Plant-based dietary patterns and risk of esophageal cancer:A prospective cohort study spanning 17 years

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.

Could saline irrigation clear all residual common bile duct stones after lithotripsy?A self-controlled prospective cohort study

BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct(CBD)stones,which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.AIM To determine whether saline irrigation can improve CBD clearance after lithotripsy.METHODS This prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large(>1.2 cm)CBD stones.After occlusion cholangiography confirmed CBD stone clearance,peroral cholangioscopy(POC)was performed to determine clearance scores based on the number of residual stones.The amounts of residual stones spotted via POC were graded on a 5-point scale(score 1,worst;score 5,best).Scores were documented after only stone removal(control)and after irrigation with 50 mL and 100 mL saline,respectively.The stone composition was analyzed using infrared spectroscopy.RESULTS Between October 2018 and January 2020,47 patients had CBD clearance scores of 2.4±1.1 without saline irrigation,3.5±0.7 with 50 mL irrigation,and 4.6±0.6 with 100 mL irrigation(P<0.001).Multivariate analysis showed that CBD diameter>15 mm[odds ratio(OR)=0.08,95%confidence interval(CI):0.01-0.49;P=0.007]and periampullary diverticula(PAD)(OR=6.51,95%CI:1.08-39.21;P=0.041)were independent risk factors for residual stones.Bilirubin pigment stones constituted the main residual stones found in patients with PAD(P=0.004).CONCLUSION Irrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy,especially in patients with PAD and/or a dilated(>15 mm)CBD.Pigment residual stones are soft and commonly found in patients with PAD.Additional saline irrigation may be required to remove retained stones.

Recovery from prolonged disorders of consciousness:A dual-center prospective cohort study in China

BACKGROUND Recent innovations in intensive care have improved the prognosis of patients with severe brain injuries and brought more patients with disorders of consciousness(DoC).Data are lacking regarding the long-term outcomes of those patients in China.It is necessary to study the long-term outcomes of patients with prolonged DoC in light of many factors likely to influence crucial decisions about their care and their life.AIM To present the preliminary results of a DoC cohort.METHODS This was a two-center prospective cohort study of inpatients with vegetative state(VS)/unresponsive wakefulness syndrome(UWS).The study outcomes were the recovery from VS/UWS to minimally conscious state(MCS)and the long-term status of patients with prolonged DoC considered in VS/UWS or MCS for up to 6 years.The patients were evaluated using the Glasgow coma scale,coma recovery scale-revised,and Glasgow outcome scale.The endpoint of follow-up was recovery of full consciousness or death.The changes in the primary clinical outcome improvement in clinical diagnosis were evaluated at 12 mo compared with baseline.RESULTS The study population included 93 patients(62 VS/UWS and 31 MCS).The postinjury interval range was 28-634 d.Median follow-up was 20 mo(interquartile range,12-37 mo).At the endpoint,33 transitioned to an emergence from MCS or full consciousness,eight had a locked-in syndrome,and there were 35 patients remaining in a VS/UWS and 11 in an MCS.Seven(including one locked-in syndrome)patients(7.5%)died within 12 mo of injury.Compared with the unresponsive group(n=52)at 12 mo,the responsive group(n=41)had a higher proportion of males(87.8%vs 63.5%,P=0.008),shorter time from injury(median,40.0 d vs 65.5 d,P=0.006),higher frequency of vascular etiology(68.3%vs 38.5%,P=0.007),higher Glasgow coma scale score at admission(median,9 vs 6,P<0.001),higher coma recovery scale-revised score at admission(median,9 vs 2.5,P<0.001),at 1 mo(median,14 vs 5,P<0.001),and at 3 mo(median,20 vs 6,P<0.001),lower frequency of VS/UWS(36.6%vs 90.0%,P<0.001),and more favorable Glasgow outcome scale outcome(P<0.001).CONCLUSION Patients with severe DoC,despite having strong predictors of poor prognosis,might recover consciousness after a prolonged time of rehabilitation.An accurate initial diagnosis of patients with DoC is critical for predicting outcome and a long-term regular follow-up is also important.

Combined Influence of Insulin Resistance and Inflammatory Biomarkers on Type 2 Diabetes:A Population-based Prospective Cohort Study of Inner Mongolians in China

This prospective study was designed to examine the combined influence of insulin resistance（IR）and inflammatory biomarker levels on type 2 diabetes mellitus（T2DM）among 1,903Inner Mongolians.

