[Propensity score matching analysis of the short-term efficacy of Kamikawa versus double- tract reconstruction in laparoscopic proximal gastric cancer surgery]

Objective: To compare the short-term efficacy of Kamikawa anastomosis and double-tract reconstruction (DTR) after proximal gastrectomy. Methods: This was a propensity score matched, retrospective, cohort study. Inclusion criteria comprised age 20-70 years, diagnosis of gastric cancer by pathological examination of preoperative endoscopic biopsies, tumor diameter ≤4 cm, and location in the upper 1/3 of the stomach (including the gastroesophageal junction), and TNM stage IA, IB, or IIA. The study cohort comprised 73 patients who had undergone laparoscopic proximal gastric cancer radical surgery in the Department of Gastroenterology, Tangdu Hospital, Air Force Medical University between June 2020 and February 2023, 19 of whom were in the Kamikawa group and 54 in the DTR group. After using R language to match the baseline characteristics of patients in a ratio of 1:2, there were 17 patients in the Kamikawa group and 34 in the DTR group. Surgery-related conditions, postoperative quality of life, and postoperative complications were compared between the two groups. Results: After propensity score matching, there were no statistically significant differences in baseline data between the two groups (P>0.05). Compared with the DTR group, the Kamikawa group had longer operative times (321.5±15.7 minutes vs. 296.8±26.1 minutes, t=32.056, P<0.001), longer anastomosis times (93.0±6.8 minutes vs. 45.3±7.7 minutes, t=56.303, P<0.001), and less bleeding (76 [54~103] mL vs.112 [82~148) mL, Z=71.536, P<0.001); these differences are statistically significant. There were no statistically significant differences between the two groups in tumor size, time to first postoperative passage of gas, postoperative hospital stay, number of lymph nodes removed, duration of lymph node dissection, or total hospitalization cost (all P>0.05). The median follow-up time was 6.1 ± 1.8 months. As to postoperative quality of life, the Kamikawa group had a lower rate of upper gastrointestinal contrast reflux than did the DTR group (0 vs. 29.4% [10/34], χ2=6.220, P=0.013); this difference is statistically significant. However, differences between the two groups in quality of life score on follow-up of 3 months and 6 months on the Gastroesophageal Reflux Disease (GERD) scale were not statistically significant (all P>0.05). The incidence of postoperative complications was 2/17 in the Kamikawa group, which is significantly lower than the 41.2% (14/34) in the DTR group (χ2=4.554, P=0.033). Conclusion: Kamikawa anastomosis and DTR are equally safe and effective procedures for reconstructing the digestive tract after proximal gastric surgery. Although Kamikawa anastomosis takes slightly longer and places higher demands on the surgical team, it is more effective at preventing postoperative reflux.

[Establishment and preliminary application of quantitative real-time PCR assay for the detection of SARS-CoV-2 subgenomic nucleocapsid RNA]

Objective: To establish a rapid and specific quantitative real-time PCR (qPCR) method for the detection of SARS-CoV-2 subgenomic nucleocapsid RNA (SgN) in patients with COVID-19 or environmental samples. Methods: The qPCR assay was established by designing specific primers and TaqMan probe based on the SARS-CoV-2 genomic sequence in Global Initiative of Sharing All Influenza Data (GISAID) database. The reaction conditions were optimized by using different annealing temperature, different primers and probe concentrations and the standard curve was established. Further, the specificity, sensitivity and repeatability were also assessed. The established SgN and genomic RNA (gRNA) qPCR assays were both applied to detect 21 environmental samples and 351 clinical samples containing 48 recovered patients. In the specimens with both positive gRNA and positive SgN, 25 specimens were inoculated on cells. Results: The primers and probes of SgN had good specificity for SARS-CoV-2. The minimum detection limit of the preliminarily established qPCR detection method for SgN was 1.5×10² copies/ml, with a coefficient of variation less than 1%. The positive rate of gRNA in 372 samples was 97.04% (361/372). The positive rates of SgN in positive environmental samples and positive clinical samples were 36.84% (7/19) and 49.42% (169/342), respectively. The positive rate and copy number of SgN in Wild strain were lower than those of SARS-CoV-2 Delta strain. Among the 25 SgN positive samples, 12 samples within 5 days of sampling time were all isolated with virus; 13 samples sampled for more than 12 days had no cytopathic effect. Conclusion: A qPCR method for the detection of SARS-CoV-2 SgN has been successfully established. The sensitivity, specificity and repeatability of this method are good.

