Reflections on four decades of physical activity epidemiology

In 1985,Public Health Reports published a series of papers prepared for a workshop sponsored by the Centers for Disease Control and Prevention(CDC).1 Building on the seminal work of Jeremy Morris and Ralph Paffenbarger Jr.,who were among the first to use epidemiological methods to study physical activity(PA),2,3 the workshop itself was the result of a growing scientific understanding of the importance of“physical fitness and exercise for improving the health of the public”.

2024 Adult Compendium of Physical Activities:A third update of the energy costs of human activities

Background:The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity(PA)across studies.The original version was updated in 2000,and again in 2011,and has been widely used to support PA research,practice,and public health guidelines.Methods:This 2024 update was tailored for adults 19-59 years of age by removing data from those≥60 years.Using a systematic review and supplementary searches,we identified new activities and their associated measured metabolic equivalent(MET)values(using indirect calorimetry)published since 2011.We replaced estimated METs with measured values when possible.Results:We screened 32,173 abstracts and 1507 full-text papers and extracted 2356 PA energy expenditure values from 701 papers.We added303 new PAs and adjusted 176 existing MET values and descriptions to reflect the addition of new data and removal of METs for older adults.We added a Major Heading(Video Games).The 2024 Adult Compendium includes 1114 PAs(912 with measured and 202 with estimated values)across 22 Major Headings.Conclusion:This comprehensive update and refinement led to the creation of The 2024 Adult Compendium,which has utility across research,public health,education,and healthcare domains,as well as in the development of consumer health technologies.The new website with the complete lists of PAs and supporting resources is available at https://pacompendium.com.

A brief history of the Compendium of Physical Activities

The Compendium of Physical Activities(Compendium)was developed to address consistent assignment of physical activity(PA)intensity values used in PA epidemiology research of the association between PA and health outcomes.1The known protective effects of PA on incident health outcomes traces to the mid-1900s,with over 50 studies examining coronary heart disease(CHD)as the outcome of interest.

Development,validation,and transportability of several machine-learned,non-exercise-based VO_(2max)prediction models for older adults

Background:There exist few maximal oxygen uptake(VO_(2max))non-exercise-based prediction equations,fewer using machine learning(ML),and none specifically for older adults.Since direct measurement of VO_(2max)is infeasible in large epidemiologic cohort studies,we sought to develop,validate,compare,and assess the transportability of several ML VO_(2max)prediction algorithms.Methods:The Baltimore Longitudinal Study of Aging(BLSA)participants with valid VO2_(max)tests were included(n=1080).Least absolute shrinkage and selection operator,linear-and tree-boosted extreme gradient boosting,random forest,and support vector machine(SVM)algorithms were trained to predict VO_(2max)values.We developed these algorithms for:(a)the overall BLSA,(b)by sex,(c)using all BLSA variables,and(d)variables common in aging cohorts.Finally,we quantified the associations between measured and predicted VO_(2max)and mortality.Results:The age was 69.0±10.4 years(mean±SD)and the measured VO_(2max)was 21.6±5.9 mL/kg/min.Least absolute shrinkage and selection operator,linear-and tree-boosted extreme gradient boosting,random forest,and support vector machine yielded root mean squared errors of 3.4 mL/kg/min,3.6 mL/kg/min,3.4 mL/kg/min,3.6 mL/kg/min,and 3.5 mL/kg/min,respectively.Incremental quartiles of measured VO_(2max)showed an inverse gradient in mortality risk.Predicted VO_(2max)variables yielded similar effect estimates but were not robust to adjustment.Conclusion:Measured VO_(2max)is a strong predictor of mortality.Using ML can improve the accuracy of prediction as compared to simpler approaches but estimates of association with mortality remain sensitive to adjustment.Future studies should seek to reproduce these results so that VO_(2max),an important vital sign,can be more broadly studied as a modifiable target for promoting functional resiliency and healthy aging.

