified for ever and never smokers,respectively.Of these predictors,cigarettes per day and quit years showed nonlinear associations with lung cancer risk(Pnon-linear<0.001).The curve of lung cancer incidence increased rapidly above 20 cigarettes per day and then was relatively flat until approximately 30 cigarettes per day.We also observed that lung cancer risk declined sharplywithin the first 5 years of quitting,and then continued to decrease but at a slower rate in the subsequent years.The 6-year area under the receiver operating curve for the ever and never smokers’models were respectively 0.778 and 0.733 in the derivation cohort,and 0.774 and 0.759 in the validation cohort.In the validation cohort,the 10-year cumulative incidence of lung cancerwas 0.39%and 2.57%for ever smokers with low(<166.2)and intermediate-high LCRS(≥166.2),respectively.Never smokers with a high LCRS(≥21.2)had a higher 10-year cumulative incidence rate than those with a low LCRS(<21.2;1.05%vs.0.22%).An online risk evaluation tool(LCKEY;http://ccra.njmu.edu.cn/lckey/web)was developed to facilitate the use of LCRS.Conclusions:The LCRS can be an effective risk assessment tool designed for ever and never smokers aged 30 to 80 years.展开更多
Following publication of the results of the National Lung Screening Trial in the United States,a randomized controlled trial in Italy(ITALUNG)and two simulation studies in China reported similar findings in 2017 favor...Following publication of the results of the National Lung Screening Trial in the United States,a randomized controlled trial in Italy(ITALUNG)and two simulation studies in China reported similar findings in 2017 favoring lung cancer screening with low-dose computed tomography among smokers.With such advances in lung cancer screening,worldwide interest has gradually shifted from evaluating whether refining lung cancer screening protocols is effective in preventing deaths.However,there are several practical problems to be resolved,including the balance of enroll-ment criteria and cost effectiveness,precise measurements to reduce false positive findings,risk-based optimization of screening frequency,challenges associated with cancer heterogeneity,strategies to combine image screening with novel biomarkers,dynamic monitoring of the natural history of cancer,accurate identification and diagnosis of cases among huge populations,and the impact of tobacco control policy and environment protection.As one in three individuals with lung cancer worldwide resides in China,these questions pose great challenges as well as research opportunities for population screening programs in China.展开更多
Background:Despite the recent large number of studies comparing endoscopic and laparoscopic resection for small gastrointestinal stromal tumors(GISTs)(diameter≤5 cm),the results remain conflicting.The objective of th...Background:Despite the recent large number of studies comparing endoscopic and laparoscopic resection for small gastrointestinal stromal tumors(GISTs)(diameter≤5 cm),the results remain conflicting.The objective of this work was to perform a cumulative meta-analysis to assess the advantages and disadvantages of endoscopic resection vs.laparoscopic resection.Methods:The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.We searched medical databases up to January 2020.Meta-analytical random or fixed effects models were used in pooled analyses.Meta-regression,cumulative meta-analyses,and sub-group analyses were performed to improve the accuracy of the conclusion.Sensitivity analyses were applied to assess the robustness of the results.Results:A total of 12 cohort studies with 1383 participants comparing endoscopic resection and laparoscopic resection were identified,while three cohort studies with 167 participants comparing endoscopic resection and laparoscopic and endoscopic cooperative surgery were found.We found that endoscopic resection had shorter operation times(weighted mean difference[WMD]=-27.1 min,95%confidence interval[CI]:-40.8 to-13.4 min)and lengths of hospital stay(WMD=-1.43 days,95%CI:-2.31 to-0.56 days)than did laparoscopic resection.The results were stable and reliable.There were no significant differences in terms of blood loss,hospitalization costs,incidence of complications or recurrence rates.For tumor sizes 2 to 5 cm,endoscopic resection increased the risk of positive margins(relative risk[RR]=5.78,95%CI:1.31-25.46).Although operation times for endoscopic resection were shorter than those of laparoscopic and endoscopic cooperative surgery(WMD=-41.03 min,95%CI:-59.53 to-22.54 min),there was a higher incidence of complications(RR=4.03,95%CI:1.57-10.34).Conclusions:In general,endoscopic resection is an alternative method for gastric GISTs≤5 cm.Laparoscopic and endoscopic cooperative surgery may work well in combination.Further randomized controlled trials are recommended to validate or update these results.展开更多
In May 2003,the World Health Organization(WHO)Framework Convention on Tobacco Control(FCTC)was released(1),which is an event of great significance in the history of tobacco control.The FCTC was signed by China in Nove...In May 2003,the World Health Organization(WHO)Framework Convention on Tobacco Control(FCTC)was released(1),which is an event of great significance in the history of tobacco control.The FCTC was signed by China in November 2003 and entered into force in January 2006.Although some achievements in tobacco control have been made over the past 15 years,much more progress is needed.In July 2021,the WHO Report on the Global Tobacco Epidemic(Report)was released.The Report evaluates and grades implementation of the 6 most effective strategies of the Monitor,Protect,Offer,Warn,Enforce and Raise(MPOWER)tobacco control package in 61 high-income countries,105 middleincome countries,and 29 low-income countries(2)(Table 1).This article summarizes current progress and challenges to tobacco control in China with reference to the Report.展开更多