Association between gastrointestinal heat retention syndrome and respiratory tract infections in children:A prospective cohort study

Objective:To explore the relationship between gastrointestinal heat retention syndrome and the incidence of pneumonia and recurrent respiratory tract infections(RRTIs)in children.Methods:A prospective cohort study was conducted in the pediatric outpatient department of Beijing Dongfang Hospital.Children without respiratory tract infections(RTIs)were consecutively recruited according to the selection criteria.A semi-structured questionnaire was used to record traditional Chinese medicine(TCM)symptoms and demographic and physiological characteristics.Gastrointestinal heat retention syndrome was considered to be a predisposing factor and was diagnosed according to a scale with reliability and validity.The participants were followed up for 12 months.Participants and their parents or guardians were contacted via clinical interviews and telephone every 6 months.Episodes of pneumonia and RTIs were recorded in detail.Results:A total of 420 children were included.Of participants,370(88.10%)were followed up for 12 months.The mean number of RTI episodes per participant was 5.37(95%CI:5.14 to 5.60).In total,186 participants in the gastrointestinal heat retention syndrome group and 184 participants in the nongastrointestinal heat retention syndrome group completed the 12-month follow-up period.The baseline of both groups was comparable.The incidence of RRTIs in children with gastrointestinal heat retention syndrome was 1.27(95%CI:1.01 to 1.59)times that in children without gastrointestinal heat retention syndrome.Logistic regression analysis revealed that abnormally increased appetite with frequent hunger,foul breath,dry stools,and dark red or purple fingerprints were positively correlated with the incidence of pneumonia.Irascibility and feverish feelings in the palms and soles were positively correlated with the occurrence of RRTI.Conclusions:Gastrointestinal heat retention syndrome is a risk factor for RRTIs in children.Studies with larger sample sizes and longer follow-up time are warranted to confirm the degree of causal risk associated with RTIs.

Comparing the Diagnostic Criteria of MAFLD and NAFLD in the Chinese Population:A Population-based Prospective Cohort Study

Background and Aims:Metabolic dysfunction-associ-ated fatty liver disease(MAFLD)is a new concept,pro-posed in 2020;however,its applicability in Asia populations has yet to be evaluated.Therefore,we aimed to compare the difference in epidemiological and clinical characteris-tics between MAFLD and non-alcoholic fatty liver disease(NAFLD)among Asian populations.Methods:Based on the Jinchang cohort,30,633 participants were collected.The prevalence and incidence of MAFLD and NAFLD were used to analyze the epidemic characteristics and its overlapping effects.In addition,the corresponding clinical character-istics of the two diagnostic criteria populations were com-pared.Results:The prevalence rates of MAFLD and NAFLD were 21.03%and 18.83%,respectively.After an average 2.28-year follow-up,the incidence densities of MAFLD and NAFLD were 41.58 per 1,000 person-years and 37.69 per 1,000 person-years,respectively.With the increase of baseline age,body mass index(BMI),and waist circumfer-ence(WC)levels,the prevalence and incidence of MAFLD and NAFLD were on the rise(all ptrend<0.05).Among the total patients diagnosed at baseline or follow-up,most pa-tients had both MAFLD and NAFLD,accounting for 78.84%and 82.88%,respectively.Compared with NAFLD,MAFLD patients had greater proportions of males and metabolic diseases(diabetes,dyslipidemia),and had higher BMI,WC,liver enzymes,blood glucose,and lipid levels in the base-line diagnosis patients(p<0.05).Additionally,lean MAFLD patients had higher metabolic disorders than lean NAFLD patients(p<0.05).Conclusions:Compared with NAFLD,the newly proposed definition of MAFLD is more practical and accurate,and it can help identify more fatty liver pa-tients with high-risk diseases.