[Design and verification of the screening questionnaire for benign paroxysmal positional vertigo]

Objective: To design and validate a high-quality rapid screening questionnaire based on the common medical history and clinical experience of benign paroxysmal positional vertigo (BPPV). Methods: A questionnaire was designed based on expert's opinions, and the first-time patients who complained of dizziness and vertigo in the vertigo clinic of the First Hospital of Shanxi Medical University from September 2020 to June 2021 were prospectively screened. Taking the displacement test as the gold standard, the reliability and validity of the questionnaire were tested to evaluate its authenticity, reliability and benefit value. This study was divided into three steps. The first step was to conduct a pre-experiment and to adjust the questionnaire items; the second step was to determine the questionnaire items and the best cut-off value; the third step was to screen patients with the best cut-off value and to evaluate the quality of the questionnaire. Results: Seven items were finalized. The Cronbach's coefficient of the questionnaire was 0.675, the content validity was 0.85, the KMO value of the construct validity was 0.648, and there were 4 factors with characteristic root>1, and the cumulative contribution rate was 76.309%. The area under the receiver operating characteristic curve (ROC) was 0.938, and its optimal cut-off value was 4.5 points. At this point, the sensitivity was 88.89% and the specificity was 85.44%. Conclusion: The BPPV rapid screening questionnaire has high sensitivity and specificity, which can be used for clinical screening of BPPV patients.

A prospective study on vulvovaginal candidiasis: multicentre molecular epidemiology of pathogenic yeasts in China

BACKGROUND

Vulvovaginal candidiasis (VVC) is frequent in women of reproductive age, but very limited data are available on the epidemiology in cases of VVC in China.

OBJECTIVES

The current study has been conducted to reveal the prevalence, species distribution of yeast causing VVC and molecular genetics of Candida albicans in China.

METHODS

Vaginal swabs were collected from 543 VVC outpatients recruited in 12 hospitals in China between September 2017 and March 2018. They were preliminarily incubated on Sabouraud dextrose agar and then positive subjects of which were then transmitted to our institute for further identification. CHROMagar™ was used to isolate Candida species, and all isolates were finally identified by DNA sequencing. Multilocus sequence typing (MLST) was used to analyse phylogenetic relationships of the various C. albicans isolates.

RESULTS

Eleven different yeast species were identified in 543 isolates, among which C. albicans (84.7%) was the most frequent, followed by C. glabrata (8.7%). We obtained 117 unique diploid sequence types from 451 clinical C. albicans isolates and 92 isolates (20.4%) belonged to a New Clade. All the strains appearing in the New Clade were from northern China and they were isolated from non-recurrent VVC.

CONCLUSIONS

Our findings suggest that C. albicans are still the main cause of VVC in China and the majority of C. albicans isolates belongs to Clade 1 with DST 79 and DST 45 being two most common. Moreover, the New Clade revealed in our study seems to be specific to northern China.

Hospitalization and mortality in heart failure with preserved ejection fraction: real-world data from a US integrated healthcare delivery system

Introduction

Heart Failure with preserved ejection fraction (HFpEF) is a major public health and economic burden, but large real-world incident rates of clinical outcomes are scarce.

Purpose

Calculate adjusted incidence rates of hospitalization and mortality in patients with HFpEF compared with heart failure with reduced ejection fraction (HFrEF) using an integrated healthcare delivery System in the United States.

Methods

Non-interventional longitudinal cohort analysis between 2005 and 2017 of existing data of adult patients with a HF diagnosis (ICD9/ICD10) in the electronic medical record of Kaiser Permanent Northwest. Clinical outcomes of interest were all-cause hospitalizations, heart failure hospitalization (HHF, defined as a discharge diagnosis of HF in the primary position) and all-cause mortality. Age/sex adjusted incidence rates were assessed generalized estimating equations over 15 years of follow-up (2005–2019).