The selection of effective genes that accurately predict chemotherapy responses might improve cancer outcomes.We compare optimized gene signatures for cisplatin,carboplatin,and oxaliplatin responses in the same cell l...The selection of effective genes that accurately predict chemotherapy responses might improve cancer outcomes.We compare optimized gene signatures for cisplatin,carboplatin,and oxaliplatin responses in the same cell lines and validate each signature using data from patients with cancer.Supervised support vector machine learning is used to derive gene sets whose expression is related to the cell line GI 50 values by backwards feature selection with cross-validation.Specific genes and functional pathways distinguishing sensitive from resistant cell lines are identified by contrasting signatures obtained at extreme and median GI 50 thresholds.Ensembles of gene signatures at different thresholds are combined to reduce the dependence on specific GI 50 values for predicting drug responses.The most accurate gene signatures for each platin are:cisplatin:BARD1,BCL2,BCL2L1,CDKN2C,FAAP24,FEN1,MAP3K1,MAPK13,MAPK3,NFKB1,NFKB2,SLC22A5,SLC31A2,TLR4,and TWIST1;carboplatin:AKT1,EIF3K,ERCC1,GNGT1,GSR,MTHFR,NEDD4L,NLRP1,NRAS,RAF1,SGK1,TIGD1,TP53,VEGFB,and VEGFC;and oxaliplatin:BRAF,FCGR2A,IGF1,MSH2,NAGK,NFE2L2,NQO1,PANK3,SLC47A1,SLCO1B1,and UGT1A1.Data from The Cancer Genome Atlas(TCGA)patients with bladder,ovarian,and colorectal cancer were used to test the cisplatin,carboplatin,and oxaliplatin signatures,resulting in 71.0%,60.2%,and 54.5%accuracies in predicting disease recurrence and 59%,61%,and 72%accuracies in predicting remission,respectively.One cisplatin signature predicted 100%of recurrence in non-smoking patients with bladder cancer(57%disease-free;N=19),and 79%recurrence in smokers(62%disease-free;N=35).This approach should be adaptable to other studies of chemotherapy responses,regardless of the drug or cancer types.展开更多
Coronavirus disease 2019(COVID-19)pandemic has continued to spread rapidly across the world.In the past nearly two years,there have been over 267 million confirmed COVID-19 cases including over five million deaths glo...Coronavirus disease 2019(COVID-19)pandemic has continued to spread rapidly across the world.In the past nearly two years,there have been over 267 million confirmed COVID-19 cases including over five million deaths globally reported to WHO[1].Facing this unprecedented public health crisis which we have not seen in a century,global experts rapidly expand scientific knowledge on this new virus,to track the spread and virulence of the virus.Different countries develop response strategies and practices tailored to their own specific epidemiological situations,resources,and values of individuals living in their countries[2].展开更多
基金supported by National Natural Science Foundation of China(82192900,82192901,82192904,81941018,and 91846303)Peking University Medicine Seed Fund for Interdisciplinary Research(BMU2022MX025)+5 种基金the Fundamental Research Funds for the Central Universitiessupported by a grant from the Kadoorie Charitable Foundation in Hong Kongsupported by grants from the UK Wellcome Trust(212946/Z/18/Z,202922/Z/16/Z,104085/Z/14/Z,and 088158/Z/09/Z)the National Key R&D Program of China(2016YFC0900500)National Natural Science Foundation of China(81390540)Chinese Ministry of Science and Technology(2011BAI09B01)。
文摘Background:Information on the association between physical activity(PA)and the risk of chronic kidney disease(CKD)is limited.We aimed to explore the associations of total,domain-specific,and intensity-specific PA with CKD and its subtypes in China.Methods:The study included 475,376 adults from the China Kadoorie Biobank aged 30-79 years during 2004-2008 at baseline.An interviewer-administered questionnaire was used to collect the information about PA,which was quantified as metabolic equivalent of task hours per day(MET-h/day)and categorized into 4 groups based on quartiles.Cox regression was used to analyze the association between PA and CKD risk.Results:During a median follow-up of 12.1 years,5415 incident CKD cases were documented,including 1159 incident diabetic kidney disease(DKD)cases and 362 incident hypertensive nephropathy(HTN)cases.Total PA was inversely associated with CKD risk,with an adjusted hazard ratio(HR,95%confidence interval(95%CI))of 0.83(0.75-0.92)for incident CKD in the highest quartile of total PA as compared with participants in the lowest quartile.Similar results were observed for risk of DKD and HTN,and the corresponding HRs(95%CIs)were 0.75(0.58-0.97)for DKD risk and 0.56(0.37-0.85)for HTN risk.Increased nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA were significantly associated with a decreased risk of CKD,with HRs(95%CIs)of 0.80(0.73-0.88),0.85(0.77-0.94),and 0.85(0.76-0.95)in the highest quartile,respectively.Conclusion:PA,including nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA,was inversely associated with the risk of CKD,including DKD,HTN,and other CKD,and such associations were dose dependent.
