BACKGROUND Previous systematic reviews have consistently reported that coffee consumption has a preventive effect on the occurrence of type 2 diabetes mellitus(T2DM).However,further evaluations between coffee consumpt...BACKGROUND Previous systematic reviews have consistently reported that coffee consumption has a preventive effect on the occurrence of type 2 diabetes mellitus(T2DM).However,further evaluations between coffee consumption and the risk of T2DM in Asian populations are needed.AIM To conduct a meta-epidemiological study on systematic reviews evaluating the association between coffee consumption and the risk of T2DM in Asian people.METHODS The selection criterion was defined as a population-based prospective cohort study evaluating the association between coffee consumption and the risk of T2DM in Asian populations,reporting the adjusted relative risk(RR)and its 95%confidence interval(CI)for potential confounders.A fixed-effect model metaanalysis was applied to calculate the summary RR and its 95%CI in less than 50%of the I2 value indicating the level of heterogeneity.A two-stage fixed-effects doseresponse meta-analysis(DRMA)was performed to calculate the risk per unit dose(a cup per day).RESULTS A total of seven studies were selected in this meta-epidemiological study.The risk of T2DM in Asian populations was significantly reduced in the highest to the lowest dose group(summary RR=0.73,95%CI:0.66-0.82;I2 value=0.0%).The DRMA showed that drinking one cup of coffee per day reduced the risk of T2DM in Asian populations by 8%(RR=0.92,95%CI:0.90-0.95).CONCLUSION These findings support the conclusion that coffee consumption has a protective effect on the occurrence of T2DM in Asian men and women.展开更多
We start with a description of the statistical inferential framework and the duality between observed data and the true state of nature that underlies it. We demonstrate here that the usual testing of dueling hypothes...We start with a description of the statistical inferential framework and the duality between observed data and the true state of nature that underlies it. We demonstrate here that the usual testing of dueling hypotheses and the acceptance of one and the rejection of the other is a framework which can often be faulty when such inferences are applied to individual subjects. This follows from noting that the statistical inferential framework is predominantly based on conclusions drawn for aggregates and noting that what is true in the aggregate frequently does not hold for individuals, an ecological fallacy. Such a fallacy is usually seen as problematic when each data record represents aggregate statistics for counties or districts and not data for individuals. Here we demonstrate strong ecological fallacies even when using subject data. Inverted simulations, of trials rightly sized to detect meaningful differences, yielding a statistically significant p-value of 0.000001 (1 in a million) and associated with clinically meaningful differences between a hypothetical new therapy and a standard therapy, had a proportion of instances of subjects with standard therapy effect better than new therapy effects close to 30%. A ―winner take all‖ choice between two hypotheses may not be supported by statistically significant differences based on stochastic data. We also argue the incorrectness across many individuals of other summaries such as correlations, density estimates, standard deviations and predictions based on machine learning models. Despite artifacts we support the use of prospective clinical trials and careful unbiased model building as necessary first steps. In health care, high touch personalized care based on patient level data will remain relevant even as we adopt more high tech data-intensive personalized therapeutic strategies based on aggregates.展开更多
Objective:To synthesize the knowledge about the association of total physical activity(TPA),leisure-time phys-ical activity(LTPA),occupational physical activity(OPA)and lung cancer risk and explore the dose-response r...Objective:To synthesize the knowledge about the association of total physical activity(TPA),leisure-time phys-ical activity(LTPA),occupational physical activity(OPA)and lung cancer risk and explore the dose-response relationship between LTPA level and lung cancer.Methods:PubMed and Web of Science were searched up to 17 November 2021.The summary relative risks(RRs)and 95%confidence intervals(CIs)were calculated by random-effects or fixed-effects model.The dose-response analysis was conducted with restricted cubic splines.Results:We identified 25 articles(42 cohort studies)that assessed the physical activity-lung cancer association,including 9,983,295 study participants and 85,988 incident cases of lung cancer.When comparing the highest to the lowest level of TPA and LTPA,lung cancer risk reduced 22%(RR,0.78;95%CI:0.70,0.86)and 12%(RR,0.88;95%CI:0.83,0.93),respectively.We found an approximately U-shaped association between LTPA and lung cancer(P non-linearity<0.001),with the lowest risk at 15 metabolic equivalent of task hours per week(h/wk)of LTPA.Compared to participants with sitting occupations,lung cancer risk significantly increased among those being unemployed(RR,1.33;95%CI:1.17,1.51)or with standing occupations(RR,1.37;95%CI:1.15,1.63),but not among those with light or high OPA.Conclusions:Our meta-analysis supported a protective effect of TPA and LTPA,but not OPA,on lung cancer risk.The novel finding of a U-shaped association between LTPA and lung cancer risk warrants further investigation.展开更多
The International Agency for Research on Cancer and the World Health Organization have designated airborne particulates, including particulates of median aerodynamic diameter 〈 2.5 gm (PM2.5), as Group 1 carcinogen...The International Agency for Research on Cancer and the World Health Organization have designated airborne particulates, including particulates of median aerodynamic diameter 〈 2.5 gm (PM2.5), as Group 1 carcinogens. It has not been determined, however, whether exposure to ambient PM2.5 is associated with an increase in respiratory related diseases. This meta-analysis assessed the association between exposure to ambient fine particulate matter (PM2.5) and the risk of respiratory tract diseases, using relevant articles extracted from PubMed, Web of Science, and Embase. In results, of the 1,126 articles originally identified, 35 (3.1%) were included in this meta-analysis. PM2.5 was found to be associated with respiratory tract diseases. After subdivision by age group, respiratory tract disease, and continent, PM2.5 was strongly associated with respiratory tract diseases in children, in persons with cough, lower respiratory illness, and wheezing, and in individuals from North America, Europe, and Asia. The risk of respiratory tract diseases was greater for exposure to traffic-related than non-traffic-related air pollution. In children, the pooled relative risk (RR) represented significant increases in wheezing (8.2%), cough (7.5%), and lower respiratory illness (15.3%). The pooled RRs in children were 1.091 (95%CI: 1.049, 1.135) for exposure to 〈 25 gg/m3 PM2.5, and 1.126 (95%CI: 1.067, l. 190) for exposure to 〉 25 gg/m3 PM2.5. In conclusion, exposure to ambient PM2.5 was significantly associated with the development of respiratory tract diseases, especially in children exposed to high concentrations of PM2.5.展开更多
TO evaluate the association between obesity and colorectal cancer risk. METHODS: We searched PubMed, EMBASE, and the Cochrane Library up to January 1, 2007. Cohort studies permitting the assessment of causal associat...TO evaluate the association between obesity and colorectal cancer risk. METHODS: We searched PubMed, EMBASE, and the Cochrane Library up to January 1, 2007. Cohort studies permitting the assessment of causal association between obesity and colorectal cancer, with clear definition of obesity and well-defined outcome of colorectal cancer were eligible. Study design, sample size at baseline, mean follow-up time, co-activators and study results were extracted. Pooled standardized effect sizes were calculated.展开更多
