Circulating 25-hydroxyvitamin D concentration can predict bowel resection risk among individuals with inflammatory bowel disease in a longitudinal cohort with 13 years of follow-up

BACKGROUND

Although the beneficial properties of vitamin D in anti-inflammation and immunity-modulation are promising in the management of inflammatory bowel disease (IBD), data were limited for the critical IBD prognosis. The association between serum vitamin D levels and the risk of bowel resection in individuals with IBD remains largely unknown.

MATERIALS AND METHODS

We performed a longitudinal cohort study among 5474 individuals with IBD in the UK Biobank. Serum 25-hydroxyvitamin D [25(OH)D] was measured using direct competitive chemiluminescent immunoassay. Bowel resection events were ascertained via national inpatient data. Multivariable-adjusted Cox proportional hazard regression was used to examine the association between serum 25(OH)D and bowel resection risk, presented with hazard ratios (HRs) and 95% confidence intervals (CIs). Restricted cubic spline (RCS) was used to evaluate dose-response associations.

RESULTS

During a mean follow-up of 13.1 years, we documented 513 incident bowel resection cases. Compared to participants with vitamin D deficiency, non-deficient participants showed a significantly reduced bowel resection risk in IBD (HR 0.72, 95% CI 0.59-0.87, P=0.001), Crohn's disease (CD, HR 0.74, 95% CI 0.56-0.98, P=0.038), and ulcerative colitis (UC, HR 0.73, 95% CI 0.57-0.95, P=0.020). When comparing extreme quintiles of 25(OH)D level, participants with IBD showed a 34% reduced risk of bowel resection (95% CI 11%-51%, P=0.007) and participants with UC showed a 46% reduced risk (95% CI 19%-64%, P=0.003), while this association was not significant in CD (HR 0.93, 95% CI 0.59-1.45, P=0.740). Linear dose-response associations were observed using the RCS curve (all P-nonlinearity>0.05).

CONCLUSION

Increased serum level of 25(OH)D is independently associated with reduced bowel resection risk in IBD. This association was significant in UC but may not be stable in CD. Vitamin D deficiency is a risk factor for bowel resection in individuals with IBD, and may be an effective metric in predicting and risk-screening surgical events.

Risk Assessment for Gastrointestinal Diseases via Clinical Dimension and Genome-Wide Polygenic Risk Scores of Type 2 Diabetes: A Population-Based Cohort Study

OBJECTIVE

We aimed to evaluate whether individuals with type 2 diabetes (T2D) were at higher risk of developing a wide range of gastrointestinal diseases based on a population-based cohort study.

RESEARCH DESIGN AND METHODS

This study included 374,125 participants free of gastrointestinal disorders at baseline; of them, 19,719 (5.27%) with T2D were followed-up by linking to multiple medical records to record gastrointestinal disease diagnoses. Multivariable Cox models were used to estimate the hazard ratios (HRs) and CIs. Logistic models were used to examine the associations between polygenic risk scores (PRS) and clinical gastrointestinal phenotypes.

RESULTS

During a median follow-up of 12.0 years, we observed the new onset of 15 gastrointestinal diseases. Compared with nondiabetes, participants with T2D had an increased risk of gastritis and duodenitis (HR 1.58, 95% CI 1.51-1.65), peptic ulcer (HR 1.56, 95% CI 1.43-1.71), diverticular disease (HR 1.19, 95% CI 1.14-1.24), pancreatitis (HR 1.45, 95% CI 1.24-1.71), nonalcoholic fatty liver disease (HR 2.46, 95% CI 2.25-2.69), liver cirrhosis (HR 2.92, 95% CI 2.58-3.30), biliary disease (HR 1.18, 95% CI 1.10-1.26), gastrointestinal tract cancers (HR 1.28, 95% CI 1.17-1.40), and hepatobiliary and pancreatic cancer (HR 2.32, 95% CI 2.01-2.67). Positive associations of PRS of T2D with gastritis, duodenitis, and nonalcoholic fatty liver disease were also observed.

CONCLUSIONS

In this large cohort study, we found that T2D was associated with increased risks of a wide range of gastrointestinal outcomes. We suggest the importance of early detection and prevention of gastrointestinal disorders among patients with T2D.

Digestive System Diseases, Genetic Risk, and Incident Dementia: A Prospective Cohort Study

INTRODUCTION

Although digestive system disease affects gut microbiota and their metabolites associated with dementia risk, the association between digestive system diseases and incident dementia has not yet been established.

METHODS

This cohort analysis included 458,181 participants free of baseline dementia in the UK Biobank (2006-2021). The associations of 14 digestive system diseases with dementia incidence were examined in 2022 using Cox proportional hazards regression models. Analyses were performed to differentiate the associations for early-onset (age <65 years) and late-onset (age ≥65 years) dementia. Interaction and stratification analyses were performed for polygenic risk score and APOE.

RESULTS

During a median follow-up of 12.4 years, 6,415 incident dementia cases were diagnosed. Eleven digestive system diseases showed significant associations with an increased risk of dementia after controlling for covariates and multiple testing. Compared with hazard ratios for individuals without digestive system diseases, the hazard ratios of dementia increased from 1.15 (95% confidence interval=1.09, 1.23) for patients with intestinal diverticular disease to 2.31 (95% confidence interval=1.98, 2.70) for patients with cirrhosis. The associations were different between certain digestive system diseases and dementia by onset age. The associations appeared to be stronger for cirrhosis (Q=0.001), irritable bowel syndrome (Q<0.001), gastritis and duodenitis (Q=0.002), gastroesophageal reflux disease (Q<0.001), ulcerative colitis (Q=0.047), gallbladder disease (Q=0.012), and peptic ulcer (Q=0.030) with early-onset dementia. There were no interactions for polygenic risk score or APOE (p>0.05).

CONCLUSIONS

These findings suggest an increased need for dementia prevention among patients with digestive system diseases.