文摘Objective To evaluate the impact of major causes of death on changes of life expectancy in China. Methods Life expectancy was calculated by standard life table techniques using mortality data from the national censuses in 1990 and 2000 and the 1% National Population Sampling Surveys in 1995 and 2005. Mortality data about the major causes of death from VR-MOH were used as reference values to estimate their death proportions of the specific age groups by sex and regions, as well as all-cause mortality and age-specific mortality rates of major causes of death. Decomposition method was used to quantitatively evaluate the impact. Results Three key findings were identified in our study. First, China's health challenge was shifted from diseases related to living conditions to those related to behavior and lifestyle, with rural areas relatively lagged behind urban areas. Second, the impacts of cardiovascular diseases and neoplasm on the middle aged and elderly population were stressed. Third, compared to the urban population, the rural population tended to have increasing mortality of neoplasm and cardiovascular diseases, especially in adults at the age of 15-39 years. Conclusion Further efforts should be made to reduce the incidence of neoplasm and cardiovascular diseases, especially in rural areas, by promoting healthy behavior and lifestyle and providing appropriate therapies for all patients in need.
基金supported by the Natural Science Foundation of Tianjin (No. 18JCQNJC80300)Chinese National Key Research and Development Project (No. 2018YFC1315600)+1 种基金National Natural Science Foundation of China (No. 81502476)the Beijing Young Talent Program (No. 2016000021469G189).
文摘Objective: To redefine overdiagnosis and reestimate the proportion of overdiagnosis of breast cancer caused by screening based on the Surveillance, Epidemiology, and End Results(SEER, 1973-2015) Program data.Methods: The breast cancer diagnosed before 1977 was defined as the no-screening cohort since America had initiated breast cancer screening from 1977. The breast cancer diagnosed in 1999 was defined as the screening cohort due to no increases in both the proportion of early-stage breast cancer until 1999 and the overall survival of early-stage breast cancer diagnosed over the three years since 1999. The magnitude of overdiagnosis was calculated as the difference in the proportions of early-stage breast cancer patients with long-time(15-year) survival to all breast cancer patients between two cohorts.Results: Over 23 years before and after widespread screening in America, the proportion of early-stage breast cancer patients increased from 52.1%(16,891/32,443) to 72.7%(16,021/22,025)(P<0.001). The 15-year survival rate of early-stage breast cancer patients increased from 51.1% to 61.5%(P<0.001), while the proportions of earlystage breast cancer patients with long-time survival to all breast cancer patients increased from 26.6%(52.1%×51.1%) to 44.7%(72.7%×61.5%). Assuming no improvements in cancer screening technology and treatment technology, 18.1%(44.7%-26.6%) of breast cancer patients were overdiagnosed associated with screening. The age-specific overdiagnosis rates were 18.9%, 24.7%, 24.5%, 20.5%, and 8.3% for breast cancer patients aged 40-49, 50-59, 60-69, 70-74, and ≥75 years old, respectively.Conclusions: Overdiagnosis caused by mammographic screening is probably overestimated in current screening practices. Further trials with more sophisticated designs and analyses are needed to validate our findings in the future.
基金financially supported by Research Deputy,Shahid Sadoughi University of Medical Sciences,Yazd,Iran,with project No.P/17/1/19412
文摘Objective: To investigate and predict the effects of climate change on the potential distribution of the main vector and reservoir hosts of the disease in Yazd province in the future.Methods: Distribution data for vector and reservoir hosts of zoonotic cutaneous leishmaniasis in Yazd province were obtained from earlier studies conducted in the area.MaxEnt ecological niche modeling was used to predict environmental suitability.BCC-CSM1-1(m) model and two climate change scenarios, RCP 4.5 and RCP 8.5 were used for horizons 2030 and 2050 climate projections.Future projections were based on data of a regional climate change model.Results: With both scenarios in 2030 and 2050, the results of jackknife test indicated that the mean temperature of wettest quarter and temperature annual range had the greatest effect on the model for the vector and the reservoir hosts, respectively.Conclusions: The climate conditions are the major determinants of zoonotic cutaneous leishmaniasis incidence rate in Yazd Province.These climate conditions provide favorable habitats for ease transmission of zoonotic cutaneous leishmaniasis in this endemic area.Habitats suitability for the vector and reservoir will be expanding in the coming years compared with the current conditions, such that, in horizon 2030 & 2050, the probability of the presence of the vector and reservoir within 38 580 and 37 949 km^2, respectively, from Yazd province is above 60%.Moreover, an increase is predicted in the presence of the vector in the western parts and the reservoir in the northern and central parts of the province in the future.Understanding the role of environmental and bioclimatic factors in zoonotic cutaneous leishmaniasis occurrence can provide a guide for policy-makers in the creation and implementation of more effective policies for prevention and control.