A comparative study on antimicrobial susceptibility of uroculturome of humans in health and urinary tract infections

Background:The uroculturome indicates the profile of culturable microbes inhabiting the urinary tract,and it is often required to do a urine culture to find an effective antimicrobial to treat urinary tract infections(UTIs).Methods:This study targeted to understand the profile of culturable pathogens in the urine of apparently healthy(128)and humans with clinical UTIs(161)and their antimicrobial susceptibility.All the urine samples were analyzed to quantify microbial load and determine the diversity and antimicrobial susceptibility of microbes following standard microbiological methods.Results:In urine samples from UTI cases,microbial counts were 1.2×10^(4)±6.02×10^(3) colony-forming units(cfu)/mL,while in urine samples from apparently healthy humans,the average count was 3.33±1.34×10^(3) cfu/mL.In eight samples(six from UTI cases and two from apparently healthy people,Candida(C.albicans 3,C.catenulata 1,C.krusei 1,C.tropicalis 1,C.parapsiplosis 1,C.gulliermondii 1)and Rhizopus species(1)were detected.Candida krusei was detected only in a single urine sample from a healthy person and C.albicans was detected both in urine of healthy and clinical UTI cases.Gram-positive(G+ve)bacteria were more commonly(Odds ratio,1.98;CI99,1.01-3.87)detected in urine samples of apparently healthy humans,and Gram-negative(G−ve)bacteria(Odds ratio,2.74;CI99,1.44-5.23)in urines of UTI cases.From urine samples of 161 UTI cases,a total of 90 different types of microbes were detected and,73 samples had only a single type of bacteria.In contrast,49,29,3,4,1,and 2 samples had 2,3,4,5,6 and 7 types of bacteria,respectively.The most common bacteria detected in urine of UTI cases was Escherichia coli(52 samples),in 20 cases as the single type of bacteria,other 34 types of bacteria were detected in pure form in 53 cases.From 128 urine samples of apparently healthy people,88 types of microbes were detected either singly or in association with others,from 64 urine samples only a single type of bacteria was detected while 34,13,3,11,2 and 1 sample yielded 2,3,4,5,6 and seven types of microbes,respectively.In the urine of apparently healthy humans too,E.coli was the most common bacteria,(10 samples)followed by Staphylococcus haemolyticus(9),S.intermedius(5),and S.aureus(5),and similar types of bacteria also dominated in cases of mixed occurrence,E.coli was detected in 26,S.aureus in 22 and S.haemolyticus in 19 urine samples,respectively.G+ve bacteria isolated from urine samples’irrespective of health status were more often(P<0.01)resistant than G−ve bacteria to ajowan oil,holy basil oil,cinnamaldehyde,and cinnamon oil,but more susceptible to sandalwood oil(P<0.01).However,for antibiotics,G+ve were more often susceptible than G−ve bacteria to cephalosporins,doxycycline,and nitrofurantoin.Conclusion:The study concludes that to understand the role of good and bad bacteria in the urinary tract microbiome more targeted studies are needed to discern the isolates at the pathotype level.Further,the study suggests the use of antibiotics by observing good antibiotic stewardship following antibiotic susceptibility testing only.

The effect of carbapenem resistance in Klebsiellae on infection outcomes in animals and birds

It is often said that the emergence of antimicrobial drug resistance(AMR)in pathogens is the major cause of mortality.In the present study,clinical microbiology data on infections caused by Klebsiella pneumoniae strains and their antimicrobial drug resistance specifically to carbapenems retrieved from Clinical Epidemiology database of the Institute were analysed to determine the impact of carbapenem resistance in Klebsiellae isolated from the clinical samples of veterinary cases and outcome of the infection because in a few recent reports it is claimed that the presence of carbapenem-resistant Klebsiellae is associated with higher mortality in humans due to Klebsiella infections.The retrospective analysis of Klebsiella infections in animals and birds revealed that 21.8%of K.pneumoniae causing pneumonic or septicemic infections were carbapenem-resistant but the carbapenem resistance was not associated with increased numbers of deaths or recovery.It may be probably due to the fact that carbapenem drugs were not used for the treatment of infected animals and carbapenem resistance may not be associated with the lethality potential of Klebsiellae.