Results

Of the 37,773 patients with HF diagnosis, 36% had no EF available. 46.4% were categorized as HFpEF, 7.2% HFmrEF and 10.4% HFrEF. Compared with patients with HFrEF, those with HFpEF were older (72.1 vs. 68.3 years), more likely to be female (55% vs. 33.2%), had higher BMI (31.9 vs. 29.3 kg/m2), higher SBP (130 vs. 121mmHg) and were less likely to have a history of myocardial infarction (26.1% vs. 43.8%). Patients with HFpEF were less likely to receive RAAS blockade compared with HFrEF (66.0% vs. 86.7%) but use of any HF-related medication (ACE/ARB, diuretics, β-blockers, or aldosterone agonists) was similarly high (89.6% vs 88.8%). As shown in Figure 1, adjusted mortality rates per 1,000 person-years, [95% CI] were lower in HFpEF (107.9 [105.5, 110.3]) vs. HFrEF (143.0 [136.5, 149.7]). Also, HHF were lower in HFpEF (41.6 [40.1, 43.2]) compared to HFrEF (72.6 [67.7, 77.9]). All-cause hospitalization rates were about 12% lower in HFpEF (197.3 [193.9, 200.7]) compared with HFrEF (222.8 [214.1, 231.7]). Nonetheless, due to the much larger size of the HFpEF group, these patients generated 1,982 more HHF, 10,427 more hospitalizations for any reason, and 6,723 more deaths during follow-up.

Conclusions

In a large real-world dataset of HF patients, incidence rates for hospitalization and mortality were relatively lower in HFpEF vs. HFrEF. However, given the greater prevalence of HFpEF (46.4% vs. 10.4% for HFrEF), this diagnosis posed a much higher public health burden.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Boehringer Ingelheim

Largely enhanced thermoelectric effect and pure spin current in silicene-based devices under hydrogen modification

Based on the density functional theory and nonequilibrium Green's function methods, we launch a systematic study of the magnetic properties and thermoelectric effects in silicene-based devices constructed by using zigzag silicene nanoribbons (ZSiNRs). By modulating the adsorption site, it is found that the ground state of ZSiNRs varies from an antiferromagnetic state to a ferromagnetic state. Meanwhile, a spin-degenerate semiconductor evolves into a spin semiconductor. The spin and charge thermoelectric figure of merits have an almost equal value of about 60 in the narrow device, which originates from the spin-dependent conductance dips and high spin-filtering effects. Moreover, a thermally-driven pure spin current in the silicene-based devices is obtained in the absence of the gate voltage, and its magnitude is effectively enhanced as the device width increases. Our results suggest that the silicene-based devices have very good prospects for spin caloritronics.

Variability of seed oil content, fatty acid composition, and nervonic acid content in

The seed oil of 138 accessions of 14 Acer truncatum (Aceraceae family) populations native to China were analyzed by pulsed nuclear magnetic resonance spectroscopy and gas chromatography-flame ionization detection. The oil content ranged from 17.81% to 36.56% (mean: 28.57%), which mainly consisted of 14 types of fatty acids. Palmitic (4.69%), stearic (2.30%), oleic (25.19%), linoleic (32.97%), linolenic (2.76%), cis-11-eicosenoic (7.90%), erucic (16.49%), and nervonic (5.76%) fatty acids accounted for 98% of total fat. The nervonic acid content ranged from 3.90% to 7.85% among the accessions. Significant variations in oil content and predominating fatty acids were observed among populations. Hierarchical cluster analysis and principal component analysis detected obvious geographical variation trends among A. truncatum populations which correlate with environmental variations (especially altitude, temperature, and precipitation) and supported the grouping of the populations into three groups according to geographic locations.

