Existing evidence suggests residential greenness is beneficial to human,while no research to date explored the associations of greenness with age-related macular degeneration(AMD).To evaluate the association of greenn...Existing evidence suggests residential greenness is beneficial to human,while no research to date explored the associations of greenness with age-related macular degeneration(AMD).To evaluate the association of greenness with AMD,modification and mediation effect of air pollution,we conducted this prospective study.We con-structed weighted quantile sum(WQS)index as co-exposure to nitrogen oxides(NO_(x)),particulate matter<2.5μm(PM_(2.5)),particulate matter<10μm(PM10).Stratified Cox regression models were applied to test the effect of exposure.Effect modification of air pollution was assessed.Stratified Cox models through the indirect method and Aalen additive risk models were used in mediation analysis.Over median follow-up of 11.67 years,4596 AMD events were ascertained.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)of incident AMD for pollution per interquartile range(IQR)increment were 1.10(1.04–1.16)for nitrogen dioxide(NO_(2)),1.09(1.03–1.15)for NO_(x),1.14(1.05–1.24)for PM_(2.5),1.13(1.05–1.21)for PM10.The HR(95%CI)of AMD associated with greenness 1000 m buffer per IQR increment was 0.91(0.86–0.97),300 m buffer was 0.94(0.89–0.99).The as-sociation between greenness 1000 m and AMD was 28.59%,44.77%,35.59%,32.31%and 27.08%mediated by the decreased WQS index,NO_(2),NO_(x),PM_(2.5) and PM10,respectively.Increased greenness was associated with lower AMD incidence,and air pollution partly mediate it,which implies that interventions aimed at improving air quality and increasing greenness could have a dual benefit in mitigating AMD risk.展开更多
BACKGROUND The atherogenic index of plasma(AIP)has been shown to be positively correlated with cardiovascular disease in previous studies.However,it is unclear whether elderly people with long-term high AIP levels are...BACKGROUND The atherogenic index of plasma(AIP)has been shown to be positively correlated with cardiovascular disease in previous studies.However,it is unclear whether elderly people with long-term high AIP levels are more likely to develop coronary heart disease(CHD).Therefore,the aim of this study was to investigate the relationship between AIP trajectory and CHD incidence in elderly people.METHODS 19,194 participants aged≥60 years who had three AIP measurements between 2018 and 2020 were included in this study.AIP was defined as log10(triglyceride/high-density lipoprotein cholesterol).The group-based trajectory model was used to identify different trajectory patterns of AIP from 2018 to 2020.Cox proportional hazards models were used to estimate the hazard ratio(HR)with 95%CI of CHD events between different trajectory groups from 2020 to 2023.RESULTS Three different trajectory patterns were identified through group-based trajectory model:the low-level group(n=7410,mean AIP:-0.25 to-0.17),the medium-level group(n=9981,mean AIP:0.02-0.08),and the high-level group(n=1803,mean AIP:0.38-0.42).During a mean follow-up of 2.65 years,a total of 1391 participants developed CHD.After adjusting for potential confounders,compared with the participants in the low-level group,the HR with 95%CI of the medium-level group and the high-level group were estimated to be 1.24(1.10-1.40)and 1.43(1.19-1.73),respectively.These findings remained consistent in subgroup analyses and sensitivity analyses.CONCLUSIONS There was a significant correlation between persistent high AIP level and increased CHD risk in the elderly.This suggests that monitoring the long-term changes in AIP is helpful to identify individuals at high CHD risk in elderly people.展开更多
To the Editor:Liver transplantation is widely regarded as the definitive treat-ment for patients with end-stage liver disease.However,the per-sistent shortage of cadaveric liver grafts has driven the develop-ment of l...To the Editor:Liver transplantation is widely regarded as the definitive treat-ment for patients with end-stage liver disease.However,the per-sistent shortage of cadaveric liver grafts has driven the develop-ment of living-donor liver transplantation(LDLT).Despite its ben-efits,LDLT raises substantial concerns regarding donor morbid-ity,as the procedure involves operating on a healthy individual.Complications associated with donor hepatectomy include abdom-inal trauma,chronic wound pain,physical stress,and psycholog-ical burdens[1,2].In light of these challenges,minimally inva-sive approaches,including laparoscopic and robotic donor hepa-tectomy,have been introduced to mitigate risks and enhance re-covery[3].However,the impact of these techniques on male sex-ual function-a critical aspect of donor quality of life-remains underexplored.Several retrospective studies have highlighted sex-ual dysfunction and altered spousal relationships following open donor hepatectomy[4-6].For instance,9%of donors reported a de-crease in sexual activity,and a significant proportion experienced low body image perceptions.展开更多
This study aimed to evaluate the association of a healthy lifestyle pattern with mortality risk among patients with type 2 diabetes mellitus(T2DM).Data were derived from a prospective cohort study enrolling 13776Chine...This study aimed to evaluate the association of a healthy lifestyle pattern with mortality risk among patients with type 2 diabetes mellitus(T2DM).Data were derived from a prospective cohort study enrolling 13776Chinese patients with T2DM.A healthy lifestyle pattern was constructed based on six lifestyle factors,including smoking status,alcohol consumption,dietary habits,physical activity,sedentary time,and sleep duration.Multivariate Cox proportional hazards models were used to estimate hazard ratios(HRs)and 95%confidence intervals(CIs)for all-cause and cause-specific mortality.During a median follow-up of 9.78 years,2497 deaths were recorded.Compared with T2DM patients with a lifestyle pattern scoring 0–2,those scoring 5–6 had a 40%lower risk for all-cause mortality(HR=0.60,95%CI:0.52–0.69),a 33%lower risk for cardiovascular disease mortality(HR=0.67,95%CI:0.52–0.86),and a 25%lower risk for cancer mortality(HR=0.75,95%CI:0.58–0.97).Additionally,we found that the association between the lifestyle pattern and all-cause mortality risk was stronger in females than in males(P for interaction<0.05).In conclusion,adherence to a healthy lifestyle pattern is associated with a decreased risk of all-cause,cardiovascular disease,and cancer mortality.These findings have important implications for reducing premature mortality among patients with T2DM.展开更多
BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct(CBD)stones,which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.AIM To d...BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct(CBD)stones,which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.AIM To determine whether saline irrigation can improve CBD clearance after lithotripsy.METHODS This prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large(>1.2 cm)CBD stones.After occlusion cholangiography confirmed CBD stone clearance,peroral cholangioscopy(POC)was performed to determine clearance scores based on the number of residual stones.The amounts of residual stones spotted via POC were graded on a 5-point scale(score 1,worst;score 5,best).Scores were documented after only stone removal(control)and after irrigation with 50 mL and 100 mL saline,respectively.The stone composition was analyzed using infrared spectroscopy.RESULTS Between October 2018 and January 2020,47 patients had CBD clearance scores of 2.4±1.1 without saline irrigation,3.5±0.7 with 50 mL irrigation,and 4.6±0.6 with 100 mL irrigation(P<0.001).Multivariate analysis showed that CBD diameter>15 mm[odds ratio(OR)=0.08,95%confidence interval(CI):0.01-0.49;P=0.007]and periampullary diverticula(PAD)(OR=6.51,95%CI:1.08-39.21;P=0.041)were independent risk factors for residual stones.Bilirubin pigment stones constituted the main residual stones found in patients with PAD(P=0.004).CONCLUSION Irrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy,especially in patients with PAD and/or a dilated(>15 mm)CBD.Pigment residual stones are soft and commonly found in patients with PAD.Additional saline irrigation may be required to remove retained stones.展开更多