Objective To determine whether there was excessive risk of cancer among workers exposed to chrysotile fiber alone by applying a meta-analysis technique. Methods All data meeting the criteria of cohort studies on c...Objective To determine whether there was excessive risk of cancer among workers exposed to chrysotile fiber alone by applying a meta-analysis technique. Methods All data meeting the criteria of cohort studies on cancer mortality among workers exposed only to chrysotile were incorporated into meta-analysis. Pooled standardized mortality ratios (SMRs) and their corresponding 95% confidence intervals (CIs) for main cancer sites were calculated using two approaches of unweighted ratio and random effect model. The heterogeneity and its sources of the results were examined with a Q-statistic and Z-score test. The dose-response effect as reflected in the percentage of all deaths due to mesothelioma served as a proxy measure of chrysotile exposure. Results A cohort of twenty six workers exposed to chrysotile alone was summarized. The significantly elevated meta-SMRs for all deaths (1.27), all cancers (1.28), cancers of respiratory organs (2.51), cancers of lung (2.35) and cancers of stomach (1.24) were observed. The significantly elevated meta-SMRs for lung cancer within occupational strata were observed among textile workers (3.55), asbestos product manufacturers (3.30), miners and millers (2.24), cement product workers (1.22), and for stomach cancer among asbestos product manufacturers (1.49). Meta-SMRs for cancers at other sites were not significant. Meta-SMR for lung cancer showed an increasing trend with an elevated percentage of all deaths from mesothelioma, but no such trend for stomach cancer. Conclusion There are excessive risks of lung cancer and mesothelioma among workers exposed to chrysotile fiber alone, and likely no convincing indication of an etiological association between chrysotile exposure and cancers at other sites.展开更多
AIM:To quantitatively assess the relationship between coffee consumption and incidence of pancreatic cancer in a meta-analysis of cohort studies. METHODS:We searched MEDLINE,EMBASE,Science Citation Index Expanded and ...AIM:To quantitatively assess the relationship between coffee consumption and incidence of pancreatic cancer in a meta-analysis of cohort studies. METHODS:We searched MEDLINE,EMBASE,Science Citation Index Expanded and bibliographies of retrieved articles.Studies were included if they reported relative risks(RRs)and corresponding 95%CIs of pancreatic cancer with respect to frequency of coffee intake.We performed random-effects meta-analyses and metaregressions of study-specific incremental estimates to determine the risk of pancreatic cancer associated with a 1 cup/d increment in coffee consumption. RESULTS:Fourteen studies met the inclusion criteria, which included 671 080 individuals(1496 cancer events) with an average follow-up of 14.9 years.Compared with individuals who did not drink or seldom drank coffee per day,the pooled RR of pancreatic cancer was 0.82 (95%CI:0.69-0.95)for regular coffee drinkers,0.86 (0.76-0.96)for low to moderate coffee drinkers,and 0.68(0.51-0.84)for high drinkers.In subgroup analyses,we noted that,coffee drinking was associated witha reduced risk of pancreatic cancer in men,while this association was not seen in women.These associations were also similar in studies from North America,Europe, and the Asia-Pacific region. CONCLUSION:Findings from this meta-analysis suggest that there is an inverse relationship between coffee drinking and risk of pancreatic cancer.展开更多
BACKGROUND Patients with BRAF V600E mutant metastatic colorectal cancer(mCRC)have a low incidence rate,poor biological activity,suboptimal response to conventional treatments,and a poor prognosis.In the previous cohor...BACKGROUND Patients with BRAF V600E mutant metastatic colorectal cancer(mCRC)have a low incidence rate,poor biological activity,suboptimal response to conventional treatments,and a poor prognosis.In the previous cohort study on mCRC conducted by our team,it was observed that integrated Chinese and Western medicine treatment could significantly prolong the overall survival(OS)of patients with colorectal cancer.Therefore,we further explored the survival benefits in the population with BRAF V600E mutant mCRC.AIM To evaluate the efficacy of integrated Chinese and Western medicine in the treatment of BRAF V600E mutant metastatic colorectal cancer.METHODS A cohort study was conducted on patients with BRAF V600E mutant metastatic colorectal cancer admitted to Xiyuan Hospital of China Academy of Chinese Medical Sciences and Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from January 2016 to December 2022.The patients were divided into two cohorts.RESULTS A total of 34 cases were included,with 23 in Chinese-Western medicine cohort(cohort A)and 11 in Western medicine cohort(cohort B).The median overall survival was 19.9 months in cohort A and 14.2 months in cohort B,with a statistically significant difference(P=0.038,hazard ratio=0.46).The 1-3-year survival rates were 95.65%(22/23),39.13%(9/23),and 26.09%(6/23)in cohort A,and 63.64%(7/11),18.18%(2/11),and 9.09%(1/11)in cohort B,respectively.Subgroup analysis showed statistically significant differences in median OS between the two cohorts in the right colon,liver metastasis,chemotherapy,and first-line treatment subgroups(P<0.05).CONCLUSION Integrated Chinese and Western medicine can prolong the survival and reduce the risk of death in patients with BRAF V600E mutant metastatic colorectal cancer,with more pronounced benefits observed in patients with right colon involvement,liver metastasis,combined chemotherapy,and first-line treatment.展开更多
Objective:Psoriasis is an immune-mediated inflammatory,chronic,recurrent skin disease associated with a high risk of developing psychiatric disorders,especially depression and suicidal ideation,leading to functional d...Objective:Psoriasis is an immune-mediated inflammatory,chronic,recurrent skin disease associated with a high risk of developing psychiatric disorders,especially depression and suicidal ideation,leading to functional disability and poor quality of life.This study was conducted to comprehensively review and assess the epidemiologic association between psoriasis and the risk ratios(RRs)of depression or suicidal ideation.Methods:Five databases(PubMed,Wanfang Database,CNKI,The Cochrane Library,and EMBASE)were searched for prospective cohort studies on the prevalence of depression and/or suicidal ideation in patients with psoriasis updated to February 2,2023.Two independent reviewers evaluated and extracted the data,which were then pooled into a summary RR with corresponding 95%confidence interval(CI)using random-effects models.Results:Sixteen cohort studies comprising 1,166,840 patients with psoriasis and 3,294,205 controls were eligible for the final analysis.The pooled RR for depression was 1.43(95%CI=1.13-1.81)in patients with psoriasis and1.55(95%CI=1.40-1.71)in patients with psoriatic arthritis.In the subgroup analysis,Asian patients with psoriasis(RR=1.38,95%CI=1.17-1.63)had a lower pooled RR for depression than non-Asian patients(RR=1.45,95%CI=1.07-1.97),and patients with moderate-to-severe psoriasis(RR=1.69,95%CI=1.15-2.50)showed a higher RR for depression than patients with mild psoriasis(RR=1.60,95%CI=1.06-2.42).We also found no increase in the RR for suicidal ideation among people with psoriasis(RR=1.25,95%CI=0.95-1.65).Conclusion:Patients with psoriasis are at an increased risk of depression.Among patients with psoriasis,those with psoriatic arthritis,those who are non-Asian,and those with moderate-to-severe psoriasis are at higher risk for depression.However,the available evidence does not support an association between psoriasis and suicidal ideation.展开更多
Background The difference of cardiovascular effects between rosiglitazone and pioglitazone treatment for diabetic patients has not been thoroughly studied. We performed a meta-analysis to compare the risk of cardiovas...Background The difference of cardiovascular effects between rosiglitazone and pioglitazone treatment for diabetic patients has not been thoroughly studied. We performed a meta-analysis to compare the risk of cardiovascular adverse effects in patients with type 2 diabetes treated with rosiglitazone compared to pioglitazone. Methods The Cochrane Library, PubMed, and Embase were searched to identify retrospective cohort studies assessing cardiovascular outcomes with rosiglitazone and pioglitazone. Meta-analysis of retrospective cohort studies was conducted using RevMan 5.0 software to calculate risk ratios. Results Of the 74 references identified, eight studies involving 945 286 patients fit the inclusion criteria for the analysis. The results of meta-analyses showed that, compared with pioglitazone, rosiglitazone therapy significantly increased the risk of myocardial infarction (risk ratios (RR) 1.17, 95% confidence interval (CI) 1.04-1.32; P=-0.01), the risk of heart failure (RR 1.18, 95% CI 1.02-1.36; P=0.03), and total mortality (RR 1.13, 95% CI 1.08-1.20; P 〈0.000 01). Conclusion Compared with pioglitazone, rosiglitazone was associated with an increased risk of myocardial infarction, heart failure, and all-cause mortality in diabetic patients.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