[Semaphorin 3A-stimulated bone marrow mesenchymal stem cells sheets promotes osteogenesis of type 2 diabetic rat]

Objective: To evaluate the effect of semaphorin 3A (Sema3A) pre-treated bone marrow mesenchymal stem cells (BMSC) sheets on new bone formation in type 2 diabetes mellitus rats. Methods: Type 2 diabetes mellitus (T2DM) were induced by injection of streptozotocin, and the BMSC were isolated, controlled, identified and induced into cell sheets. Fifteen T2DM rats were randomly divided into control, sheets and Sema3A-sheets group and the calvarial critical size defect (CSD) model of rats were established. The defect zone of rats from control group were implanted with bone powder. The defect zone of rats from sheets group were implanted with bone powder and BMSC sheets. The defect zone of rats from Sema3A-sheets group were implanted with bone powder and BMSC sheets pretreated with 1.0 mg/L Sema3A. After 8 weeks, the bone samples were harvested and analyzed by micro-CT scanning, HE staining for the evaluation of new bone formation, and the immunohistochemical analysis for the expression of osteogenesis-related proteins including type Ⅰ collagen (COL- Ⅰ ), bone morphogenetic protein-2 (BMP-2), and osteocalcin (OCN). Results: The BMSC were isolated and cultured, and oil red O and Alizarin red S staining proved the multi-potential differentiation. Eight weeks after the establishment of calvarial CSD model, Sema3A-sheet group showed the most abundant new bone formation (0.516±0.070), with increased bone volume fraction, namely bone volume/tissue volume (BV/TV) compared with sheets group (0.319±0.050) and control group (0.224±0.037) (P<0.05), and the sheets group showed increased BV/TV compared with control group (P<0.05). While trabecular thickness (Tb.Th) control group showed no difference in three groups (P>0.05). HE staining also confirmed that Sema3A-sheets group showed the most new bone formation. Sheet group (0.174±0.051) compared showed difference with control group (0.099±0.033) (P< 0.05), and Sema3A-sheet group (0.421±0.069) showed increased bone formation compared with sheet group and control group (P<0.05). Immunohistochemistry showed that BMSC sheet increased the expression of osteogenesis-related proteins including COL-Ⅰ, BMP-2 and OCN, while Sema3A pretreatment showed more obvious increase of the expression of COL-Ⅰ and OCN. Conclusions: The combined implantation of bone powder and Sema3A stimulated BMSC sheets significantly increased bone regeneration in vivo. Therefore, Sema3A pre-treated BMSC sheets transplantation provides a new strategy for restoring bone defect in T2DM.

Ventilation strategy and anesthesia management in patients with severe tracheal stenosis undergoing urgent tracheal stenting

BACKGROUND

Stenting of airway stenosis is a common procedure in specialized centers. The aim of this study was to summarize our clinical experience in ventilation strategy and anesthesia management of patients undergoing urgent tracheal stenting.

METHODS

Clinical data of 22 patients with severe tracheal stenosis who underwent urgent endoscopic placement of a tracheal stent during a 2-year period were retrospectively reviewed. The efficacy and safety of different ventilation strategies and veno-arterial extracorporeal membrane oxygenation (ECMO), individualized based on the cause and location of tracheal narrowing, were evaluated.

RESULTS

Sufficient ventilation was successfully established in all patients; ECMO was used in five patients with stenosis in the mid-trachea who were unable to tolerate conventional intubation; a laryngeal mask airway (LMA) was used in five patients with post-intubation tracheal stenosis; a cuffed tracheal tube was used in eight patients with lower tracheal stenosis; and low-frequency jet ventilation in rigid bronchoscopy was used in four patients with mid- or lower tracheal stenosis. Tracheal stents were successfully placed and there were significant improvements in dyspnea. There were significant increases in the partial pressure of carbon dioxide in patients ventilated with the LMA and cuffed tracheal tube. There was no hypoxia during the operative period.

CONCLUSION

Establishment of effective airway ventilation in patients with severe tracheal stenosis should be based on the cause, location, and severity of tracheal narrowing. Veno- arterial ECMO may be considered in patients with severe stenosis, if they are judged unable to tolerate conventional ventilation or jet ventilation.