文摘BACKGROUND Growing evidence have demonstrated that thyroid hormones have been involved in the processes of cardiovascular metabolism.However,the causal relationship of thyroid function and cardiometabolic health remains partly unknown.METHODS The Mendelian randomization(MR)was used to test genetic,potentially causal relationships between instrumental variables and cardiometabolic traits.Genetic variants of free thyroxine(FT4)and thyrotropin(TSH)levels within the reference range were used as instrumental variables.Data for genetic associations with cardiometabolic diseases were acquired from the genome-wide association studies of the FinnGen,CARDIoGRAM and CARDIoGRAMplusC4D,CHARGE,and MEGASTROKE.This study was conducted using summary statistic data from large,previously described cohorts.Association between thyroid function and essential hypertension(EHTN),secondary hypertension(SHTN),hyperlipidemia(HPL),type 2 diabetes mellitus(T2DM),ischemic heart disease(IHD),myocardial infarction(MI),heart failure(HF),pulmonary heart disease(PHD),stroke,and non-rheumatic valve disease(NRVD)were examined.RESULTS Genetically predicted FT4 levels were associated with SHTN(odds ratio=0.48;95%CI=0.04−0.82,P=0.027),HPL(odds ratio=0.67;95%CI=0.18−0.88,P=0.023),T2DM(odds ratio=0.80;95%CI=0.42−0.86,P=0.005),IHD(odds ratio=0.85;95%CI=0.49−0.98,P=0.039),NRVD(odds ratio=0.75;95%CI=0.27−0.97,P=0.039).Additionally,genetically predicted TSH levels were associated with HF(odds ratio=0.82;95%CI=0.68−0.99,P=0.042),PHD(odds ratio=0.75;95%CI=0.32−0.82,P=0.006),stroke(odds ratio=0.95;95%CI=0.81−0.97,P=0.007).However,genetically predicted thyroid function traits were not associated with EHTN and MI.CONCLUSIONS Our study suggests FT4 and TSH are associated with cardiometabolic diseases,underscoring the importance of the pituitary-thyroid-cardiac axis in cardiometabolic health susceptibility.
文摘BACKGROUND AND AIM: Although admission hyperglycemia has been reported to be associated with unfavorable outcomes in acute stroke, little is known about this association in sub-Saharan Africa. Therefore, the aim of the present study was to assess the prognostic significance of admission hyperglycemia in the acute phase of stroke in Congolese patients. METHODS: In a multicenter prospective cohort study, consecutive patients with acute stroke were examined in 5 Emergency Rooms or Intensive Care Units of Kinshasa between July 15th, 2017 and March 15th, 2018. The severity of stroke was assessed at admission using the Glasgow Coma Scale. Stress hyperglycemia was defined as random blood glucose levels at admission > 140 mg/dL in patients without known type 2 diabetes mellitus (T2DM). The endpoint was 10-day all-cause in-hospital mortality. Survival (time-to-death) curves were built using the Kaplan Meier methods. Cox proportional analysis was used to identify predictors of 10-day all-cause in-hospital mortality. The predictive performance of blood glucose level to predict 10-day all-cause in-hospital mortality was assessed using ROC curve analysis. RESULTS: Out of 194 patients (mean age 58.7 ± 13.1 years;64% males, 74.7% light to moderate stroke severity;63.4% ischemic stroke) enrolled, 106 (54.6%) had admission hyperglycemia with 77 (72.6%) having stress hyperglycemia. Ninety four deaths (48.5%);mortality rate of 6 deaths per 100 person-days (95%CI 2.7 - 9.3) occurred during a median follow up time 6 (5 - 7) days equivalent to 1542 person-days. Independent predictors of 10-day all-cause in-hospital mortality were admission hyperglycemia regardless of diabetes status (aHR 3.77;95%CI 1.92 - 7.42;p < 0.001), GCS - 5.23;p = 0.001) and non-use of mechanical ventilation (aHR 1.97;95%CI 1.05 - 3.70;p = 0.034). Blood glucose concentrations (AUC 0.743;95%CI 0.672 - 0.814) had a better predictive performance for 10-day all-cause in-hospital mortality with an optimal value of 154 mg/dL (sensitivity 76.6% and specificity 70%). CONCLUSION: More than half of critically ill stroke patients exhibit admission hyperglycemia that impacts negatively on their survival in the acute phase highlighting thus the need for a better blood glucose control to improve outcomes.
基金This study was sponsored by Chinese National Natural Science Foundation(Grant Nos.81941018&81390540)the National Key R&D Program of China(Nos.2016YFC0900500,2016YFC0900501,2016YFC0900504)+1 种基金Chinese Ministry of Science and Technology(Project No.2011BAI09B01,2012-14)YP acknowledges support from the China Postdoctoral Science Foundation(Grant No.2019TQ0008).
