Prediction and prophylaxis of hepatocellular carcinoma occurrence and postoperative recurrence in chronic hepatitis B virus-infected subjects

Hepatocellular carcinoma(HCC) is one of the most common and highly fatal malignancies worldwide. Chronic infection with hepatitis B virus(HBV) is a major cause of HCC. High HBV replication rate and related non-resolving inflammation are the major risk factors of HCC occurrence and postoperative recurrence. Early prophylactic options are effective in reducing HCC occurrence and improving survival. Therefore, it is important to identify HBV-infected patients who are at a higher risk of developing HCC and HBV-HCC patients who are more likely to relapse after surgery, thus providing them with more precise prophylactic strategies. Several prediction models of HCC occurrence have been constructed, with satisfactory predictive accuracy and discriminatory ability. However, there is a lack of consensus for their clinical implementation. Several staging systems have been proposed for HCC prognosis. However, the accuracy of these staging systems based on demographic characteristics and clinical measurements needs to be further improved, possibly by systematically incorporating viral and inflammatory factors. Since antiviral treatments are effective in promoting liver function reserve, reducing HCC occurrence and prolonging postoperative survival in some HBV-infected subjects, it is very important to identify subgroups of HBV-infected patients who would most benefit from antiviral treatment.

Epidemiology of Diabetes in Adults Aged 35 and Older from Shanghai,China

Objective This study aimed to investigate the epidemiology of diabetes in adults from Shanghai, aged 35 and older, in 2013. Methods We estimated the diabetes prevalence in a representative sample of 18,736 adults who were selected through a multistage stratified cluster sampling process. A standard questionnaire containing questions about demographic characteristics and lifestyle factors was distributed. After an overnight fast of at least 10 hours, a venous blood sample was collected from each participant. For each patient without a history of diabetes, another blood sample was drawn 120 min after an oral glucose tolerance test to identify undiagnosed diabetes and prediabetic condition. Results Among Shanghai residents aged 35 and above, the overall weighted prevalence of diabetes was 17.6% [95% confidence interval（CI）： 16.4%-18.8%]. The prevalences were 19.3% in men and 15.8% in women as well as 19.1%, 15.4%, and 16.1% in urban, suburban, and rural residents, respectively. In addition, the weighted prevalence of prediabetes was 16.5%（95% CI： 15.3%-17.8%）, with the prevalences of 16.5% in men, 16.6% in women, 15.2% in urban residents, 18.0% in suburban residents, and 18.5% in rural residents. Among all patients with diabetes, 68.1%（95% CI： 64.3%-71.6%） were aware of their status, 63.5%（95% CI： 60.0%-66.9%） received diabetes treatment, but only 35.1%（95% CI： 32.4%-37.8%） had adequate glycemic control. Conclusion In Shanghai, diabetes and prediabetes are highly prevalent. However, 1/3rd of diabetes cases are undiagnosed, and the rate of glycemic control is low.

Appropriateness of Screening of Angiopathic Complications Prevention in Ambulatory Patients with Diabetes

Background: Preventive care of diabetic foot and eye complications is essential. However, data on the prevalence of and factors associated with screening of angiopathic complications in ambulatory patients with diabetes are very limited in Switzerland. We aimed to fill this gap of knowledge. Methods: Cross-sectional data on recommended preventive care using RAND’s criteria in a random sample of patients aged 50-80 years in 2005-2006. Participants were recruited from 4 Swiss university primary care settings (in Lausanne, Geneva, Zürich and Basel). Scores for general preventive care in patients with and without diabetes were calculated by using generalized estimating equation binomial models. Multivariate regression models were used to identify determinants of appropriateness of angiopathic complications prevention. The main outcome measure was appropriateness of screening for angiopathic complications based on the 2005 American Diabetes Association recommendations corresponding to the period of data collection. Results: Among the 1002 patients aged 50 - 80 years, 292 (29.1%) had diabetes (101/292 [34.6%] female, mean BMI 30.7 [SD 5.7]). Fifty-nine percent had appropriate preventive foot care and 55.8% had appropriate preventive eye care. Only 34.6% had appropriate preventive care of both foot and eye. No differences in aggregate scores for general preventive care in patients with and without diabetes were found (67.5% vs. 69.1%, p value 0.39). In multivariate model, obesity was negatively (OR = 0.28, 0.15 - 0.53) and hyperlipidemia positively (OR = 2.29, 1.20 - 4.38) associated with appropriate eye preventive care and with appropriate combined foot and eye preventive care (OR = 0.35, 0.18 - 0.70 for obesity and OR = 2.82, 1.24 - 6.40 for hyperlipidemia). Conclusions: Preventive care of diabetic angiopathic complications is low among ambulatory patients despite universal health care coverage. Particular attention should be paid to obese patients with diabetes.