Excipient effect on antimicrobial activity of Cinnamon (Cinnamomum zelylanicum album) oil, Thyme (Thymus vulgaris) oil and Ajowan (Trachyspermum ammi) oil

Background:Many herbal essential oils are potential antimicrobials but their pharmaceutical utility is restricted due to a lack of suitable excipients to mollify their dermatotoxicity and irritant property,and outcome of their therapeutic use may vary with different diluents used.Methods:Effect of 16 diluents(dimethyl sulfoxide,liquid paraffin,glycerine,oils of mustard,sunflower,rice bran,palm,groundnut,olive,coconut,sesame,avocado,jojoba,castor,linseed and soybean)was assessed on antimicrobial activity of 2%cinnamon(Cinnamomum zelylanicum album),thyme(Thymus vulgaris)and ajowan(Trachyspermum ammi)oils using agar well diffusion assay.The effect of excipients was evaluated on six Candida albicans,five Escherichia coli,four Acinetobacter lwoffii,two strains each of Staphylococcus aureus,Enterobacter agglomerans,and Enterococcus faecium and one strain each of Acinetobacter calcoaceticus,Escherichia fergusonii,Klebsiella oxytoca,K.pneumoniae ssp.pneumoniae,Leclercia adecarboxylata,Paenibacillus amylolyticus,Proteus mirabilis,P.vulgaris,Pseudomonas aeruginosa,Raoultella terrigena,Staphylococcus capitis ssp.capitis,S.chromogenes,S.epidermidis,S.warneri and Streptococcus pyogenes.Results:Thyme oil(2%)maintained it antimicrobial activity on dilution in dimethyl sulfoxide and glycerine,and ajowan oil(2%)completely lost its antibacterial activity in all diluents except dimethyl sulfoxide.However,cinnamon oil partially lost its antimicrobial activity upon dilution in glycerine,vegetable,and mineral oils in comparison to dimethyl sulfoxide.Olive oil was the best vegetable oil,almost comparable to dimethyl sulfoxide and castor oil was the worst diluent for maintaining antimicrobial activity of cinnamon oil.Conclusion:The study indicated the non-suitability of vegetable oils for pharmaceutical formulations of essential oils except olive oil for dilution of cinnamon oil and glycerol for thyme oil to replace dimethyl sulfoxide as diluent.

Effect of picking multiple colonies on antimicrobial susceptibility diagnostic outcome in a clinical bacteriology setting

giving results of antimicrobial susceptibility testing(AST)even if the infection is detected due to a single type of bacteria.However,what should be the minimum number of colonies?The clinical laboratory manuals are silent and give different numbers.Thus,the present study was conducted to evaluate the impact of picking up more than one colony for antimicrobial susceptibility.Method:The study was conducted on those clinical samples yielding Escherichia coli either as pure culture or as a prominent cause of infection.The impact of testing multiple colonies of Escherichia coli isolates was assessed on AST results through the detection of extended-spectrum β-lactamase(ESBL)producing and Metallo-β-lactamase(MBL)producing Escherichia coli carriage in clinical samples.Results:A total of 1031 samples having E.coli as the most prominent or single pathogen were analyzed.It included testing either one,two,three,four,five,or more than five(6-10)representative E.coli colonies from 526,247,115,76,31,and 36 samples,respectively.The study revealed that testing of less than three representative colonies significantly(p<0.05)impacts the outcome.However,the best outcome was when≥6 representative colonies were tested for AST.Conclusion:The study suggested that≥6 representative colonies should be emulsified for antimicrobial susceptibility tests not to miss possible infection with ESBL or MBL-producing mutants,even in mono-culture infections.

Lifestyle improvement and the reduced risk of cardiovascular disease:the China-PAR project

BACKGROUND The benefits of healthy lifestyles are well recognized. However, the extent to which improving unhealthy lifestyles reduces cardiovascular disease(CVD) risk needs to be discussed. We evaluated the impact of lifestyle improvement on CVD incidence using data from the China-PAR project(Prediction for Atherosclerotic Cardiovascular Disease Risk in China).METHODS A total of 12,588 participants free of CVD were followed up for three visits after the baseline examination. Changes in four lifestyle factors(LFs)(smoking, diet, physical activity, and alcohol consumption) were assessed through questionnaires from the baseline to the first follow-up visit. Cox proportional hazard models were used to estimate hazard ratios(HRs) and corresponding 95% confidence intervals(CIs). The risk advancement periods(RAPs: the age difference between exposed and unexposed participants reaching the same incident CVD risk) and population-attributable risk percentage(PAR%) were also calculated.RESULTS A total of 909 incident CVD cases occurred over a median follow-up of 11.14 years. Compared with maintaining 0-1healthy LFs, maintaining 3–4 healthy LFs was associated with a 40% risk reduction of incident CVD(HR = 0.60, 95% CI: 0.45–0.79)and delayed CVD risk by 6.31 years(RAP:-6.31 [-9.92,-2.70] years). The PAR% of maintaining 3–4 unhealthy LFs was 22.0%compared to maintaining 0-1 unhealthy LFs. Besides, compared with maintaining two healthy LFs, improving healthy LFs from 2to 3–4 was associated with a 23% lower risk of CVD(HR = 0.77, 95% CI: 0.60–0.98).CONCLUSIONS Long-term sustenance of healthy lifestyles or improving unhealthy lifestyles can reduce and delay CVD risk.

