Alcohol consumption and risks of more than 200 diseases in Chinese men

Alcohol consumption accounts for ~3 million annual deaths worldwide, but uncertainty persists about its relationships with many diseases. We investigated the associations of alcohol consumption with 207 diseases in the 12-year China Kadoorie Biobank of >512,000 adults (41% men), including 168,050 genotyped for ALDH2- rs671 and ADH1B- rs1229984 , with >1.1 million ICD-10 coded hospitalized events. At baseline, 33% of men drank alcohol regularly. Among men, alcohol intake was positively associated with 61 diseases, including 33 not defined by the World Health Organization as alcohol-related, such as cataract (n = 2,028; hazard ratio 1.21; 95% confidence interval 1.09-1.33, per 280 g per week) and gout (n = 402; 1.57, 1.33-1.86). Genotype-predicted mean alcohol intake was positively associated with established (n = 28,564; 1.14, 1.09-1.20) and new alcohol-associated (n = 16,138; 1.06, 1.01-1.12) diseases, and with specific diseases such as liver cirrhosis (n = 499; 2.30, 1.58-3.35), stroke (n = 12,176; 1.38, 1.27-1.49) and gout (n = 338; 2.33, 1.49-3.62), but not ischemic heart disease (n = 8,408; 1.04, 0.94-1.14). Among women, 2% drank alcohol resulting in low power to assess associations of self-reported alcohol intake with disease risks, but genetic findings in women suggested the excess male risks were not due to pleiotropic genotypic effects. Among Chinese men, alcohol consumption increased multiple disease risks, highlighting the need to strengthen preventive measures to reduce alcohol intake.

Artificial Intelligence-Based Imaging Transcoding System for Multiplex Screening of Viable Foodborne Pathogens

Multiplex detection of viable foodborne pathogens is critical for food safety and public health, yet current assays suffer trade-offs between cost, assay complexity, sensitivities, and the specificity between live and dead bacteria. We herein developed a sensing method using artificial intelligence transcoding (SMART) for rapid, sensitive, and multiplex profiling of foodborne pathogens. The assay utilizes the programmable polystyrene (PS) microspheres to encode different pathogens, inducing subsequent visible signals under conventional microscopy that can be analyzed using a customized, artificial intelligence-computer vision, which was trained to decode the intrinsic properties of PS microspheres to reveal the numbers and types of pathogens. Our approach enabled the rapid and simultaneous detection of multiple bacteria from egg samples of <10² CFU/mL without DNA amplification and showed strong consistency with the standard microbiologic and genotypic methods. We adopted our assay through phage-guided targeting to enable the discrimination between live and dead bacteria.

Clinical characteristics and antibiotic resistance profile of invasive MRSA infections in newborn inpatients: a retrospective multicenter study from China

BACKGROUND

Methicillin-resistant Staphylococcus aureus (MRSA) can cause invasive infections with significant mortality in neonates. This study aimed to analyze the clinical characteristics and antibiotic resistance profiles of invasive MRSA infections and determine risk factors associated with invasive MRSA infections in newborn inpatients.

METHODS

This multicenter retrospective study of inpatients from eleven hospitals in the Infectious Diseases Surveillance of Pediatrics (ISPED) group of China was performed over a two-year period (2018-2019). Statistical significance was calculated by applying the χ2 test or by Fisher's exact test in the case of small sample sizes.

RESULTS

A total 220 patients were included. Among included cases, 67 (30.45%) were invasive MRSA infections, including two deaths (2.99%), while 153 (69.55%) were noninvasive infections. The invasive infections of MRSA occurred at a median age of 8 days on admission, which was significantly younger compared to 19 days in noninvasive cases. Sepsis (86.6%) was the most common invasive infection, followed by pneumonia (7.4%), bone and joint infections (3.0%), central nervous system infection (1.5%), and peritonitis (1.5%). Congenital heart disease, low birth weight infant (<2500 g), but not preterm neonates, and bronchopulmonary dysplasia, were more commonly found in invasive MRSA infections. All these isolates were susceptible to vancomycin and linezolid and were resistant to penicillin. Additionally, 69.37% were resistant to erythromycin, 57.66% to clindamycin, 7.04% to levofloxacin, 4.62% to sulfamethoxazole-trimethoprim, 4.29% to minocycline, 1.33% to gentamicin, and 3.13% were intermediate to rifampin.

CONCLUSION

Low age at admission (≤8 days), congenital heart disease, and low birth weight were associated with invasive MRSA infections in neonates, and no isolates resistant to vancomycin and linezolid were found. Determining these risks in suspected neonates may help identify patients with imminent invasive infections who may require intensive monitoring and therapy.

Differential responses from the left postcentral gyrus, right middle frontal gyrus, and precuneus to meal ingestion in patients with functional dyspepsia

Background

Functional dyspepsia (FD) is most often a meal-induced syndrome. Studies using resting-state functional magnetic resonance imaging (rs-fMRI) reported abnormal connectivity in areas related to pain processing in FD. However, only a few studies have attempted to determine how meal ingestion affects the brain's working patterns. Through rs-fMRI, this study observed how meal ingestion affected brain regions related to visceral hypersensitivity and emotional response networks in FD patients.