BACKGROUND:Previous studies have reported inconsistent results with positive,negative,and J-shaped associations between alcohol consumption and the hazard of aortic aneurysm and dissection(AAD).This study aimed to exa...BACKGROUND:Previous studies have reported inconsistent results with positive,negative,and J-shaped associations between alcohol consumption and the hazard of aortic aneurysm and dissection(AAD).This study aimed to examine the connections between weekly alcohol consumption and the subsequent risk of AAD.METHODS:The UK Biobank study is a population-based cohort study.Weekly alcohol consumption was assessed using self-reported questionnaires and the congenital risk of alcohol consumption was also evaluated using genetic risk score(GRS).Cox proportional hazards models were used to estimate hazard ratios(HRs)with 95% confidence intervals(CIs)for the associations between alcohol consumption and AAD.Several sensitivity analyses were performed to assess the robustness of the results.RESULTS:Among the 388,955 participants(mean age:57.1 years,47.4% male),2,895 incident AAD cases were documented during a median follow-up of 12.5 years.Compared with never-drinkers,moderate drinkers(adjusted HR:0.797,95%CI:0.646-0.984,P<0.05)and moderate-heavy drinkers(adjusted HR:0.794,95%CI:0.635-0.992,P<0.05)were significantly associated with a decreased risk of incident AAD.Interaction-based subgroup analysis revealed that the protective effect of moderate drinking was reflected mainly in participants younger than 65 years and women.CONCLUSION:Our findings support a protective effect of moderate alcohol consumption on AAD,but are limited to participants younger than 65 years and women.展开更多
Objective The aim of this study was to investigate the prospective association between physical activity(PA),independently or in conjunction with other contributing factors,and osteoporosis(OP)outcomes.Methods The Phy...Objective The aim of this study was to investigate the prospective association between physical activity(PA),independently or in conjunction with other contributing factors,and osteoporosis(OP)outcomes.Methods The Physical Activity in Osteoporosis Outcomes(PAOPO)study was a community-based cohort investigation.A structured questionnaire was used to gather the participants’sociodemographic characteristics.Bone mineral density(BMD)measurements were performed to assess OP outcomes,and the relationship between BMD and OP was evaluated within this cohort.Results From 2013 to 2014,8,471 participants aged 18 years and older were recruited from Tangshan,China’s Jidong community.Based on their PA level,participants were categorized as inactive,moderately active,or very active.Men showed higher physical exercise levels than women across the activity groups.BMD was significantly higher in the very active group than in the moderately active and inactive groups.Individuals aged>50 years are at a higher risk of developing OP and osteopenia.Conclusion The PAOPO study offers promising insights into the relationship between PA and OP outcomes,encouraging the implementation of PA in preventing and managing OP.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
AIM: To reduce the incidence and mortality of rectal cancer and address the hypothesis that colorectal cancer often arise from precursor lesion(s), either adenomas or non-adenomatous polyps, by conducting a population...AIM: To reduce the incidence and mortality of rectal cancer and address the hypothesis that colorectal cancer often arise from precursor lesion(s), either adenomas or non-adenomatous polyps, by conducting a population-based mass screening for colorectal cancer in Haining County, Zhejiang, PRC. METHODS: From 1977 to 1980, physicians screened the population of Haining County using 15 cm rigid endoscopy. Of over 240000 participants, 4076 of them were diagnosed with precursor lesions, either adenomas or non-adenomatous polyps, which were then removed surgically. All individuals with precursor lesions were followed up and reexamined by endoscopy every two to five years up to 1998. RESULTS: After the initial screening, 953 metachronous adenomas and 417 non-adenomatous polyps were detected and removed from the members of this cohort. Further, 27 cases of colorectal cancer were detected and treated. Log-rank tests showed that the survival time among those cancer patients who under went mass screening increased significantly compared to that of other colorectal cancer patients (P【0.0001). According to the population-based cancer registry in Haining County, age-adjusted incidence and mortality of rectal cancer decreased by 41% and 29% from 1977-1981 to 1992-1996, respectively. Observed cumulative 20-year rectal cancer incidence was 31% lower than the expected in the screened group; the mortality due to rectal cancer was 18% lower than the expected in the screened group. CONCLUSION:Mass screening for rectal cancer and precursor lesions with protocoscopy in the general population and periodical following-up with routine endoscopy for high-risk patients may decrease both the incidence and mortality of rectal cancer.展开更多
AIM: To conduct a cohort study of 101 patients with hepatocellular carcinoma (HCC) presenting to a tertiary care medical referral center in Germany between 1997 and 1999. METHODS AND RESULTS: Data were retrospectively...AIM: To conduct a cohort study of 101 patients with hepatocellular carcinoma (HCC) presenting to a tertiary care medical referral center in Germany between 1997 and 1999. METHODS AND RESULTS: Data were retrospectively analyzed by chart review. In 95 cases (72 males and 23 females) sufficient data were available for analysis. Twenty five (29%) of 85 patients were HBsAg or anti HBc positive, 21/85 (25%) were anti HCV positive, and 6/85 (7%) were positive for both HBV and HCV-markers. Age was significantly lower in HBV positive patients than in the other two groups. Thirty one (34%) of 90 patients had histories of alcohol abuse. In 79/94 (84%) patients, cirrhosis was diagnosed. Of these cirrhotic patients, 29/79 (37%) belonged to Child Pugh's group (CHILD) A, 32/79 (40%) to CHILD B, and 18/79 (23%) to CHILD C. AFP was elevated in 61/91 (67%) patients. A single tumor nodule was found in 38/94 (40%), more than one nodule in 31/94 (34%), and 25/94 (26%) had a diffusely infiltrating tumor, i.e. the tumor margins could not be seen on imaging procedures. Portal vein thrombosis was present in 19/94 (20%). Imaging data consistent with lymph node metastases were found in 10/92 (11%), while distant metastases were found in 8/93 (9%). According to Okuda 28/94 (30%) were grouped to stage I, 53/94 (56%) were grouped to stage II, and 13/94 (14%) were grouped to stage II. Survival data were available for 83 patients. The Kaplan-Meier estimate for median survival was 8 4 months. Factors influencing survival were the Okuda score, the presence of portal vein thrombosis, and the presence of ascites. The presence of non complicated liver cirrhosis by itself, distant metastases, or infection with hepatitis viruses did not influence survival. AFP positivity by itself did not influence survival, though patients with an AFP value greater than 100 microg/L did experience shortened survival. Treatment besides tamoxifen or supportive care was associated with prolonged survival. The influence of therapy on survival was most pronounced in Okuda stage II patients. There was longer survival in those Okuda stage II patients who were treated with percutaneous ethanol injection. CONCLUSION: Even in a low incidence area such as Germany, the majority of HCC is caused by viral hepatitis and therefore potentially preventable. Reflecting the high proportion of advanced stage tumors in our patients, the median survival was poor. Patients who received active therapy had a longer survival.展开更多