Lysine bioavailability among 2 lipid-coated lysine products after exposure to silage

We conducted 2 experiments to determine lysine bioavailability from 2 lipid-coated lysine products. In an in vitro experiment we mixed each lipid-coated lysine product with either alfalfa- or corn-silage at different amounts of acidity. Scanning electron micrographs indicated that surface structure of each lipid-coated lysine particle was eroded after mixing with silage. Additionally, visual evaluation of scanning electron micrographs suggested that peripheral surface abrasion of lipid-coated lysine may be greater when lipid-coated lysine was mixed with alfalfa silage in comparison to corn silage. In a corresponding experiment, in vivo measures of lysine bioavailability to sheep from 2 lipid-coated lysine products and lysine-HCl were determined after mixing in corn silage. Plasma lysine concentrations increased linearly (P < 0.01) in response to abomasal lysine infusion indicating that our model was sensitive to increases in metabolizable lysine flow. Bioavailability of each lipid-coated lysine source and dietary lysine-HCl were calculated to be 23, 15, and 18%, respectively. Even though each dietary source of lysine increased plasma lysine, rates of increases in plasma lysine from one lipid-coated lysine source (linear; P = 0.20) and lysine-HCl (linear; P = 0.11) were not different from plasma lysine levels supported by diet alone. However, the rate of plasma lysine increase in response to lysine from the other lipid-coated lysine source was greater (P = 0.04) than plasma lysine from feed alone. Nonetheless, the rate of plasma lysine increase in response to lipid-coated lysine did not differ (P ≥ 0.70) from the rate of plasma lysine increase from lysine-HCl. Clearly, methods of manufacture, together with physical and chemical characteristics of diet, can impact amounts of metabolizable lysine provided from lipid-coated lysine products. Direct measures of lysine bioavailability from lipid-coated lysine products after mixing with diets should be based on measurements with the products treated similarly to the method of feeding.

[Analysis of sonographic characteristics of thyroid nodules diagnosed as false positive or negative results in shear wave elastography]

Objective:In order to improve diagnostic accuracy, we study the characteristics of two dimensional ultrasound and shear wave elastography in the diagnosis of false negative or false positive thyroid nodules by shear wave elastography.Method:One hundred and eighty-nine nodules in 189 consecutive patients who had been determined by surgical operation and pathology. Conventional ultrasound features and SWE elasticity imaging characteristics and properties of the final postoperative pathology were recorded. A comparative study between true and false results of quantitative SWE elasticity imaging, and the corresponding conventional ultrasound nodule characteristics were compared.Result:Postoperative pathology showed 189 nodules, 74(39.2%) were benign and 115(60.8%) were malignant. The sensitivity, specificity of conventional ultrasound in the diagnosis of thyroid nodules were 56.5% and 81.1% respectively, and those of SWE were 60.9% and 85.1%. The false positive rate of shear wave elastography in diagnosing benign nodules and the false negative rate of malignant nodules were 14.9% and 39.1%, respectively. The false negative rate was higher than the false positive rate. A vertical growth (P< 0.01) and smaller diameter of the masses were significantly associated with false SWE findings (P< 0.01).Conclusion:The SWE imaging has important significance for differentiating benign and malignant thyroid nodules, but false results are inevitable, which requires clinicians conjunction with other test results to prevent errors judgment when reviewing the SWE imaging.

A novel FOXM1 isoform, FOXM1D, promotes epithelial-mesenchymal transition and metastasis through ROCKs activation in colorectal cancer

Epithelial-mesenchymal transition (EMT) is a critical event in metastasis of colorectal cancer (CRC). Rho/ROCKs signaling has a pivotal role in orchestrating actin cytoskeleton, leading to EMT and cancer invasion. However, the underlying mechanisms for ROCKs activation are not fully understood. Here, we identified FOXM1D, a novel isoform of Forkhead box M1 (FOXM1) that has a pivotal role in ROCKs activation by directly interacting with coiled-coil region of ROCK2. FOXM1D overexpression significantly polymerizes actin assembly and impairs E-cadherin expression, resulting in EMT and metastasis in xenograft mouse model and knockdown of FOXM1D has the opposite effect. Moreover, a high FOXM1D level correlates closely with clinical CRC metastasis. FOXM1D-induced ROCKs activation could be abrogated by the ROCKs inhibitors Y-27632 and fasudil. These observations indicate that the FOXM1D-ROCK2 interaction is crucial for Rho/ROCKs signaling and provide novel insight into actin cytoskeleton regulation and therapeutic potential for CRC metastasis.