Methods

A total of 30 FD patients and 32 healthy controls (HC) were enrolled and underwent clinical investigations. Rs-fMRI was performed twice after a 4-h fast and 50 min after a meal. The mean functional connectivity strength (FCS) values were extracted from brain regions with significant differences to show the trend of changes related to meal ingestion after FCS analyses.

Results

Depression, anxiety, sleep disturbances, and weight loss were more common in FD patients (P ≤ 0.001). Compared with HCs (corrected cluster P-value < 0.05), FD patients had significantly higher FCS in the right middle frontal gyrus before meals and higher meal-induced FCS in the left postcentral gyrus. HCs had greater meal-induced activation in the right precuneus and anterior cingulate cortex. FD patients had a decreasing trend in the right inferior frontal gyrus compared to the increasing trend in HCs. We only found anxiety to be negatively correlated with FCS in the right inferior frontal gyrus in FD (r = -0.459, p = 0.048, uncorrected).

Conclusions

In this study, we discovered that FD patients have different perceptual and emotional responses to food intake in defined brain areas, providing promising impetus for understanding pathogenic brain mechanisms in FD.

Exogenous Interleukin-37 Alleviates Hepatitis with Reduced Dendritic Cells and Induced Regulatory T Cells in Acute Murine Cytomegalovirus Infection

Human cytomegalovirus (HCMV) infection is globally distributed, and the liver is one of the major targeting organs. So far, the mechanisms for cell and organ damage have not fully been elucidated and the treatments for the infection are mainly at symptoms. IL-37 has shown a protective role in certain inflammatory diseases. In the present study, potential protective effect of exogenous IL-37 on murine cytomegalovirus- (MCMV-) infected hepatitis was evaluated through analyses of serum transaminases, the liver histopathology and cytokine expression, and functional state of dendritic cells (DCs) and regulatory T cells (Tregs). These analyses showed a significant decrease in serum transaminase levels and a lower Ishak histopathologic score at the early stage of MCMV-infected mice with exogenous IL-37 pretreatment. The frequencies of MHC-Ⅱ, CD40, CD80, and CD86 positive DCs in the liver and spleen were decreased significantly at 7 days postinfection (dpi) in MCMV-infected mice with IL-37 pretreatment when compared with those without the pretreatment, while the total number of DCs in the liver was reduced in IL-37-pretreated mice. The induction of Tregs in the spleen was enhanced at dpi 3 with IL-37 pretreatment in MCMV-infected mice. The mRNA expression levels of cytokines in the liver were decreased significantly (IL-1β, IL-6, IL-10, IL-4) or to some extent (TGF-β and TNF-α). The present study suggested that exogenous IL-37 can alleviate MCMV-infected hepatitis, likely through reduced DCs and induced Tregs with a weaker cytokine storm, demonstrating its potential value in clinical management for HCMV-infected hepatitis.

Integrated Assessment of Water Environmental Health Risk through Drinking Water Ingestion in Lhasa River Basin: Quantitative Analysis and Environmental Significance

An integrated assessment of water environmental health risk through drinking water ingestion in Lhasa River has been implemented. The health risks caused by different pollutants in different age groups (children, juvenile and adult groups) are in the order of 10^-8 ~ 10^-7, 10^-7 ~ 10^-5 and 10^-13 ~ 10^-8 a^-1, respectively. The total health risks for all age groups are lower than the International Commission on Radiation Protection recommended value and the U.S. Environmental Protection Agency recommended value at all points except LS4, LS12 and LS13. The total health risk levels in different age groups at most points are class III or II, which means that there are low or negligible negative effect in these points and age groups. It is more important to monitor the arsenic concentration. The water environment quality protecting in Lhasa River Basin must be consistent with the clear water and blue sky protecting in Tibet Autonomous Region and the national ecological security barrier construction on the Tibetan Plateau.

"Lollipop" particle counting immunoassay based on antigen-powered CRISPR-Cas12a dual signal amplification for the sensitive detection of deoxynivalenol in the environment and food samples

Deoxynivalenol is one of the most widely distributed mycotoxins in cereals and poses tremendous threats to the agricultural environment and public health. Therefore, it is particularly important to develop sensitive and interference-resistant deoxynivalenol analysis methods. Here, we establish a "Lollipop" particle counting immunoassay (LPCI) based on antigen-powered CRISPR-Cas12a dual signal amplification. LPCI achieves high sensitivity and accuracy through antigen-powered CRISPR-Cas dual signal amplification combined with particle counting immunoassay. This strategy not only broadens the applicability of the CRISPR-Cas system in the field of non-nucleic acid target detection; it also improves the sensitivity of particle counting immunoassay. The introduction of a polystyrene "lollipop" immunoassay carrier further enables efficiently simultaneous pre-treatment of multiple samples and overcomes complex matrix interference in real samples. The linear detection range of LPCI for deoxynivalenol was 0.1-500 ng/mL with a detection limit of 0.061 ng/mL. The platform greatly broadens the scope of the CRISPR-Cas sensor for the detection of non-nucleic acid hazards in the environment and food samples.

Acupuncture Alleviates CUMS-Induced Depression-Like Behaviors by Restoring Prefrontal Cortex Neuroplasticity

Purpose

To explore the therapeutic efficiency of acupuncture and the related molecular mechanism of neural plasticity in depression.