BACKGROUND Recent innovations in intensive care have improved the prognosis of patients with severe brain injuries and brought more patients with disorders of consciousness(DoC).Data are lacking regarding the long-ter...BACKGROUND Recent innovations in intensive care have improved the prognosis of patients with severe brain injuries and brought more patients with disorders of consciousness(DoC).Data are lacking regarding the long-term outcomes of those patients in China.It is necessary to study the long-term outcomes of patients with prolonged DoC in light of many factors likely to influence crucial decisions about their care and their life.AIM To present the preliminary results of a DoC cohort.METHODS This was a two-center prospective cohort study of inpatients with vegetative state(VS)/unresponsive wakefulness syndrome(UWS).The study outcomes were the recovery from VS/UWS to minimally conscious state(MCS)and the long-term status of patients with prolonged DoC considered in VS/UWS or MCS for up to 6 years.The patients were evaluated using the Glasgow coma scale,coma recovery scale-revised,and Glasgow outcome scale.The endpoint of follow-up was recovery of full consciousness or death.The changes in the primary clinical outcome improvement in clinical diagnosis were evaluated at 12 mo compared with baseline.RESULTS The study population included 93 patients(62 VS/UWS and 31 MCS).The postinjury interval range was 28-634 d.Median follow-up was 20 mo(interquartile range,12-37 mo).At the endpoint,33 transitioned to an emergence from MCS or full consciousness,eight had a locked-in syndrome,and there were 35 patients remaining in a VS/UWS and 11 in an MCS.Seven(including one locked-in syndrome)patients(7.5%)died within 12 mo of injury.Compared with the unresponsive group(n=52)at 12 mo,the responsive group(n=41)had a higher proportion of males(87.8%vs 63.5%,P=0.008),shorter time from injury(median,40.0 d vs 65.5 d,P=0.006),higher frequency of vascular etiology(68.3%vs 38.5%,P=0.007),higher Glasgow coma scale score at admission(median,9 vs 6,P<0.001),higher coma recovery scale-revised score at admission(median,9 vs 2.5,P<0.001),at 1 mo(median,14 vs 5,P<0.001),and at 3 mo(median,20 vs 6,P<0.001),lower frequency of VS/UWS(36.6%vs 90.0%,P<0.001),and more favorable Glasgow outcome scale outcome(P<0.001).CONCLUSION Patients with severe DoC,despite having strong predictors of poor prognosis,might recover consciousness after a prolonged time of rehabilitation.An accurate initial diagnosis of patients with DoC is critical for predicting outcome and a long-term regular follow-up is also important.展开更多
Objective: Plant-based diets have multiple health benefits for cancers;however, little is known about the association between plant-based dietary patterns and esophageal cancer(EC).This study presents an investigation...Objective: Plant-based diets have multiple health benefits for cancers;however, little is known about the association between plant-based dietary patterns and esophageal cancer(EC).This study presents an investigation of the prospective associations among three predefined indices of plant-based dietary patterns and the risk of EC.Methods: We performed endoscopic screening for 15,709 participants aged 40-69 years from two high-risk areas of China from January 2005 to December 2009 and followed the cohort until December 31, 2022. The overall plant-based diet index(PDI), healthful plant-based diet index(h PDI), and unhealthful plant-based diet index(u PDI), were calculated using survey responses to assess dietary patterns. We applied Cox proportional hazard regression to estimate the multivariable hazard ratios(HRs) and 95% confidence intervals(95% CIs) of EC across 3plant-based diet indices and further stratified the analysis by subgroups.Results: The final study sample included 15,184 participants in the cohort. During a follow-up of 219,365person-years, 176 patients with EC were identified. When the highest quartile was compared with the lowest quartile, the pooled multivariable-adjusted HR of EC was 0.50(95% CI, 0.32-0.77) for h PDI. In addition, the HR per 10-point increase in the h PDI score was 0.42(95% CI, 0.27-0.66) for ECs. Conversely, u PDI was positively associated with the risk of EC, and the HR was 1.80(95% CI, 1.16-2.82). The HR per 10-point increase in the u PDI score was 1.90(95% CI, 1.26-2.88) for ECs. The associations between these scores and the risk of EC were consistent in most subgroups. These results remained robust in sensitivity analyses.Conclusions: A healthy plant-based dietary pattern was associated with a reduced risk of EC. Emphasizing the healthiness and quality of plant-based diets may be important for preventing the development of EC.展开更多
This prospective study was designed to examine the combined influence of insulin resistance（IR）and inflammatory biomarker levels on type 2 diabetes mellitus（T2DM）among 1,903Inner Mongolians.
Objective:To explore the relationship between gastrointestinal heat retention syndrome and the incidence of pneumonia and recurrent respiratory tract infections(RRTIs)in children.Methods:A prospective cohort study was...Objective:To explore the relationship between gastrointestinal heat retention syndrome and the incidence of pneumonia and recurrent respiratory tract infections(RRTIs)in children.Methods:A prospective cohort study was conducted in the pediatric outpatient department of Beijing Dongfang Hospital.Children without respiratory tract infections(RTIs)were consecutively recruited according to the selection criteria.A semi-structured questionnaire was used to record traditional Chinese medicine(TCM)symptoms and demographic and physiological characteristics.Gastrointestinal heat retention syndrome was considered to be a predisposing factor and was diagnosed according to a scale with reliability and validity.The participants were followed up for 12 months.Participants and their parents or guardians were contacted via clinical interviews and telephone every 6 months.Episodes of pneumonia and RTIs were recorded in detail.Results:A total of 420 children were included.Of participants,370(88.10%)were followed up for 12 months.The mean number of RTI episodes per participant was 5.37(95%CI:5.14 to 5.60).In total,186 participants in the gastrointestinal heat retention syndrome group and 184 participants in the nongastrointestinal heat retention syndrome group completed the 12-month follow-up period.The baseline of both groups was comparable.The incidence of RRTIs in children with gastrointestinal heat retention syndrome was 1.27(95%CI:1.01 to 1.59)times that in children without gastrointestinal heat retention syndrome.Logistic regression analysis revealed that abnormally increased appetite with frequent hunger,foul breath,dry stools,and dark red or purple fingerprints were positively correlated with the incidence of pneumonia.Irascibility and feverish feelings in the palms and soles were positively correlated with the occurrence of RRTI.Conclusions:Gastrointestinal heat retention syndrome is a risk factor for RRTIs in children.Studies with larger sample sizes and longer follow-up time are warranted to confirm the degree of causal risk associated with RTIs.展开更多
BACKGROUND Blonanserin(BNS)is a well-tolerated and effective drug for treating schizophrenia.AIM To investigate which types of patients would obtain the most benefit from BNS treatment.METHODS A total of 3306 particip...BACKGROUND Blonanserin(BNS)is a well-tolerated and effective drug for treating schizophrenia.AIM To investigate which types of patients would obtain the most benefit from BNS treatment.METHODS A total of 3306 participants were evaluated in a 12-week,prospective,multicenter,open-label post-marketing surveillance study of BNS.Brief psychiatric rating scale(BPRS)scores were calculated to evaluate the effectiveness of BNS,and its safety was assessed with the incidence of adverse drug reactions.Linear regression was used to screen the influencing factors for the reduction of BPRS total score,and logistic regression was used to identify patients with a better response to BNS.RESULTS The baseline BPRS total score(48.8±15.03)decreased to 27.7±10.08 at 12 weeks(P<0.001).Extrapyramidal symptoms(14.6%)were found to be the most frequent adverse drug reactions.The acute phase,baseline BPRS total score,current episode duration,number of previous episodes,dose of concomitant antipsychotics,and number of types of sedative-hypnotic agents were found to be independent factors affecting the reduction of BPRS total score after treatment initiation.Specifically,patients in the acute phase with baseline BPRS total score≥45,current episode duration<3 months,and≤3 previous episodes derived greater benefit from 12-week treatment with BNS.CONCLUSION Patients in the acute phase with more severe symptoms,shorter current episode duration,fewer previous episodes,and a lower psychotropic drug load derived the greatest benefit from treatment with BNS.展开更多
In the article by Li et al,[1]“Association Between Clonal Hematopoiesis of Indeterminate Potential and Cardiovascular Outcomes in Patients With Acute Coronary Syndrome Who Have Quit Smoking:Study Design of a Prospect...In the article by Li et al,[1]“Association Between Clonal Hematopoiesis of Indeterminate Potential and Cardiovascular Outcomes in Patients With Acute Coronary Syndrome Who Have Quit Smoking:Study Design of a Prospective Cohort Study”,Which was published in the December 2024 issue of the journal(Cardiol Discov 2024;4(4):280-283.doi:10.1097/CD9.0000000000000139),correction is needed.1.In the“Endpoints and follow-up”section(Page 281),the first sentence should be corrected from“The primary endpoint is major adverse cardiovascular and cerebrovascular events(MACCEs)at 12 months after discharge,”to“The primary outcome is the incidence of CHIP mutations.The secondary outcome is major adverse cardiovascular and cerebrovascular events(MACCEs)at 12 months after discharge,”2.In Figure 1(Page 281),the contents of primary and secondary outcomes were added as follows.展开更多