Associations between meat consumption and all-cause and cause-specific mortality in middle-aged and older adults with frailty

OBJECTIVES

This study aimed to explore the associations between different types of meat consumption and mortality risk among people with frailty.

DESIGN

Longitudinal study.

SETTING AND PARTICIPANTS

We included 19,913 physically frail participants from the UK Biobank.

MEASUREMENTS

We used the validated brief food frequency questionnaire (FFQ) to measure meat consumption. Baseline diet data from 2006 to 2010 were collected, and participants were followed up until March 23, 2021. Cox proportional hazards regression models were conducted to examine the associations of meat consumption with mortality risk.

RESULTS

We identified 3,622 all-cause deaths, 1,453 cancer deaths, and 1,663 cardiovascular deaths during a median follow-up time of 11.2 years. Higher consumption of unprocessed poultry (per 25 g/day increment) was associated with a lower risk of all-cause mortality (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.75-0.88), cancer mortality (HR 0.84, 95% CI 0.74-0.96), and cardiovascular mortality (HR 0.72, 95% CI 0.63-0.81). Consumption of unprocessed red meat had a U-shaped relationship with mortality. Moderate consumption of unprocessed red meat 1.0-1.9 times/week was associated with a 14% (95% CI: 3 %-24%) lower risk of all-cause mortality than the lowest consumption frequency group (0-0.9 times/week). The hazard of cancer and CV mortality was also lower in the 1.0-1.9 times/week group, though the associations were not statistically significant. More frequent consumption of processed meat was associated with an increased risk of all-cause mortality (HR 1.20, 95% CI 1.07-1.34) and cardiovascular mortality (HR 1.20, 95% CI 1.02-1.42). Fish consumption was not associated with all types of mortality.

CONCLUSIONS

Higher consumption of processed meat, not fish, was associated with increased all-cause and cardiovascular mortality. In contrast, higher consumption of unprocessed poultry and moderate consumption of unprocessed red meat was associated with reduced all-cause, cancer, and cardiovascular mortality. These findings warrant further investigation to establish optimal dietary patterns for frail individuals.

Associations of sugar-sweetened beverages, artificially sweetened beverages, and natural juices with cardiovascular disease and all-cause mortality in individuals with inflammatory bowel disease in a prospective cohort study

Background

Beverage consumption was found to be associated with cardiovascular disease and mortality in the general population. However, it is unclear whether this association still exists in individuals with inflammatory bowel disease (IBD).

Objectives

To investigate the associations of sugar-sweetened beverages, artificially sweetened beverages, and natural juices with cardiovascular disease and all-cause mortality among individuals with IBD.

Design

Prospective cohort study.

Methods

We included 1981 participants with IBD in the UK Biobank. Consumption of beverages was measured using a validated 24-h diet recall. Outcomes of interest were overall cardiovascular disease and all-cause mortality. Cox proportional hazard models were used to estimate the hazard ratios and 95% confidence intervals (CIs).

Results

During a mean (SD) follow-up of 10.1 (1.7) years, we documented 205 cardiovascular events and 133 deaths. Compared to non-consumers, those consuming sugar-sweetened beverages more than 1 unit/day (reported in glasses/cans/250 ml/cartons) were associated with 64% (95% CI: 5-155, p = 0.030) and 97% (95% CI: 16-233, p = 0.012) increased risk of cardiovascular disease and all-cause mortality, respectively. We also observed a 78% (95% CI: 3-205, p = 0.038) increased risk of cardiovascular disease in participants who consumed artificially sweetened beverages more than 1 unit/day when compared with non-consumers. We did not observe significant associations between natural juice consumption and the two outcomes in IBD.

Conclusion

Higher sugar- and artificially sweetened beverage consumption were associated with adverse cardiovascular and mortality outcomes in IBD. These exploratory results were consistent with the evidence in the general population and highlighted the importance of diet management in individuals with IBD.

Editorial: Unravelling the fibres-low dietary fibre may lower risk of developing IBD. Authors' reply

This article is linked to Deng et al papers. To view these articles, visit https://doi.org/10.1111/apt.17649 and https://doi.org/10.1111/apt.17663

Serum 25-hydroxyvitamin D, type 2 diabetes, and liver-related outcomes: Secondary data analysis of a prospective recruited cohort

BACKGROUND

The association of vitamin D deficiency, which is prevalent in type 2 diabetes mellitus (T2DM), with liver disease and related mortality has not been quantified. Our study aimed to (1) investigate whether there is a synergistic association of vitamin D deficiency and T2DM with liver-related outcomes and (2) explore whether high 25-hydroxyvitamin D [25(OH)D] concentrations are associated with a lower risk of liver-related outcomes in T2DM.

METHOD

Leveraging the data from UK Biobank, we conducted 2 studies: study I assessed the joint associations of vitamin D deficiency [25(OH)D <50 nmol/L] and T2DM with liver-related outcomes among 439,276 participants, and study II explored the associations of vitamin D status with liver-related outcomes among 21,519 individuals with T2DM. Baseline T2DM was identified through medication, laboratory test, and electronic health-related records. Serum 25(OH)D was measured by direct competitive chemiluminescent immunoassay. Liver-related outcomes included 6 liver disease end points and mortality by overall liver disease, chronic liver disease, and severe liver disease.

RESULTS

During an average follow-up duration of 11.6 years, we observed a significant positive additive interaction effect (all synergy index>1.0) of T2DM and vitamin D deficiency on the risk of liver-related outcomes. Compared with participants without either T2DM or vitamin D deficiency, the multivariable-adjusted HRs of overall liver diseases were 1.29 for participants without T2DM but with vitamin D deficiency, 1.73 for participants with T2DM but without vitamin D deficiency, and 2.19 for participants with both T2DM and vitamin D deficiency. In individuals with T2DM, we observed that participants without vitamin D deficiency were inversely associated with incident liver disease and related mortality (multivariable-adjusted HRs 0.41-0.81) when compared with individuals with vitamin D deficiency.

