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.

Clinical characteristics and outcome of autoimmune pancreatitis based on serum immunoglobulin G4 level:A single-center,retrospective cohort study

BACKGROUND Autoimmune pancreatitis(AIP)has been linked with elevated immunoglobulin(Ig)G4 levels.The characteristics and outcomes of AIP based on serum markers have not been fully evaluated.AIM To compare clinical features,treatment efficacy,and outcome of AIP based on serum IgG4 levels and analyze predictors of relapse.METHODS A total of 213 patients with AIP were consecutively reviewed in our hospital from 2006 to 2021.According to the serum IgG4 level,all patients were divided into two groups,the abnormal group(n=148)with a high level of IgG4[>2×upper limit of normal(ULN)]and the normal group(n=65).The t-test or Mann-Whitney U test was used to compare continuous variables.Categorical parameters were compared by theχ^(2) test or Fisher’s exact test.Kaplan-Meier curves Zhou GZ et al.Clinical characteristics and outcome of AIP WJG https://www.wjgnet.com 5126 September 21,2023 Volume 29 Issue 35 and log-rank tests were established to assess the cumulative relapse rates.Univariate and multivariate analyses were used to investigate potential risk factors of AIP relapse.RESULTS Compared with the normal group,the abnormal group had a higher average male age(60.3±10.4 vs 56.5±12.9 years,P=0.047);higher level of serum total protein(72.5±7.9 g/L vs 67.2±7.5 g/L,P<0.001),IgG4(1420.5±1110.9 mg/dL vs 252.7±106.6 mg/dL,P<0.001),and IgE(635.6±958.1 IU/mL vs 231.7±352.5 IU/mL,P=0.002);and a lower level of serum complement C3(100.6±36.2 mg/dL vs 119.0±45.7 mg/dL,P=0.050).In addition,a lower number of cases with abnormal pancreatic duct and pancreatic atrophy(23.6%vs 37.9%,P=0.045;1.6%vs 8.6%,P=0.020,respectively)and a higher rate of relapse(17.6%vs 6.2%,P=0.030)were seen in the abnormal group.Multivariate analyses revealed that serum IgG4[(>2×ULN),hazard ratio(HR):3.583;95%confidence interval(CI):1.218–10.545;P=0.020]and IgA(>1×ULN;HR:5.908;95%CI:1.199–29.120;P=0.029)and age>55 years(HR:2.383;95%CI:1.056–5.378;P=0.036)were independent risk factors of relapse.CONCLUSION AIP patients with high IgG4 levels have clinical features including a more active immune system and higher relapse rate.Several factors,such as IgG4 and IgA,are associated with relapse.

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.

Edible mushrooms as a potent therapeutics of subclinical thyroid dysfunction among adults,especially in obese individuals:a prospective cohort study

Background:Mushrooms are a good source of many nutrients which are potentially beneficial for chronic diseases.We speculated that due to its abundant nutrients edible mushrooms might have a beneficial effect on the prevention of subclinical thyroid dysfunction(SCTD).Therefore,we designed a large-scale cohort study to examine whether mushrooms consumption is a protective factor for SCTD in adults.Methods:This prospective cohort study investigated 6631 participants(mean age:(45.0±10.2)years;55.1%men).Edible mushrooms consumption was measured at baseline using a validated food frequency questionnaire.SCTD was defined as abnormal serum thyroid-stimulating hormone levels and normal free thyroxine.Cox proportional hazards regression models were used to examine the association of edible mushrooms consumption with incident SCTD.Results:During follow-up period,a total of 262 new cases of SCTD were identified,the incidence rate of subclinical hypothyroidism was 8.9/1000 person-years and subclinical hyperthyroidism was 7.2/1000 person-years.After adjusting potential confounding factors,the multivariable hazard ratios(95%confidence intervals)for subclinical hypothyroidism were 1.00(reference)for almost never,0.53(0.29,0.97)for 1-3 times/week and 0.30(0.10,0.87)for≥4 times/week(P for trend=0.02).It also showed edible mushrooms consumption was inversely associated with subclinical hypothyroidism in obese individuals but not non-obese individuals,the final hazard ratios(95%confidence intervals)were 0.14(0.03,0.73)(P for trend<0.01).Conclusions:This population-based prospective cohort study has firstly demonstrated that higher edible mushrooms consumption was significantly associated with lower incidence of subclinical hypothyroidism among general adult population,especially in obese individuals.