Objectives Despite the potential spillover effect,the optimal duration of dual antiplatelet therapy for minor stroke within 72 hours of symptom onset is still uncertain.Methods Safety and Efficacy of Aspirin-Clopidogr...Objectives Despite the potential spillover effect,the optimal duration of dual antiplatelet therapy for minor stroke within 72 hours of symptom onset is still uncertain.Methods Safety and Efficacy of Aspirin-Clopidogrel in Acute Noncardiogenic Minor Ischemic Stroke(National Institutes of Health Stroke Scale(NIHSS)score≤5)is a prospective cohort study involving patients with minor ischaemic stroke within 72 hours of symptom onset.The DAPT group was further categorised into three subgroups:shorter duration(<10 days),short duration(10-21 days)and long duration(>21 days).The primary efficacy and safety outcomes were composite vascular event and severe bleeding during 90 days.Results Among 3061 eligible patients(age was 61.7±12.0 years,73.3%were men,median(IQR)NIHSS score,2(1-3)),2977(97.4%)completed the follow-up.Dual antiplatelet therapy(DAPT)and single antiplatelet therapy(SAPT)were administered in 61.0%and 39.0%of patients.Among them,305 patients(16.8%)received a shorter duration of DAPT,937 patients(51.7%)received a short duration and 572 patients(31.5%)received a long duration.In the propensity-weighted Cox proportional hazards regression analysis,the use of DAPT in the short-duration group was associated with a lower risk of the primary vascular event outcome(HR(HR)=0.66,95%CI 0.46 to 0.94,p=0.02)compared with SAPT group.The incidence of severe bleeding events at 90 days was similar.Similar findings were obtained from the propensity score-matching analysis.Conclusion Short duration of DAPT(10-21 days)is superior to SAPT in minor stroke within 72 hours,reducing 90-day composite vascular events without increasing bleeding risk.展开更多
Research in high-income countries has established the health benefits of physical activity(PA),but evidence from low-and middle-income countries,including China,where PA patterns vary from those in high-income countri...Research in high-income countries has established the health benefits of physical activity(PA),but evidence from low-and middle-income countries,including China,where PA patterns vary from those in high-income countries,remains limited.Moreover,previous research,mainly focused on specific diseases,failing to fully capture the health impacts of PA.We investigated the associations of PA with 425 distinct diseases and 53 causes of death using data from 511,088 participants aged 30–79 years in the China Kadoorie Biobank.Baseline PA was assessed using a questionnaire between 2004 and 2008,and usual PA levels were estimated using the resurvey data in 2013–2014.Cox regression was employed to estimate the associations between PA and outcomes,adjusting for potential confounders.During a median follow-up time of 12 years,722,183 incident events and 39,320 deaths were recorded across 18 chapters of the International Classification of Diseases,10th Revision(ICD-10).Total PA was significantly and inversely associated with incidence risks of 14 ICD-10 chapters,specifically 65 diseases and 19 causes of death,with the highest quintile group of PA showing a 14%lower disease incidence and 40%lower all-cause mortality compared with the lowest group.Of these diseases,54 were not highlighted in World Health Organization PA guidelines.Dose-response analyses revealed L-shaped associations for most PA types,except moderate-tovigorous intensity PA,which showed a U-shaped relationship.In this population,physical inactivity accounted for 12.8%of PA-related deaths.The findings underscore the broad health benefits of PA across a variety of body systems and the significant disease burden due to inactivity in China,highlighting the urgent need for PA promotion.展开更多
To the Editor:Diabetes,which is a rapidly growing global health concern,is prevalent in 12.4%of adults in China.[1]People with diabetes usually limit fruit intake to maintain blood glucose concentrations.However,there...To the Editor:Diabetes,which is a rapidly growing global health concern,is prevalent in 12.4%of adults in China.[1]People with diabetes usually limit fruit intake to maintain blood glucose concentrations.However,there has been limited research on the effect of the frequency of fresh fruit intake on the incidence of cardiovascular events and mortality in patients with diabetes.This gap in knowledge extends to understanding the optimal level of fruit consumption for cardiovascular risk reduction and its variability across patient subgroups and event subtypes.We used a prospective cohort design to investigate the association between the frequency of fresh fruit intake and the risk of cardiovascular events,including ischemic heart disease and stroke,in patients with diabetes.We also examined potential differences in this relationship across various subgroups of individuals with diabetes.展开更多
Objective To study the clinical efficacy of Wenyang Lishui Formula(WYLSF)in preventing ovarian hyperstimulation syndrome(OHSS)and explore the suitable range of estradiol(E_(2))on the human chorionic gonadotropin(HCG)d...Objective To study the clinical efficacy of Wenyang Lishui Formula(WYLSF)in preventing ovarian hyperstimulation syndrome(OHSS)and explore the suitable range of estradiol(E_(2))on the human chorionic gonadotropin(HCG)day in patients with OHSS using WYLSF.Methods Part Ⅰ:eligible patients at high risk for OHSS undergoing ovulation induction between January and December,2023 were randomized into 2 groups based on the actual treatment.The treatment group received 200 mL WYLSF formula twice daily for 5 days after oocyte retrieval in a combination of lifestyle coaching(LC)intervention including regular diet and exercise,whereas the LC group received LC intervention alone.The incidence of OHSS,OHSS self-assessment scales,changes in E_(2) levels on HCG day and 5 days after oocyte retrieval,ovarian morphology changes,and menstrual recovery were compared between the two groups.Part Ⅱ:patients at high risk for OHSS treated with WYLSF were studied.The optimal E_(2) threshold on the HCG day was determined using the maximum selection test,and a multivariate analysis was adopted to compare the relationship between different E_(2) levels on HCG day and hospitalization rate,incidence of moderate to severe OHSS,and self-assessment scales,to explore the preventive effect of WYLSF on OHSS in patients with varying E_(2) levels.Results A total of 120 patients were included in the Part Ⅰ analysis.The treatment group(60 cases)showed a significant reduction in the incidence,duration,and severity of abdominal distension,as well as the incidence of vomiting compared with the LC group(P<0.05).The post-retrieval E_(2) levels in the treatment group decreased significantly more(P=0.032).Among 1,652 patients treated with WYLSF in the Part Ⅱ,90 patients with≤10092 pmol/L,159 with>31074 pmol/L,and 1,403 in the middle range group were formed based on E_(2) levels on HCG day in Part two analysis.Univariate and regression analyses showed that patients with E_(2) levels>31073 pmol/L had a significantly higher incidence of moderate to severe OHSS compared to those with E_(2) levels≤10092 pmol/L(P<0.05).Conclusions WYLSF can effectively reduce specific symptoms in high-risk OHSS patients after ovulation induction and significantly lower E_(2) levels.It may be more suitable for high-risk OHSS patients with E_(2) levels<31073 pmol/L on HCG day.(Registration No.MR-11-23-032493,https://www.medicalresearch.org.cn/login)展开更多
This prospective study aimed to investigate the associations of untreated cholesterol levels and their longitudinal changes,especially low levels,with all-cause and cause-specific mortality in different populations.Pa...This prospective study aimed to investigate the associations of untreated cholesterol levels and their longitudinal changes,especially low levels,with all-cause and cause-specific mortality in different populations.Participants were drawn from two Chinese cohorts and the UK Biobank,excluding those with lipid-lowering medications,coronary heart disease(CHD),stroke,cancer,clinically diagnosed chronic obstructive pulmonary disease,low body mass index(<18.5 kg·m^(-2))at baseline,and deaths within the first two years to minimize reverse causality.Individual cholesterol changes were assessed in a subset who attended the resurvey after over four years.Mortality data were linked to registries,and risks were estimated using Cox proportional hazards models.A total of 163115 Chinese and 317305 UK adults were included(mean age,49-61 years),with 43%,81%,and 44%males in Dongfeng-Tongji,Kailuan,and UK Biobank cohorts,respectively.During a median follow-up of 9.7-12.9 years,9553 and 15760 deaths were documented in the Chinese cohorts and UK Biobank,respectively.After multivariate adjustments,nonlinear relationships were observed between total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),and non-high-density lipoprotein cholesterol(non-HDL-C)levels and mortality.In both populations,high cholesterol was primarily associated with CHD mortality,while low cholesterol associated with all-cause and cancer mortality(Pnonlinear≤0.0161).The optimal levels for all-cause mortality risk in Chinese adults(TC:200 mg·dL^(-1);LDL-C:130 mg·dL^(-1);non-HDL-C:155 mg·dL^(-1))were lower than those in the UK Biobank but consistent with guideline recommendation.Additionally,decreasing cholesterol levels over four years were associated with higher all-cause and cancer mortality in the Chinese cohorts(P_(nonlinear)≤0.0100).Participants with low TC,LDL-C,or non-HDL-C levels at both baseline and resurvey experienced elevated all-cause mortality risks in both populations,as did those with low/medium baseline levels and>20%reductions over time in Chinese adults.In conclusion,higher TC,LDL-C,and non-HDL-C levels are associated with elevated CHD mortality.Importantly,low and/or longitudinally decreasing cholesterol levels are robustly associated with increased all-cause and cancer mortality,potentially serving as markers of premature death.Regular cholesterol monitoring,with attention to both high and low levels,is recommended to inform guideline updates and clinical strategies.展开更多