Local excision of ciliary body tumors： a long-term prospective cohort study in China

Background Ciliary body tumors are usually difficult to diagnose and treat in early stages. However, treatment of such tumors has trended toward ocular conservation instead of enucleation. Local excision of ciliary body tumors has become effective with the development of the modern vitrectomy, but long-term outcomes are still not clear. Therefore, we reported the outcome of locally excised ciliary body tumors after long-term follow-up. Methods Twenty-two patients （22 eyes）, who had been diagnosed with ciliary body tumors in Beijing Tongren Hospital from January 1996 to June 2001, were enrolled in this prospective cohort study. Localized lamellar sclera-ciliary excisions were performed. In some cases, vitrectomies, scleral graft transplantations, and further excisions of the anterior choroid were performed. Diagnoses were confirmed by histopathologic examination. Patients were followed from five to eleven years after surgery. Their visual acuity, intraocular pressure and local recurrence were recorded with descriptive percentages. Results After surgery, all patients maintained normal eyeball appearances. Six patients maintained circular pupils. The final best corrected visual acuities （BCVA） varied from 0.02-1.00, including 18 patients （81.82%） who had BCVA equal to or better than that before surgery. Fifteen patients （68.18%） had BCVA better than 0.3. Only two patients had intraocular pressure （lOP） of less than 10 mmHg and the other patients maintained normal lOP. Nine cases （40.91%） were given confirmed diagnosis of malignant melanoma, four （18.18%） of melanocytoma, six （27.27%） of nonpigmented ciliary epithelial adenoma, two （9.09%） of neurofibroma, and one （4.55%） of neurinoma. Twenty patients （90.91%） had no recurrence during the follow-up period. In one case melanocytoma recurred seven years after surgery and enucleation was performed. One patient, whose operation removed a malignant melanoma with a diameter of 16 mm, died of hepatic metastasis five years after the operation. Conclusion For some ciliary body tumors, especially in the early stages, local excision is an effective and safe method to save the vision and the eyeball.

Are tuberculosis patients adherent to prescribed treatments in China? Results of a prospective cohort study

Background:Tuberculosis(TB)patients face numerous difficulties adhering to the long-term,rigorous TB treatment regimen.Findings on TB patients’treatment adherence vary across existing literature and official reports.The present study attempted to determine the actual treatment adherence of new TB patients and to identify factors leading to non-adherence.Methods:A prospective cohort of 481 newly confirmed TB patients from three counties in western China were enrolled during June to December 2012 and was followed until June 2013.Patients who missed at least one dose of drugs or one follow-up re-examination during the treatment course were deemed as non-adherent.Influencing factors were identified using a logistic regression model.Results:A total of 173(36.0%)patients experienced non-adherence and the loss to follow-up cases reached 136(28.2%).Only 13.9%of patients took drugs under direct observation,and 60.5%of patients were supervised by phone calls.Factor analyses suggested that patients who were observed by family members(OR:5.54,95%CI:2.87–10.69)and paying monthly service expenses above 450 RMB(OR:2.08,95%CI:1.35–3.19)were more likely to be non-adherent,while supervision by home visit(OR:0.06,95%CI:0.01–0.28)and phone calls(OR:0.27,95%CI:0.17–0.44)were protective factors.Conclusions:Despite recent efforts,a large proportion of newly confirmed TB patients could not adhere to standard TB treatment,and patients’lost to follow-up was still a serious problem.Poor treatment supervision and heavy financial burden might be the main causes for non-adherence.More needs to be done to enhance treatment supervision policies and financial supports to both health providers and TB patients.

The relationship between physical activity in early pregnancy and hypertensive disorders of pregnancy: a cohort study in Chinese women

BACKGROUND:We aimed to examine prospective associations between diff erent intensities and diff erent types of physical activity(PA)in early pregnancy and hypertensive disorders of pregnancy(HDP)among Chinese women.METHODS:A total of 6,820 pregnant women from the Tongji-Shuangliu Birth Cohort were included in this study.The pregnancy physical activity questionnaire(PPAQ)was used to assess PA,including household/caregiving,occupational,sports/exercise,and transportation activities in the first trimester of pregnancy.The diagnosis of HDP was collected,including gestational hypertension(GH)and preeclampsia(PE).Data were analyzed by unconditional multivariate logistic regression,and the odds ratio(OR)and 95%confi dence interval(CI)were calculated.RESULTS:A total of 178(2.6%)of the 6,820 women were diagnosed with HDP,of which 126(1.8%)were GH and 52(0.8%)were PE.Overall,we found no association between PA in early pregnancy and PE.A trend toward lower risk was found only among women with GH and among those with higher levels of moderate-to-vigorous intensity physical activity(MVPA)(adjusted OR 0.54,95%CI 0.31–0.96).No association was observed between PA and HDP in early pregnancy,regardless of diff erent intensities or types of PA.CONCLUSION:MVPA in the first trimester is an influencing factor of HDP.Encouraging pregnant women to engage in MVPA in the fi rst trimester may help to prevent GH.