LipoCol Forte capsules reduce the risk of liver cancer:A propensity score-matched,nationwide,population-based cohort study

BACKGROUND Liver cancer is among the top five most common cancers globally. Lipid-lowering drugs such as statins can lower the risk of liver cancer, but may also cause liver damage. LipoCol Forte capsules(LFC), a red yeast rice product, have demonstrated significant antihypercholesterolemic effects and a good safety profile in clinical studies.AIM To evaluate whether LFC lowers the risk of liver cancer in adults in this propensity score-matched, nationwide, population-based cohort study.METHODS We used data from Taiwan’s National Health Insurance Research Database, which includes electronic medical records for up to 99.99% of Taiwan’s population. LFC users and LFC non-users were matched 1:1 by propensity scores between January 2010 and December 2017. All had followup data for at least 1 year. Statistical analyses compared demographic distributions including sex, age, comorbidities, and prescribed medications. Cox regression analyses estimated adjusted hazard ratios(aHRs) after adjusting for potential confounders.RESULTS We enrolled 33231 LFC users and 33231 non-LFC users(controls). No significant differences between the study cohorts were identified regarding comorbidities and medications [standardized mean difference(SMD) < 0.05]. At follow-up, the overall incidence of liver cancer was significantly lower in the LFC cohort compared with controls [aHR 0.91;95% confidence interval(CI): 0.86-0.95;P < 0.001]. The risk of liver cancer was significantly reduced in both females(aHR 0.87;95%CI: 0.8-0.94;P < 0.001) and males(aHR 0.93;95%CI: 0.87-0.98;P < 0.01) in the LFC cohort compared with their counterparts in the non-LFC cohort. The antitumor protective effects applied to patients with comorbidities(including hypertension, ischemic stroke, diabetes mellitus, hyperlipidemia, hepatitis B infection and hepatitis C infection). Those using LFC for more than 84 drug days had a 0.64-fold lower risk of liver cancer compared with controls(P < 0.001). Compared with controls, the risk of developing liver cancer in the LFC cohort progressively decreased over time;the lowest incidence of liver cancer occurred in LFC users followed-up for more than 6 years(27.44 vs 31.49 per 1,000 person-years;aHR 0.75;95%CI: 0.68-0.82;P < 0.001).CONCLUSION This retrospective cohort study indicates that LFC has a significantly protective effect on lowering the risk of liver cancer, in a dose-dependent and time-dependent manner.

Coffee consumption and risk of type 2 diabetes mellitus in Asians:A meta-epidemiological study of population-based cohort studies

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.

Acupuncture for stroke cohort construction:a protocol describing a multicenter,prospective,real-world cohort construction study

Background:Acupuncture for stroke has been endorsed by the World Health Organization,and the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018 lists acupuncture for stroke as a Level II recommendation with Level B evidence.The efficacy of acupuncture in the treatment of acute ischaemic stroke needs to be approved by more high-quality studies.However,there are currently no real-world studies of acupuncture for stroke.Methods:Stroke patients who meet the study criteria and are hospitalized from February 2021 to March 2022 in 23 medical institutions across China,including the First Teaching Hospital of Tianjin University of Chinese Medicine.The number of patients planned to be recruited is 3,000.Due to the impact of COVID-19,we have applied to the competent authorities for an extension(recruit patients until December 2022).Basic patient information and treatment information will be registered at admission,at discharge,and on the following dates after the onset of the disease:90±7 days,180±7 days,and 360±7 days after the onset of the disease.Establish a database for statistical analysis.Discussion:This study proposes to conduct a prospective cohort study of acupuncture intervention for stroke in a real-world medical setting.Analysis of the effect pattern of acupuncture intervention on the recovery of neurological function system and swallowing disorder in stroke patients.Evaluate the long-term effects of acupuncture intervention for stroke and recurrence of cardiovascular and cerebrovascular events.