Objective To evaluate the effectiveness of Qishen Yiqi dripping pill(QYDP)in patients with non-STsegment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods A multicenter,p...Objective To evaluate the effectiveness of Qishen Yiqi dripping pill(QYDP)in patients with non-STsegment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods A multicenter,prospective cohort study was conducted,enrolling 807 patients with NSTE-ACS who underwent PCI between 2012 and 2015.展开更多
Prospective epidemiological evidence about the associations between phthalates(PAEs)and incident cardiovascular disease(CVD)risk among type 2 diabetes mellitus(T2DM)population has been urgently needed.A total of 2806 ...Prospective epidemiological evidence about the associations between phthalates(PAEs)and incident cardiovascular disease(CVD)risk among type 2 diabetes mellitus(T2DM)population has been urgently needed.A total of 2806 participants with T2DM were recruited based on the baseline of the Dongfeng-Tongji cohort study(2008-2010)and followed up to 2018.Serum di-n-butyl phthalate(DnBP),Σdibutyl phthalate(ΣDBP),andΣlow-molecular-weight phthalate(ΣLMW)levels were associated with incident stroke risk,whether their levels were treated as continuous variables[HR(95%CI):1.36(1.02,1.80),1.35(1.01,1.81),and 1.50(1.07,2.10),respectively]or divided by quartiles[HR(95%CI):1.41(1.01,1.98),1.48(1.05,2.08),and 1.53(1.08,2.15)in the highest quartile with Ptrend=0.03,0.02,and 0.02,respectively]after multiple adjustment in Cox proportional hazard models.Meanwhile,linear associations for serum di-iso-butyl phthalate(DiBP),DnBP,ΣDBP,andΣLMW,and a nonlinear U-shaped dose-response association for serum butyl-benzyl phthalate(BBP)with incident stroke risk were proved by restricted cubic spline regression analyses.Furthermore,a positive correlation between PAE mixture and incident stroke risk was identified in Quantile-based g-computation[HR(95%CI):1.24(1.05,1.46)].However,serum PAEs,either as individuals or as a mixture,were not associated with incident CVD or coronary heart disease risk.Our study revealed that serum PAEs were positively associated with increased incident stroke risk in the T2DM population.More prospective cohort and mechanism studies are warranted to validate our findings.展开更多
Despite considerable research underscoring the importance of carbohydrate intake in relation to the risk of type 2 diabetes(T2D),a comprehensive assessment of this relationship is currently lacking.We aimed to examine...Despite considerable research underscoring the importance of carbohydrate intake in relation to the risk of type 2 diabetes(T2D),a comprehensive assessment of this relationship is currently lacking.We aimed to examine the associations of various types and food sources of dietary carbohydrate intake with the risk of T2D,to evaluate potential effect modification by other factors,including genetic susceptibility,and to explore the potential mediators for such associations.The present study included 161,872 participants of the UK Biobank who were free of prevalent cancer,cardiovascular disease,or diabetes,and had at least one validated 24-h dietary recall assessment.Multivariableadjusted age-stratified Cox proportional hazard regression models were applied to estimate hazard ratios(HRs)and 95%confidence intervals(CI)for the associations of various types and food sources of dietary carbohydrate intake with risk of T2D.During a median follow-up of 13.6 years,4,176 incident cases of T2D were identified.In the multivariable-adjusted models,a greater intake of fiber,carbohydrates from whole grains,and carbohydrates from non-starchy vegetables was significantly associated with a lower risk of T2D(highest vs.lowest quantile,HR[95%CI]=0.70[0.62–0.79],0.74[0.67–0.82],and 0.83[0.75–0.92],respectively,all P for trend<0.005).In contrast,a higher intake of starch and carbohydrate from starchy vegetables was associated with an increased risk of T2D(highest vs.lowest quantile,HR[95%CI]=1.31[1.16–1.48]and 1.19[1.09–1.31],respectively,both P for trend<0.005).Replacing one serving of refined grains or starchy vegetables with an equal amount of whole grains or non-starchy vegetables was associated with 4%to 10%lower risk of T2D(all P values<0.001).The observed associations were generally similar across population subgroups,including individuals with different genetic susceptibility to T2D.Mediation analyses of the inverse association between T2D risk and isocaloric substitution of carbohydrates from refined grains with carbohydrate from whole grains demonstrated that 39.6%,43.4%,44.0%,27.8%,and 34.9%were mediated through body mass index,waistto-hip ratio,glycosylated hemoglobin,high-density lipoprotein cholesterol,and C-reactive protein,respectively.In addition,the inverse association between the isocaloric substitution of carbohydrates from starchy vegetables with carbohydrates from non-starchy vegetables and T2D was partially mediated through high-density lipoprotein cholesterol(15.9%).These findings underscore the importance of dietary modifications of carbohydrates,particularly considering types and food sources of carbohydrate intake,in the primary prevention of T2D.展开更多
Purpose:Early mortality in major trauma has decreased,but MODS remains a leading cause of poor outcomes,driven by trauma-induced cytokine storms that exacerbate injuries and organ damage.Methods:This prospective cohor...Purpose:Early mortality in major trauma has decreased,but MODS remains a leading cause of poor outcomes,driven by trauma-induced cytokine storms that exacerbate injuries and organ damage.Methods:This prospective cohort study included 79 major trauma patients(ISS>15)treated in the National Center for Trauma Medicine,Peking University People''s Hospital,from September 1,2021,to July 31,2023.Patients(1)with ISS>15(according to AIS 2015),(2)aged 15-80 years,(3)admitted within 6 h of injury,(4)having no prior treatment before admission,were included.Exclusion criteria were(1)GCS score<9 or AIS score≥3 for TBI,(2)confirmed infection,infectious disease,or high infection risk,(3)pregnancy,(4)severe primary diseases affecting survival,(5)recent use of immunosuppressive or cytotoxic drugs within the past 6 months,(6)psychiatric patients,(7)participation in other clinical trials within the past 30 days,(8)patients with incomplete data or missing blood samples.Admission serum inflammatory cytokines and pathophysiological data were analyzed to develop machine learning models predicting MODS within 7 days.LR,DR,RF,SVM,NB,and XGBoost were evaluated based on the area under the AUROC.The SHAP method was used to interpret results.Results:This study enrolled 79 patients with major trauma,and the median(Q1,Q3)age was 51(35,59)years(52 males,65.8%).The inflammatory cytokine data were collected for all participants.Among these patients,35(44.3%)developed MODS,and 44(55.7%)did not.Additionally,2 patients(2.5%)from the MODS group succumbed.The logistic regression model showed strong performance in predicting MODS.Ten key cytokines,IL-18,Eotaxin,MCP-4,IP-10,CXCL12,MIP-3α,MCP-1,IL-1RA,Cystatin C,and MRP8/14 were identified as critical to the trauma-induced cytokine storm and MODS development.Early elevation of these cytokines achieved high predictive accuracy,with an AUROC of 0.887(95%CI 0.813-0.976).Conclusion:Trauma-induced cytokine storms are strongly associated with MODS.Early identification of inflammatory cytokine changes enables better prediction and timely interventions to improve outcomes.展开更多
基金supported by the High-level Talents Introduction Plan from Central South University(No.502045003)the National Natural Science Foundation of China(No.42277438)Hunan Provincial Natural Science Foundation for Distinguished Young Scholars(No.2024JJ2082)to Fang Xiao,and the Postgraduate Independent Exploration and Innovation Project of Central South University,China(Nos.2024ZZTS0557 and 2023ZZTS0993)。
文摘Existing evidence suggests residential greenness is beneficial to human,while no research to date explored the associations of greenness with age-related macular degeneration(AMD).To evaluate the association of greenness with AMD,modification and mediation effect of air pollution,we conducted this prospective study.We con-structed weighted quantile sum(WQS)index as co-exposure to nitrogen oxides(NO_(x)),particulate matter<2.5μm(PM_(2.5)),particulate matter<10μm(PM10).Stratified Cox regression models were applied to test the effect of exposure.Effect modification of air pollution was assessed.Stratified Cox models through the indirect method and Aalen additive risk models were used in mediation analysis.Over median follow-up of 11.67 years,4596 AMD events were ascertained.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)of incident AMD for pollution per interquartile range(IQR)increment were 1.10(1.04–1.16)for nitrogen dioxide(NO_(2)),1.09(1.03–1.15)for NO_(x),1.14(1.05–1.24)for PM_(2.5),1.13(1.05–1.21)for PM10.The HR(95%CI)of AMD associated with greenness 1000 m buffer per IQR increment was 0.91(0.86–0.97),300 m buffer was 0.94(0.89–0.99).The as-sociation between greenness 1000 m and AMD was 28.59%,44.77%,35.59%,32.31%and 27.08%mediated by the decreased WQS index,NO_(2),NO_(x),PM_(2.5) and PM10,respectively.Increased greenness was associated with lower AMD incidence,and air pollution partly mediate it,which implies that interventions aimed at improving air quality and increasing greenness could have a dual benefit in mitigating AMD risk.