CONCLUSIONS

There are positive synergistic associations of vitamin D deficiency and T2DM with liver-related outcomes. Inverse associations between serum 25(OH)D concentrations and liver-related outcomes were observed in individuals with T2DM.

Higher dietary fibre intake is associated with lower risk of inflammatory bowel disease: prospective cohort study

BACKGROUND

Limited prospective studies that have examined the association of dietary fibre with IBD have provided inconsistent evidence.

AIM

To examine any associations between dietary fibre intake and subsequent incidence of IBD, Crohn's disease (CD) and ulcerative colitis (UC) METHODS: We conducted a prospective cohort study of 470,669 participants from the UK Biobank and estimated dietary fibre intake from a valid food frequency questionnaire at baseline. Incident IBD was ascertained from primary care data and inpatient data. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between dietary fibre intake and the risk of IBD, CD and UC.

RESULTS

During an average follow-up of 12.1 years, we ascertained 1473 incident IBD cases, including 543 cases of CD and 939 cases of UC. Comparing the lowest quintiles, an inverse association was observed between dietary fibre intake and risk of IBD (HR 0.74, 95% CI 0.58-0.93, p = 0.011) and CD (HR 0.48, 95% CI 0.32-0.72, p < 0.001), but not UC (HR 0.92, 95% CI 0.69-1.24, p = 0.595). For specified sources, dietary fibre intake from fruit and bread decreased the risk of CD, while dietary fibre intake from cereal decreased the risk of UC.

CONCLUSIONS

Higher consumption of dietary fibre was associated with a lower risk of IBD and CD, but not UC. Our findings support current recommendations to increase the intake of dietary fibre.

Higher Fiber Intake is Associated with Reduced Risk of Related Surgery among Individuals with Inflammatory Bowel Disease in a Prospective Cohort Study

BACKGROUND

Evidence for the effects of dietary fiber on adverse outcomes in individuals with inflammatory bowel disease (IBD) is insufficient and controversial.

OBJECTIVES

We aimed to prospectively explore the association between dietary fiber intake and the risk of IBD-related surgery.

METHODS

We identified 5580 individuals with diagnosed IBD [Crohn disease (CD, n = 1908) and ulcerative colitis (UC, n = 3672)] at baseline in the UK Biobank via electronic medical records and self-reported information. Dietary fiber intake was estimated by a partial fiber score derived from a valid food frequency questionnaire. IBD-related surgery (enterotomy, perianal surgery, and others) was ascertained via inpatient data. Cox proportional model was applied to estimate hazard ratios with 95% confidence intervals (CIs) of dietary fiber in quartiles for the risk of IBD-related surgery.

RESULTS

During a mean follow-up period of 11.2 y, we documented 624 IBD-related surgery among 5580 individuals with IBD (mean age, 57.3; 52.8% females). Compared with individuals in the lowest quartiles, those with second to fourth quartiles of fiber intake were associated with 23% (95% CI: 5%, 38%, P = 0.015), 29% (95% CI: 11%, 43%, P = 0.003), and 28% (95% CI: 10%, 43%, P = 0.005) reduced risk (P-trend = 0.002) of IBD-related surgery. Similar associations were observed in CD (P-trend = 0.005) but not UC (P-trend = 0.131). We observed inverse associations of fiber in vegetables and fruits (P-trend = 0.017 and 0.007) but positive associations of fiber in bread (P-trend = 0.046) with the risk of IBD-related surgery.

CONCLUSIONS

Higher intake of fiber is associated with reduced IBD-related surgery risk in patients with IBD with CD but not UC.

Higher Adherence to Cardioprotective Diet is Associated with Reduced Risk of Enterotomy and All-Cause Mortality among 5549 Individuals with Inflammatory Bowel Disease in a Prospective Cohort Study

BACKGROUND

The cardioprotective diet has been previously reported to be inversely associated with the development of inflammatory bowel disease (IBD), but whether it is beneficial to improve adverse outcomes in IBD remains unknown.

OBJECTIVES

We aimed to investigate whether the cardioprotective diet is associated with enterotomy and all-cause mortality among individuals with IBD.

METHODS

We conducted a prospective cohort study of 5549 participants with IBD from the UK Biobank. Cardioprotective diet scores (range 0-7) were calculated based on the consumption of 7 common food groups collected by a validated food frequency questionnaire. Outcomes of interest were enterotomy and all-cause mortality, ascertained via inpatient data and death registry, respectively. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

During an average follow-up duration of 12.0 y, we documented 506 enterotomy and 566 death events. Compared with participants with the lowest adherence to the cardioprotective diet (score of 0-2), participants with the highest adherence to the cardioprotective diet (score of 5-7) were observed to have a lower risk of enterotomy (HR: 0.60; 95% CI: 0.47, 0.76; P < 0.001; P-trend < 0.001) and all-cause mortality (HR: 0.77; 95% CI: 0.61, 0.98; P = 0.031; P-trend = 0.025).

CONCLUSIONS

A greater adherence to the cardioprotective diet is associated with a lower risk of enterotomy and all-cause mortality among individuals with IBD.

Ambient Air Pollution and Risk of Enterotomy, Gastrointestinal Cancer, and All-Cause Mortality among 4,708 Individuals with Inflammatory Bowel Disease: A Prospective Cohort Study

BACKGROUND

Previous studies indicated that air pollution plausibly increases the risk of adverse outcomes in inflammatory bowel disease (IBD) via proinflammatory mechanisms. However, there is scant epidemiological data and insufficient prospective evidence assessing associations between ambient air pollution and clinical outcomes of IBD.

OBJECTIVES

We aimed to investigate the associations between ambient air pollution and clinical outcomes among individuals with IBD.

METHODS

Leveraging data from the UK Biobank, we included 4,708 individuals with IBD recruited in the period 2006-2010 in this study. A land use regression model was used to assess annual mean concentrations of ambient air pollutants nitrogen including oxides (NO x ), nitrogen dioxide (NO 2 ), and particulate matter (PM) with aerodynamic diameter ≤ 10 μ m (PM 10 ) and PM with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ). Individuals with IBD were followed up for incident clinical outcomes of enterotomy, gastrointestinal cancer, and all-cause mortality, ascertained via death registry, inpatient, primary care, and cancer registry data. Cox proportional hazard model was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the magnitude of the associations.