IM To investigate the relationship between different sources of drinking water supply, water quality improvement and gastric cancer mortality rate in a high risk area.METHODS A retrospectivecohort survey was carried...IM To investigate the relationship between different sources of drinking water supply, water quality improvement and gastric cancer mortality rate in a high risk area.METHODS A retrospectivecohort survey was carried out in all towns of this county to study the effect of different sources of drinking water supply and water quality improvement on gastric cancer mortality rate.RESULTS The gastric cancer mortality rate among the population 12405/105 drinking river water was obviously higher than that of drinking shallow well water (7485/105) (P<001) according to the Zhanggang Town 16 years accumulated data. The same pattern was presented in 7 towns after balancing the confounders. The gastric cancer mortality rate of population drinking river water was 8603/105, which was higher than those drinking shallow well water (6203/105) and tap water (2978/105) (P<001). When the drinking water switched from river and well water to tap water, the gastric cancer incidence decreased to 3033/105 and 2610/105, and the gastric cancer mortality decreased by 59% and 57% respectively.CONCLUSION The quality of drinking water is one of the important factors of increased incidence of gastric cancer in Changle County, and water quality improvement has a beneficial effect, but the cause of high gastric cancer incidence may be multifactorial in this area..展开更多
BACKGROUND Uric acid is the end product of purine metabolism.Previous studies have found that serum uric acid(SUA)levels are associated with the total cancer risk.However,due to the dual effect of uric acid on cancer,...BACKGROUND Uric acid is the end product of purine metabolism.Previous studies have found that serum uric acid(SUA)levels are associated with the total cancer risk.However,due to the dual effect of uric acid on cancer,the relationship between the SUA levels and most specific-site cancer remains unclear.AIM To investigate the associations between the SUA levels and incidence of hepatobiliary-pancreatic cancer.METHODS In this prospective cohort study,444462 participants free of cancer from the UK Biobank were included.The SUA levels were measured at baseline,and the incidence of hepatobiliary-pancreatic cancer was determined by contacting the cancer registry.The hazard ratios(HRs)and 95%confidence intervals(CIs)between the SUA levels and hepatobiliary-pancreatic cancer were investigated using multiple adjusted Cox regression models adjusted for potential confounders.RESULTS In total,920 participants developed liver,gallbladder,biliary tract or pancreatic cancer during a median of 6.6 yrs of follow-up.We found that the HR of pancreatic cancer in the highest SUA group was 1.77(95%CI:1.29-2.42)compared with that in the lowest group.After stratifying by gender,we further found that SUA was associated with an increased risk of pancreatic cancer only among the females(highest quartile vs lowest quartile HR 2.04,95%CI:1.35-3.08).Among the males,the SUA levels were positively associated with the gallbladder cancer risk(highest quartile vs lowest quartile HR 3.09,95%CI:1.28-7.46),but a U-shaped association with the liver cancer risk was observed(P-nonlinear=0.03).CONCLUSION SUA is likely to have gender-specific effects on hepatobiliary-pancreatic cancer.High SUA levels are a risk factor for pancreatic cancer in females and gallbladder cancer in males.A U-shaped association with the liver cancer risk was identified.展开更多
Inflammatory bowel diseases(IBDs) are characterized by a chronic course with an alternation of relapses and remissions.Questions about prognosis are important for the patient who wants to know how the disease will aff...Inflammatory bowel diseases(IBDs) are characterized by a chronic course with an alternation of relapses and remissions.Questions about prognosis are important for the patient who wants to know how the disease will affect his/her life and also for clinicians to make management decisions.Correct selection of the patients is the basis for good methodological studies on the course of IBD.A great proportion of data on the course of IBD is derived from a limited number of cohort studies.Studies help to define the endpoints for clinical trials and to identify subsets of patients in whom the prognosis of the disease can be stratified according to clinical features.Specific scientific requirements for high-quality studies on prognosis are the following:use of inception cohort,description of referral patterns,completeness of follow-up,objective outcome criteria,blind outcome assessment,adjustment for extraneous prognostic factors and statistical issues.We analyzed each of these requirements in studies on IBDs.To date,prospective and populationbased cohort studies are the standard for an unbiased assessment of prognosis.A better knowledge of the course of disease of chronic disorders ideally requires:(1) data from population-based studies,to avoid selection bias from referral centers in which patients with a more severe disease are usually treated;(2) inclusion of patients seen at the onset of the disease excluding misdiagnosed cases;and(3) follow-up from the onset of the disease to the end without dropouts.展开更多
Objective Waist circumference, waist-to-hip ratio and waist-to-height ratio, which are the indicators or measures of abdominal adiposity, have long been hypothesized to increase the risk of stroke; yet evidence accumu...Objective Waist circumference, waist-to-hip ratio and waist-to-height ratio, which are the indicators or measures of abdominal adiposity, have long been hypothesized to increase the risk of stroke; yet evidence accumulated till date is not conclusive. Here, we conducted a dose-response meta-analysis to summarize evidences of the association between these measures of abdominal adiposity and the risk of stroke. Methods PubMed and Web of Science databases were searched from inception to May 2015. Two investigators independently conducted the study selection and data extraction. Dose-response relationships were assessed by the generalized least squares trend estimation, while the summary effect estimates were evaluated by the use of fixed- or random-effect models. Subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity and the robustness of the pooled estimation. Publication bias of the literature was evaluated using Begg's and Egger's test. Results Altogether 15 prospective cohort studies were identified in this study. The summary of relative risks (95% confidence intervals) of stroke for the highest versus the lowest categories was 1.28 (1.18-1.40) for waist circumference, 1.32 (1.21-1.44) for waist-to-hip ratio, and 1.49 (1.24-1.78) for waist-to-height ratio. For a 10-cm increase in waist circumference, the relative risk of stroke increased by 10%; for a 0.1-unit increase in waist-to-hip ratio, the relative risk increased by 16%; and for a 0.05-unit increase in waist-to-height ratio, the relative risk increased by 13%. There was evidence of a nonlinear association between waist-to-hip ratio and stroke risk, Pnonlinearity=0.028, Conclusion Findings from our meta-analysis indicated that waist circumference, waist-to-hip ratio, and waist-to-height ratio were positively associated with the risk of stroke, particularly ischemic stroke.展开更多
文摘BACKGROUND Previous systematic reviews have consistently reported that coffee consumption has a preventive effect on the occurrence of type 2 diabetes mellitus(T2DM).However,further evaluations between coffee consumption and the risk of T2DM in Asian populations are needed.AIM To conduct a meta-epidemiological study on systematic reviews evaluating the association between coffee consumption and the risk of T2DM in Asian people.METHODS The selection criterion was defined as a population-based prospective cohort study evaluating the association between coffee consumption and the risk of T2DM in Asian populations,reporting the adjusted relative risk(RR)and its 95%confidence interval(CI)for potential confounders.A fixed-effect model metaanalysis was applied to calculate the summary RR and its 95%CI in less than 50%of the I2 value indicating the level of heterogeneity.A two-stage fixed-effects doseresponse meta-analysis(DRMA)was performed to calculate the risk per unit dose(a cup per day).RESULTS A total of seven studies were selected in this meta-epidemiological study.The risk of T2DM in Asian populations was significantly reduced in the highest to the lowest dose group(summary RR=0.73,95%CI:0.66-0.82;I2 value=0.0%).The DRMA showed that drinking one cup of coffee per day reduced the risk of T2DM in Asian populations by 8%(RR=0.92,95%CI:0.90-0.95).CONCLUSION These findings support the conclusion that coffee consumption has a protective effect on the occurrence of T2DM in Asian men and women.