基金supported by the National Key Research and Development Program of China(2017YFC1307705).
文摘BACKGROUND The atherogenic index of plasma(AIP)has been shown to be positively correlated with cardiovascular disease in previous studies.However,it is unclear whether elderly people with long-term high AIP levels are more likely to develop coronary heart disease(CHD).Therefore,the aim of this study was to investigate the relationship between AIP trajectory and CHD incidence in elderly people.METHODS 19,194 participants aged≥60 years who had three AIP measurements between 2018 and 2020 were included in this study.AIP was defined as log10(triglyceride/high-density lipoprotein cholesterol).The group-based trajectory model was used to identify different trajectory patterns of AIP from 2018 to 2020.Cox proportional hazards models were used to estimate the hazard ratio(HR)with 95%CI of CHD events between different trajectory groups from 2020 to 2023.RESULTS Three different trajectory patterns were identified through group-based trajectory model:the low-level group(n=7410,mean AIP:-0.25 to-0.17),the medium-level group(n=9981,mean AIP:0.02-0.08),and the high-level group(n=1803,mean AIP:0.38-0.42).During a mean follow-up of 2.65 years,a total of 1391 participants developed CHD.After adjusting for potential confounders,compared with the participants in the low-level group,the HR with 95%CI of the medium-level group and the high-level group were estimated to be 1.24(1.10-1.40)and 1.43(1.19-1.73),respectively.These findings remained consistent in subgroup analyses and sensitivity analyses.CONCLUSIONS There was a significant correlation between persistent high AIP level and increased CHD risk in the elderly.This suggests that monitoring the long-term changes in AIP is helpful to identify individuals at high CHD risk in elderly people.
文摘To the Editor:Liver transplantation is widely regarded as the definitive treat-ment for patients with end-stage liver disease.However,the per-sistent shortage of cadaveric liver grafts has driven the develop-ment of living-donor liver transplantation(LDLT).Despite its ben-efits,LDLT raises substantial concerns regarding donor morbid-ity,as the procedure involves operating on a healthy individual.Complications associated with donor hepatectomy include abdom-inal trauma,chronic wound pain,physical stress,and psycholog-ical burdens[1,2].In light of these challenges,minimally inva-sive approaches,including laparoscopic and robotic donor hepa-tectomy,have been introduced to mitigate risks and enhance re-covery[3].However,the impact of these techniques on male sex-ual function-a critical aspect of donor quality of life-remains underexplored.Several retrospective studies have highlighted sex-ual dysfunction and altered spousal relationships following open donor hepatectomy[4-6].For instance,9%of donors reported a de-crease in sexual activity,and a significant proportion experienced low body image perceptions.
基金supported by the Jiangsu Provincial Health Commission Medical Research Project(Grant Nos.M2020085 to J.S.and H2023022 to X.F.)the Outstanding Youth Fund of Jiangsu Natural Science Foundation(Grant No.BK20230005 to D.H.)Suzhou Science and Technology Bureau Livelihood Technology-Technology Demonstration Project(Grant No.SS202010 to Y.L.)。
文摘This study aimed to evaluate the association of a healthy lifestyle pattern with mortality risk among patients with type 2 diabetes mellitus(T2DM).Data were derived from a prospective cohort study enrolling 13776Chinese patients with T2DM.A healthy lifestyle pattern was constructed based on six lifestyle factors,including smoking status,alcohol consumption,dietary habits,physical activity,sedentary time,and sleep duration.Multivariate Cox proportional hazards models were used to estimate hazard ratios(HRs)and 95%confidence intervals(CIs)for all-cause and cause-specific mortality.During a median follow-up of 9.78 years,2497 deaths were recorded.Compared with T2DM patients with a lifestyle pattern scoring 0–2,those scoring 5–6 had a 40%lower risk for all-cause mortality(HR=0.60,95%CI:0.52–0.69),a 33%lower risk for cardiovascular disease mortality(HR=0.67,95%CI:0.52–0.86),and a 25%lower risk for cancer mortality(HR=0.75,95%CI:0.58–0.97).Additionally,we found that the association between the lifestyle pattern and all-cause mortality risk was stronger in females than in males(P for interaction<0.05).In conclusion,adherence to a healthy lifestyle pattern is associated with a decreased risk of all-cause,cardiovascular disease,and cancer mortality.These findings have important implications for reducing premature mortality among patients with T2DM.
基金Supported by National Natural Science Foundation of China,No.81872036 and No.82060551.
文摘BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct(CBD)stones,which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.AIM To determine whether saline irrigation can improve CBD clearance after lithotripsy.METHODS This prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large(>1.2 cm)CBD stones.After occlusion cholangiography confirmed CBD stone clearance,peroral cholangioscopy(POC)was performed to determine clearance scores based on the number of residual stones.The amounts of residual stones spotted via POC were graded on a 5-point scale(score 1,worst;score 5,best).Scores were documented after only stone removal(control)and after irrigation with 50 mL and 100 mL saline,respectively.The stone composition was analyzed using infrared spectroscopy.RESULTS Between October 2018 and January 2020,47 patients had CBD clearance scores of 2.4±1.1 without saline irrigation,3.5±0.7 with 50 mL irrigation,and 4.6±0.6 with 100 mL irrigation(P<0.001).Multivariate analysis showed that CBD diameter>15 mm[odds ratio(OR)=0.08,95%confidence interval(CI):0.01-0.49;P=0.007]and periampullary diverticula(PAD)(OR=6.51,95%CI:1.08-39.21;P=0.041)were independent risk factors for residual stones.Bilirubin pigment stones constituted the main residual stones found in patients with PAD(P=0.004).CONCLUSION Irrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy,especially in patients with PAD and/or a dilated(>15 mm)CBD.Pigment residual stones are soft and commonly found in patients with PAD.Additional saline irrigation may be required to remove retained stones.
基金Supported by the National Natural Science Foundation of China,No.81371194 and No.81873723.