RESULTS

During a mean follow-up of 12.0 y, 265 enterotomy events, 124 incident gastrointestinal cancer, and 420 death events were documented among individuals with IBD. We found that each interquartile range (IQR) increase in exposure to PM 2.5 was associated with increased risk of enterotomy (HR = 1.16 ; 95% CI: 1.00, 1.34, p = 0.043 ), whereas an IQR increase in exposure to NO x (HR = 1.10 ; 95% CI: 1.01, 1.20, p = 0.016 ), NO 2 (HR = 1.16 ; 95% CI: 1.03, 1.29, p = 0.010 ), PM 10 (HR = 1.15 ; 95% CI: 1.03, 1.30, p = 0.015 ), and PM 2.5 (HR = 1.14 ; 95% CI: 1.02, 1.28, p = 0.019 ) was associated with increased risk of all-cause mortality among individuals with IBD. We did not observe any significant associations between air pollutants and gastrointestinal cancer in the primary analyses. Consistent results were observed in subgroup and sensitivity analyses.

CONCLUSIONS

Ambient pollution exposure was associated with an increased risk of enterotomy and all-cause mortality among individuals with IBD, highlighting the important role of environmental health in improving the prognosis of IBD. https://doi.org/10.1289/EHP12215.

Sales of antibiotics without a prescription in pharmacies, 2017 and 2021, China

Objective

To measure sales of antibiotics without a prescription in pharmacies in China in 2017 and 2021, before and during the coronavirus disease 2019 (COVID-19) pandemic, and determine the factors associated with such sales.

Methods

We conducted cross-sectional surveys using the simulated patient method in retail pharmacies in 13 provinces in eastern, central and western China in 2017 and 2021. At the pharmacies, the simulated patients (trained medical students) reported that they had mild respiratory tract symptoms and asked for treatment, using a three-stage process: (i) request some treatment; (ii) request antibiotics; (iii) request specific antibiotics. We used multivariable logistic regression analysis to determine factors associated with sale of antibiotics without a prescription.

Findings

Of the pharmacies visited in 2017, 83.6% (925/1106) sold antibiotics without a prescription; this figure was 78.3% (853/1090) in 2021 (P-value: 0.002). After excluding pharmacies prohibited from selling antibiotics because of COVID-19, this difference was not significant (83.6% versus 80.9%; 853/1054; P-value: 0.11). Factors significantly associated with selling antibiotics without a prescription in both 2017 and 2019 were: location in central and western China compared with eastern China; being in a township or village compared with in a city; and presence of a counter where antibiotics were dispensed.

Conclusion

Although laws became stricter between 2017 and 2021, antibiotic sales without a prescription were still common in pharmacies across China. Existing regulations need to be more strictly enforced, and pharmacy staff and the public should be made more aware of the risks of antibiotic misuse and dangers of antimicrobial resistance.

Homocysteine, folate, and nonalcoholic fatty liver disease: a systematic review with meta-analysis and Mendelian randomization investigation

BACKGROUND

Circulating concentrations of homocysteine and folate are inconsistently associated with the risk of nonalcoholic fatty liver disease (NAFLD) in observational studies.

OBJECTIVES

We conducted a meta-analysis and Mendelian randomization (MR) analyses to examine these associations.

METHODS

We performed a meta-analysis of observational studies identified from 3 databases to evaluate the associations of serum homocysteine and folate concentrations with NAFLD from inception to 7 April 2022. We conducted MR analyses to strengthen the causal inference in these associations. Independent single-nucleotide polymorphisms without linkage disequilibrium (r2 < 0.01) that were strongly associated (P < 5 × 10-8) with serum homocysteine (n = 13) and folate (n = 2) concentrations were selected as instrumental variables from 2 meta-analyses of genome-wide association studies (GWASs) of 44,147 and 37,645 individuals of European ancestry, respectively. Data on NAFLD were obtained from a GWAS of 8434 NAFLD cases and 770,180 controls of European ancestry. We further included 4 liver enzymes as secondary outcomes from a GWAS of 361,194 individuals with European descent.

RESULTS

Twenty-two observational studies comprising 30,368 participants were included in the meta-analysis. There was a positive association between serum homocysteine and NAFLD risk (n = 20; OR: 1.96; 95% CI: 1.57, 2.45) and an inverse association between serum folate and NAFLD risk (n = 12; OR: 0.75; 95% CI: 0.58, 0.99). In MR analysis, the ORs of NAFLD were 1.17 (95% CI: 1.01, 1.36) and 0.75 (95% CI: 0.55, 1.02) per 1-SD increment of genetically predicted circulating concentrations of homocysteine and folate, respectively. Each 1-SD increase of genetically predicted circulating homocysteine and folate conferred a change in ALT concentrations of 0.62 U/L (95% CI: 0.20, 1.04) and -0.84 U/L (95% CI: -0.14, -1.54).

CONCLUSIONS

This study suggests a potential role of circulating homocysteine and possibly folate in NAFLD, which calls for future clinical exploration of the possibility of lowering homocysteine concentrations to prevent NAFLD. This systematic review was registered at PROSPERO as CRD42021296434.