“No Need to Get Salty” Or Is There? Sodium Functionality as a Consideration in Nutrition Public Health Policy

Aim: Public health professionals focus on both downstream (individual) and upstream (population-level) interventions to reduce sodium consumption and prevent sodium-related chronic diseases. Effective upstream interventions specifically aimed at reducing dietary sodium intake include the implementation of comprehensive nutrition standards that restrict the amount of sodium contained in foods available for purchase. The aim of this work was to identify sought-after foods that did not meet the Philadelphia Nutrition Standards’ sodium limits and reformulate those foods to be standards-compliant and consumer-acceptable. Subject and Methods: Two foods were reformulated for compliancy with the Philadelphia Nutrition Standards’ sodium limits and consumer acceptability: the hoagie roll and soft pretzel. Reformulation included sensory testing and engaging potential manufacturing partners to investigate products’ commercial potential. Results: While hoagie roll reformulation led to a local company manufacturing and selling the reformulated product, soft pretzel reformulation stalled due to lack of consumer acceptability of the reformulated product. Salt contributes desirable characteristics in the texture, taste, and appearance of the soft pretzel, the absence of which consumers found unacceptable. Conclusion: Product reformulation holds great potential to create lower-sodium foods that otherwise have all of the characteristics of the higher-sodium “original” products but requires an understanding of the role of salt in product recipes. Reducing salt without considering its multiple functions in food may result in a product that is unacceptable or even unsafe. A simple four-step tool can help public health practitioners evaluate the extent to which products are suitable for reformulation.

Association of miRNA-122-binding site polymorphism at the interleukin-1 a gene and its interaction with hepatitis B virus mutations with hepatocellular carcinoma risk

This study was designed to investigate the contribution of miRNA-122-binding site polymorphism at the IL-1A gene and its multiplicative interactions with hepatitis B virus （HBV） mutations in the risk of hepatocellular carcinoma （HCC）. A total of 1021 healthy controls, 302 HBV surface antigen （HBsAg） seroclearance subjects, and 2011 HBsAg-positive subjects （including 1021 HCC patients） were enrolled in this study. Quantitative PCR was used to genotype rs3783553. HBV mutations were determined by direct sequencing. Multivariate logistic regression analyses were performed to test the associations of rs3783553, mutations, and their interactions with the risk of HCC. No significant association was found between rs3783553 and the risk of HCC among healthy controls, HBsAg seroclearance subjects, HBsAg-positive subjects without HCC, and all controls. Additionally, rs3783553 was not significantly associated with chronic HBV infection, liver cirrhosis, HBV e antigen seroconversion, abnormal alanine aminotransferase, and high viral load （ 〉 10^4 copies/ml）. However, the TTCA insertion allele of rs3783553 was significantly associated with an increased frequency of HBV C7A mutation compared with homozygous TTCA deletion carriers [（del/ins ＋ ins/ins） vs. del/del, adjusted odds ratio （OR）= 1.48, 95% confidence interval （CI）= 1.09-2.02, P = 0.013]. Multiplicative interaction of rs3783553 with HBV preS deletion significantly reduced the risk of HCC in males, with an adjusted OR of 0.64 （95% CI = 0.42-0.98; P = 0.041） after age and HBV genotype were adjusted. Although rs3783553 did not significantly affect genetic susceptibility to HBV-related HCC, its variant allele may predispose the host to selecting HBV C7A mutation during evolution and significantly reduce the risk of HCC caused by HBV preS deletion. This study provides an insight into the complex host-virus interaction in HBV-induced hepatocarcinogenesis and is helpful in determining HBsAg-positive subjects who are likely to develop HCC.