文摘Cardiovascular disease(CVD)is the leading cause of death in both urban and rural areas of China.The current evidence regarding CVD risk factors was primarily established in Western countries,with limited generalizability to the Chinese population.In China,a growing number of population-based prospective cohort studies have emerged that have yielded substantial research data on CVD risk factors in the past five years.The research studies have covered biological risk factors(e.g.,blood lipids,blood pressure,blood glucose,adiposity),lifestyle risk factors(e.g.,smoking,alcohol,diet,physical activity),environmental risk factors(e.g.,ambient and indoor air pollution),and risk prediction.This study aimed to systematically review the research progress on CVD risk factors in the Chinese population in the past five years.Prospective studies in China have identified biological,lifestyle,and environmental risk factors for CVD and its main subtypes,along with some protective factors unique to the Chinese(e.g.,spicy food and green tea).This review aimed to provide high-quality evidence for achieving the Outline of Healthy China 2030,developing disease prevention guidelines and measures,and deepening efforts for popularization of health knowledge.
基金This project was funded by the National Natural Science Foundation of China(Award#81001297).The authors would like to thank participants on the expert panel for the discussion during the process of proposing the framework.The authors would like to acknowledge Professor Shenglan Tang of the Institute of Global Health,Duke University for his comments on the paper.
文摘Background:Although TB health promotion directed at policy makers and healthcare workers(HCWs)is considered important to tuberculosis(TB)control,no indicators currently assess the impact of such promotional activities.This article is the second in a series of papers that seek to establish a framework of behavioral indicators for outcome evaluation of TB health promotion,using the Delphi method.In the first article,we sought to establish a framework of behavioral indicators for outcome evaluation of TB health promotion among TB suspects and patients.The objective of this second article is to present an indicator framework that can be used to assess behavioral outcomes of TB health promotion directed at policy makers and HCWs.Methods:A two-round,modified Delphi method was used to establish the indicators.Sixteen experts who were knowledgeable and experienced in the field of TB control were consulted in Delphi surveys.A questionnaire was developed following 4 steps,and involved ranking indicators on a five-point Likert scale.The consensus level was 70%.Median,mode,and Coefficient of variation(CV)were used to describe expert responses.An authority coefficient(Cr)was used to assess the degree of each expert’s authority.Results:Consensus was achieved following the two survey rounds and several iterations among the experts.For TB health-promotion activities directed at policymakers,the experts reached consensus on 2 domains(“Resource inputs”and“Policymaking and monitoring behaviors”),4 subdomains(“Human resources”among others),and 13 indicators(“Human resources per 100,000 person”among others).For TB health-promotion activities directed at HCWs,the experts reached consensus on 5 domains(“Self-protective behaviors”among others),6 sub-domains(“Preventing infection”among others),and 15 indicators(“Average hours of daily workplace disinfection by ultraviolet radiation”among others).Conclusions:This study identified a conceptual framework of core behavioral indicators to evaluate TB health-promotion activities directed at policymakers and HCWs involved in TB control.Validation in other parts of the world could lead to global consensus on behavioral indicators to evaluate TB health promotion targeted at policymakers and HCWs.
基金supported by the National Natural Science Foundation of China(No.81825003,91957123)the Peking University Start-up Grant(BMU2018YJ002)+1 种基金High-performance Computing Platform of Peking University and Beijing Technology and Business University Grant(No.88442Y0033)Thyroid Hormone Replacement for Subclinical Hypothyroidism and Dyslipidemia in Patients with Atherosclerotic Cardiovascular Diseases(NCT03606824)。
文摘Background:Thyroid dysfunction is associated with cardiovascular diseases.However,the role of thyroid function in lipid metabolism remains partly unknown.The present study aimed to investigate the causal association between thyroid function and serum lipid metabolism via a genetic analysis termed Mendelian randomization(MR).Methods:The MR approach uses a genetic variant as the instrumental variable in epidemiological studies to mimic a randomized controlled trial.A two-sample MR was performed to assess the causal association,using summary statistics from the Atrial Fibrillation Genetics Consortium(n=537,409)and the Global Lipids Genetics Consortium(n=188,577).The clinical measures of thyroid function include thyrotropin(TSH),free triiodothyronine(FT3)and free thyroxine(FT4)levels,FT3:FT4 ratio and concentration of thyroid peroxidase antibodies(TPOAb).The serum lipid metabolism traits include total cholesterol(TC)and triglycerides,high-density lipoprotein,and low-density lipoprotein(LDL)levels.The MR estimate and MR inverse variance-weighted method were used to assess the association between thyroid function and serum lipid metabolism.Results:The results demonstrated that increased TSH levels were significantly associated with higher TC(β=0.052,P=0.002)and LDL(β=0.041,P=0.018)levels.In addition,the FT3:FT4 ratio was significantly associated with TC(β=0.240,P=0.033)and LDL(β=0.025,P=0.027)levels.However,no significant differences were observed between genetically predicted FT4 and TPOAb and serum lipids.Conclusion:Taken together,the results of the present study suggest an association between thyroid function and serum lipid metabolism,highlighting the importance of the pituitary-thyroid-cardiac axis in dyslipidemia susceptibility.