Greater Adherence to Cardioprotective Diet Can Reduce Inflammatory Bowel Disease Risk: A Longitudinal Cohort Study

Background: The cardioprotective diet was reported to be associated with several chronic cardiometabolic diseases through an anti-inflammation effect. However, the association between the cardioprotective diet and the risk of inflammatory bowel disease (IBD) was unclear and deserved to be further explored. Methods: We calculated the cardioprotective diet score based on the consumptions of seven common food groups using the validated food frequency questionnaire data in the UK Biobank. Incident IBD was ascertained from primary care data, inpatient data, and the death registry. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between the cardioprotective diet score and the risk of IBD. Results: During a mean follow-up of 12.1 years, we documented 2717 incident IBD cases, including 851 cases of Crohn’s disease and 1866 cases of ulcerative colitis. Compared to participants with a cardioprotective diet score of 0−1, we observed a decreased risk of IBD among participants with cardioprotective diet scores of 3 (HR 0.85, 95% CI 0.73−0.99), 4 (HR 0.84, 95% CI 0.72−0.98), and 5−7 (HR 0.77, 95% CI 0.66−0.89) (p-trend < 0.001). Conclusions: A greater adherence to the cardioprotective diet was associated with a lower risk of IBD. Our finding highlighted the importance of focusing on the cardioprotective diet to prevent IBD.

Nonlinear Association between Serum 25-Hydroxyvitamin D and All-Cause Mortality in Adults with Inflammatory Bowel Disease in a Prospective Cohort Study

BACKGROUND

Nonlinear association between serum 25-hydroxyvitamin D [25(OH)D] concentration and all-cause mortality has been widely reported for the general population, but this association has not been quantified for individuals with inflammatory bowel disease (IBD).

OBJECTIVES

The aim was to explore the association between serum 25(OH)D and all-cause mortality in individuals with IBD.

METHODS

We identified 2690 females and 2532 males aged 40-69 y with diagnosed IBD at baseline in the UK Biobank. Serum 25(OH)D concentration was measured by direct competitive chemiluminescent immunoassay. The outcome was all-cause mortality, ascertained via the death registry. Cox proportional hazard regression was used to evaluate associations between serum 25(OH)D in quintiles and all-cause mortality among individuals with IBD [Crohn disease (CD; n = 1760) and ulcerative colitis (UC; n = 3462)]. Restricted cubic splines were used to investigate potential nonlinearity.

RESULTS

During the mean follow-up period of 11.9 y, 529 deaths (198 in CD and 331 in UC) were documented among 5222 individuals with IBD. Compared with the lowest quintile of serum 25(OH)D, HRs for the second to the highest quintiles were 0.82 (95% CI: 0.63, 1.06), 0.63 (95% CI: 0.47, 0.83), 0.64 (95% CI: 0.48, 0.85), and 0.74 (95% CI: 0.55, 0.99), respectively. Nonlinearity was detected in the dose-response association between serum 25(OH)D concentration and all-cause mortality (P-nonlinearity < 0.001), and 25(OH)D concentrations of 44-78 nmol/L were associated with a 50% lower risk of all-cause mortality (than 10 nmol/L). Subgroup analyses showed that the nonlinear association mostly applied to females (P-nonlinearity < 0.001 compared with 0.080 in males).

CONCLUSIONS

We observed a nonlinear association, mostly applicable to females, between serum 25(OH)D concentrations and all-cause mortality among individuals with IBD. A 25(OH)D concentration range of 44-78 nmol/L can serve as a starting point for future research to confirm recommended 25(OH)D concentrations for individuals with IBD.

Effectiveness of Educational Interventions for Health Workers on Antibiotic Prescribing in Outpatient Settings in China: A Systematic Review and Meta-Analysis

Educational interventions are considered an important component of antibiotic stewardship, but their effect has not been systematically evaluated in outpatient settings in China. This research aims to evaluate the effectiveness of educational interventions for health workers on antibiotic prescribing rates in Chinese outpatient settings. Eight databases were searched for relevant randomized clinical trials, non-randomized trials, controlled before–after studies and interrupted time-series studies from January 2001 to July 2021. A total of 16 studies were included in the systematic review and 12 in the meta-analysis. The results showed that educational interventions overall reduced the antibiotic prescription rate significantly (relative risk, RR 0.72, 95% confidence interval, CI 0.61 to 0.84). Subgroup analysis demonstrated that certain features of education interventions had a significant effect on antibiotic prescription rate reduction: (1) combined with compulsory administrative regulations (RR With: 0.65 vs. Without: 0.78); (2) combined with financial incentives (RR With: 0.51 vs. Without: 0.77). Educational interventions can also significantly reduce antibiotic injection rates (RR 0.83, 95% CI 0.74 to 0.94) and the inappropriate use of antibiotics (RR 0.61, 95% CI 0.51 to 0.73). The limited number of high-quality studies limits the validity and reliability of the results. More high-quality educational interventions targeting the reduction of antibiotic prescribing rates are needed.

Meat consumption and all-cause mortality in 5763 patients with inflammatory bowel disease: A retrospective cohort study

BACKGROUND

Whether meat consumption is related to risk of mortality in patients with inflammatory bowel disease (IBD) remains poorly understood.

METHODS

In the UK Biobank, 5763 patients with IBD were recruited from 2007 to 2010 and finished a brief food frequency questionnaire at baseline. We followed them until March 13, 2021 to document all-cause death events. Cox proportional hazard models were used to estimate hazard ratios (HRs) for all-cause mortality associated with consumptions of fish, unprocessed poultry, unprocessed red meat, and processed meat among the patients.

FINDINGS

During 67,095 person-years (mean follow-up 11·7 years, mean age 57·3, 52·5% female), we documented 590 death events. Higher consumption of processed meat was associated with an increased risk of all-cause mortality in patients with IBD (HR comparing >4·0 with 0-0·9 time/week=1·52, 95% confidence interval (CI) 1·05-2·19), but the P-trend for each 25 g increment was 0·075. This association remained significant in patients with Crohn's disease (HR 1·77, 95% CI 1·01-3·10) but not in patients with ulcerative colitis (HR 1·34, 95% CI 0·82-2·20). Consumptions of fish (HR 1·27, 95% CI 0·84-1·91), unprocessed poultry (HR 0·59, 95% CI 0·28-1·21), or unprocessed red meat (HR 0·87, 95% CI 0·60-1·26) were not significantly associated with the mortality of patients with IBD.

INTERPRETATION

More frequent consumption of processed meat was associated with an increased risk of mortality in patients with IBD, while no associations were observed for consumption of other types of meat. Our exploratory and speculative findings should be cautiously interpreted and need further replication in other cohorts.