Phosphatase and Tensin Homologue Genetic Polymorphisms and their Interactions with Viral Mutations on the Risk of Hepatocellular Carcinoma

Background： Chronic hepatitis B virus （HBV） infection is the major cause of hepatocellular carcinoma （HCC）. Some HBV mutants and dysregulation of phosphatase and tensin homolog （PTEN） may promote the development of HCC synergistically. We aimed to test the effects of PTEN genetic polymorphisms and their interactions with important HBV mutations on the development of HCC in HBV-infected subjects. Methods： Quantitative po[ymerase chain reaction was applied to genotype PTEN polymorphisms （rs1234220, rs2299939, rsl234213） in 1012 healthy controls, 302 natural clearance subjects, and 2011 chronic H BV-infected subjects including 1021 HCC patients. HBV mutations were determined by sequencing. The associations of PTEN polymorphisms and their interactions with HBV mutations with HCC risk were assessed using multivariate logistic regression analysis. Results： Rs1234220 C allele was significantly associated with HCC risk compared to healthy controls （adjusted odds ratio [AOR] = 1.35, 95% confidence interval [CI] = 1,07-1.69） and HCC-free HBV-infected subjects （AOR = 1.27, 95% CI = 1.01-1 .57）. rsl234220 C allele was significantly associated with increased frequencies of HCC-risk A 1652G, C 1673T, and C 1730G mutations in genotype B H BV-in fected subjects. Rs2299939 GT genotype was inversely associated with HCC risk in HBV-infected patients （AOR 0.75, 95% CI 0.62-0.92）. The interaction of rs2299939 variant genotypes （GT＋TT） with A3054T mutation significantly increased HCC risk （AOR = 2.41, 95% CI = 1.08-5.35）; whereas its interaction with C3116T mutation significantly reduced HCC risk （AOR = 0.34, 95% CI 0.18-0.66）. These significant effects were only evident in males alter stratification. Conclusions： PTEN polymorphisms and their interactions with HBV mutations may contribute to hepatocarcinogenesis in males. The host-virus interactions are important in identifying HBV-infected subjects who are more likely to develop HCC.

Association of human leukocyte antigen-DR-DQ-DP haplotypes with the risk of hepatitis B virus-related hepatocellular carcinoma

Aim:Genetic polymorphisms of human leukocyte antigen(HLA)class II molecules are associated with chronic hepatitis B virus(HBV)infection.We aimed to investigate the impacts of HLA-II haplotypes on viral evolution and the risks of HBV-caused liver diseases.Methods:HLA-DR-DQ-DP haplotypes were estimated in 1210 healthy controls,296 HBV clearance subjects,301 asymptomatic hepatitis B surface antigen carriers,770 chronic hepatitis B patients,443 HBV-related liver cirrhosis(LC)patients,and 1037 HBV-related hepatocellular carcinoma(HCC)patients.HBV mutations were determined by sequencing.The associations of HLA-DR-DQ-DP haplotypes with viral mutations and the risks of liver diseases were assessed by multivariate logistic regression.Results:Compared to HBV-free subjects,the haplotypes CCAACG,CCGACG,TCAATA,and TCGATA were associated with decreased HCC risk,with an odds ratio(OR)[95%confidence interval(CI)]of 0.62(0.40-0.95),0.60(0.39-0.92),0.73(0.54-0.98),and 0.58(0.42-0.78),respectively.CCAACG,CCGACG,and TCAATA were significantly associated with decreased frequencies of the HCC-risk HBV mutations:preS1 deletion,APOBECsignature HBV mutations in the core promoter and preS regions,A51C/T,G104C/T,and G146C/T.TCGATA and TTAACG were associated with increased LC risk,with an OR(95%CI)of 1.54(1.03-2.30)and 2.23(1.50-3.33),respectively.However,TCGATA and TTAACG were not consistently associated with the cirrhosis-risk HBV mutations.Conclusion:CCAACG,CCGACG,and TCAATA are inversely associated with HCC risk,possibly because they are involved in creating an immune microenvironment attenuating the generation of HCC-risk HBV mutations.TCGATA and TTAACG might predispose the polarity of immunity towards Th17 isotype related to LC.

Insufficient Physical Activity among Students Aged 6-17 Years in China,2016-2017

Regular physical activity of sufficient duration and intensity can provide health benefits such as improved physical fitness,which promotes bone health,prevents hypertension,improves mental health,and reduces adiposity^([1]).Furthermore,the benefits of regular physical exercise during youth may persist into adulthood^([2]).