文摘Purpose::Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury(ASOI).The purpose of this study was to investigate the correlation of ASOI with the number,location,and involved segments of rib fracture(s)in blunt chest trauma.Methods::This retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years,who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020.After ethic committee approval,a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected.Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age,gender,injury severity score,trauma mechanism,number and sides of the fractured ribs(left/right/bilateral),rib fracture segments(upper,middle,lower zone)and results of chest and abdominal spiral CT scan were recorded.The correlation between ASOI and the sides,segments and number of rib fracture(s)was assessed by Pearson's correlation coefficient.Results::Altogether 1056 patients with rib fracture(s)were included.The mean age was(42.76±13.35)years and 85.4%were male.The most common mechanism of trauma was car accident(34.6%).Most fractures occurred in the middle rib zone(60.44%)and the most commonly involved ribs were the 6th and 7th ones(15.7%and 16.4%,respectively).Concurrent abdominal injuries were observed in 103 patients(34.91%)and were significantly associated with middle zone rib fractures.Conclusion::There is a significant relationship between middle zone rib fractures and ASOI.Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.
基金This work was supported by Directorate for Mathematical and Physical Sciences[1924724].
文摘The main goal of this paper is to employ longitudinal trajectories in a significant number of sub-regional brain volumetric MRI data as statistical predictors for Alzheimer's disease(AD)clas-sification.We use logistic regression in a Bayesian framework that includes many functional predictors.The direct sampling of regression Coefficients from the Bayesian logistic model is dif-ficult due to its complicated likelihood function.In high-dimensional scenarios,the selection of predictors is paramount with the introduction of either spike-and-slab priors,non-local priors,or Horseshoe priors.We seek to avoid the complicated Metropolis-Hastings approach and to develop an easily implementable Gibbs sampler.In addition,the Bayesian estimation provides proper estimates of the model parameters,which are also useful for building inference.Another advantage of working with logistic regression is that it calculates the log of odds of relative risk for AD compared to normal control based on the selected longitudinal predictors,rather than simply classifying patients based on cross-sectional estimates.Ultimately,however,we com-bine approaches and use a probability threshold to classify individual patients.We employ 49 functional predictors consisting of volumetric estimates of brain sub-regions,chosen for their established clinical significance.Moreover,the use of spike and slab priors ensures that many redundant predictors are dropped from the model.
基金The author(s)received no financial support for the research,authorship and/or publication of this article.
文摘The purpose of this study was to develop a tool for community-based health organisations(CBHOs)to evaluate the preparedness in biohazards concerning epidemics or bioterrorism.We searched concepts on partnerships of CBHOs with health systems in guidelines of the Centers for Disease Control and Prevention and literature.Then,we validated the researcher-made tool by face validity,content validity,exploratory factor analysis(EFA),confirmatory factor analysis(CFA)and criterion validity.Data were collected by sending the tool to 620 CBHOs serving under supervision of Iran’s ministry of health.Opinions of health professionals and stakeholders in CBHOs were used to assess face and content validity.Factor loads in EFA were based on three-factor structure that verified by CFA.We used SPSS V.18 and Mplus7 software for statistical analysis.About 105 health-based CBHOs participated.After conducting face validity and calculating content validity ratio and content validity index,we reached 54 items in the field of planning,training and infrastructure.We conducted construct validity using 105 CBHOs.Three items exchanged between the fields according to factor loads in EFA,and CFA verified the model fit as Comparative Fit Index,Tucker-Lewis index and root mean square error of approximation were 0.921,0918 and 0.052,respectively.The Cronbach’s of the whole tool was 0.944.Spearman correlation coefficient confirmed criterion validity as coefficient was 0.736.Planning,training and infrastructure fields are the most important aspects of preparedness in health-based CBHOs.Applying the new assessment tool in future studies will show the weaknesses and capabilities of health-based CBHOs in biohazard and clear necessary intervention actions for health authorities.
文摘Objective.The strongest locus which associated with type 2 diabetes(T2D)by the common variant rs7903146 is the transcription factor 7-like 2 gene(TCF7L2).We aimed to quantify the interaction of diet/lifestyle interventions and the genetic effect of TCF7L2 rs7903146 on glycemic traits,body weight,or waist circumference in overweight or obese adults in several randomized controlled trials(RCTs).Methods.From October 2016 to May 2018,a large collaborative analysis was performed by pooling individualparticipant data from 7 RCTs.These RCTs reported changes in glycemic control and adiposity of the variant rs7903146 after dietary/lifestyle-related interventions in overweight or obese adults.Gene treatment interaction models which used the genetic effect encoded by the allele dose and common covariates were applicable to individual participant data in all studies.Results.In the joint analysis,a total of 7 eligible RCTs were included(n=4,114).Importantly,we observed a significant effect modification of diet/lifestyle-related interventions on the TCF7L2 variant rs7903146 and changes in fasting glucose.Compared with the control group,diet/lifestyle interventions were related to lower fasting glucose by-3.06(95%CI,-5.77 to-0.36)mg/dL(test for heterogeneity and overall effect:I^(2)=45:1%,p<0:05;z=2:20,p=0:028)per one copy of the TCF7L2 T risk allele.Furthermore,regardless of genetic risk,diet/lifestyle interventions were associated with lower waist circumference.However,there was no significant change for diet/lifestyle interventions in other glycemic control and adiposity traits per one copy of TCF7L2 risk allele.Conclusions.Our findings suggest that carrying the TCF7L2 T risk allele may have a modestly greater benefit for specific diet/lifestyle interventions to improve the control of fasting glucose in overweight or obese adults.