FUNDING

The National Natural Science Foundation of China (81,970,494); Key Project of Research and Development Plan of Hunan Province (2019SK2041).

Propranolol induces apoptosis of human umbilical vein endothelial cells through downregulation of CD147

BACKGROUND

Infantile haemangiomas (IHs) are benign tumours in infancy. Most patients suffering from IHs do not require treatment. However, if there is a dramatic aesthetic or functional impairment, treatment is needed. Currently the most promising therapy for complicated IHs is the oral administration of propranolol, but its mechanism is unclear.

OBJECTIVES

To investigate the role of CD147 in propranolol-induced apoptosis in human umbilical vein endothelial cells (HUVECs).

METHODS

Human umbilical vein endothelial cells were treated with propranolol, and the treatment effects were investigated through the following methodology. (i) Cell proliferation and apoptosis were detected using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and flow cytometric analysis. (ii) The expression level of CD147 was measured by reverse-transcription polymerase chain reaction and Western blotting. (iii) HUVECs were transfected with lentivirus encoding CD147 short hairpin (sh)RNA or CD147 cDNA. Ensuing changes in cell proliferation and apoptosis after transfection were measured using the MTT assay and flow cytometry. (iv) The level of phosphorylation of Bcl-2-associated death promoter (BAD) at Ser112 in HUVECs after propranolol treatment and/or CD147 shRNA transfection was detected by Western blotting.

RESULTS

Propranolol inhibited cell proliferation and induced apoptosis in HUVECs. It decreased CD147 protein expression in a concentration-dependent manner. Knocking down CD147 not only induced apoptosis but also exacerbated the apoptosis triggered by propranolol in HUVECs. Overexpression of CD147 can protect HUVECs from apoptosis and propranolol-induced apoptosis. Furthermore, knockdown of both propranolol and CD147 can downregulate Ser112 phosphorylation of BAD, indicating that propranolol and CD147 induce apoptosis in HUVECs through the same signalling transduction pathway.

CONCLUSIONS

Our studies demonstrate that propranolol-induced apoptosis may be mediated through the downregulation of CD147 in HUVECs. This study highlights a novel step in propranolol action and suggests a potential new target for the treatment of IHs.

Abstract A44: Minority enrollment to clinical trials: Experience at the Dan L. Duncan Cancer Center

Background: The Dan L Duncan Cancer Center (DLDCC) is located in Houston, Texas, and provides care to uninsured and minority patients in several large hospitals including Ben Taub General Hospital, The Michael E. DeBakey VA Medical Center, and Texas Children's Hospital. The catchment area for the DLDCC is Harris County, an urban area with a population of nearly 4 million; approximately 18% of county residents are African American and 39% are Hispanic. While the percentage of African Americans in Harris County is nearly equal in all age groups, Hispanics make up nearly 45% of residents less than 30 years old, but only 10% of residents over 60, those most likely to develop cancer. One-third of the county population has no health insurance.

Objective: In 2006 the DLDCC set out to increase overall enrollment to therapeutic clinical trials while maintaining enrollment of patients belonging to racial and ethnic minorities.

Methods: A four-pronged strategy was used to maintain and improve accrual of racial and ethnic minority patients to cancer-related clinical trials while increasing overall accrual. First, the DLDCC invested significant resources in establishing research infrastructure in the hospitals including hiring bilingual coordinators and nurses, translating consents into Spanish, and underwriting the cost for conduct of NCI-sponsored trials. Second, the DLDCC partnered with hospitals to make office space available for research personnel, to provide discounted investigational pharmacy services and to obtain access to laboratory and imaging data and pathology samples. Third, the DLDCC introduced programs to make minority residents aware of clinical trials and build relationships and trust in the community including the establishment of a community advisory board, sponsorship of plays by minority playwrights that carry a cancer message, sponsorship of community health events, and creation of clinical trials newsletters and websites. Finally, the DLDCC pioneered and gained IRB approval for a form designed to collect accurate racial and ethnic data from trial participants.

Results: Overall enrollment to DLDCC therapeutic clinical trials increased by more than 50% between 2005/2006 and 2009 to an average of 13.4% of new cancer patients enrolled on trial. In 2009, 16.8% of subjects enrolled to therapeutic trials were African American, and 35.4% were Hispanic. Accrual of minority subjects was equivalent in pediatric and adult programs and on therapeutic and nontherapeutic trials.

Conclusion: Recruitment of pediatric and adult members of underserved minorities to clinical trials is possible with targeted strategies, dedicated research staff, hospital partnership and community involvement.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A44.

Influence of humic substances on the migration of237Np,238Pu and241Am in a weak loess aquifer

The influence of humic substances on the migration of radionuclides237Np,238Pu and241Am in a weak loess aquifer was investigated in situ with bisectional experimental columns. The experimental columns were constructed by connecting two undisturbed aquifer medium columns together, and inserted into the aquifer horizontally through holes pre-prepared in the wall of a vertical Experimental Shaft in an Underground Research Facility at the CIRP´s field test site. Quartz containing radionuclides3H,237Np,238Pu and241Am was introduced as point source and plane source at the central parts of the experimental columns, respectively. Outflow water of the experimental columns were collected and3H in the outflows were analyzed for calculating the water flow velocity in the experimental columns. When the experiment was completed, the experimental columns were dismounted and cut into slices and the activities of237Np,238Pu and241Am in the sliced samples were determined.

The water flow velocity in the point source experimental column and in the plane source experimental column was calculated as 1.15±0.05 cm/d and 1.06±0.05 cm/d, respectively. The concentration distribution of237Np,238Pu and241Am in the experimental columns indicate that, adjacent to the source, the concentration of each radionuclide is very large and decreases abruptly as the distance increases. In addition, some other high concentration regions/points were observed. This phenomenon may suggest that multiple species of these radionuclides with different mobility may exist in the in-situ aquifer condition. The calculated apparent distribution coefficients (Kd, ml/g) of the main specie of these radionuclides with and without additional humic substances are 8.90×101and 8.90×102for237Np, 1.93×102and 9.48×102for238Pu, 7.60×102and 9.79×102for241Am, respectively. These data suggest that the introduction of additional humic substances into the aquifer may enhance the mobility of237Np and238Pu, while it has no obvious influence on the migration of241Am.