Methods

Chronic unpredictable mild stress- (CUMS-) induced rats were established for the depression animal model. There were a total of four rat groups, including the control group, the CUMS group, the CUMS+acupuncture group, and the CUMS+fluoxetine group. The acupuncture group and the fluoxetine group were given a 3-week treatment after the modeling intervention. The researcher performed the open-field, elevated plus maze, and sucrose preference tests to evaluate depressive behaviors. The number of nerve cells, dendrites' length, and the prefrontal cortex's spine density were detected using Golgi staining. The prefrontal cortex expression, such as BDNF, PSD95, SYN, and PKMZ protein, was detected using the western blot and RT-PCR.

Results

Acupuncture could alleviate depressive-like behaviors and promote the recovery of the neural plasticity functions in the prefrontal cortex, showing the increasing cell numbers, prolonging the length of the dendrites, and enhancing the spine density. The neural plasticity-related proteins in the prefrontal cortex, including BDNF, PSD95, SYN, and PKMZ, were all downregulated in the CUMS-induced group; however, these effects could be partly reversed after being treated by acupuncture and fluoxetine (P < 0.05).

Conclusion

Acupuncture can ameliorate depressive-like behaviors by promoting the recovery of neural plasticity functions and neural plasticity-related protein upregulation in the prefrontal cortex of CUMS-induced depressed rats. Our study provides new insights into the antidepressant approach, and further studies are warranted to elucidate the mechanisms of acupuncture involved in depression treatment.

Arsenic pollution remediation mechanism and preliminary application of arsenic-oxidizing bacteria isolated from industrial wastewater

Microbial remediation is vital for improving heavy metal-polluted water. In this work, two bacterial strains, K1 (Acinetobacter gandensis) and K7 (Delftiatsuruhatensis), with high tolerance to and strong oxidation of arsenite [As(III)], were screened from industrial wastewater samples. These strains tolerated 6800 mg/L As(III) in a solid medium and 3000 mg/L (K1) and 2000 mg/L (K7) As(III) in a liquid medium; arsenic (As) pollution was repaired through oxidation and adsorption. The As(III) oxidation rates of K1 and K7 were the highest at 24 h (85.00 ± 0.86%) and 12 h (92.40 ± 0.78%), respectively, and the maximum gene expression levels of As oxidase in these strains were observed at 24 and 12 h. The As(III) adsorption efficiencies of K1 and K7 were 30.70 ± 0.93% and 43.40 ± 1.10% at 24 h, respectively. The strains exchanged and formed a complex with As(III) through the -OH, -CH3, and C]O groups, amide bonds, and carboxyl groups on the cell surfaces. When the two strains were co-immobilized with Chlorella, the adsorption efficiency of As(III) improved (76.46 ± 0.96%) within 180 min, thereby exhibiting good adsorption and removal effects of other heavy metals and pollutants. These results outlined an efficient and environmentally friendly method for the cleaner production of industrial wastewater.

Development, validation, and evaluation of a risk assessment tool for personalized screening of gastric cancer in Chinese populations

BACKGROUND

Effective risk prediction models are lacking for personalized endoscopic screening of gastric cancer (GC). We aimed to develop, validate, and evaluate a questionnaire-based GC risk assessment tool for risk prediction and stratification in the Chinese population.

METHODS

In this three-stage multicenter study, we first selected eligible variables by Cox regression models and constructed a GC risk score (GCRS) based on regression coefficients in 416,343 subjects (aged 40-75 years) from the China Kadoorie Biobank (CKB, development cohort). In the same age range, we validated the GCRS effectiveness in 13,982 subjects from another independent Changzhou cohort (validation cohort) as well as in 5348 subjects from an endoscopy screening program in Yangzhou. Finally, we categorized participants into low (bottom 20%), intermediate (20-80%), and high risk (top 20%) groups by the GCRS distribution in the development cohort.

RESULTS

The GCRS using 11 questionnaire-based variables demonstrated a Harrell's C-index of 0.754 (95% CI, 0.745-0.762) and 0.736 (95% CI, 0.710-0.761) in the two cohorts, respectively. In the validation cohort, the 10-year risk was 0.34%, 1.05%, and 4.32% for individuals with a low (≤ 13.6), intermediate (13.7~30.6), and high (≥ 30.7) GCRS, respectively. In the endoscopic screening program, the detection rate of GC varied from 0.00% in low-GCRS individuals, 0.27% with intermediate GCRS, to 2.59% with high GCRS. A proportion of 81.6% of all GC cases was identified from the high-GCRS group, which represented 28.9% of all the screened participants.

CONCLUSIONS

The GCRS can be an effective risk assessment tool for tailored endoscopic screening of GC in China. Risk Evaluation for Stomach Cancer by Yourself (RESCUE), an online tool was developed to aid the use of GCRS.