Comparative antimicrobial activity of Moricin(naturally produced by silk worm,Bombyx mori larvae)against clinically important pathogens

With the emergence and spread of antimicrobial resistance(AMR)it becomes pertinent to search for an antimicrobial alternative to cater for the imminent need to control total drug-resistant(TDR)and multiple-drug-resistant(MDR)infections.Antimicrobial peptides(AMPs)have shown some promise and this study was designed to evaluate antimicrobial activity of Moricin(a naturally produced AMP by silkworm,Bombyx mori larvae)against 276 microbial strains of 83 species.Only two(Erwinia amylovora 1,Hafnia alvei 1)strains were classified as susceptible to Moricin at a concentration≤8μg/mL.If susceptibility criteria were set at MIC equivalent to≤128μg/mL then Moricin inhibited 17 strains.All of the Bacillus species strains and majority of the strains of Acinetobacter,Aeromonas,Enterococcus,Erwinia,Raoultella,and Serratia species were significantly(p<0.05)more often resistant(MIC>512μg/mL)to Moricin than strains belonging to Alacligenes,Bacillus,Escherichia,Klebsiella,Pantoea,Pasteurella,Salmonella,Staphylococcus and Streptococcus species.Susceptibility of different bacteria not only varied significantly to Moricin but also to most of the commonly used antibiotics.The susceptibility of microbes not only affected by their type but also by their source of origin.The study concluded that Moricin has a wide spectrum but limited potential to inhibit clinically important microbial strains belonging to different species and genera.

The assessment of good and bad bacteria in holy basil(Ocimum sanctum)leaves

Holy basil(Tulsi,Ocimum sanctum)is considered to be a pious plant.It is used not only in many of the rituals of Hindus but is also known for its innumerable medicinal qualities.Holy basil leaves(HBLs)are often consumed raw thus it is pertinent to detect the bacteria on Tulsi leaves.This study was conducted to understand the diversity of the aerobically growing microbiome of edible holy basil leaves.A total of 112 samples of leaves were collected from households of six localities in and around Bareilly,India for detecting culturable bacteria growing aerobically.A sum of 579 bacterial isolates belonging to 106 different species was identified.Pantoea agglomerans isolates were detected in 43 samples followed by isolates Virgibacillus pantothenticus(21),Bacillus coagulans(18),Bacillus cereus(17),Geobacillus stearothermophilus(16),Klebsiella pneumoniae(13),Citrobacter freundii(12),Lysinibacillus sphaericus(12),Acinetobacter calcoaceticus(11),Escherichia coli(11),and Xenorhabdus bovienii(11).Isolates of 95 species of bacteria were detected on<10 samples of HBLs.Of 579 isolates,161 isolates detected in 68(60.71%)samples were of putatively good bacteria belonging to eight genera(Bacillus,Brevibacillus,Lysinibacillus,Paenibacillus,Photobacter,Siccibacter,Virgibacillus,Xenoirhabdus)and 23 species.However,418 bacterial isolates detected in 108(96.43%)of the HBL samples were classified as potentially pathogenic for humans and animals belonging to 34 genera and 73 species.There were only four samples(three from Mahanagar and one from Bhojipura)that had no potential pathogenic bacteria detected in this study.The analysis indicated that HBL leaves from the ICAR-IVRI campus had a lower probability(P<0.04)of harbouring good bacteria than samples from Bhojpura,Mahanagar,North City and Rajendra Nagar.Cinnamaldehyde inhibiting 96.72%of the isolates and carvacrol inhibiting 96.37%of the isolates were the best herbal antimicrobials and among antibiotics,meropenem inhibited 98.96%of bacterial isolates.Antimicrobial resistance in non-pathogenic or good bacteria was significantly more common(P<0.01)for ajowan oil but they were more often(P<0.05)susceptible to holy basil oil,lemongrass oil,citral,P.embalica leaf extract,P.longifolia seed oil,nitrofurantoin,ciprofloxacin,chloramphenicol,colistin and minocycline than isolates of potentially pathogenic bacteria.The study concludes that HBLs may harbour both good and bacteria,and should be consumed raw only after proper decontamination.