文摘We start with a description of the statistical inferential framework and the duality between observed data and the true state of nature that underlies it. We demonstrate here that the usual testing of dueling hypotheses and the acceptance of one and the rejection of the other is a framework which can often be faulty when such inferences are applied to individual subjects. This follows from noting that the statistical inferential framework is predominantly based on conclusions drawn for aggregates and noting that what is true in the aggregate frequently does not hold for individuals, an ecological fallacy. Such a fallacy is usually seen as problematic when each data record represents aggregate statistics for counties or districts and not data for individuals. Here we demonstrate strong ecological fallacies even when using subject data. Inverted simulations, of trials rightly sized to detect meaningful differences, yielding a statistically significant p-value of 0.000001 (1 in a million) and associated with clinically meaningful differences between a hypothetical new therapy and a standard therapy, had a proportion of instances of subjects with standard therapy effect better than new therapy effects close to 30%. A ―winner take all‖ choice between two hypotheses may not be supported by statistically significant differences based on stochastic data. We also argue the incorrectness across many individuals of other summaries such as correlations, density estimates, standard deviations and predictions based on machine learning models. Despite artifacts we support the use of prospective clinical trials and careful unbiased model building as necessary first steps. In health care, high touch personalized care based on patient level data will remain relevant even as we adopt more high tech data-intensive personalized therapeutic strategies based on aggregates.
基金supported by the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(grant number:2021-RC310-009).
文摘Objective:To synthesize the knowledge about the association of total physical activity(TPA),leisure-time phys-ical activity(LTPA),occupational physical activity(OPA)and lung cancer risk and explore the dose-response relationship between LTPA level and lung cancer.Methods:PubMed and Web of Science were searched up to 17 November 2021.The summary relative risks(RRs)and 95%confidence intervals(CIs)were calculated by random-effects or fixed-effects model.The dose-response analysis was conducted with restricted cubic splines.Results:We identified 25 articles(42 cohort studies)that assessed the physical activity-lung cancer association,including 9,983,295 study participants and 85,988 incident cases of lung cancer.When comparing the highest to the lowest level of TPA and LTPA,lung cancer risk reduced 22%(RR,0.78;95%CI:0.70,0.86)and 12%(RR,0.88;95%CI:0.83,0.93),respectively.We found an approximately U-shaped association between LTPA and lung cancer(P non-linearity<0.001),with the lowest risk at 15 metabolic equivalent of task hours per week(h/wk)of LTPA.Compared to participants with sitting occupations,lung cancer risk significantly increased among those being unemployed(RR,1.33;95%CI:1.17,1.51)or with standing occupations(RR,1.37;95%CI:1.15,1.63),but not among those with light or high OPA.Conclusions:Our meta-analysis supported a protective effect of TPA and LTPA,but not OPA,on lung cancer risk.The novel finding of a U-shaped association between LTPA and lung cancer risk warrants further investigation.
基金supported by the National Natural Science Foundation of China(Grant No.81473013 and No.81673210)Jiangsu Province Blue Project of UniversityInnovation of Graduate Student Training Project in Jiangsu Province(KYLX15_0976)
文摘The International Agency for Research on Cancer and the World Health Organization have designated airborne particulates, including particulates of median aerodynamic diameter 〈 2.5 gm (PM2.5), as Group 1 carcinogens. It has not been determined, however, whether exposure to ambient PM2.5 is associated with an increase in respiratory related diseases. This meta-analysis assessed the association between exposure to ambient fine particulate matter (PM2.5) and the risk of respiratory tract diseases, using relevant articles extracted from PubMed, Web of Science, and Embase. In results, of the 1,126 articles originally identified, 35 (3.1%) were included in this meta-analysis. PM2.5 was found to be associated with respiratory tract diseases. After subdivision by age group, respiratory tract disease, and continent, PM2.5 was strongly associated with respiratory tract diseases in children, in persons with cough, lower respiratory illness, and wheezing, and in individuals from North America, Europe, and Asia. The risk of respiratory tract diseases was greater for exposure to traffic-related than non-traffic-related air pollution. In children, the pooled relative risk (RR) represented significant increases in wheezing (8.2%), cough (7.5%), and lower respiratory illness (15.3%). The pooled RRs in children were 1.091 (95%CI: 1.049, 1.135) for exposure to 〈 25 gg/m3 PM2.5, and 1.126 (95%CI: 1.067, l. 190) for exposure to 〉 25 gg/m3 PM2.5. In conclusion, exposure to ambient PM2.5 was significantly associated with the development of respiratory tract diseases, especially in children exposed to high concentrations of PM2.5.
文摘TO evaluate the association between obesity and colorectal cancer risk. METHODS: We searched PubMed, EMBASE, and the Cochrane Library up to January 1, 2007. Cohort studies permitting the assessment of causal association between obesity and colorectal cancer, with clear definition of obesity and well-defined outcome of colorectal cancer were eligible. Study design, sample size at baseline, mean follow-up time, co-activators and study results were extracted. Pooled standardized effect sizes were calculated.
基金This study was partially supported by a grant from the Research Foundation in the year of 1997 of the Japan-China Medical Association (No. 001).