The migration of radionuclides237Np,238Pu and241Am in a weak loess aquifer: A field column experiment

The migration of radionuclides237Np,238Pu and241Am in a weak loess aquifer were investigated in-situ with a bisectional experimental column. The experimental column was constructed by connecting 2 undisturbed aquifer medium columns together and inserted into the aquifer horizontally through holes pre-prepared in the wall of a vertical experimental shaft in an Underground Research Facility at the CIRP´s field test site. Quartz containing radionuclides3H,237Np,238Pu and241Am was introduced as a point source at the center of the experimental column. Outflow water of the experimental column was collected and3H in the outflow was determined for calculating the water flow velocity through the experimental column. The experimental column was cut into slices of 0.3 cm long and the radioactivity of237Np,238Pu and241Am in the sliced soil samples was analyzed when the experiment was completed.

The water flow velocity in the experimental column was calculated as 1.15±0.05 cm/d. The activity distribution of237Np,238Pu and241Am in the experimental column indicate that each radionuclide has a very strong activity distribution region adjacent to the source introduction point and decreases abruptly as the distance increases. In addition there are other secondary activity distribution regions with different strength and widths. The calculated apparent distribution coefficients of the main specie of these radionuclides is (8.90±1.51)×102ml/g for237Np, (9.48±1.61)×102ml/g for238Pu and (9.79±1.66)×102ml/g for241Am.

Prenatal molecular diagnosis of beta-thalassemia: report on the first two cases in Romania

Thalassaemia major is a classical example of a disease that can be prevented by prenatal diagnosis. In Romania there are currently 300 patients with thalassaemia major under the management of specialized institutions. Prenatal diagnoses of thalassemia have offered a new dimension to the prevention of this disease, but in order to implement prenatal diagnosis, knowledge of mutations and of their incidence is essential. Molecular testing using Denaturing Gradient Gel Electrophoresis (DGGE) scanning and direct mutation detection with Amplificaton Refractory Mutation System-PCR (ARMS-PCR) and Restriction endonuclease Analysis of PCR fragments (PCR-RFLP) was performed by using amplified DNA from amniotic cells samples, while mutations in the parents were determined in advance. Using our experience in molecular diagnosis, we were able to perform the first prenatal diagnosis for two young couples at risk for thalassaemia major. Foetal samplings were collected by amniocentesis and chorionic villus sampling in the second trimester of the pregnancies. Maternal contamination of the foetal DNA was ruled out by STR genotyping. The prenatal diagnosis revealed affected foetuses with homozygous status of beta-thalassemia major. The IVSI-110 (G-A)/IVS II-745 (C-G) genotype in the first case foetus and ed 8 (-AA)/cd 8 (-AA) in the second case foetus were reported. The results of this study point to a successful future prenatal diagnosis of beta-thalassnemia in Romania, using a rapid and accurate molecular method. Together with the implementation of proper preventive health measures and the education of parents regarding their carrier status, we are hoping that this method will be used as the common application approach to decrease the incidence of thalassacmia major.

Quantitation of the mass of fatty acid ethyl esters synthesized by Hep G2 cells incubated with ethanol

Fatty acid ethyl esters (FAEE), esterification products of fatty acids and ethanol, have been increasingly implicated as mediators of ethanol-induced organ damage. The first goal of this study was to determine the mass of FAEE synthesized by Hep G2 cells exposed to a given dose of ethanol. The second goal was to determine whether all fatty acids in cells are equally available for FAEE synthesis. Hep G2 cells and essential fatty acid deficient Hep G2 cells (Hep G2-EFD) were used to study the synthesis of FAEE upon exposure to ethanol. A two-pool fatty acid model was created: (1) a "previously incorporated pool" formed by incubating the cells with 14C-labeled fatty acids for 24 hr; and (2) a "newly incorporated pool" formed by incubating cells with 3H-labeled fatty acids for 0.5 hr. The FAEE production from each pool was then determined. The total production of FAEE within 3 hr by Hep G2 cells in culture was 150 to 250 pmol/mg cell protein. The fatty acids most recently incorporated into the cells were preferred as substrates for FAEE synthesis because a higher percentage of fatty acids from the newly incorporated pool was used for FAEE synthesis than from the previously incorporated pool. Furthermore, a dose-response relationship was observed between the amount of fatty acid in the newly incorporated pool and FAEE production, but not between the amount of fatty acid in the previously incorporated pool and FAEE synthesis. Taken together, the results indicate that a relatively small amount of endogenously synthesized FAEE is generated from specific intracellular pools of fatty acid since not all fatty acids are equally available for FAEE synthesis. This indicates that if endogenous FAEE are toxic, they exert their toxic effect at very low intracellular FAEE concentrations.