A community-based prospective cohort study of dengue viral infection in Malaysia: the study protocol

Background:Globally,dengue infections constitute a significant public health burden.In recent decades,Malaysia has become a dengue hyper-endemic country with the co-circulation of the four dengue virus serotypes.The cyclical dominance of sub-types contributes to a pattern of major outbreaks.The consequences can be observed in the rising incidence of reported dengue cases and dengue related deaths.Understanding the complex interaction of the dengue virus,its human hosts and the mosquito vectors at the community level may help develop strategies for addressing the problem.Methods:A prospective cohort study will be conducted in Segamat district of Johor State in Peninsular Malaysia.Researchers received approval from the Malaysian Medical Research Ethics Committee and Monash University Human Research Ethics Committee.The study will be conducted at a Malaysian based health and demographic surveillance site over a 1 year period in three different settings(urban,semi-urban and rural).The study will recruit healthy adults(male and female)aged 18 years and over,from three ethnic groups(Malay,Chinese and Indian).The sample size calculated using the Fleiss method with continuity correction is 333.Sero-surveillance of participants will be undertaken to identify asymptomatic,otherwise healthy cases;cases with dengue fever who are managed as out-patients;and cases with dengue fever admitted to a hospital.A genetic analysis of the participants will be undertaken to determine whether there is a relationship between genetic predisposition and disease severity.A detailed medical history,past history of dengue infection,vaccination history against other flaviviruses such as Japanese encephalitis and Yellow fever,and the family history of dengue infection will also be collected.In addition,a mosquito surveillance will be carried out simultaneously in recruitment areas to determine the molecular taxonomy of circulating vectors.Discussion:The research findings will estimate the burden of asymptomatic and symptomatic dengue at the community level.It will also examine the relationship between virus serotypes and host genotypes,and the association of the clinical manifestation of the early phase with the entire course of illness.

A comparison of efficacy and safety between Chinese generic imatinib and branded imatinib in patients with newly-diagnosed chronic myeloid leukemia in the chronic phase:a single-center prospective cohort study

Objective To compare the efficacy and safety between Chinese generic imatinib(Xinwei~,Jiansu Hansoh Pharmaceutical Group Co.,Ltd.)and branded imatinib(Glivec~,Novartis)in patients with newly-diagnosed chronic myeloid leukemia in chronic phase(CML-CP).Methods Patients with newly diagnosed CML-CP

Changes in muscle strength and risk of cardiovascular disease among middle-aged and older adults in China:Evidence from a prospective cohort study

Background:Evidence indicates that low muscle strength is associated with an increased cardiovascular diseases(CVDs)risk.However,the association between muscle strength changes based on repeated measurements and CVD incidence remains unclear.Methods:The study used data from the China Health and Retirement Longitudinal Study in 2011(Wave 1),2013(Wave 2),2015(Wave 3),and 2018(Wave 4).Low muscle strength was defined as handgrip strength<28 kg for men or<18 kg for women,or chair-rising time≥12 s.Based on changes in muscle strength from Waves 1 to 2,participants were categorized into four groups of Normal-Normal,Low-Normal,Normal-Low,and Low-Low.CVD events,including heart disease and stroke,were recorded using a self-reported questionnaire during Waves 3 and 4 visits.Cox proportional hazards models were used to investigate the association between muscle strength changes and CVD incidence after multivariable adjustments.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)were estimated with the Normal-Normal group as the reference.Results:A total of 1164 CVD cases were identified among 6608 participants.Compared to participants with sustained normal muscle strength,the CVD risks increased progressively across groups of the Low-Normal(HR=1.20,95%CI:1.01-1.43),the Normal-Low(HR=1.35,95%CI:1.14-1.60),and the Low-Low(HR=1.76,95%CI:1.49-2.07).Similar patterns were observed for the significant associations between muscle strength status and the incidence risks of heart disease and stroke.Subgroup analyses showed that the significant associations between CVD and muscle strength changes were consistent across age,sex,and body mass index(BMI)categories.Conclusions:The study found that muscle strength changes were associated with CVD risk.This suggests that continuous tracking of muscle status may be helpful in screening cardiovascular risk.