文摘Objective To determine whether there was excessive risk of cancer among workers exposed to chrysotile fiber alone by applying a meta-analysis technique. Methods All data meeting the criteria of cohort studies on cancer mortality among workers exposed only to chrysotile were incorporated into meta-analysis. Pooled standardized mortality ratios (SMRs) and their corresponding 95% confidence intervals (CIs) for main cancer sites were calculated using two approaches of unweighted ratio and random effect model. The heterogeneity and its sources of the results were examined with a Q-statistic and Z-score test. The dose-response effect as reflected in the percentage of all deaths due to mesothelioma served as a proxy measure of chrysotile exposure. Results A cohort of twenty six workers exposed to chrysotile alone was summarized. The significantly elevated meta-SMRs for all deaths (1.27), all cancers (1.28), cancers of respiratory organs (2.51), cancers of lung (2.35) and cancers of stomach (1.24) were observed. The significantly elevated meta-SMRs for lung cancer within occupational strata were observed among textile workers (3.55), asbestos product manufacturers (3.30), miners and millers (2.24), cement product workers (1.22), and for stomach cancer among asbestos product manufacturers (1.49). Meta-SMRs for cancers at other sites were not significant. Meta-SMR for lung cancer showed an increasing trend with an elevated percentage of all deaths from mesothelioma, but no such trend for stomach cancer. Conclusion There are excessive risks of lung cancer and mesothelioma among workers exposed to chrysotile fiber alone, and likely no convincing indication of an etiological association between chrysotile exposure and cancers at other sites.
文摘AIM:To quantitatively assess the relationship between coffee consumption and incidence of pancreatic cancer in a meta-analysis of cohort studies. METHODS:We searched MEDLINE,EMBASE,Science Citation Index Expanded and bibliographies of retrieved articles.Studies were included if they reported relative risks(RRs)and corresponding 95%CIs of pancreatic cancer with respect to frequency of coffee intake.We performed random-effects meta-analyses and metaregressions of study-specific incremental estimates to determine the risk of pancreatic cancer associated with a 1 cup/d increment in coffee consumption. RESULTS:Fourteen studies met the inclusion criteria, which included 671 080 individuals(1496 cancer events) with an average follow-up of 14.9 years.Compared with individuals who did not drink or seldom drank coffee per day,the pooled RR of pancreatic cancer was 0.82 (95%CI:0.69-0.95)for regular coffee drinkers,0.86 (0.76-0.96)for low to moderate coffee drinkers,and 0.68(0.51-0.84)for high drinkers.In subgroup analyses,we noted that,coffee drinking was associated witha reduced risk of pancreatic cancer in men,while this association was not seen in women.These associations were also similar in studies from North America,Europe, and the Asia-Pacific region. CONCLUSION:Findings from this meta-analysis suggest that there is an inverse relationship between coffee drinking and risk of pancreatic cancer.
基金Supported by National Natural Science Foundation of China,No.82174461Hospital Capability Enhancement Project of Xiyuan Hospital,CACMS,No.XYZX0201-22Technology Innovation Project of China Academy of Chinese Medical Sciences,No.CI2021A01811.
文摘BACKGROUND Patients with BRAF V600E mutant metastatic colorectal cancer(mCRC)have a low incidence rate,poor biological activity,suboptimal response to conventional treatments,and a poor prognosis.In the previous cohort study on mCRC conducted by our team,it was observed that integrated Chinese and Western medicine treatment could significantly prolong the overall survival(OS)of patients with colorectal cancer.Therefore,we further explored the survival benefits in the population with BRAF V600E mutant mCRC.AIM To evaluate the efficacy of integrated Chinese and Western medicine in the treatment of BRAF V600E mutant metastatic colorectal cancer.METHODS A cohort study was conducted on patients with BRAF V600E mutant metastatic colorectal cancer admitted to Xiyuan Hospital of China Academy of Chinese Medical Sciences and Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from January 2016 to December 2022.The patients were divided into two cohorts.RESULTS A total of 34 cases were included,with 23 in Chinese-Western medicine cohort(cohort A)and 11 in Western medicine cohort(cohort B).The median overall survival was 19.9 months in cohort A and 14.2 months in cohort B,with a statistically significant difference(P=0.038,hazard ratio=0.46).The 1-3-year survival rates were 95.65%(22/23),39.13%(9/23),and 26.09%(6/23)in cohort A,and 63.64%(7/11),18.18%(2/11),and 9.09%(1/11)in cohort B,respectively.Subgroup analysis showed statistically significant differences in median OS between the two cohorts in the right colon,liver metastasis,chemotherapy,and first-line treatment subgroups(P<0.05).CONCLUSION Integrated Chinese and Western medicine can prolong the survival and reduce the risk of death in patients with BRAF V600E mutant metastatic colorectal cancer,with more pronounced benefits observed in patients with right colon involvement,liver metastasis,combined chemotherapy,and first-line treatment.
基金supported by the Guangzhou Basic Research Plan Jointly Funded by the City,School(Hospital),and/or Enterprise(No.SL2022A03J00202)the Science and Technology Program of Guangzhou(Grant No.202102080095)+1 种基金the Characteristic Clinic Project of Guangzhou Health Commission(No.2019TS68)the Medical Science and Technology Research Foundation of Guangdong Province(No.A2022052).
文摘Objective:Psoriasis is an immune-mediated inflammatory,chronic,recurrent skin disease associated with a high risk of developing psychiatric disorders,especially depression and suicidal ideation,leading to functional disability and poor quality of life.This study was conducted to comprehensively review and assess the epidemiologic association between psoriasis and the risk ratios(RRs)of depression or suicidal ideation.Methods:Five databases(PubMed,Wanfang Database,CNKI,The Cochrane Library,and EMBASE)were searched for prospective cohort studies on the prevalence of depression and/or suicidal ideation in patients with psoriasis updated to February 2,2023.Two independent reviewers evaluated and extracted the data,which were then pooled into a summary RR with corresponding 95%confidence interval(CI)using random-effects models.Results:Sixteen cohort studies comprising 1,166,840 patients with psoriasis and 3,294,205 controls were eligible for the final analysis.The pooled RR for depression was 1.43(95%CI=1.13-1.81)in patients with psoriasis and1.55(95%CI=1.40-1.71)in patients with psoriatic arthritis.In the subgroup analysis,Asian patients with psoriasis(RR=1.38,95%CI=1.17-1.63)had a lower pooled RR for depression than non-Asian patients(RR=1.45,95%CI=1.07-1.97),and patients with moderate-to-severe psoriasis(RR=1.69,95%CI=1.15-2.50)showed a higher RR for depression than patients with mild psoriasis(RR=1.60,95%CI=1.06-2.42).We also found no increase in the RR for suicidal ideation among people with psoriasis(RR=1.25,95%CI=0.95-1.65).Conclusion:Patients with psoriasis are at an increased risk of depression.Among patients with psoriasis,those with psoriatic arthritis,those who are non-Asian,and those with moderate-to-severe psoriasis are at higher risk for depression.However,the available evidence does not support an association between psoriasis and suicidal ideation.