A 12-year cohort study on the efficacy of plasmaderived hepatitis B vaccine in rural newborns

AIM To understand the anti-HBs persistenceand the long-term preventive efficacy in ruralnewborns after vaccination with plasma-derivedhepatitis B vaccine.METHODS In the time of expanded program onimmunization(EPI),the newborns werevaccinated with 10μg×3 doses of hepatitis Bvaccine and 762 newborns who were HBsAgnegative after primary immunization wereselected for cohort observation from 1986 to1998.Their serum samples were detectedqualitatively and quantitatively for hepatitis Binfecting markers,including HBsAg,anti-HBsand anti-HBc by SPRIA Kits.The annual HBsAgpositive conversion rate was counted by life-table method.RESULTS①The anti-HBs positive rate was94.44% for the babies born to HBsAg negativemothers and 84.21% for those born to HBsAgpositive mothers in the 1st year afterimmunization,and dropped to 51.31% and52.50% in the 12th year respectively.GMT valuewas dropped from 31.62 to 3.13 and 23.99 to 3.65in the 2nd to the 12th year respectively.Therewas a marked drop in GMT at the 3rd to the 5thyear,and in anti-HBs positive rate at the 9th tothe 10th year.②In the period of 12 yearsobservation,the person-year HBsAg positive conversion rates were 0.12%(5/4150.0)innewborns born to HBsAg negative mothers and0.20%(1/508.0)in those born to HBsAgpositive mothers,and none of the HBsAgpositive converted children became HBsAgchronic carriers.Compared with the baselinebefore immunization,the protective rates were97.19% and 95.32% respectively.CONCLUSION The protective efficacy ofplasma-derived hepatitis B vaccine persisted atleast 12 years,and a booster dose seems notnecessary within at least 12 years after theprimary three-doses immunization to newbornsborn to HBsAg negative mothers.

Effect of exposure to ambient PM2.5 pollution on the risk of respiratory tract diseases： a meta-analysis of cohort studies

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.

Silicosis in Automobile Foundry Workers: A 29-Year Cohort Study

Objectives The purposes were to determine the relationship between silicosis among foundry workers and their cumulative exposure to silica dust, and to establish a regression model to predict the risk for developing silicosis by a given length of employment and air concentrations of silica at worksites. Methods A 29-year cohort study was conducted, including all those employed for more than one year during January 1, 1980 to December 31, 1996 and all members of the cohort were followed-up to December 3 1, 2008. In total, 2 009 workers of an automobile foundry in Shiyan, Hubei province were recruited in the study, 1 300 at eight worksites including sand preparation, cast shakeout, and finishing, melting, moulding, core-making, overhead crane operation and pouring as exposed group, and the other 709 auxiliary workers at the same factory, such as electricians, inspectors, fitters, and so on, as control group. Person-years of observation were calculated by persons observed and years followed-up for each of them. Person-year incidence of silicosis and its relative risk （RR） or odds ratio （OR） and 95% confidence intervals （CI） among the workers were estimated, adjusted for relevant factors with logistic regression model using SPSS version 15.0 software. Results Totally, 2 009 workers were followed-up for 37 151 person-years and 48 cases of silicosis were found, with an overall incidence of 1.34 per thousand, 2.02 per thousand in exposed group, and 0.15 per thousand in control one. Risk of silicosis was significantly higher in the exposed group than that in the control one （RR=13.13, 95% CI 3.18-54.13）, higher in men than that in women （RR=13.92, 95% CI 1.92-100.93）. Risks of silicosis varied by job, highest in those exposed to cast shakeout and finishing （RR=28.14, 95% CI 6.43-123.11）, followed by those exposed to pouring （RR-22.23, 95% CI 5.01-98.55） in the foundry. Average length of employment at onset of silicosis was 25.94 years, and silicosis incidence increased with length of employment. Average age at onset of silicosis was 47.83 years old. The risk of silicosis in workers with pulmonary tuberculosis was 2.57 folds as those without it （P〈0.01）. Ten deaths were recorded in those with silicosis, with a case-fatality rate of 20.83 percent three of them died of lung cancer, three of liver cancer, two of ischemic heart disease, and two of other diseases as their immediate causes of death. Incidence of silicosis in foundry workers positively correlated with their cumulative silica exposure （OR-3.00, 95% CI 2.34-3.83）. Risks of silicosis increased by 4.38 folds with an increase of 1 mg/m^3-year of cumulative silica exposure, and by 3.79 folds with smoking, respectively, adjusted for alcohol drinking and age. Based on a logistic regression model fitted, incidence of silicosis is expected to be 44.6 per thousand for those with daily exposure to silica of 4.18 mg/m^3 in average for 30 years, and if incidence of silicosis is expected to be less than 1 per thousand, daily exposure to silica should be controlled below 0.2 mg/m^3 for those with 20 years of employment, or below 0.1 mg/m^3 for those with 30 or 40 years of silica exposure. Conclusions At present, foundry workers in China still face high risk of developing silicosis. For lowering occurrence of silicosis in exposed workers, it seems necessary that current occupational exposure limits for silica at worksites in China should be reexamined and silica dust control measures be strengthend.