Exposure to famine in early life and the risk of obesity in adulthood in Qingdao: Evidence from the 1959-1961 Chinese famine

BACKGROUND AND AIMS

We aimed to evaluate the association between famine exposure during early life and obesity and obesity_max (obese at the highest weight) in adulthood.

METHODS AND RESULTS

Data were from two population-based cross-sectional surveys conducted in 2006 and 2009 in Qingdao, China. A total of 8185 subjects born between 1/1/1941 and 12/31/1971 were categorized into unexposed (born between 01/01/1962 and 12/31/1971), fetal/infant exposed (born between 01/01/1959 and 12/31/1961), childhood exposed (born between 01/01/1949 and 12/31/1958) and adolescence exposed (born between 01/01/1941 and 12/31/1948) according to their age when exposed to the Chinese famine from 1959 to 1961. Obesity was defined as BMI (body mass index) ≥28.0 and obesity_max was defined as BMI_max (BMI at the highest weight) ≥28.0. We compared fetal/infant exposed, childhood exposed and adolescence exposed to the unexposed using logistic regression models to assess the effect of famine exposure on later obesity and obesity_max. Fetal/infant exposed (OR = 1.59, P < 0.001), childhood exposed (OR = 1.42, P < 0.01) and adolescence exposed (OR = 1.86, P < 0.01) all had higher risks of obesity than the unexposed. Exposure groups were more likely to be obese at their highest weight than the unexposed, and ORs (95%CIs) for obesity_max in the fetal/infant exposed, childhood exposed and adolescence exposed were 1.49(1.20-1.86), 1.24(1.02-1.49) and 1.64 (1.40-1.93), respectively. Similar results were found in both men and women.

CONCLUSION

Exposure to famine in early life was associated with increased risks of obesity and obesity_max in adulthood. Preventing undernutrition in early life appears beneficial to reduce the prevalence of later obesity.

Impact of classical risk factors of type 2 diabetes among Asian Indian, Chinese and Japanese populations

AIMS

This review investigated the population impact of major modifiable type 2 diabetes (T2D) risk factors, with special focus on native Asian Indians, to estimate population attributable risks (PARs) and compare them with estimates from Chinese and Japanese populations.

METHODS

Information was obtained on risk factors in 21,041 Asian Indian, 17,774 Chinese and 17,986 Japanese populations from multiple, large, cross-sectional studies (the DECODA project) of T2D. Crude and adjusted PARs were estimated for the major T2D risk factors.

RESULTS

Age had the highest crude and adjusted PARs among Asian Indians and Chinese in contrast to waist-hip ratio among Japanese. After adjusting for age, the PAR for body mass index (BMI) in Asian Indians (41.4% [95% CI: 37.2%; 45.4%]) was second only to triglycerides (46.4% [95% CI: 39.5%; 52.8%]) compared with 35.8% [95% CI: 29.9%; 41.4%] in Japanese and 38.4% [95% CI: 33.5%; 43.2%] in Chinese people. The PAR for BMI adjusted for age, LDL and triglycerides (39.7% [95% CI: 31.6%; 47.2%]) was higher than for any other factor in Asian Indians, and was much higher than in the Chinese (16.8% [95% CI: 3.0%; 30.9%]) and Japanese (30.4% [95% CI: 17.5%; 42.2%]) populations.

CONCLUSION

This review provides estimates of the association between major risk factors and prevalences of T2D among Asian populations by examining their PARs from large population-based samples. From a public-health point of view, the importance of BMI in Asian Indians is especially highlighted in comparison to the other Asian populations. Given these results and other recent findings on the causality link between BMI and T2D, it can be postulated that obesity may be involved in the aetiology of T2D through interaction with ethnic-specific genetic factors, although ethnicity itself is not a direct risk factor for T2D as people of all ethnic backgrounds develop diabetes.

Cardiovascular and all-cause mortality in relation to various anthropometric measures of obesity in Europeans

BACKGROUND AND AIMS

Cardiovascular and all-cause mortality in relation to various anthropometric measures of obesity is still controversial.