Identification of pollutant delivery processes during different storm events and hydrological years in a semi-arid mountainous reservoir basin

A comprehensive understanding of pollutant delivery processes during storm events is essential for developing strategies to minimize adverse impacts on receiving water bodies. In this paper, hysteresis analysis and principal component analysis were coupled with identified nutrient dynamics to determine different pollutant export forms and transport pathways and analyze the impact of precipitation characteristics and hydrological conditions on pollutant transport processes through continuous sampling between different storm events (4 events) and hydrological years (2018-wet, 2019-dry) in a semi-arid mountainous reservoir watershed. Results showed pollutant dominant forms and primary transport pathways were inconsistent between different storm events and hydrological years. Nitrogen (N) was mainly exported in the form of nitrate-N(NO₃-N). Particle phosphorous (PP) was the dominant P form in wet years, but total dissolved P (TDP) in dry year. Ammonia-N (NH₄-N), total P (TP), total dissolved P(TDP) and PP had prominent flushing responses to storm events and were delivered mainly from overland sources by surface runoff; while the concentrations of total N(TN) and nitrate-N(NO₃-N) were mainly diluted during storm events. Rainfall intensity and amount had significant control over P dynamics and extreme events played a key role in TP exports, accounting for >90 % of the total TP load exports. However, the cumulative rainfall and runoff regime during rainy season exerted significant control over N exports than individual rainfall features. In the dry year, NO₃-N and TN were delivered primarily through soil water flow paths during storm events; nevertheless, wet year registered complex control on TN exports via soil water release, followed by surface runoff transport. Relative to dry year, wet year registered higher N concentration and more N load exports. These findings could provide scientific basis for determining effective pollution mitigation strategies in Miyun Reservoir basin and provide important references for other semi-arid mountain watersheds.

[Summary of experience with patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision in rectal cancer]

Objective: To examine the patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision (APE) in rectal cancer. Methods: The clinical data of 8 patients with perineal hernia after APE who accepted surgical treatment in the Department of Hepatopancreatobiliary and Hernia Surgery, the First Affiliated Hospital of Fujian Medical University from March 2017 to December 2022 were retrospectively reviewed. There were 3 males and 5 females, aged (67.6±7.2) years (range: 56 to 76 years). Eight patients developed a perineal mass at (11.3±2.9) months (range: 5 to 13 months) after APE. After surgical separation of adhesion and exposing the pelvic floor defect, a 15 cm×20 cm anti-adhesion mesh was fashioned as a three-dimensional pocket shape to fit the pelvic defect, then fixed to the promontory or sacrum and sutured to the pelvic sidewalls and the anterior peritoneum, while two side slender slings were tailored in front of the mesh and fixed on the pectineal ligament. Results: The repair of their perineal hernias went well, with an operating time of (240.6±48.8) minutes (range: 155 to 300 minutes). Five patients underwent laparotomy, 3 patients tried laparoscopic surgery first and then transferred to laparotomy combined with the perineal approach. Intraoperative bowel injury was observed in 3 patients. All patients did not have an intestinal fistula, bleeding occurred. No reoperation was performed and their preoperative symptoms improved significantly. The postoperative hospital stay was (13.5±2.9) days (range: 7 to 17 days) and two patients had postoperative ileus, which improved after conservative treatment. Two patients had a postoperative perineal hernia sac effusion, one of them underwent placement of a tube to puncture the hernia sac effusion due to infection, and continued irrigation and drainage. The postoperative follow-up was (34.8±14.0) months (range: 13 to 48 months), and 1 patient developed recurrence in the seventh postoperative month, no further surgery was performed. Conclusions: Surgical repair of the perineal hernia after APE can be preferred transabdominal approach, routine application of laparoscopy is not recommended, combined abdominoperineal approach can be considered if necessary. The perineal hernia after APE can be repaired safely and effectively using the described technique of patterning cropped and shaped mesh repair.

Cartridge voltage-sensitive micropump immunosensor based on a self-assembled polydopamine coating mediated signal amplification strategy

Current biosensing detection assays were developed to focus on rapid, low-cost, stable detection for clinical diagnosis and food safety monitoring. In this work, a novel portable cartridge voltage-sensitive micropump immunosensor (CVMS) biosensing device based on the integration of the microchannel circuit biosensing principle and polydopamine (PDA) was presented for rapid and sensitive detection of pathogenic factors in real samples at trace levels. The CVMS can sensitively evaluate voltage signal changes caused by clogging effects in the closed-loop circuit when the insulated microspheres pass through the microchannel. The targets could trigger the immune reaction between antibody-antigens that leads to the change in the concentration of horseradish peroxidase (HRP). And the HRP was further employed to catalyze the polymerization of dopamine into PDA, resulting in the rapid formation of the magnetic @PDA nanoparticles (MNP@PDA) with core-shell structures. The abundant functional groups on the MNP@PDA surface can efficiently adsorb polystyrene microspheres, thus causing changes in the number of polystyrene microspheres (PS). The CVMS can accurately monitor the change of PS with a portable device, which weighs less than 0.8 kg and costs only $50. The completion of CVMS takes 90 min to complete. The limit of detection of this immunosensor for procalcitonin and ochratoxin A were 42 pg/mL and 77 pg/mL, respectively, which improved about 15 folds and 38 folds, respectively, than those of enzyme-linked immunosorbent assay.