基金National Natural Science Foundation of China,Grant/Award Numbers:81820108028,81922061,81973123,82273714,82192901,82192904,82192900Excellent Youth Foundation of Jiangsu Province,Grant/Award Number:BK20220100+3 种基金Research Unit of Prospective Cohort of Cardiovascular Diseases and CancerChinese Academy of Medical Sciences,Grant/Award Number:2019RU038Science and Technology Service Network Initiative of Chinese Academy of Sciences,Grant/Award Number:No.KFJ-STS-QYZD-2021-08-001the National Key Research and Development Program of China,Grant/Award Number:2016YFC0900500。
文摘Background:Most lung cancer risk prediction models were developed in European and North-American cohorts of smokers aged≥55 years,while less is known about risk profiles in Asia,especially for never smokers or individuals aged<50 years.Hence,we aimed to develop and validate a lung cancer risk estimate tool for ever and never smokers across a wide age range.Methods:Based on the China Kadoorie Biobank cohort,we first systematically selected the predictors and explored the nonlinear association of predictors with lung cancer risk using restricted cubic splines.Then,we separately developed risk prediction models to construct a lung cancer risk score(LCRS)in 159,715 ever smokers and 336,526 never smokers.The LCRS was further validated in an independent cohort over a median follow-up of 13.6 years,consisting of 14,153 never smokers and 5,890 ever smokers.Results:A total of 13 and 9 routinely available predictors were identified for ever and never smokers,respectively.Of these predictors,cigarettes per day and quit years showed nonlinear associations with lung cancer risk(Pnon-linear<0.001).The curve of lung cancer incidence increased rapidly above 20 cigarettes per day and then was relatively flat until approximately 30 cigarettes per day.We also observed that lung cancer risk declined sharplywithin the first 5 years of quitting,and then continued to decrease but at a slower rate in the subsequent years.The 6-year area under the receiver operating curve for the ever and never smokers’models were respectively 0.778 and 0.733 in the derivation cohort,and 0.774 and 0.759 in the validation cohort.In the validation cohort,the 10-year cumulative incidence of lung cancerwas 0.39%and 2.57%for ever smokers with low(<166.2)and intermediate-high LCRS(≥166.2),respectively.Never smokers with a high LCRS(≥21.2)had a higher 10-year cumulative incidence rate than those with a low LCRS(<21.2;1.05%vs.0.22%).An online risk evaluation tool(LCKEY;http://ccra.njmu.edu.cn/lckey/web)was developed to facilitate the use of LCRS.Conclusions:The LCRS can be an effective risk assessment tool designed for ever and never smokers aged 30 to 80 years.
基金supported by CAMS Innovation Fund for Medical Sciences(2017-I2M-1-009)PUMC Youth Fund and the Fundamental Research Funds for the Central Universities(2017310049).
文摘Following publication of the results of the National Lung Screening Trial in the United States,a randomized controlled trial in Italy(ITALUNG)and two simulation studies in China reported similar findings in 2017 favoring lung cancer screening with low-dose computed tomography among smokers.With such advances in lung cancer screening,worldwide interest has gradually shifted from evaluating whether refining lung cancer screening protocols is effective in preventing deaths.However,there are several practical problems to be resolved,including the balance of enroll-ment criteria and cost effectiveness,precise measurements to reduce false positive findings,risk-based optimization of screening frequency,challenges associated with cancer heterogeneity,strategies to combine image screening with novel biomarkers,dynamic monitoring of the natural history of cancer,accurate identification and diagnosis of cases among huge populations,and the impact of tobacco control policy and environment protection.As one in three individuals with lung cancer worldwide resides in China,these questions pose great challenges as well as research opportunities for population screening programs in China.