METHODS AND RESULTS

Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR) were measured at baseline in a cohort of 46,651 European men and women aged 24-99 years. The relationship between anthropometric measures of obesity and mortality was evaluated by the Cox proportional hazards model with age as a time-scale and with threshold detected by a piecewise regression model. Over a median follow-up of 7.9 years, 2381 men and 1055 women died, 1071 men (45.0%) and 339 women (32.1%) from cardiovascular disease (CVD). BMI had a J-shaped relationship with CVD mortality, whereas anthropometric measures of abdominal obesity had positive linear relationships. BMI, WC and WHtR showed J-shaped associations with all-cause mortality, whereas WHR, ABSI and WHHR demonstrated positive linear relationships. Accordingly, a threshold value was detected at 29.29 and 30.98 kg/m(2) for BMI, 96.4 and 93.3 cm for WC, 0.57 and 0.60 for WHtR, 0.0848 and 0.0813 m(11/6) kg(-2/3) for ABSI with CVD mortality in men and women, respectively; 29.88 and 29.50 kg/m(2) for BMI, 104.3 and 105.6 for WC, 0.61 and 0.67 for WHtR, 0.95 and 0.86 for WHR, 0.0807 and 0.0765 for ABSI in men and women, respectively, and 0.52 for WHHR in women with all-cause mortality.

CONCLUSION

All anthropometric measures of abdominal obesity had positive linear associations with CVD mortality, whereas some showed linear and the others J-shaped relationships with all-cause mortality. BMI had a J-shaped relationship with either CVD or all-cause mortality. Thresholds detected based on mortality may help with clinical definition of obesity in relation to mortality.

Cardiovascular risk profiles in relation to newly diagnosed type 2 diabetes diagnosed by either glucose or HbA1c criteria in Chinese adults in Qingdao, China

AIMS

To study the cardiovascular disease risk profiles in newly diagnosed diabetes diagnosed by either glucose or/and HbA(1c) criteria in Chinese adults.

METHODS

Two population-based cross-sectional studies were conducted in 2006 and 2009, respectively. Data from 1987 men and 2815 women aged 35-74 years were analysed. Newly diagnosed diabetes was defined according to either glucose (fasting and/or 2-h glucose), HbA(1c) or both criteria.

RESULTS

Ageing, positive family history of diabetes, elevated levels of waist circumference, systolic blood pressure, total cholesterol, triglycerides and γ-glutamyl transferase were independently associated with newly diagnosed diabetes defined by glucose criterion alone, but not for diabetes defined by HbA(1c) criterion alone. Only waist circumference, total cholesterol and smoking were significantly associated with the presence of diabetes defined by HbA(1c) criterion alone.

CONCLUSIONS

Cardiovascular disease risk profiles were different in patients with newly diagnosed diabetes defined by the two diagnostic criteria for diabetes. This may have certain clinical implications on diabetes management and research.

Comparison of various surrogate obesity indicators as predictors of cardiovascular mortality in four European populations

BACKGROUND/OBJECTIVES

Body mass index (BMI) is the most commonly used surrogate marker for evaluating the risk of cardiovascular disease (CVD) mortality in relation to general obesity, while abdominal obesity indicators have been proposed to be more informative in risk prediction.

SUBJECT/METHODS

A prospective cohort study consisting of 46 651 Europeans aged 24-99 years was conducted to investigate the relationship between CVD mortality and different obesity indicators including BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR). Hazard ratio (HR) was estimated by the Cox proportional hazards model using age as timescale, and compared using paired homogeneity test.

RESULTS

During a median follow-up of 7.9 years, 3435 participants died, 1409 from CVD. All obesity indicators were positively associated with increased risk of CVD mortality, with HRs (95% confidence intervals) per standard deviation increase of 1.19 (1.12-1.27) for BMI, 1.29 (1.21-1.37) for WC, 1.28 (1.20-1.36) for WHR, 1.35 (1.27-1.44) for WSR, 1.34 (1.26-1.44) for ABSI and 1.34 (1.25-1.42) for WHHR in men and 1.37 (1.24-1.51), 1.49 (1.34-1.65), 1.45 (1.31-1.60), 1.52 (1.37-1.69), 1.32 (1.18-1.48) and 1.45 (1.31-1.61) in women, respectively. The prediction was stronger with abdominal obesity indicators than with BMI or ABSI (P<0.05 for all paired homogeneity tests). WSR appeared to be the strongest predictor among all the indicators, with a linear relationship with CVD mortality in both men and women.