Differences in soil water storage, consumption, and use efficiency of typical vegetation types and their responses to precipitation in the Loess Plateau, China

After massive afforestation, the Loess Plateau is facing the severe challenge of water shortages. Water use efficiency (WUE) is an important indicator of plant drought resistance, and high WUE is an important way to reconcile the contradiction between vegetation growth and soil water consumption (SWC). Different vegetation types significantly influence hydrological cycle process and WUE. In this study, the Biome-BGC model was used to simulate and analyze the soil water storage (SWS), SWC, and WUE of 3 typical vegetation types in the Loess Plateau from 2005 to 2020. The results showed that the order of SWS of different vegetation types from largest to smallest was grassland (GL, 81.82 mm/day), abandoned farmland (AF, 66.92 mm/day), and Robinia pseudoacacia forest (RP, 55.64 mm/day); SWC was RP (480.09 mm/year), GL (464.68 mm/year), and AF (421.79 mm/year); WUE was RP (2.37 gC/kgH₂O), GL (1.10 gC/kgH₂O), and AF (0.60 gC/kgH₂O). GL showed a better water retention capacity. Precipitation recharge did not meet the full SWC of vegetation. In years of high vegetation growth, as well as in the dry season when water was scarce, both RP and GL showed varying degrees of water deficit. Correlation analysis revealed that a positive effect of precipitation on WUE has a threshold effect, and the thresholds range from approximately 15-50 mm/day for RP, 15-25 mm/day for GL, and no clear pattern for AF. Overall, in water-stressed areas, a large expansion of forest land should be reduced and GL should be increased. In seasons and areas where vegetation is growing vigorously or extremely arid, irrigation regarding precipitation thresholds should be carried out to improve the WUE of vegetation and promote the sustainable development of regional ecology.

Association of dietary patterns, circulating lipid profile, and risk of obesity

OBJECTIVE

The aim of this study was to simultaneously explore the associations of major dietary patterns (DP) with lipid profiles and the associations of these profiles with general and central obesity risks and to evaluate the extent to which the metabolites mediate such associations.

METHODS

Habitual food consumption of 4778 participants with an average age of 47.0 from the China Kadoorie Biobank was collected using a 12-item food frequency questionnaire. Plasma samples were analyzed via targeted nuclear magnetic resonance (NMR) spectroscopy to quantify 129 lipid-related metabolites. Anthropometric information was measured by trained staff.

RESULTS

Two DPs were derived by factor analysis. The newly affluent southern pattern was characterized by high intakes of rice, meat, poultry, and fish, whereas the balanced pattern was characterized by consuming meat, poultry, fish, fresh fruit, fresh vegetables, dairy, eggs, and soybean. The newly affluent southern pattern was positively associated with 45 metabolites, which were positively associated with risks of obesity at the same time. The global lipid profile potentially explained 30.9%, 34.7%, and 53.1% of the effects of this DP on general obesity, waist circumference-defined central obesity, and waist-hip ratio-defined central obesity, respectively.

CONCLUSIONS

The newly affluent southern pattern points to an altered lipid profile, which showed higher general and central obesity risks. These findings partly suggest the biological mechanism for the obesogenic effects of this DP.

WHO cardiovascular disease risk prediction model performance in 10 regions, China

Objective

To validate the World Health Organization (WHO) non-laboratory-based cardiovascular disease risk prediction model in regions of China.

Methods

We performed an external validation of the WHO model for East Asia using the data set of China Kadoorie Biobank, an ongoing cohort study with 512 725 participants recruited from 10 regions of China from 2004-2008. We also recalculated the recalibration parameters for the WHO model in each region and evaluated the predictive performance of the model before and after recalibration. We assessed discrimination performance by Harrell's C index.

Findings

We included 412 225 participants aged 40-79 years. During a median follow-up of 11 years, 58 035 and 41 262 incident cardiovascular disease cases were recorded in women and men, respectively. Harrell's C of the WHO model was 0.682 in women and 0.700 in men but varied among regions. The WHO model underestimated the 10-year cardiovascular disease risk in most regions. After recalibration in each region, discrimination and calibration were both improved in the overall population. Harrell's C increased from 0.674 to 0.749 in women and from 0.698 to 0.753 in men. The ratios of predicted to observed cases before and after recalibration were 0.189 and 1.027 in women and 0.543 and 1.089 in men.

Conclusion

The WHO model for East Asia yielded moderate discrimination for cardiovascular disease in the Chinese population and had limited prediction for cardiovascular disease risk in different regions in China. Recalibration for diverse regions greatly improved discrimination and calibration in the overall population.

Long-term exposure to ambient PM2·5, active commuting, and farming activity and cardiovascular disease risk in adults in China: a prospective cohort study

BACKGROUND

Increased physical activity is associated with a reduced risk of cardiovascular disease, but outdoor physical activity can be accompanied by increased inhalation of fine particulate matter (PM2·5). The extent to which long-term exposure to PM2·5 can offset the cardiovascular benefits of physical activity is unknown. We aimed to evaluate whether the associations between active commuting or farming activity and incident risks of cerebrovascular disease and ischaemic heart disease were consistent between populations with different ambient PM2·5 exposures.

METHODS

We did a prospective cohort study using data from people aged 30-79 years without cardiovascular disease at baseline from the China Kadoorie Biobank (CKB). Active commuting and farming activity were assessed at baseline using questionnaires. A high-resolution (1 × 1 km) satellite-based model was used to estimate annual average PM2·5 exposure during the study period. Participants were stratified according to PM2·5 exposure (54 μg/m3 or greater vs less than 54 μg/m3). Hazard ratios (HRs) and 95% CIs for incident cerebrovascular disease and ischaemic heart disease by active commuting and farming activity were estimated using Cox proportional hazard models. Effect modifications by PM2·5 exposure were tested by likelihood ratio tests. Analyses were restricted to the period from Jan 1, 2005, to Dec 31, 2017.