文摘Background The difference of cardiovascular effects between rosiglitazone and pioglitazone treatment for diabetic patients has not been thoroughly studied. We performed a meta-analysis to compare the risk of cardiovascular adverse effects in patients with type 2 diabetes treated with rosiglitazone compared to pioglitazone. Methods The Cochrane Library, PubMed, and Embase were searched to identify retrospective cohort studies assessing cardiovascular outcomes with rosiglitazone and pioglitazone. Meta-analysis of retrospective cohort studies was conducted using RevMan 5.0 software to calculate risk ratios. Results Of the 74 references identified, eight studies involving 945 286 patients fit the inclusion criteria for the analysis. The results of meta-analyses showed that, compared with pioglitazone, rosiglitazone therapy significantly increased the risk of myocardial infarction (risk ratios (RR) 1.17, 95% confidence interval (CI) 1.04-1.32; P=-0.01), the risk of heart failure (RR 1.18, 95% CI 1.02-1.36; P=0.03), and total mortality (RR 1.13, 95% CI 1.08-1.20; P 〈0.000 01). Conclusion Compared with pioglitazone, rosiglitazone was associated with an increased risk of myocardial infarction, heart failure, and all-cause mortality in diabetic patients.
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 grants from the Ministry of Science and Technology of the People’s Republic of China,(No.2020AAA0109605 to XL)grants from the National Natural Science Foundation of China(No.82272246 and 82072225 to XL)+1 种基金Science and Technology Program of Guangzhou,China(No.202206010044 to XL)High-level Hospital Construction Project of Guangdong Provincial People’s Hospital(No.DFJHBF202104 to XL).
文摘BACKGROUND:Previous studies have reported inconsistent results with positive,negative,and J-shaped associations between alcohol consumption and the hazard of aortic aneurysm and dissection(AAD).This study aimed to examine the connections between weekly alcohol consumption and the subsequent risk of AAD.METHODS:The UK Biobank study is a population-based cohort study.Weekly alcohol consumption was assessed using self-reported questionnaires and the congenital risk of alcohol consumption was also evaluated using genetic risk score(GRS).Cox proportional hazards models were used to estimate hazard ratios(HRs)with 95% confidence intervals(CIs)for the associations between alcohol consumption and AAD.Several sensitivity analyses were performed to assess the robustness of the results.RESULTS:Among the 388,955 participants(mean age:57.1 years,47.4% male),2,895 incident AAD cases were documented during a median follow-up of 12.5 years.Compared with never-drinkers,moderate drinkers(adjusted HR:0.797,95%CI:0.646-0.984,P<0.05)and moderate-heavy drinkers(adjusted HR:0.794,95%CI:0.635-0.992,P<0.05)were significantly associated with a decreased risk of incident AAD.Interaction-based subgroup analysis revealed that the protective effect of moderate drinking was reflected mainly in participants younger than 65 years and women.CONCLUSION:Our findings support a protective effect of moderate alcohol consumption on AAD,but are limited to participants younger than 65 years and women.
基金supported by the Integrated Project of Major Research Plan of the National Natural Science Foundation of China(No.92249303)National Natural Science Foundation of China(Nos.82371603,82230071,82102217)+3 种基金Shanghai Committee of Science and Technology Laboratory Animal Research Project(No.23141900600)Science and Technology Commission of Shanghai Municipality(21YF1413100)Shanghai Hospital Development Center(SHDC2023CRT013)Baoshan District Health Commission Talents(Excellent Academic Leaders)Program(BSWSYX-2024-05).
文摘Objective The aim of this study was to investigate the prospective association between physical activity(PA),independently or in conjunction with other contributing factors,and osteoporosis(OP)outcomes.Methods The Physical Activity in Osteoporosis Outcomes(PAOPO)study was a community-based cohort investigation.A structured questionnaire was used to gather the participants’sociodemographic characteristics.Bone mineral density(BMD)measurements were performed to assess OP outcomes,and the relationship between BMD and OP was evaluated within this cohort.Results From 2013 to 2014,8,471 participants aged 18 years and older were recruited from Tangshan,China’s Jidong community.Based on their PA level,participants were categorized as inactive,moderately active,or very active.Men showed higher physical exercise levels than women across the activity groups.BMD was significantly higher in the very active group than in the moderately active and inactive groups.Individuals aged>50 years are at a higher risk of developing OP and osteopenia.Conclusion The PAOPO study offers promising insights into the relationship between PA and OP outcomes,encouraging the implementation of PA in preventing and managing OP.
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.
基金The 7~(th) 5-year Nation'a] Medical Strategic Science and Technology Plan,No.75-61-02-17The 8~(th) 5-year National Medical Strategic Science and Technology Plan,No.85-914-01-09
文摘AIM: To reduce the incidence and mortality of rectal cancer and address the hypothesis that colorectal cancer often arise from precursor lesion(s), either adenomas or non-adenomatous polyps, by conducting a population-based mass screening for colorectal cancer in Haining County, Zhejiang, PRC. METHODS: From 1977 to 1980, physicians screened the population of Haining County using 15 cm rigid endoscopy. Of over 240000 participants, 4076 of them were diagnosed with precursor lesions, either adenomas or non-adenomatous polyps, which were then removed surgically. All individuals with precursor lesions were followed up and reexamined by endoscopy every two to five years up to 1998. RESULTS: After the initial screening, 953 metachronous adenomas and 417 non-adenomatous polyps were detected and removed from the members of this cohort. Further, 27 cases of colorectal cancer were detected and treated. Log-rank tests showed that the survival time among those cancer patients who under went mass screening increased significantly compared to that of other colorectal cancer patients (P【0.0001). According to the population-based cancer registry in Haining County, age-adjusted incidence and mortality of rectal cancer decreased by 41% and 29% from 1977-1981 to 1992-1996, respectively. Observed cumulative 20-year rectal cancer incidence was 31% lower than the expected in the screened group; the mortality due to rectal cancer was 18% lower than the expected in the screened group. CONCLUSION:Mass screening for rectal cancer and precursor lesions with protocoscopy in the general population and periodical following-up with routine endoscopy for high-risk patients may decrease both the incidence and mortality of rectal cancer.