Kinematic Analysis of Patients before and after Abdominoplasty

Background: Abdominoplasty has consistently been one of the top cosmetic procedures performed each year with a high patient satisfaction rate. Excision of the excess abdominal skin has been shown to reduce low back pain and improve posture. The effects of the excess skin removal would, theoretically, be demonstrated through changes in gait. This study aimed to measure kinematic differences during gait to obtain objective measures for abdominoplasty. Methods: Subjects were recruited from a large, academic plastic surgery clinic. Patients were included if they were 18 years of age, able to walk without an assistive device or any hindrance by any existing medical condition, and were scheduled for abdominoplasty. Kinematic measurements were taken before and after surgery using a plug-in-gait marker set, cameras, and a treadmill. Pre- and postoperative measurements were compared and a post-hoc power analysis was created. Results: Nine total patients were included in the study. Joint angles before and after surgery demonstrated moderate differences. However, analysis revealed few significant differences for spatiotemporal or kinematic variables. The power analysis demonstrated an inadequate number of patients to detect significance. Conclusions: Despite the literature describing subjective and objective improvements following abdominoplasty, we were unable to validate this. Overall, there were noticeable differences in joint angles pre- and postoperatively, though the study is too underpowered to reach statistical significance. This preliminary data shows that if the study was powered through a larger cohort, then more generalizable conclusions could be drawn.

Comparative antimicrobial activity in Murrah buffalo (Bubalus bubalis) Heifers’ urine and urine distillate

Background:Murrah buffalo is a breed of water buffalo(Bubalus bubalis)reared for milk and meat,especially in Northern India.There are so many studies on the antimicrobial potential of the cow(Bos indicus)urine but buffalo urine has rarely been studied.This study was aimed to evaluate the antimicrobial activity in whole buffalo urine and its distillate.Methods:Urine specimens were collected from seven Murrah buffalo heifers in the morning over three days from all seven heifers and distillated to prepare urine distillate(UD).The antimicrobial activity was determined through 96 well microplate method diluting(1:1)urine and UD in Mueller Hinton liquid medium against 919 microbial strains belonging to 148 species of 49 genera(Candia,11 genera of Gram+ve bacteria,37 genera of Gram-ve bacteria).The test strains were taken from the repository,revived and tested for purity before testing.The test strains were of clinical origin(372),environmental origin(496)and also from reference strain repositories(51).Results:Of the 919 test strains,a total of 57.89%and 56.04%of the tested strains were susceptible to UD and urine,respectively.There was a no significant(p>0.4)difference in the antimicrobial activity of UD and urine against 919 strains of microbes,regardless of their genus,species,and Gram staining reaction.Similarly,there was no significant(p>0.4)difference between the susceptibility of bacterial and Candida strains to UD or urine.However,strains of clinical origin were more often resistant to buffalo UD and urine(p<0.01)than strains isolated from environmental sources irrespective of their Gram staining characteristics(p>0.05).A significantly(p<0.01)higher proportion of reference strains was susceptible to UD and urine than microbial strains of clinical and environmental origin.For buffalo urine and UD,the most susceptible strains were Stenotrophomonas maltophilia(13/13)followed by Citrobacter freundii(8/10);Salmonella enterica ssp.enterica(21/27),Geobacillus stearothermophilus(23/30),Staphylococcus aureus(13/17),and Paenibacillus larvae(7/10)strains.The most resistant strains belonged to Acinetobacter calcoaceticus(15/20)species followed by strains of Paenibacillus alvei(11/16),Edwardsiella tarda(20/30),Bacillus megaterium(7/11)and Escherichia coli(59/110)species.There was insignificant(p,>0.05)difference in susceptibility of strains of different species of the same genus;however,among all the Bacillus species strains of B.coagulans were the most susceptible(66.7%)and strains of B.megaterium were the least susceptible(36.4%),similarly Enterococcus faecium strains were more susceptible(68.2%)than strains of Enterococcus faecalis(38.9%),70%strains of P.larvae were susceptible to urine and UD but only 31.3%of strains of P.alvei were susceptible.Strains of Klebsiella pneumoniae and Raoultella terrigena,earlier belonging to the same genus Klebsiella,had comparable susceptibility to buffalo urine and UD.Conclusion:The study concluded that buffalo urine may be a potential antimicrobial and may be explored further for identification of active antimicrobial compounds in buffalo urine.