Association of maternal hypertensive disorders in pregnancy with infant neurodevelopment

Inconsistent findings have been reported regarding the associations between hypertensive disorders in pregnancy (HDP) and infant neurodevelopment. Leveraging data from the Jiangsu Birth Cohort, in the present study, we re-visited such associations in one-year-old infants from 2 576 singleton pregnancies and 261 twin pregnancies. We first assessed infant neurodevelopment by the Bayley Scales of Infant and Toddler Development Screening Test (the Third Edition), and then estimated its association with maternal HDP using general linear regression models and Poisson regression models. In singleton pregnancies, compared with mothers unexposed to HDP, infants born to mothers with chronic hypertension exhibited a lower score (β, −0.67;95% confidence interval [CI], −1.19-−0.15) and a higher risk of "non-optimal" gross motor development (risk ratio [RR], 2.21;95% CI, 1.02-4.79);in twin pregnancies, infants born to mothers with HDP exhibited lower scores in cognition (β, −0.49;95% CI, −0.96-−0.01), receptive communication (β, −0.55;95% CI, −1.03-−0.06), and gross motor (β, −0.44;95% CI, −0.86-−0.03), and at a higher risk of "non-optimal" gross motor development (RR, 2.12;95% CI, 1.16-3.88). These findings indicate that infants born to mothers with HDP may have inferior neurodevelopment outcomes at the age of one year.

A prospective comparison cohort study between baseline serum uric acid level and coronary artery disease in first-degree relatives and non-first-degree relatives of type 2 diabetes males

Objective To investigate the relationship between baseline serum uric acid and the severity of coronary artery disease(CAD)in the first-degree relatives or nonfirst-degree relatives of men with type 2 diabetes.Methods Three hundred and eighty-one men with negative coronary angiography for the first time were divided into diabetes and non-diabetes groups and followed-up for

Association between the Neutrophil-to-lymphocyte Ratio and New-onset Subclinical Macrovascular and Microvascular Diseases in the Chinese Population

Objective The association between neutrophil-to-lymphocyte ratio(NLR)with subclinical macrovascular and microvascular diseases has been less investigated.We sought to examine the association between NLR and new-onset subclinical macrovascular and microvascular abnormalities in the Chinese population.Methods From a community cohort,we included 6,430 adults aged≥40 years without subclinical macrovascular and microvascular diseases at baseline.We measured subclinical macrovascular and microvascular abnormalities separately using the ankle-brachial index(ABI),brachial-ankle pulse wave velocity(baPWV),and albuminuria.Results During a mean follow-up of 4.3 years,110 participants developed incident abnormal ABI,746 participants developed incident elevated baPWV,and 503 participants developed incident albuminuria.Poisson regression analysis indicated that NLR was significantly associated with an increased risk of newonset abnormal ABI,elevated baPWV,and albuminuria.Compared to overweight/obese participants,we found a much stronger association between NLR and subclinical vascular abnormalities in participants with normal weight.Furthermore,we found an interaction between the NLR and body mass index(BMI)on the risk of new-onset abnormal ABI(P for interaction:0.01).Conclusion NLR was associated with subclinical macrovascular and microvascular diseases in the Chinese population.Furthermore,in participants with normal weight,the association between NLR and subclinical vascular abnormalities was much stronger.

High Frequency Ultrasound in Determining the Causes of Acute Shoulder Joint Pain

Shoulder ultrasonography is approved as the examination of choice for rotator cuff abnormality in many centers around the world since it is an inexpensive and safe tool for investigation of rotator cuff abnormalities. The goal of this study was to determine the ultrasound findings in patients with acute shoulder joint pain, and also to identify possible predictors of shoulder pain, as well as to compare the ultrasound diagnostic performance to that of MRI in such condition. A total of 65 (mean age 28 ± 1.2 years) consequential patients were recruited for a period of six months between July 2015 and June 2016 in this study. Collected data were confined on age, medical history, and clinical symptoms. Shoulder ultrasound was performed with a linear array transducer (10 - 15 MHz) connected to HI vision Avius ultrasound unit;Hitachi. MRI for the shoulder joint was performed in all cases to confirm the ultrasound results, using 1.5-T MRI system (Magnetom Espree);Siemens. Statistical analysis was completed using the standard Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) version 20 for windows. Ultrasound manages to determine the causes of acute shoulder joint pain in 98% of the patients. Fitted achievement values for shoulder ultrasound in the diagnosis the causes of shoulder joint pain were 100% sensitivity and a range of 96% to 100% of accuracy. Ultrasound presents a high sensitivity and accuracy in diagnosis a wide spectrum of shoulder joint lesions, with a diagnostic performance near to that of MRI.