FINDINGS

Between June 25, 2004, and July 15, 2008, 512 725 people were enrolled in the CKB cohort. 322 399 eligible participants completed the baseline survey and were included in the analysis of active commuting (118 274 non-farmers and 204 125 farmers). Among 204 125 farmers, 2985 reported no farming time and 201 140 were included in the farming activity analysis. During a median follow-up of 11 years, 39 514 cerebrovascular disease cases and 22 313 ischaemic heart disease cases were newly identified. Among non-farmers with exposure to annual average PM2·5 concentrations of less than 54 μg/m3, increased active commuting was associated with lower risks of cerebrovascular disease (highest active commuting vs lowest active commuting HR 0·70, 95% CI 0·65-0·76) and ischaemic heart disease (0·60, 0·54-0·66). However, among non-farmers with exposure to annual average PM2·5 concentrations of 54 μg/m3 or greater, there was no association between active commuting and cerebrovascular disease or ischaemic heart disease. Among farmers with exposure to annual average PM2·5 concentrations of less than 54 μg/m3, increased active commuting (highest active commuting vs lowest active commuting HR 0·77, 95% CI 0·63-0·93) and increased farming activity (highest activity vs lowest activity HR 0·85, 95% CI 0·79-0·92) were both associated with a lower cerebrovascular disease risk. However, among farmers with exposure to annual average PM2·5 concentrations of 54 μg/m3 or greater, increases in active commuting (highest active commuting vs lowest active commuting HR 1·12, 95% CI 1·05-1·19) and farming activity (highest activity vs lowest activity HR 1·18, 95% CI 1·09-1·28) were associated with an elevated cerebrovascular disease risk. The above associations differed significantly between PM2·5 strata (all interaction p values <0·0001).

INTERPRETATION

For participants with long-term exposure to higher ambient PM2·5 concentrations, the cardiovascular benefits of active commuting and farming activity were significantly attenuated. Higher levels of active commuting and farming activity even increased the cerebrovascular disease risk among farmers with exposure to annual average PM2·5 concentrations of 54 μg/m3 or greater.

FUNDING

National Natural Science Foundation of China, National Key Research and Development Program of China, Kadoorie Charitable Foundation, UK Wellcome Trust.

Healthy lifestyle, DNA methylation age acceleration, and incident risk of coronary heart disease

BACKGROUND

DNA methylation clocks emerged as a tool to determine biological aging and have been related to mortality and age-related diseases. Little is known about the association of DNA methylation age (DNAm age) with coronary heart disease (CHD), especially in the Asian population.

RESULTS

Methylation level of baseline blood leukocyte DNA was measured by Infinium Methylation EPIC BeadChip for 491 incident CHD cases and 489 controls in the prospective China Kadoorie Biobank. We calculated the methylation age using a prediction model developed among Chinese. The correlation between chronological age and DNAm age was 0.90. DNA methylation age acceleration (Δage) was defined as the residual of regressing DNA methylation age on the chronological age. After adjustment for multiple risk factors of CHD and cell type proportion, compared with participants in the bottom quartile of Δage, the OR (95% CI) for CHD was 1.84 (1.17, 2.89) for participants in the top quartile. One SD increment in Δage was associated with 30% increased risk of CHD (OR = 1.30; 95% CI 1.09, 1.56; Ptrend = 0.003). The average number of cigarette equivalents consumed per day and waist-to-hip ratio were positively associated with Δage; red meat consumption was negatively associated with Δage, characterized by accelerated aging in those who never or rarely consumed red meat (all P < 0.05). Further mediation analysis revealed that 10%, 5% and 18% of the CHD risk related to smoking, waist-to-hip ratio and never or rarely red meat consumption was mediated through methylation aging, respectively (all P for mediation effect < 0.05).

CONCLUSIONS

We first identified the association between DNAm age acceleration and incident CHD in the Asian population, and provided evidence that unfavorable lifestyle-induced epigenetic aging may play an important part in the underlying pathway to CHD.

[Investigate of the etiology and prevention status of liver cirrhosis]

Objective: To investigate the etiology, prevention and treatment status, and their corresponding regional differences of the patients with liver cirrhosis in China, in order to provide scientific basis for the development of diagnosis and control strategies in China. Methods: Clinical data of patients diagnosed with liver cirrhosis for the first time through January 1, 2018 to December 31, 2020 from 50 hospitals in seven different regions of China were collected and analyzed retrospectively, and the difference of etiology, treatment, and their differences in various regions were analyzed. Results: A total of 11 861 cases with liver cirrhosis were included in the study. Thereinto, 5 093 cases (42.94%) were diagnosed as compensated cirrhosis, and 6 768 cases (57.06%) had decompensated cirrhosis. Notably, 8 439 cases (71.15%) were determined as chronic hepatitis B-caused cirrhosis, 1 337 cases (11.27%) were alcoholic liver disease, 963 cases (8.12%) were chronic hepatitis C, 698 cases (5.88%) were autoimmune liver disease, 367 cases (3.09%) were schistosomiasis, 177 cases (1.49%) were nonalcoholic fatty liver, and 743 cases (6.26%) of other types of liver disease. There were significant differences in the incidence of chronic hepatitis B, chronic hepatitis C, alcoholic liver disease, fatty liver, schistosomiasis liver disease, and autoimmune liver disease among the seven regions (P<0.001). Only 1 139 cases (9.60%) underwent endoscopic therapy, thereinto, 718 cases (6.05%) underwent surgical therapy, and 456 cases (3.84%) underwent interventional therapy treatment. In patients with compensated liver cirrhosis, 60 cases (0.51%) underwent non-selective β receptor blockers(NSBB), including 59 cases (0.50%) underwent propranolol and 1 case (0.01%) underwent carvedilol treatment. In patients with decompensated liver cirrhosis, 310 cases (2.61%) underwent NSBB treatment, including 303 cases (2.55%) underwent propranolol treatment and 7 cases (0.06%) underwent carvedilol treatment. Interestingly, there were significant differences in receiving endoscopic therapy, interventional therapy, NSBB therapy, splenectomy and other surgical treatments among the seven regions (P<0.001). Conclusion: Currently, chronic hepatitis B is the main cause (71.15%) of liver cirrhosis in several regions of China, and alcoholic liver disease has become the second cause (11.27%) of liver cirrhosis in China. The three-level prevention and control of cirrhosis in China should be further strengthened.