Alcohol Drinking, Dyslipidemia, and Diabetes： A Population-based Prospective Cohort Study among Inner Mongolians in China

Objective No previous studies have evaluated the association between dyslipidemia, alcohol drinking, and diabetes in an Inner Mongolian population. We aimed to evaluate the co-effects of drinking and dyslipidemia on diabetes incidence in this population. Methods The present study was based on 1880 participants from a population-based prospective cohort study among Inner Mongolians living in China. Participants were classified into four subgroups according to their drinking status and dyslipidemia. Multivariate logistic regression analysis and receiver operating characteristic （ROC） curves were used to evaluate the association between alcohol drinking, dyslipidemia, and diabetes. Results During the follow-up period, 203 participants were found to have developed diabetes. The multiva riable-adjusted odds ratios （95% confidence interval） for the incidence of non-dyslipidemia/drinkers, dyslipidemia/non-drinkers, and dyslipidemia/drinkers in diabetic patients were 1.40 （0.82-2.37）, 1.73 （1.17-2.55）, and 2.31 （1.38-3.87）, respectively, when compared with non-dyslipidemia/non-drinkers. The area under the ROC curve for a model containing dyslipidemia and drinking status along with conventional factors （AUC=0.746） was significantly （P=O.003） larger than the one containing only conventional factors （AUC=0.711）. Conclusion The present study showed that dyslipidemia was an independent risk factor for diabetes, and that drinkers with dyslipidemia had the highest risk of diabetes in the Mongolian population. These findings suggest that dyslipidemia and drinkin8 status may be valuable in predicting diabetes incidence.

Nickel-exposed Workers in China: A Cohort Study

There are more than S0 000 workers in Jinchuan Group Co, Ltd （JNMC）. Since all staff in JNMC are eligible for a medical examination every two years, only 23 484 nickel-exposed subjects who participated in medical examination were included in this study. Their data, collected from June 22, 2011 to September 28, 2012, in a comprehensive epidemiological survey and during medical examinations, permitted an extensive evaluation of the relation between metal exposure, gene, epigenetics and risk of human diseases. Their lifestyle investigation showed that the overall prevalence of current smokers, alcohol drinkers, and tea drinkers was 39.1%, 19.7%, and 55.2%, respectively. The prevalence of hypertension, allergic rhinitis and cholecystitis, the top 3 prevalent diseases, was 11.7%, 11.0%, and 8.9%, respectively.

Survival and clinical outcomes in patients with metastatic epidural spinal cord compression after spinal surgery:a prospective,multicenter,observational cohort study

Background:High quality studies have been challenging to undertake in patients with metastatic epidural spinal cord compression.Nonetheless,in the article "Survival and Clinical Outcomes in Surgically Treated Patients With Metastatic Epidural Spinal Cord Compression:Results of the Prospective Multicenter AOSpine Study" recently published in the Journal of Clinical Oncology,our team provided convincing evidence that spinal surgery improves overall quality of life in patients with this potentially devastating complication of cancer.Considering that metastatic spinal lesions treated with surgery have the highest mean cost among all oncological musculo-skeletal issues,it is essential to provide high quality data to optimize the therapeutic approaches and cost-effective use of health care resources.Main body:Although the AOSpine Study provided high quality prospective data,it was primarily limited by the lack of non-operative controls and the relatively small sample size.Given the dearth of medical equipoise and the fundamental difference between patients deemed to be adequate surgical candidates and those who are not amenable to operative intervention,conducting a randomized controlled trial in this patient population was not felt to be ethically or medically feasible.Consequently,the optimal option to overcome limitations of both the lack of controls and the relatively small sample size is through collection of large prospective datasets through rigorously developed and maintained registries.Conclusions:With the alarming increase in the incidence of cancer in China and China's parallel growing cancer control efforts,China would offer a fantastic platform to set up a national metastatic spinal lesion registry.Such registry would not only enhance metastatic epidural spinal cord compression translational research but also optimize patient care.