Percent body fat,but not body mass index,is associated with cardiometabolic risk factors in children and adolescents

Background:The epidemic of overweight and obesity has become a worldwide public health problem.Cardiometabolic diseases may originate in childhood.We investigated the association between percent body fat(PBF)measured by the bioelectrical impedance assay and cardiometabolic risk(CMR)in pediatrics.Methods:This cross-sectional study involved 3819 subjects(6-17 years old)in Shanghai.We assessed the association between PBF and body mass index(BMI)with multiple CMR factors.We examined the risk for cardiometabolic abnormalities attributable to overweight and obesity based on age-and sexspecific PBF Z-scores and BMI Z-scores,respectively.Results:PBF,but not BMI,was positively associated with multiple CMR factors in males and females except for total cholesterol in females(all p<0.05).Compared with the non-overweight group based on PBF,overweight and obese subjects had increasingly higher odds ratio of dyslipidemia(2.90(1.99-4.23),4.59(2.88-7.32)for males and 1.82(1.20-2.75),2.46(1.47-4.11)for females)and elevated blood pressure(BP)(3.26(2.35-4.51),4.55(2.92-7.09)for males and 1.59(1.07-2.34),3.98(2.27-6.17)for females).Obesity females showed a higher likelihood for hyperglycemia(2.19(1.24-3.84))than non-overweight females.In both sexes,the predictive effect of PBF on dyslipidemia and elevated BP in adolescents was better than that in children.For hyperglycemia,the predictive effect of PBF was better in male adolescents and female children.There was no risk difference for cardiometabolic abnormalities attributable to BMI-based obesity categories.Conclusions:PBF but not BMI was associated with CMR.Overweight and obesity categories based on PBF had an increased risk for cardiometabolic abnormalities in children and adolescents.

Sleep Status Among Children and Adolescents Aged 6-17 Years—China,2016-2017

Summary What is already known about this topic?There has been little to no description of sleep status among children and adolescents nationwide in recent years.What is added by this report?This report assesses the sleep duration and sleep patterns of children and adolescents in China.Approximately half of the adolescents did not get the recommended amount of sleep on school days,and more than half overslept on weekends.

Association between admission haematocrit and mortality among men with acute ischaemic stroke

Objective Anaemia is associated with higher mortality among patients with non-stroke cardiovascular conditions;less is known regarding the relationship between anaemia and mortality among patients with acute ischaemic stroke.Methods Medical records were abstracted for n=3965 veterans from 131 Veterans Health Administration facilities who were admitted with ischaemic stroke in fiscal year 2007.Haematocrit values within 24 hours of admission were classified as≤27%,28%-32%,33%-37%,38%-42%,43%-47% or≥48%.Multivariate logistic regression was used to examine the relationship between anaemia and in-hospital,30-day,6-month and 1-year mortality,adjusting for age,medical comorbidities,modified Acute Physiology and Chronic Health Evaluation-III and stroke severity.Impact factors were calculated to standardise comparisons between haematocrit tier and other covariates.results Among n=3750 patients included in the analysis,the haematocrit values were≤27%in 2.1%(n=78),28%-32% in 6.2%(n=234),33%-37%in 17.9%(n=670),38%-42% in 36.4%(n=1366),43%-47% in 28.2%(n=1059)and≥48% in 9.1%(n=343).Patients with haematocrit≤27%,compared with patients in the 38%-42% range,were more likely to have died across all follow-up intervals,with statistically significant adjusted ORs(aORs)ranging from 2.5 to 3.5.Patients with polycythaemia(ie,haematocrit≥48%)were at increased risk of in-hospital mortality(aOR=2.9;95%CI 1.4 to 6.0),compared with patients with mid-range admission haematocrits.Pronounced differences between patients receiving and not receiving blood transfusion limited our ability to perform a propensity analysis.Impact factors in the 1-year mortality model were 0.46(severe anaemia),0.06(cancer)and 0.018(heart disease).Conclusions Anaemia is independently associated with an increased risk of death throughout the first year post stroke;high haematocrit is associated with early poststroke mortality.Severe anaemia is associated with 1-year mortality to a greater degree than cancer or heart disease.These data cannot address the question of whether interventions targeting anaemia might improve patient outcomes.