Histological changes of gastric mucosa after Helicobacter pylori eradication:a systematic review and meta-analysis

AIM: To systematically review pathological changes of gastric mucosa in gastric atrophy (GA) and intestinal metaplasia (IM) after Helicobacter pylori (H. pylori) eradication.

Polymorphisms of alcohol dehydrogenase-2 and aldehyde dehydrogenase-2 and esophageal cancer risk in Southeast Chinese males

AIM： To evaluate the impact of alcohol dehydrogenase-2 （ADH2） and aldehyde dehydrogenase-2 （ALDH2） polymorphisms on esophageal cancer susceptibility in Southeast Chinese males.METHODS： Two hundred and twenty-one esophageal cancer patients and 292 healthy controls from Taixing city in Jiangsu Province were enrolled in this study. ADH2 and ALDH2 genotypes were examined by polymerase chain reaction and denaturing high-performance liquid chromatography. Unconditional logistic regression was used to calculate the odds ratios （OR） and 95% confidence interval （CI）.RESULTS： The ADH G allele carriers were more susceptible to esophageal cancer, but no association was found between ADH2 genotypes and risk of esophageal cancer when disregarding alcohol drinking status. Regardless of ADH2 genotype, ALDH2G/A or A/A carriers had significantly increased risk of developing esophageal cancer, with homozygous individuals showing higher esophageal cancer risk than those who were heterozygous. A significant interaction between ALDH2 and drinking was detected regarding esophageal cancer risk; the OR was 3.05 （95% CI： 2.49-6.25）. Compared with non-drinkers carrying both ALDH2 G/G and ADH2 A/A, drinkers carrying both ALDH2 A allele and ADH2 G allele showed a significantly higher risk of developing esophageal cancer （OR = 8.36, 95% CI： 2.98-23.46）.CONCLUSION： Both ADH2 G allele and ALDH2 A allele significantly increase the risk of esophageal cancer development in Southeast Chinese males. ALDH2 A allele significantly increases the risk of esophageal cancer development especially in alcohol drinkers. Alcohol drinkers carrying both ADH2 G allele and ALDH2 A allele have a higher risk of developing esophageal cancer.

CYP2E1 RsaⅠpolymorphism impacts on risk of colorectal cancer association with smoking and alcohol drinking

AIM： To investigate associations between the Rsa I polymorphism of CYP2E1 and risk of colorectal cancer. METHODS： A case-control study was conducted with 315 colorectal cancer cases （105 colon, 210 rectal） and 439 population-based controls in Jiangsu Province of China. Genomic DNA samples were assayed for restriction fragment length polymorphisms in CYP2E1 by PCR amplification followed by digestion with Rsa I. Information on smoking and alcohol drinking was collected using a questionnaire. Odds ratios （ORs） were estimated with an unconditional logistic model. RESULTS： The proportional distribution of the CYP2E1 Rsa I c1/c1, c1/c2 and c2/c2 genotypes were 61.4%, 35.6% and 3.0% in controls, 60.6%, 33.7% and 5.8% in colon cancer cases, and 58.4%, 34.0% and 7.7% in rectal cancer cases, respectively. A significant differencewas noted between controls and rectal cancer cases （P = 0.029）, the c2/c2 genotype being associated with elevated OR （adjusted age, sex and status of the smoking and alcohol drinking） for rectal cancer （1.64, 95% CI, 1.12-2.41, vs cl allele carriers）, but not for colon cancer. In interaction analysis between the CYP2E1 Rsa I genotype and smoking and drinking habits, we found a significant cooperative action between the c2/c2 genotype and alcohol drinking in the sex-, age-adjusted ORs for both colon （4.74, 95% CI, 1.10-20.40） and rectal （5.75, 95% CI, 1.65-20.05） cancers. Among nonsmokers, the CYP2E1 Rsa I c2/c2 genotype was also associated with elevated ORs in the two sites （1.95, 95% CI, 0.99-3.86 and 2.30, 95% CI, 1.32-3.99）. CONCLUSION： The results of the present study suggest that the CYP2E1 c2/c2 genotype increases susceptibility to rectal cancer and the gene-environmental interactions between the CYP2E1 polymorphism and smoking or alcohol drinking exist for colorectal neoplasia in general.