基金This research Was supported by a grant from Bonfor(O-107.0022)to C. Rabe
文摘AIM: To conduct a cohort study of 101 patients with hepatocellular carcinoma (HCC) presenting to a tertiary care medical referral center in Germany between 1997 and 1999. METHODS AND RESULTS: Data were retrospectively analyzed by chart review. In 95 cases (72 males and 23 females) sufficient data were available for analysis. Twenty five (29%) of 85 patients were HBsAg or anti HBc positive, 21/85 (25%) were anti HCV positive, and 6/85 (7%) were positive for both HBV and HCV-markers. Age was significantly lower in HBV positive patients than in the other two groups. Thirty one (34%) of 90 patients had histories of alcohol abuse. In 79/94 (84%) patients, cirrhosis was diagnosed. Of these cirrhotic patients, 29/79 (37%) belonged to Child Pugh's group (CHILD) A, 32/79 (40%) to CHILD B, and 18/79 (23%) to CHILD C. AFP was elevated in 61/91 (67%) patients. A single tumor nodule was found in 38/94 (40%), more than one nodule in 31/94 (34%), and 25/94 (26%) had a diffusely infiltrating tumor, i.e. the tumor margins could not be seen on imaging procedures. Portal vein thrombosis was present in 19/94 (20%). Imaging data consistent with lymph node metastases were found in 10/92 (11%), while distant metastases were found in 8/93 (9%). According to Okuda 28/94 (30%) were grouped to stage I, 53/94 (56%) were grouped to stage II, and 13/94 (14%) were grouped to stage II. Survival data were available for 83 patients. The Kaplan-Meier estimate for median survival was 8 4 months. Factors influencing survival were the Okuda score, the presence of portal vein thrombosis, and the presence of ascites. The presence of non complicated liver cirrhosis by itself, distant metastases, or infection with hepatitis viruses did not influence survival. AFP positivity by itself did not influence survival, though patients with an AFP value greater than 100 microg/L did experience shortened survival. Treatment besides tamoxifen or supportive care was associated with prolonged survival. The influence of therapy on survival was most pronounced in Okuda stage II patients. There was longer survival in those Okuda stage II patients who were treated with percutaneous ethanol injection. CONCLUSION: Even in a low incidence area such as Germany, the majority of HCC is caused by viral hepatitis and therefore potentially preventable. Reflecting the high proportion of advanced stage tumors in our patients, the median survival was poor. Patients who received active therapy had a longer survival.
文摘IM To investigate the relationship between different sources of drinking water supply, water quality improvement and gastric cancer mortality rate in a high risk area.METHODS A retrospectivecohort survey was carried out in all towns of this county to study the effect of different sources of drinking water supply and water quality improvement on gastric cancer mortality rate.RESULTS The gastric cancer mortality rate among the population 12405/105 drinking river water was obviously higher than that of drinking shallow well water (7485/105) (P<001) according to the Zhanggang Town 16 years accumulated data. The same pattern was presented in 7 towns after balancing the confounders. The gastric cancer mortality rate of population drinking river water was 8603/105, which was higher than those drinking shallow well water (6203/105) and tap water (2978/105) (P<001). When the drinking water switched from river and well water to tap water, the gastric cancer incidence decreased to 3033/105 and 2610/105, and the gastric cancer mortality decreased by 59% and 57% respectively.CONCLUSION The quality of drinking water is one of the important factors of increased incidence of gastric cancer in Changle County, and water quality improvement has a beneficial effect, but the cause of high gastric cancer incidence may be multifactorial in this area..
基金Supported by National Natural Science Foundation of China,No.81872036.
文摘BACKGROUND Uric acid is the end product of purine metabolism.Previous studies have found that serum uric acid(SUA)levels are associated with the total cancer risk.However,due to the dual effect of uric acid on cancer,the relationship between the SUA levels and most specific-site cancer remains unclear.AIM To investigate the associations between the SUA levels and incidence of hepatobiliary-pancreatic cancer.METHODS In this prospective cohort study,444462 participants free of cancer from the UK Biobank were included.The SUA levels were measured at baseline,and the incidence of hepatobiliary-pancreatic cancer was determined by contacting the cancer registry.The hazard ratios(HRs)and 95%confidence intervals(CIs)between the SUA levels and hepatobiliary-pancreatic cancer were investigated using multiple adjusted Cox regression models adjusted for potential confounders.RESULTS In total,920 participants developed liver,gallbladder,biliary tract or pancreatic cancer during a median of 6.6 yrs of follow-up.We found that the HR of pancreatic cancer in the highest SUA group was 1.77(95%CI:1.29-2.42)compared with that in the lowest group.After stratifying by gender,we further found that SUA was associated with an increased risk of pancreatic cancer only among the females(highest quartile vs lowest quartile HR 2.04,95%CI:1.35-3.08).Among the males,the SUA levels were positively associated with the gallbladder cancer risk(highest quartile vs lowest quartile HR 3.09,95%CI:1.28-7.46),but a U-shaped association with the liver cancer risk was observed(P-nonlinear=0.03).CONCLUSION SUA is likely to have gender-specific effects on hepatobiliary-pancreatic cancer.High SUA levels are a risk factor for pancreatic cancer in females and gallbladder cancer in males.A U-shaped association with the liver cancer risk was identified.
文摘Inflammatory bowel diseases(IBDs) are characterized by a chronic course with an alternation of relapses and remissions.Questions about prognosis are important for the patient who wants to know how the disease will affect his/her life and also for clinicians to make management decisions.Correct selection of the patients is the basis for good methodological studies on the course of IBD.A great proportion of data on the course of IBD is derived from a limited number of cohort studies.Studies help to define the endpoints for clinical trials and to identify subsets of patients in whom the prognosis of the disease can be stratified according to clinical features.Specific scientific requirements for high-quality studies on prognosis are the following:use of inception cohort,description of referral patterns,completeness of follow-up,objective outcome criteria,blind outcome assessment,adjustment for extraneous prognostic factors and statistical issues.We analyzed each of these requirements in studies on IBDs.To date,prospective and populationbased cohort studies are the standard for an unbiased assessment of prognosis.A better knowledge of the course of disease of chronic disorders ideally requires:(1) data from population-based studies,to avoid selection bias from referral centers in which patients with a more severe disease are usually treated;(2) inclusion of patients seen at the onset of the disease excluding misdiagnosed cases;and(3) follow-up from the onset of the disease to the end without dropouts.
基金supported by the National Natural Science Foundation of China(Grant no:81172761)by a Project of the Priority Academic Program Development of Jiangsu Higher Education Institutions
文摘Objective Waist circumference, waist-to-hip ratio and waist-to-height ratio, which are the indicators or measures of abdominal adiposity, have long been hypothesized to increase the risk of stroke; yet evidence accumulated till date is not conclusive. Here, we conducted a dose-response meta-analysis to summarize evidences of the association between these measures of abdominal adiposity and the risk of stroke. Methods PubMed and Web of Science databases were searched from inception to May 2015. Two investigators independently conducted the study selection and data extraction. Dose-response relationships were assessed by the generalized least squares trend estimation, while the summary effect estimates were evaluated by the use of fixed- or random-effect models. Subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity and the robustness of the pooled estimation. Publication bias of the literature was evaluated using Begg's and Egger's test. Results Altogether 15 prospective cohort studies were identified in this study. The summary of relative risks (95% confidence intervals) of stroke for the highest versus the lowest categories was 1.28 (1.18-1.40) for waist circumference, 1.32 (1.21-1.44) for waist-to-hip ratio, and 1.49 (1.24-1.78) for waist-to-height ratio. For a 10-cm increase in waist circumference, the relative risk of stroke increased by 10%; for a 0.1-unit increase in waist-to-hip ratio, the relative risk increased by 16%; and for a 0.05-unit increase in waist-to-height ratio, the relative risk increased by 13%. There was evidence of a nonlinear association between waist-to-hip ratio and stroke risk, Pnonlinearity=0.028, Conclusion Findings from our meta-analysis indicated that waist circumference, waist-to-hip ratio, and waist-to-height ratio were positively associated with the risk of stroke, particularly ischemic stroke.