The effects of different surgical approaches on the psychological status, medical coping mode and quality of life of patients with lung cancer

Objective

This study aimed to compare the effects of robot-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS), and thoracotomy on the psychological status, medical coping mode, and quality of life of patients with lung cancer.

Methods

A total of 158 patients with lung cancer were selected from the thoracic surgery center of a third-grade hospital in Hunan Province, China, from September to November 2020. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Medical Coping Modes Questionnaire (MCMQ), and Medical Outcomes Study (MOS) 36-item Short Form Health Survey (SF-36) were used to assess the effects of the surgical approaches on the study parameters before and 48–96 h after surgery. The t-test and analysis of variance were used to analyze the data.

Results

The results revealed that the patients’ depression increased, their short-term quality of life decreased, and they tended to adopt a positive coping mode after surgery (p &lt; 0.05). The RATS and VATS groups differed in avoidance dimension of medical coping modes (p &lt; 0.05). The VATS and thoracotomy groups differed in the body pain dimension of quality of life (p &lt; 0.05). Different surgical approaches had no effect on the psychological status, medical coping modes except the avoidance dimension, and quality of life except the body pain dimension.

Conclusion

Surgical approaches have little effect on the psychological status, medical coping modes, and quality of life of patients with lung cancer; however, their depression increased and quality of life decreased after the surgery.

Sustainable development of urban agglomeration based on material metabolism: a case study on Fujian Delta, China

As highly concentrated urbanized areas, urban agglomerations bear increasing resource depletion and environmental pressures, which threaten the regional sustainable development. Resource and environmental problems arising from the process of urbanization can be attributed to the dislocation or maladjustment of material metabolism in time or space. Conducting research on material metabolism at the level of urban agglomerations is helpful in finding the root causes of environmental problems to provide support for the reduction of regional resource consumption and pollution emissions. The material metabolism characteristics of the urban agglomeration and internal cities of the Fujian Delta Urban Agglomeration (FDUA) in China are evaluated using the material flow analysis. The following results are observed. (1) The economic development of the FDUA is still at risk of resource consumption, and a large proportion of hidden flow (HF > 80%) drags down the overall metabolic efficiency and sustainable development. (2) The discharge of various pollutants in the FDUA generally shows a downward trend. Improving metabolic efficiency, delayed MCI growth, and improved overall regional environmental quality are observed. (3) Cities that have relatively scarce land resources but are economically developed, such as Xiamen, still bear a relatively heavy ecological burden (ECdmc > 1). (4) Regional collaboration is conducive to the sustainable development of multiple regions. On the one hand, the results of this study provide decision-making basis for the sustainable development of the national ecological civilization demonstration area. On the other hand, this work guides the establishment of a comprehensive industrial linkage and cooperation mechanism for the same type of small- and medium-sized urban agglomerations.

Electronic Health Record-Based Absolute Risk Prediction Model for Esophageal Cancer in the Chinese Population: Model Development and External Validation

BACKGROUND

China has the largest burden of esophageal cancer (EC). Prediction models can be used to identify high-risk individuals for intensive lifestyle interventions and endoscopy screening. However, the current prediction models are limited by small sample size and a lack of external validation, and none of them can be embedded into the booming electronic health records (EHRs) in China.

OBJECTIVE

This study aims to develop and validate absolute risk prediction models for EC in the Chinese population. In particular, we assessed whether models that contain only EHR-available predictors performed well.

METHODS

A prospective cohort recruiting 510,145 participants free of cancer from both high EC-risk and low EC-risk areas in China was used to develop EC models. Another prospective cohort of 18,441 participants was used for validation. A flexible parametric model was used to develop a 10-year absolute risk model by considering the competing risks (full model). The full model was then abbreviated by keeping only EHR-available predictors. We internally and externally validated the models by using the area under the receiver operating characteristic curve (AUC) and calibration plots and compared them based on classification measures.

RESULTS

During a median of 11.1 years of follow-up, we observed 2550 EC incident cases. The models consisted of age, sex, regional EC-risk level (high-risk areas: 2 study regions; low-risk areas: 8 regions), education, family history of cancer (simple model), smoking, alcohol use, BMI (intermediate model), physical activity, hot tea consumption, and fresh fruit consumption (full model). The performance was only slightly compromised after the abbreviation. The simple and intermediate models showed good calibration and excellent discriminating ability with AUCs (95% CIs) of 0.822 (0.783-0.861) and 0.830 (0.792-0.867) in the external validation and 0.871 (0.858-0.884) and 0.879 (0.867-0.892) in the internal validation, respectively.