Ethyl palmitate and ethyl oleate are the predominant fatty acid ethyl esters in the blood after ethanol ingestion and their synthesis is differentially influenced by the extracellular concentrations of their corresponding fatty acids

The possibility that fatty acid ethyl esters (FAEEs), esterification products of fatty acids and ethanol, are mediators of ethanol-induced organ damage was suggested by an autopsy study in which individuals who died while acutely intoxicated were found to have FAEEs predominantly in the organs damaged by ethanol abuse. We initially observed in human subjects after ethanol consumption that there is a marked preference for the synthesis of ethyl palmitate and ethyl oleate over other FAEEs. To investigate the basis for this relative fatty acid specificity for FAEE synthesis, we used an in vitro system of Hep G2 cells incubated with ethanol. The cells were capable of synthesizing FAEEs upon exposure to ethanol and they showed a preference for synthesis of ethyl palmitate and ethyl oleate, as was found in human plasma after ethanol ingestion. This finding allowed us to explore the metabolic preference for palmitate and oleate for FAEE synthesis at the biochemical level using intact cells. We demonstrated that the preferential selection of palmitate and oleate for FAEE synthesis was not likely to be the result of specificity for palmitate and oleate by FAEE synthase or preferential uptake of palmitate and oleate by Hep G2 cells. In studies to determine whether the preference for ethyl palmitate and ethyl oleate synthesis was a result of higher concentrations of palmitate and oleate in the extracellular medium, we observed that the synthesis of ethyl oleate, ethyl linoleate, and ethyl arachidonate, but not ethyl palmitate, is influenced by the extracellular concentration of its corresponding fatty acid. The results of our studies indicate that ethyl palmitate and ethyl oleate are the predominant ethyl esters synthesized, that there is no preferential uptake or enzyme affinity for their fatty acid precursors to explain the predominance, and that ethyl palmitate synthesis is uniquely unaffected by the concentration of palmitate in the extracellular medium.

Aspects of hydatidosis in the adult population in Banat

An epidemiological study was performed on a lot of 505 adult subjects (over 20 years old) diagnosed with E.granulosus hydatidosis and operated in surgery units in hospitals from such towns as Timişoara, Arad and Reşita (1985-1992). The incidence of hydatid infection was almost uniformly distributed by sexes, being a little higher in rural areas (52.0%); the highest number of cases was reported in Timiş County (63.6%), followed by Caraş-Severin County (21.2%). Hydatidosis was most frequently found in liver (67.5%) and lungs (23.7%) and more rarely in kidneys (0.4%), brain (0.2%), pancreas (0.2%), ovary (0.2%). Secondary hydatidosis was reported on 12.7% of cases and multiple cyst forms in 12.7% of cases. The distribution of cases by age group was relatively balanced, a slightly increased incidence being found in the 20-29 years age group (23.2%), about 1/3 of pulmonary localizations being reported in the age group. Post-surgery complications were reported in 13.5% of the total hepatic localizations and in 30% of the pulmonary localizations. The average number of days in hospital was 29.5 days/case. The average morbidity in the adult population in Banat over an eight years time interval was 5.36%ooo, being higher in Timiş county-7.8%ooo where a peak (11%ooo) was reported in 1987.

[Effect of the T4 on the viscera and embryo of perinatal mice]

58 Female Kun Ming mice of perinatal stage (from the 15th day of pregnacy to the 21th day after birth) were fed with Tripcholorolide (T4) isolated from multiglycosides of Tripterygium wilfordii (GTW) at a doze of 0.6 mg/kg for group 1 or 0.3 mg/kg for group 2 per day for 4 weeks. Lactation was decreased in some females and some F1 off spring died. The succinic dehydrogenase (SDH) activity of the mice liver were increased due to the destruction of its mitocondian. Liver cells degenerated and glycogen decreased. Distal tubules of kidney degenerated. Heart and spleen were normal. T4 was also fed to 10 female mice from the 5th to 17th day of pregnacy. However, neither the absorbed fetus nor dead fetus increased.

[The antifertility effect of gossypol plus testosterone and estrogen]

In order to reduce the side effect of gossypol, gossypol was used in combination with steroid hormones so that the dose of both drugs can be reduced. Silastic capsules containing testosterone (T) + estradiol (E) were implanted under the skin male wister rats for 8 weeks. After removing the implants, testosterone was given orally at the dose of 15 mg.kg-1 which is only 50% of the usual antifertility dose. Mating tests showed that the male rats became infertile. Microscopic examination of the heart, liver and kidneys showed no pathologic changes. The treated rats gained body weight as well as the controls. The fertility of the treated rats recovered four to five weeks after treatment. Thus, gossypol in combination with testosterone and estrogen exhibited a low degree of side effect and high antifertility activity.

[The radiofrequency ablation of Mahaim and Kent fibers during the repair of Ebstein's anomaly]

A young man 20 years old was referred to the Institute with Ebstein anomaly. He had experienced palpitations since the age of eight. Those episodes occurred several times a year. During the electrophysiologic study a regular antidromic reciprocating tachycardia was induced using a right atriofascicular connection (Mahaim). The atrial insertion of the Mahaim fibers was in the right posterolateral atrium. Also another orthodromic supraventricular tachycardia was induced with anterograde conduction over atrioventricular node and retrograde conduction over to canceled atrioventricular right posteroseptal bypass tract (Kent). During surgery to repair Ebstein anomaly we decided to perform radiofrequency catheter ablation of both Mahaim and Kent fibers at the tricuspid annulus in the posteroseptal and lateral regions, eliminating accessory pathways conduction. There were no complications during the procedure. The tachycardia has not recur in a six months period of follow up. No antiarrhythmic drugs has been given.

[The radiofrequency ablation of accessory pathways in 100 consecutive patients with supraventricular tachycardias]

The purpose of this study is to describe the results and the complications of radiofrequency catheter ablation, of accessory pathways in 100 consecutive patients. We had one patient with two pathways. Of the 101 accessory pathways, 56 were overt and 45 concealed. Only 19 patients have had a previous electrophysiology study, in the others, the study and the ablation were performed simultaneously. The location of the accessory pathways were as follows: 61 pathways in the free wall of the left ventricle, 4 in the free wall of the right ventricle, 25 in the left posteroseptal region, 9 in the right posteroseptal region and 2 in the right anteroseptal area. The time required for the diagnostic component of the electrophysiology study, the ablation procedure and the fluoroscopic time was recorded for each patient. Ninety-one of 101 accessory AV connections were successfully ablated (90%). Our success rate for the initial attempt was 87%. We had the opportunity to do a second attempt in only 4 out of 14 patients. The mean time of the procedure, including the electrophysiology test and the ablation was 95.6 %/-55.3 minutes. We have had a recurrence of 9% and 4% of non fatal complications. Radiofrequency catheter ablation can be performed safely and with a high success rate.