Relationship between different sources of drinking water,water quality improvement and gastric cancer mortality in Changle County--A retrospectivecohort study in high incidence area

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Combined Effect of Smoking and Obesity on Coronary Heart Disease Mortality in Male Veterans:A 30-year Cohort Study

Objective Evidence is lacking regarding the combined effects of smoking and obesity on mortality from coronary heart disease in male veterans.This study aimed to explore the combined effect of smoking and obesity on coronary heart disease mortality in male veterans in China.Methods A cohort of 1,268 male veterans from 22 veteran centers in Xi’an(Shaanxi Province,China)were followed up once every 2 years from February 1,1987 to October 30,2016.The endpoint was death from any cause.The hazard ratio(HR)of each risk factor and the 95%confidence interval(CI)were calculated using a multivariate Cox proportional hazard model.Results The total follow-up was 24394.21 person-years;each subject was followed up for a mean duration of 19.24 years.By the end of the study,of the 1,268 veterans,889 had died,363 were alive,and 16 were lost to follow-up.Cox regression analysis results revealed that current smoking(HR:1.552,95%CI:1.074–2.243),obesity(HR:1.625,95%CI:1.024–2.581),and the combined effect of the two factors(HR:2.828,95%CI:1.520–5.262)were associated with coronary heart disease mortality.Conclusion Our results suggest that obese veterans who smoke might be an important target population for coronary heart disease mortality control.

Different metabolic/obesity phenotypes are differentially associated with development of prediabetes in adults: Results from a 14-year cohort study

BACKGROUND The risk of developing prediabetes based on the metabolic/obesity phenotypes has been poorly investigated. AIM To examine the association of baseline metabolic/obesity phenotypes and their changes over time with the risk of prediabetes development. METHODS In a population-based cohort study, 1741 adults (aged > 19 years) with normal blood glucose were followed for 14 years. Anthropometric and biochemical measures were evaluated regularly during the follow-up period. According to body mass index and metabolic health status, participants were categorized into four groups: Metabolically healthy normal weight (MHNW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW) and metabolically unhealthy obese (MUO). Multivariable Cox regression analysis was used to measure the risk of prediabetes according to the baseline metabolic/obesity phenotype and their changes during the follow-up. RESULTS In the whole population with a mean (95CCI for mean) follow up duration of 12.7 years (12.6-12.9), all three MUNW, MHO, MUO groups were at higher risk for developing prediabetes compared to the MHNW group (P = 0.022). The MUNW group had the highest risk for developing prediabetes (hazard ratio (HR): 3.84, 95%CI: 1.20, 12.27). In stratified analysis by sex, no significant association was found in men, while women in the MUNW group were at the greatest risk for prediabetes (HR: 6.74, 95%CI: 1.53, 29.66). Transforming from each phenotype to MHNW or MHO was not related to the risk of prediabetes development, whereas transforming from each phenotype to MUO was associated with an increased risk of prediabetes (HR > 1;P < 0.05). CONCLUSION Our findings indicate that MHO is not a high risk, unless it transforms into MUO over time. However, people in the MUNW group have the greatest risk for developing prediabetes, and therefore, they should be screened and treated.

Effect of tumor necrosis factor inhibitors on rheumatoid arthritis-induced peripheral neuropathy A cohort study

In this historical cohort study, 236 patients with primary rheumatoid arthritis were treated with the tumor necrosis factor inhibitors, etanercept or infliximab （n = 80）, or by conventional methods （n = 156）. Results revealed that 11 patients developed varying types of peripheral neuropathy at 1-2 years post-treatment （mean 16 months）. The incidence of peripheral neuropathy in the tumor necrosis factor inhibitors treatment group was 8.8% （7/80）, which was significantly higher than the conventional treatment group （2.6%; 4/156）. The relative risk of developing peripheral neuropathy in the tumor necrosis factor inhibitors treatment group was 3.41 （95% confidence interval： 1.03 11.31）. Comparison of the tumor necrosis factor inhibitors revealed that etanercept and infliximab had no significant difference in terms of inducing peripheral neuropathy. Experimental findings indicate that tumor necrosis factor inhibitors may increase the risk of peripheral neuropathy.