CONCLUSIONS

Three nested 10-year EC absolute risk prediction models for Chinese adults aged 30-79 years were developed and validated, which may be particularly useful for populations in low EC-risk areas. Even the simple model with only 5 predictors available from EHRs had excellent discrimination and good calibration, indicating its potential for broader use in tailored EC prevention. The simple and intermediate models have the potential to be widely used for both primary and secondary prevention of EC.

CRISPR/Cas12a-Assisted Chemiluminescence Sensor for Aflatoxin B1 Detection in Cereal Based on Functional Nucleic Acid and In-Pipet Rolling Circle Amplification

Herein, we report a CRISPR/Cas12a-assisted chemiluminescence sensor for aflatoxin B₁ (AFB₁) detection based on functional nucleic-acid-mediated target recognition and in-pipet rolling circle amplification-mediated signal amplification. In this sensor, we performed rolling circle amplification on the inside of the pipet to enrich horseradish peroxidase (pipet-poly-HRP). When AFB₁ is present, it interacts with functional nucleic acids and results in the release of the activator. The activator is designed to activate the CRISPR/Cas12a system, which cleaves the pipet-poly-HRP to liberate HRP. The freed HRP can then be measured by chemiluminescence to quantify AFB₁. This CRISPR/Cas12a-assisted chemiluminescence sensor enables facile, highly sensitive, and specific detection of AFB₁, with a linear range from 50 pg/mL to 100 ng/mL and a detection limit of 5.2 pg/mL. Furthermore, it exhibits satisfactory recovery and has successfully challenged AFB₁ detection in cereal samples. The proposed sensor offers a novel rapid screening approach that holds great promise for food security monitoring.

Facilitators and barriers to the delivery of palliative care to patients with Parkinson's disease: a qualitative study of the perceptions and experiences of stakeholders using the socio-ecological model

OBJECTIVE

Palliative care (PC) can improve the quality of life of Parkinson's disease (PD) patients and their carers. However, the impact of PC services on patients with PD remains unclear. This research was conducted to identify the barriers and facilitators influencing PC services for patients with PD based on the Social Ecological Model (SEM) framework.

METHODS

This research was conducted through semi-structured interviews, employing SEM to organize themes and identify potential solutions across multiple levels.

RESULTS

A total of 29 interviewees (5 PD clinicians, 7 PD registered nurses, 8 patients, 5 caregivers, and 4 policy makers) completed the interviews. Facilitators and barriers were identified according to the levels of the SEM. Several facilitators were identified, i.e., (1) individual level: the critical needs among PD patients and their relatives and the desire for PC knowledge among health professionals; (2) interpersonal level: social support; (3) organizational level: the investments towards systematization of PC; and nurses are the bridge between patients and doctors; (4) community level: the convenience of community services; and hospital-community-family-based services; (5) culture and policy level: existing policy.

CONCLUSION

The social-ecological model proposed in this study helps illuminate the complex and multilevel factors that may influence PC delivery to PD patients.

Shenqi granule upregulates CD2AP and α-actinin4 and activates autophagy through regulation of mTOR/ULK1 pathway in MPC5 cells

ETHNOPHARMACOLOGICAL RELEVANCE

The incidence of membranous nephropathy (MN) continues to rise globally. Shenqi granule (SQ), composed of thirteen Chinese medicinal herbs, has clinical efficacy in the treatment of MN and has been used in China for decades. However, the mechanism behind this effect remains unclear.

AIM OF THE STUDY

In this study, we documented the effects of SQ on cultured mouse podocytes (MPC5) cytoskeletal proteins (CD2AP, α-actinin4) and autophagic activity, and identified the mechanism underlying the ameliorating effects of SQ on MN.

MATERIALS AND METHODS

The main components of SQ was analysed using High-performance liquid chromatography (HPLC). We induced MPC5 cells with puromycin aminonucleoside (PAN) as a model of MN-like disease. Cyclosporine A (CsA) was used as a positive control drug. MPC5 cells viability was analysed using CCK-8 assays to select the PAN dose and SQ dose. CD2AP and α-actinin4 mRNA expression was examined by RT-PCR, CD2AP and α-actinin4 protein expression as well as autophagic activity (LC3, Beclin1) was examined by Western blot in MPC5 cells, and the mechanism of action of SQ granule was assessed by Western blot to detect the protein expression at the phosphorylation level of PI3K/AKT/mTOR pathway.

RESULTS

In PAN-induced MPC5 cells, mRNA and protein expression of α-actinin-4 and CD2AP were significantly reduced, and SQ granule was able to alleviate this manifestation. In contrast to the inhibition of LC3 and Beclin1 expression in the PAN model, SQ granule was able to activate cellular autophagic activity. In addition to this, our study revealed that PAN could activate the mTOR/ULK1 pathway, resulting in a significant increase in p-mTOR and p-ULK1 protein expression, while the SQ group was able to significantly inhibit the phosphorylation level of this pathway.

CONCLUSIONS

SQ granule attenuated PAN-induced MPC5 cell damage similar to MN. The mechanism may be to upregulate the expression of α-actinin-4 and CD2AP and activate autophagy activity, which may be achieved by inhibiting the phosphorylation level of mTOR/ULK1.