Population attributable risks of cigarette smoking for deaths of all causes, all cancers and other chronic diseases among adults aged 40-74 years in urban Shanghai, China

Objective： To evaluate the population attributable risks （PARs） between cigarette smoking and deaths of all causes, all cancers, lung cancer and other chronic diseases in urban Shanghai. Methods： In total, 61,480 men aged 40-74 years from 2002 to 2006 and 74,941 women aged 40-70 years from 1997 to 2000 were recruited to undergo baseline surveys in urban Shanghai, with response rates of 74.0% and 92.3%, respectively. A Cox proportional hazards regression model was used to estimate relative risks （RRs） and 95% confidence intervals （95% CIs） of deaths associated with cigarette smoking. PARs and 95 % CIs for deaths were estimated from smoking exposure rates and the estimated RRs. Results： Cigarette smoking was responsible for 23.9% （95% CI： 19.4-28.3%） and 2.4% （95% Ch 1.6- 3.2%） of all deaths in men and women, respectively, in our study population. Respiratory disease had the highest PAR in men [37.5% （95% CI： 21.5-51.6%）], followed by cancer [31.3% （95% Ch 24.6-37.7%）] and cardiovascular disease （CVD） [24.1% （95% CI： 16.7-31.2%）]. While the top three PARs were 12.7% （95% CI： 6.1-19.3%）, 4.0% （95% CI： 2.4-5.6%）, and 1.1% （95% CI： 0.0-2.3%）, for respiratory disease, CVD, and cancer, respectively in women. For deaths of lung cancer, the PAR of smoking was 68.4% （95% CI： 58.2- 76.5%） in men. Conclusions： In urban Shanghai, 23.9% and 2.4% of all deaths in men and women could have been prevented if no people had smoked in the area. Effective control programs against cigarette smoking should be strongly advocated to reduce the increasing smoking-related death burden.

Breastfeeding and genetic factors in the etiology of inflammatory bowel disease in children

Inflammatory bowel disease is a chronic,debilitating disorder of the gastrointestinal tract.The etiology of inflammatory bowel disease has not been elucidated,but is thought to be multifactorial with both environmental and genetic influences.A large body of research has been conducted to elucidate the etiology of inflammatory bowel disease.This article reviews this literature,emphasizing the studies of breastfeeding and the studies of genetic factors,particularly NOD2 polymorphisms.

Beneficial effects of moderate to vigorous physical activity on cardiovascular disease among Chinese adults

Background In China,lack of evidence remains a significant challenge for the national initiative to promote physical activity(PA).We aimed to quantify the beneficial effects of meeting or maintaining the recommended PA level[150 minutes per week(min/wk)of moderate PA or 75 min/wk of vigorous PA or an equivalent combination]on incident cardiovascular disease(CVD)among Chinese population.Methods We included 100,560 participants without history of CVD from three cohorts in the Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project.Cox proportional hazards models were used to estimate hazard ratios(HRs)and 95%confidence intervals(CIs)for CVD events and its subtypes,including stroke,coronary heart disease,heart failure,and CVD death.Results During a median follow-up of 7.3 years(range:6–15 years),777,163 person-years and 4693 incident CVD events were observed.Compared with participants who were inactive at baseline,the multivariable adjusted HR(95%CI)of developing CVD was 0.74(0.69–0.79)for those who met recommended moderate to vigorous physical activity(MVPA)level at baseline.Furthermore,the risk of CVD incidence was reduced with increment of MVPA(Ptrend<0.001),and the HR(95%CI)of highly-active versus inactive category was 0.62(0.56–0.68).Compared with individuals who were inactive both at the baseline and follow-up,those keeping active over the period of follow-up had a substantial lower risk of incident CVD with the HR(95%CI)of 0.57(0.43–0.77).Conclusions The findings demonstrated that meeting and maintaining the recommended MVPA level could reduce the cardiovascular risk.Wider adoption of the PA recommendations would have considerable health impacts to the Chinese population.

Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.