文摘BACKGROUND Recent innovations in intensive care have improved the prognosis of patients with severe brain injuries and brought more patients with disorders of consciousness(DoC).Data are lacking regarding the long-term outcomes of those patients in China.It is necessary to study the long-term outcomes of patients with prolonged DoC in light of many factors likely to influence crucial decisions about their care and their life.AIM To present the preliminary results of a DoC cohort.METHODS This was a two-center prospective cohort study of inpatients with vegetative state(VS)/unresponsive wakefulness syndrome(UWS).The study outcomes were the recovery from VS/UWS to minimally conscious state(MCS)and the long-term status of patients with prolonged DoC considered in VS/UWS or MCS for up to 6 years.The patients were evaluated using the Glasgow coma scale,coma recovery scale-revised,and Glasgow outcome scale.The endpoint of follow-up was recovery of full consciousness or death.The changes in the primary clinical outcome improvement in clinical diagnosis were evaluated at 12 mo compared with baseline.RESULTS The study population included 93 patients(62 VS/UWS and 31 MCS).The postinjury interval range was 28-634 d.Median follow-up was 20 mo(interquartile range,12-37 mo).At the endpoint,33 transitioned to an emergence from MCS or full consciousness,eight had a locked-in syndrome,and there were 35 patients remaining in a VS/UWS and 11 in an MCS.Seven(including one locked-in syndrome)patients(7.5%)died within 12 mo of injury.Compared with the unresponsive group(n=52)at 12 mo,the responsive group(n=41)had a higher proportion of males(87.8%vs 63.5%,P=0.008),shorter time from injury(median,40.0 d vs 65.5 d,P=0.006),higher frequency of vascular etiology(68.3%vs 38.5%,P=0.007),higher Glasgow coma scale score at admission(median,9 vs 6,P<0.001),higher coma recovery scale-revised score at admission(median,9 vs 2.5,P<0.001),at 1 mo(median,14 vs 5,P<0.001),and at 3 mo(median,20 vs 6,P<0.001),lower frequency of VS/UWS(36.6%vs 90.0%,P<0.001),and more favorable Glasgow outcome scale outcome(P<0.001).CONCLUSION Patients with severe DoC,despite having strong predictors of poor prognosis,might recover consciousness after a prolonged time of rehabilitation.An accurate initial diagnosis of patients with DoC is critical for predicting outcome and a long-term regular follow-up is also important.
基金supported by grants from the Beijing Nova Program (No. Z201100006820069)CAMS Innovation Fund for Medical Sciences (CIFMS, No. 2021-I2M-1-023, 2021-I2M-1-010)Talent Incentive Program of Cancer Hospital Chinese Academy of Medical Sciences (Hope Star)。
文摘Objective: Plant-based diets have multiple health benefits for cancers;however, little is known about the association between plant-based dietary patterns and esophageal cancer(EC).This study presents an investigation of the prospective associations among three predefined indices of plant-based dietary patterns and the risk of EC.Methods: We performed endoscopic screening for 15,709 participants aged 40-69 years from two high-risk areas of China from January 2005 to December 2009 and followed the cohort until December 31, 2022. The overall plant-based diet index(PDI), healthful plant-based diet index(h PDI), and unhealthful plant-based diet index(u PDI), were calculated using survey responses to assess dietary patterns. We applied Cox proportional hazard regression to estimate the multivariable hazard ratios(HRs) and 95% confidence intervals(95% CIs) of EC across 3plant-based diet indices and further stratified the analysis by subgroups.Results: The final study sample included 15,184 participants in the cohort. During a follow-up of 219,365person-years, 176 patients with EC were identified. When the highest quartile was compared with the lowest quartile, the pooled multivariable-adjusted HR of EC was 0.50(95% CI, 0.32-0.77) for h PDI. In addition, the HR per 10-point increase in the h PDI score was 0.42(95% CI, 0.27-0.66) for ECs. Conversely, u PDI was positively associated with the risk of EC, and the HR was 1.80(95% CI, 1.16-2.82). The HR per 10-point increase in the u PDI score was 1.90(95% CI, 1.26-2.88) for ECs. The associations between these scores and the risk of EC were consistent in most subgroups. These results remained robust in sensitivity analyses.Conclusions: A healthy plant-based dietary pattern was associated with a reduced risk of EC. Emphasizing the healthiness and quality of plant-based diets may be important for preventing the development of EC.
基金supported by the National Natural Science Foundation of China[Grant No.81773509][Grant No.81102190]
文摘This prospective study was designed to examine the combined influence of insulin resistance（IR）and inflammatory biomarker levels on type 2 diabetes mellitus（T2DM）among 1,903Inner Mongolians.
基金funded by the National Natural Science Foundation of China(81373769)Beijing Educational Committee cooperation projects(1000062520115)+1 种基金National Key R&D Program of China(2018YFC1704101)granted to Prof.Xiaohong Gufunded by China Postdoctoral Science Foundation(2020T130009ZX)。
文摘Objective:To explore the relationship between gastrointestinal heat retention syndrome and the incidence of pneumonia and recurrent respiratory tract infections(RRTIs)in children.Methods:A prospective cohort study was conducted in the pediatric outpatient department of Beijing Dongfang Hospital.Children without respiratory tract infections(RTIs)were consecutively recruited according to the selection criteria.A semi-structured questionnaire was used to record traditional Chinese medicine(TCM)symptoms and demographic and physiological characteristics.Gastrointestinal heat retention syndrome was considered to be a predisposing factor and was diagnosed according to a scale with reliability and validity.The participants were followed up for 12 months.Participants and their parents or guardians were contacted via clinical interviews and telephone every 6 months.Episodes of pneumonia and RTIs were recorded in detail.Results:A total of 420 children were included.Of participants,370(88.10%)were followed up for 12 months.The mean number of RTI episodes per participant was 5.37(95%CI:5.14 to 5.60).In total,186 participants in the gastrointestinal heat retention syndrome group and 184 participants in the nongastrointestinal heat retention syndrome group completed the 12-month follow-up period.The baseline of both groups was comparable.The incidence of RRTIs in children with gastrointestinal heat retention syndrome was 1.27(95%CI:1.01 to 1.59)times that in children without gastrointestinal heat retention syndrome.Logistic regression analysis revealed that abnormally increased appetite with frequent hunger,foul breath,dry stools,and dark red or purple fingerprints were positively correlated with the incidence of pneumonia.Irascibility and feverish feelings in the palms and soles were positively correlated with the occurrence of RRTI.Conclusions:Gastrointestinal heat retention syndrome is a risk factor for RRTIs in children.Studies with larger sample sizes and longer follow-up time are warranted to confirm the degree of causal risk associated with RTIs.
文摘BACKGROUND Blonanserin(BNS)is a well-tolerated and effective drug for treating schizophrenia.AIM To investigate which types of patients would obtain the most benefit from BNS treatment.METHODS A total of 3306 participants were evaluated in a 12-week,prospective,multicenter,open-label post-marketing surveillance study of BNS.Brief psychiatric rating scale(BPRS)scores were calculated to evaluate the effectiveness of BNS,and its safety was assessed with the incidence of adverse drug reactions.Linear regression was used to screen the influencing factors for the reduction of BPRS total score,and logistic regression was used to identify patients with a better response to BNS.RESULTS The baseline BPRS total score(48.8±15.03)decreased to 27.7±10.08 at 12 weeks(P<0.001).Extrapyramidal symptoms(14.6%)were found to be the most frequent adverse drug reactions.The acute phase,baseline BPRS total score,current episode duration,number of previous episodes,dose of concomitant antipsychotics,and number of types of sedative-hypnotic agents were found to be independent factors affecting the reduction of BPRS total score after treatment initiation.Specifically,patients in the acute phase with baseline BPRS total score≥45,current episode duration<3 months,and≤3 previous episodes derived greater benefit from 12-week treatment with BNS.CONCLUSION Patients in the acute phase with more severe symptoms,shorter current episode duration,fewer previous episodes,and a lower psychotropic drug load derived the greatest benefit from treatment with BNS.
文摘In the article by Li et al,[1]“Association Between Clonal Hematopoiesis of Indeterminate Potential and Cardiovascular Outcomes in Patients With Acute Coronary Syndrome Who Have Quit Smoking:Study Design of a Prospective Cohort Study”,Which was published in the December 2024 issue of the journal(Cardiol Discov 2024;4(4):280-283.doi:10.1097/CD9.0000000000000139),correction is needed.1.In the“Endpoints and follow-up”section(Page 281),the first sentence should be corrected from“The primary endpoint is major adverse cardiovascular and cerebrovascular events(MACCEs)at 12 months after discharge,”to“The primary outcome is the incidence of CHIP mutations.The secondary outcome is major adverse cardiovascular and cerebrovascular events(MACCEs)at 12 months after discharge,”2.In Figure 1(Page 281),the contents of primary and secondary outcomes were added as follows.