Development and validation of a prognostic model for patients with hepatorenal syndrome:A retrospective cohort study

BACKGROUND Hepatorenal syndrome(HRS)is a severe complication of cirrhosis with high mortality,which necessitates accurate clinical decision.However,studies on prognostic factors and scoring systems to predict overall survival of HRS are not enough.Meanwhile,a multicenter cohort study with a long span of time could be more convincing.AIM To develop a novel and effective prognostic model for patients with HRS and clarify new prognostic factors.METHODS We retrospectively enrolled 1667 patients from four hospitals,and 371 eligible patients were finally analyzed to develop and validate a novel prognostic model for patients with HRS.Characteristics were compared between survivors and non-survivors,and potential prognostic factors were selected according to the impact on 28-d mortality.Accuracy in predicting 28-d mortality was compared between the novel and other scoring systems,including Model for End-Stage Liver Disease(MELD),Chronic Liver Failure-Sequential Organ Failure Assessment(CLIF-SOFA),and Chinese Group on the Study of Severe Hepatitis BAcute-on-Chronic Liver Failure(COSSH-ACLF).RESULTS Five prognostic factors,comprised of gender,international normalized ratio,mean corpuscular hemoglobin concentration,neutrophil percentage,and stage,were integrated into a new score,GIMNS;stage is a binary variable defined by the number of failed organs.GIMNS was positively correlated with MELD,CLIFSOFA,and COSSH-ACLF.Additionally,it had better accuracy[area under the receiver operating characteristic curve(AUROC):0.830]than MELD(AUROC:0.759),CLIF-SOFA(AUROC:0.767),and COSSH-ACLF(AUROC:0.759)in the derivation cohort(P<0.05).It performed better than MELD and CLIF-SOFA in the validation cohort(P<0.050)and had a higher AUROC than COSSH-ACLF(P=0.122).CONCLUSION We have developed a new scoring system,GIMNS,to predict 28-d mortality of HRS patients.Mean corpuscular hemoglobin concentration and stage were first proposed and found to be related to the mortality of HRS.Additionally,the GIMNS score showed better accuracy than MELD and CLIF-SOFA,and the AUROC was higher than that of COSSH-ACLF.

Constructing Large Scale Cohort for Clinical Study on Heart Failure with Electronic Health Record in Regional Healthcare Platform:Challenges and Strategies in Data Reuse

Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform.In this paper,we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology.We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform.Secondly,we built special disease case repositories (i.e.,heart failure repository) that utilize the graph to search the related patients and to normalize the data.Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure,we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository.After the propensity score matching,the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired.Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients.This paper presents the workflow and application example of big data mining based on regional EHR data.

The effect of long-term traditional Chinese medicine treatment on disease-free survival of postoperative stage I-III lung cancer patients:a retrospective cohort study

Objective:Traditional Chinese medicine(TCM)has been extensively used as one of popular alternative therapies for several cancers.However,it remains unclear whether TCM treatment is associated with longer survival in lung cancer patients.In this study,we explored the effect of long-term TCM treatment on patients with different stages of lung cancer.Methods:All information of lung cancer patients with stage I-III disease from January 2007 to September 2015 was collected for this retrospective cohort study.Those who were treated with TCM after surgery were divided into TCM group and the others were into the non-TCM group(control group).All patients were regularly followed up by clinic appointment or phone,and all survival data were collected from databases after the last follow-up in October 2017.Results:A total of 575 patients were included in this study,with 299 patients in the TCM group and 276 in the control group.For all patients,5-year disease-free survival(DFS)was 62.2% in TCM group and 42.1% in the control group,and 6-year DFSs were 51.8% and 35.4%,respectively(HR=0.51,95% CI:0.40 to 0.66,log-rank P≤0.001).For patients with stage I,5-year DFSs were 83.7%(TCM group)and 57.5%(control group)and 6-year DFSs were 73.7% and 51.9%,respectively(HR=0.30,95% CI:0.18 to 0.50,log-rank P≤0.001).For patients with stage II in the TCM group and the control group,5-year DFSs were 59.4% and 17.6% and 6-year DFSs were 44.7% and 17.6%,respectively(HR=0.31,95% CI:0.19 to 0.52,log-rank P≤0.001),and for patients with stage III,5-year and 6-year DFSs in the TCM group were 18.7% and 12.5% compared with 28.4% and 20.3% in the control group(HR=1.06,95% CI:0.72 to 1.56,log-rank P=0.76).Conclusions:This study demonstrated that long-term TCM treatment as an adjuvant therapy is able to improve the DFS of postoperative stage I-III lung cancer patients,especially in patients with stage I and II disease.However,these observational findings need being validated by large sample randomized controlled trials.