基金This work was supported by grants from the Key Project in Soft Science by the Science and Technology Department of Zhejiang Province(No.2019C25009)the National Natural Science Funds of Young Scientists of China(No.81802944)the Public Welfare Technological Research Program of Zhejiang Province(No.LGF18H160007)。
文摘Background:Despite the recent large number of studies comparing endoscopic and laparoscopic resection for small gastrointestinal stromal tumors(GISTs)(diameter≤5 cm),the results remain conflicting.The objective of this work was to perform a cumulative meta-analysis to assess the advantages and disadvantages of endoscopic resection vs.laparoscopic resection.Methods:The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.We searched medical databases up to January 2020.Meta-analytical random or fixed effects models were used in pooled analyses.Meta-regression,cumulative meta-analyses,and sub-group analyses were performed to improve the accuracy of the conclusion.Sensitivity analyses were applied to assess the robustness of the results.Results:A total of 12 cohort studies with 1383 participants comparing endoscopic resection and laparoscopic resection were identified,while three cohort studies with 167 participants comparing endoscopic resection and laparoscopic and endoscopic cooperative surgery were found.We found that endoscopic resection had shorter operation times(weighted mean difference[WMD]=-27.1 min,95%confidence interval[CI]:-40.8 to-13.4 min)and lengths of hospital stay(WMD=-1.43 days,95%CI:-2.31 to-0.56 days)than did laparoscopic resection.The results were stable and reliable.There were no significant differences in terms of blood loss,hospitalization costs,incidence of complications or recurrence rates.For tumor sizes 2 to 5 cm,endoscopic resection increased the risk of positive margins(relative risk[RR]=5.78,95%CI:1.31-25.46).Although operation times for endoscopic resection were shorter than those of laparoscopic and endoscopic cooperative surgery(WMD=-41.03 min,95%CI:-59.53 to-22.54 min),there was a higher incidence of complications(RR=4.03,95%CI:1.57-10.34).Conclusions:In general,endoscopic resection is an alternative method for gastric GISTs≤5 cm.Laparoscopic and endoscopic cooperative surgery may work well in combination.Further randomized controlled trials are recommended to validate or update these results.
基金Reforming the Public Health Preparedness and Response of China:from Evidence to Policy Recommendations.China Medical Board(20-366).
文摘In May 2003,the World Health Organization(WHO)Framework Convention on Tobacco Control(FCTC)was released(1),which is an event of great significance in the history of tobacco control.The FCTC was signed by China in November 2003 and entered into force in January 2006.Although some achievements in tobacco control have been made over the past 15 years,much more progress is needed.In July 2021,the WHO Report on the Global Tobacco Epidemic(Report)was released.The Report evaluates and grades implementation of the 6 most effective strategies of the Monitor,Protect,Offer,Warn,Enforce and Raise(MPOWER)tobacco control package in 61 high-income countries,105 middleincome countries,and 29 low-income countries(2)(Table 1).This article summarizes current progress and challenges to tobacco control in China with reference to the Report.
基金P.K.R.is supported by NSERC(RGPIN-2015-06290)Canadian Foundation for Innovation,Canada Research Chairs,and CytoGnomix.
文摘The selection of effective genes that accurately predict chemotherapy responses might improve cancer outcomes.We compare optimized gene signatures for cisplatin,carboplatin,and oxaliplatin responses in the same cell lines and validate each signature using data from patients with cancer.Supervised support vector machine learning is used to derive gene sets whose expression is related to the cell line GI 50 values by backwards feature selection with cross-validation.Specific genes and functional pathways distinguishing sensitive from resistant cell lines are identified by contrasting signatures obtained at extreme and median GI 50 thresholds.Ensembles of gene signatures at different thresholds are combined to reduce the dependence on specific GI 50 values for predicting drug responses.The most accurate gene signatures for each platin are:cisplatin:BARD1,BCL2,BCL2L1,CDKN2C,FAAP24,FEN1,MAP3K1,MAPK13,MAPK3,NFKB1,NFKB2,SLC22A5,SLC31A2,TLR4,and TWIST1;carboplatin:AKT1,EIF3K,ERCC1,GNGT1,GSR,MTHFR,NEDD4L,NLRP1,NRAS,RAF1,SGK1,TIGD1,TP53,VEGFB,and VEGFC;and oxaliplatin:BRAF,FCGR2A,IGF1,MSH2,NAGK,NFE2L2,NQO1,PANK3,SLC47A1,SLCO1B1,and UGT1A1.Data from The Cancer Genome Atlas(TCGA)patients with bladder,ovarian,and colorectal cancer were used to test the cisplatin,carboplatin,and oxaliplatin signatures,resulting in 71.0%,60.2%,and 54.5%accuracies in predicting disease recurrence and 59%,61%,and 72%accuracies in predicting remission,respectively.One cisplatin signature predicted 100%of recurrence in non-smoking patients with bladder cancer(57%disease-free;N=19),and 79%recurrence in smokers(62%disease-free;N=35).This approach should be adaptable to other studies of chemotherapy responses,regardless of the drug or cancer types.
文摘Coronavirus disease 2019(COVID-19)pandemic has continued to spread rapidly across the world.In the past nearly two years,there have been over 267 million confirmed COVID-19 cases including over five million deaths globally reported to WHO[1].Facing this unprecedented public health crisis which we have not seen in a century,global experts rapidly expand scientific knowledge on this new virus,to track the spread and virulence of the virus.Different countries develop response strategies and practices tailored to their own specific epidemiological situations,resources,and values of individuals living in their countries[2].