文摘Objectives Despite the potential spillover effect,the optimal duration of dual antiplatelet therapy for minor stroke within 72 hours of symptom onset is still uncertain.Methods Safety and Efficacy of Aspirin-Clopidogrel in Acute Noncardiogenic Minor Ischemic Stroke(National Institutes of Health Stroke Scale(NIHSS)score≤5)is a prospective cohort study involving patients with minor ischaemic stroke within 72 hours of symptom onset.The DAPT group was further categorised into three subgroups:shorter duration(<10 days),short duration(10-21 days)and long duration(>21 days).The primary efficacy and safety outcomes were composite vascular event and severe bleeding during 90 days.Results Among 3061 eligible patients(age was 61.7±12.0 years,73.3%were men,median(IQR)NIHSS score,2(1-3)),2977(97.4%)completed the follow-up.Dual antiplatelet therapy(DAPT)and single antiplatelet therapy(SAPT)were administered in 61.0%and 39.0%of patients.Among them,305 patients(16.8%)received a shorter duration of DAPT,937 patients(51.7%)received a short duration and 572 patients(31.5%)received a long duration.In the propensity-weighted Cox proportional hazards regression analysis,the use of DAPT in the short-duration group was associated with a lower risk of the primary vascular event outcome(HR(HR)=0.66,95%CI 0.46 to 0.94,p=0.02)compared with SAPT group.The incidence of severe bleeding events at 90 days was similar.Similar findings were obtained from the propensity score-matching analysis.Conclusion Short duration of DAPT(10-21 days)is superior to SAPT in minor stroke within 72 hours,reducing 90-day composite vascular events without increasing bleeding risk.
基金supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0510100)supported by the Kadoorie Charitable Foundation in Hong Kong.The long-term follow-up has been supported by Wellcome grants to Oxford University(212946/Z/18/Z,202922/Z/16/Z,104085/Z/14/Z,088158/Z/09/Z)and grants(2016YFC0900500)+4 种基金the National Key Research and Development Programof China,theNational Natural Science Foundation of China(82192900,82388102,81390540,91846303,81941018)the ChineseMinistry of Science and Technology(2011BAI09B01)The UK Medical Research Council(MC_UU_00017/1,MC_UU_12026/2,MC_U137686851),Cancer Research UK(C16077/A29186C500/A16896)the British Heart Foundation(CH/1996001/9454),provide core funding to the Clinical Trial Service Unit and Epidemiological Studies Unit at Oxford University for the project.
文摘Research in high-income countries has established the health benefits of physical activity(PA),but evidence from low-and middle-income countries,including China,where PA patterns vary from those in high-income countries,remains limited.Moreover,previous research,mainly focused on specific diseases,failing to fully capture the health impacts of PA.We investigated the associations of PA with 425 distinct diseases and 53 causes of death using data from 511,088 participants aged 30–79 years in the China Kadoorie Biobank.Baseline PA was assessed using a questionnaire between 2004 and 2008,and usual PA levels were estimated using the resurvey data in 2013–2014.Cox regression was employed to estimate the associations between PA and outcomes,adjusting for potential confounders.During a median follow-up time of 12 years,722,183 incident events and 39,320 deaths were recorded across 18 chapters of the International Classification of Diseases,10th Revision(ICD-10).Total PA was significantly and inversely associated with incidence risks of 14 ICD-10 chapters,specifically 65 diseases and 19 causes of death,with the highest quintile group of PA showing a 14%lower disease incidence and 40%lower all-cause mortality compared with the lowest group.Of these diseases,54 were not highlighted in World Health Organization PA guidelines.Dose-response analyses revealed L-shaped associations for most PA types,except moderate-tovigorous intensity PA,which showed a U-shaped relationship.In this population,physical inactivity accounted for 12.8%of PA-related deaths.The findings underscore the broad health benefits of PA across a variety of body systems and the significant disease burden due to inactivity in China,highlighting the urgent need for PA promotion.
基金supported by the Fujian Province Pilot Project(No.2020Y0060)the Fujian Provincial Health Youth Project(No.2020QNB017)the Chinese Academy of Medical Sciences Innovation Fund for Medical Science(No.2021-I2M-1-011).
文摘To the Editor:Diabetes,which is a rapidly growing global health concern,is prevalent in 12.4%of adults in China.[1]People with diabetes usually limit fruit intake to maintain blood glucose concentrations.However,there has been limited research on the effect of the frequency of fresh fruit intake on the incidence of cardiovascular events and mortality in patients with diabetes.This gap in knowledge extends to understanding the optimal level of fruit consumption for cardiovascular risk reduction and its variability across patient subgroups and event subtypes.We used a prospective cohort design to investigate the association between the frequency of fresh fruit intake and the risk of cardiovascular events,including ischemic heart disease and stroke,in patients with diabetes.We also examined potential differences in this relationship across various subgroups of individuals with diabetes.
基金Supported by the National Natural Science Foundation of China(No.82074193)Youth Fund of the National Natural Science Foundation of China(No.82301962)+2 种基金the Special Grant for Capital Health Research and Development(No.2022-2-4097)Key Clinical Projects of Peking University Third Hospital(No.BYSYZD2024008)Capital Medical Research&Development Fund(No.2024-2-4099)。
文摘Objective To study the clinical efficacy of Wenyang Lishui Formula(WYLSF)in preventing ovarian hyperstimulation syndrome(OHSS)and explore the suitable range of estradiol(E_(2))on the human chorionic gonadotropin(HCG)day in patients with OHSS using WYLSF.Methods Part Ⅰ:eligible patients at high risk for OHSS undergoing ovulation induction between January and December,2023 were randomized into 2 groups based on the actual treatment.The treatment group received 200 mL WYLSF formula twice daily for 5 days after oocyte retrieval in a combination of lifestyle coaching(LC)intervention including regular diet and exercise,whereas the LC group received LC intervention alone.The incidence of OHSS,OHSS self-assessment scales,changes in E_(2) levels on HCG day and 5 days after oocyte retrieval,ovarian morphology changes,and menstrual recovery were compared between the two groups.Part Ⅱ:patients at high risk for OHSS treated with WYLSF were studied.The optimal E_(2) threshold on the HCG day was determined using the maximum selection test,and a multivariate analysis was adopted to compare the relationship between different E_(2) levels on HCG day and hospitalization rate,incidence of moderate to severe OHSS,and self-assessment scales,to explore the preventive effect of WYLSF on OHSS in patients with varying E_(2) levels.Results A total of 120 patients were included in the Part Ⅰ analysis.The treatment group(60 cases)showed a significant reduction in the incidence,duration,and severity of abdominal distension,as well as the incidence of vomiting compared with the LC group(P<0.05).The post-retrieval E_(2) levels in the treatment group decreased significantly more(P=0.032).Among 1,652 patients treated with WYLSF in the Part Ⅱ,90 patients with≤10092 pmol/L,159 with>31074 pmol/L,and 1,403 in the middle range group were formed based on E_(2) levels on HCG day in Part two analysis.Univariate and regression analyses showed that patients with E_(2) levels>31073 pmol/L had a significantly higher incidence of moderate to severe OHSS compared to those with E_(2) levels≤10092 pmol/L(P<0.05).Conclusions WYLSF can effectively reduce specific symptoms in high-risk OHSS patients after ovulation induction and significantly lower E_(2) levels.It may be more suitable for high-risk OHSS patients with E_(2) levels<31073 pmol/L on HCG day.(Registration No.MR-11-23-032493,https://www.medicalresearch.org.cn/login)
基金supported by the National Natural Science Foundation of China(82021005,82192903,81930092)the Chief Scientist Research Project of Hubei Shizhen Laboratory(HSL2024SX0003)+1 种基金the Fundamental Research Funds for the Central Universities(2019kfyXMBZ015)the 111 Project and the Program for Changjiang Scholars and Innovative Research Team in University.
文摘This prospective study aimed to investigate the associations of untreated cholesterol levels and their longitudinal changes,especially low levels,with all-cause and cause-specific mortality in different populations.Participants were drawn from two Chinese cohorts and the UK Biobank,excluding those with lipid-lowering medications,coronary heart disease(CHD),stroke,cancer,clinically diagnosed chronic obstructive pulmonary disease,low body mass index(<18.5 kg·m^(-2))at baseline,and deaths within the first two years to minimize reverse causality.Individual cholesterol changes were assessed in a subset who attended the resurvey after over four years.Mortality data were linked to registries,and risks were estimated using Cox proportional hazards models.A total of 163115 Chinese and 317305 UK adults were included(mean age,49-61 years),with 43%,81%,and 44%males in Dongfeng-Tongji,Kailuan,and UK Biobank cohorts,respectively.During a median follow-up of 9.7-12.9 years,9553 and 15760 deaths were documented in the Chinese cohorts and UK Biobank,respectively.After multivariate adjustments,nonlinear relationships were observed between total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),and non-high-density lipoprotein cholesterol(non-HDL-C)levels and mortality.In both populations,high cholesterol was primarily associated with CHD mortality,while low cholesterol associated with all-cause and cancer mortality(Pnonlinear≤0.0161).The optimal levels for all-cause mortality risk in Chinese adults(TC:200 mg·dL^(-1);LDL-C:130 mg·dL^(-1);non-HDL-C:155 mg·dL^(-1))were lower than those in the UK Biobank but consistent with guideline recommendation.Additionally,decreasing cholesterol levels over four years were associated with higher all-cause and cancer mortality in the Chinese cohorts(P_(nonlinear)≤0.0100).Participants with low TC,LDL-C,or non-HDL-C levels at both baseline and resurvey experienced elevated all-cause mortality risks in both populations,as did those with low/medium baseline levels and>20%reductions over time in Chinese adults.In conclusion,higher TC,LDL-C,and non-HDL-C levels are associated with elevated CHD mortality.Importantly,low and/or longitudinally decreasing cholesterol levels are robustly associated with increased all-cause and cancer mortality,potentially serving as markers of premature death.Regular cholesterol monitoring,with attention to both high and low levels,is recommended to inform guideline updates and clinical strategies.
文摘Objective To evaluate the effectiveness of Qishen Yiqi dripping pill(QYDP)in patients with non-STsegment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods A multicenter,prospective cohort study was conducted,enrolling 807 patients with NSTE-ACS who underwent PCI between 2012 and 2015.
基金supported by grants from National Key Research and Development Program of China(2023YFA0915101)the National Natural Science Foundation of China(82273717 and 82073656).
文摘Prospective epidemiological evidence about the associations between phthalates(PAEs)and incident cardiovascular disease(CVD)risk among type 2 diabetes mellitus(T2DM)population has been urgently needed.A total of 2806 participants with T2DM were recruited based on the baseline of the Dongfeng-Tongji cohort study(2008-2010)and followed up to 2018.Serum di-n-butyl phthalate(DnBP),Σdibutyl phthalate(ΣDBP),andΣlow-molecular-weight phthalate(ΣLMW)levels were associated with incident stroke risk,whether their levels were treated as continuous variables[HR(95%CI):1.36(1.02,1.80),1.35(1.01,1.81),and 1.50(1.07,2.10),respectively]or divided by quartiles[HR(95%CI):1.41(1.01,1.98),1.48(1.05,2.08),and 1.53(1.08,2.15)in the highest quartile with Ptrend=0.03,0.02,and 0.02,respectively]after multiple adjustment in Cox proportional hazard models.Meanwhile,linear associations for serum di-iso-butyl phthalate(DiBP),DnBP,ΣDBP,andΣLMW,and a nonlinear U-shaped dose-response association for serum butyl-benzyl phthalate(BBP)with incident stroke risk were proved by restricted cubic spline regression analyses.Furthermore,a positive correlation between PAE mixture and incident stroke risk was identified in Quantile-based g-computation[HR(95%CI):1.24(1.05,1.46)].However,serum PAEs,either as individuals or as a mixture,were not associated with incident CVD or coronary heart disease risk.Our study revealed that serum PAEs were positively associated with increased incident stroke risk in the T2DM population.More prospective cohort and mechanism studies are warranted to validate our findings.
基金supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0508200,2023ZD0508201)the National Natural Science Foundation of China(82100949,82470931)+2 种基金the Outstanding Young Investigator Award of Hunan Province(2022JJ10094)Central South University Research Programme of Advanced Interdisciplinary Studies(2023QYJC008)to J.Hthe Intramural Research Program of the U.S.National Cancer Institute(NCI),National Institutes of Health(NIH)to D.A。
文摘Despite considerable research underscoring the importance of carbohydrate intake in relation to the risk of type 2 diabetes(T2D),a comprehensive assessment of this relationship is currently lacking.We aimed to examine the associations of various types and food sources of dietary carbohydrate intake with the risk of T2D,to evaluate potential effect modification by other factors,including genetic susceptibility,and to explore the potential mediators for such associations.The present study included 161,872 participants of the UK Biobank who were free of prevalent cancer,cardiovascular disease,or diabetes,and had at least one validated 24-h dietary recall assessment.Multivariableadjusted age-stratified Cox proportional hazard regression models were applied to estimate hazard ratios(HRs)and 95%confidence intervals(CI)for the associations of various types and food sources of dietary carbohydrate intake with risk of T2D.During a median follow-up of 13.6 years,4,176 incident cases of T2D were identified.In the multivariable-adjusted models,a greater intake of fiber,carbohydrates from whole grains,and carbohydrates from non-starchy vegetables was significantly associated with a lower risk of T2D(highest vs.lowest quantile,HR[95%CI]=0.70[0.62–0.79],0.74[0.67–0.82],and 0.83[0.75–0.92],respectively,all P for trend<0.005).In contrast,a higher intake of starch and carbohydrate from starchy vegetables was associated with an increased risk of T2D(highest vs.lowest quantile,HR[95%CI]=1.31[1.16–1.48]and 1.19[1.09–1.31],respectively,both P for trend<0.005).Replacing one serving of refined grains or starchy vegetables with an equal amount of whole grains or non-starchy vegetables was associated with 4%to 10%lower risk of T2D(all P values<0.001).The observed associations were generally similar across population subgroups,including individuals with different genetic susceptibility to T2D.Mediation analyses of the inverse association between T2D risk and isocaloric substitution of carbohydrates from refined grains with carbohydrate from whole grains demonstrated that 39.6%,43.4%,44.0%,27.8%,and 34.9%were mediated through body mass index,waistto-hip ratio,glycosylated hemoglobin,high-density lipoprotein cholesterol,and C-reactive protein,respectively.In addition,the inverse association between the isocaloric substitution of carbohydrates from starchy vegetables with carbohydrates from non-starchy vegetables and T2D was partially mediated through high-density lipoprotein cholesterol(15.9%).These findings underscore the importance of dietary modifications of carbohydrates,particularly considering types and food sources of carbohydrate intake,in the primary prevention of T2D.
文摘Purpose:Early mortality in major trauma has decreased,but MODS remains a leading cause of poor outcomes,driven by trauma-induced cytokine storms that exacerbate injuries and organ damage.Methods:This prospective cohort study included 79 major trauma patients(ISS>15)treated in the National Center for Trauma Medicine,Peking University People''s Hospital,from September 1,2021,to July 31,2023.Patients(1)with ISS>15(according to AIS 2015),(2)aged 15-80 years,(3)admitted within 6 h of injury,(4)having no prior treatment before admission,were included.Exclusion criteria were(1)GCS score<9 or AIS score≥3 for TBI,(2)confirmed infection,infectious disease,or high infection risk,(3)pregnancy,(4)severe primary diseases affecting survival,(5)recent use of immunosuppressive or cytotoxic drugs within the past 6 months,(6)psychiatric patients,(7)participation in other clinical trials within the past 30 days,(8)patients with incomplete data or missing blood samples.Admission serum inflammatory cytokines and pathophysiological data were analyzed to develop machine learning models predicting MODS within 7 days.LR,DR,RF,SVM,NB,and XGBoost were evaluated based on the area under the AUROC.The SHAP method was used to interpret results.Results:This study enrolled 79 patients with major trauma,and the median(Q1,Q3)age was 51(35,59)years(52 males,65.8%).The inflammatory cytokine data were collected for all participants.Among these patients,35(44.3%)developed MODS,and 44(55.7%)did not.Additionally,2 patients(2.5%)from the MODS group succumbed.The logistic regression model showed strong performance in predicting MODS.Ten key cytokines,IL-18,Eotaxin,MCP-4,IP-10,CXCL12,MIP-3α,MCP-1,IL-1RA,Cystatin C,and MRP8/14 were identified as critical to the trauma-induced cytokine storm and MODS development.Early elevation of these cytokines achieved high predictive accuracy,with an AUROC of 0.887(95%CI 0.813-0.976).Conclusion:Trauma-induced cytokine storms are strongly associated with MODS.Early identification of inflammatory cytokine changes enables better prediction and timely interventions to improve outcomes.