CONCLUSIONS

Abdominal obesity indicators such as WC, WHR, WSR and WHHR, are stronger predictors for CVD mortality than general obesity indicator of BMI.

Renal carcinomas associated with Xp11.2 translocations: are CT findings suggestive of the diagnosis?

AIM

The purpose of the present study was to summarize the computed tomography (CT) features of renal carcinomas associated with Xp11.2 translocations, and determine whether the diagnosis can be reliably deduced from imaging findings.

MATERIALS AND METHODS

Radiological studies of six patients (aged from 9-29 years) with renal carcinoma associated with Xp11.2 translocations were retrospectively analysed.

RESULTS

The tumours varied in size from 3.3-11 cm (mean 5.4 cm). Unenhanced CT and cortical, medullary, and pelvic-phase contrast-enhanced CT imaging was undertaken in all cases. Unenhanced CT revealed that tumours had a relatively increased radiodensity (4/6, ranged from 45-60 HU) and suggested the possibility of diffuse haemorrhage. Three of the six cases showed irregular and boundary calcification of the lesion. Contrast-enhanced CT showed relatively well demarcated tumours with heterogeneous enhancement (6/6). Prolonged enhancement of tumours might be a common sign (6/6) in Xp11.2 translocations. Three out of the six cases were combined with retroperitoneal lymph nodes metastasis.

CONCLUSION

Renal carcinomas associated with Xp11.2 translocations should be considered, particularly in children and young patients, when the lesion has calcification and is hyper-dense on unenhanced CT, and has prolonged enhancement on contrast-enhanced images.

First Report of Sweet potato leaf curl Georgia virus on Sweet Potato in China

Begomoviruses infecting sweet potato (Ipomoea batatas) are phylogenetically distinct from other members of the genus Begomovirus, and have been named "sweepoviruses" (1). Sweepoviruses cause sweet potato yield losses and cultivar decline, and have been found in China (1,3). In 2011, a survey was conducted to determine the incidence, genetic diversity, and distribution of sweepoviruses in China. Thirty sweet potato cuttings showing upward leaf curl, leaf roll, chlorosis, and stunting were collected from fields in Jiangsu, Guangxi, Guizhou, Shanxi, Henan, and Hebei Provinces. Five-leaf growth stage I. setosa plants were inoculated by side-grafting with scions from these samples, and grown in an insect-proof greenhouse in 20-cm-diameter clay pots. Each sample was grafted onto three replicate plants. Healthy, non-grafted I. setosa plants were used as the negative control treatment. Total nucleic acids were extracted from 100 mg fresh leaves harvested 30 days post-inoculation (dpi) from symptomatic and negative control plants using the Universal Genomic DNA Extraction Kit (TaKaRa, Dalian, China). Universal primers for amplification of Geminiviruses (BM-V [5'-KSGGGTCGACGTCATCAATGACGTTRTAC-3'] and BM-C [5'-AARGAATTCATKGGGGCCCARARRGACTGGC-3']) (2) were used to amplify the begomovirus A component by PCR assay. A DNA fragment of the expected size (2.8 kb) was obtained from grafted leaf samples of the Hebei Province plant, and was cloned into the pMD-19T vector (TaKaRa). The recombinant plasmid was transformed into competent cells of Escherichia coli strain JM109, and the inserted fragment sequenced. The nucleotide sequence obtained (GenBank Accession No. JX448368) was 2,785 nt long, and contained two open reading frames (ORFs) in the virion sense, and four ORFs in the complementary sense, similar to other monopartite begomoviruses (1). The sequence was compared with sequences in GenBank using BLAST. The results revealed the greatest nucleotide sequence identity, 90.8%, with that of the Sweet potato leaf curl Georgia virus (SPLCGV) from Georgia, United States (AF326775). The sequence also shared identities of <89% with other sweepoviruses, and was therefore designated SPLCGV-China: Hebei: 2011. Comparison of the complete genome sequence of SPLCGV-China: Hebei: 2011 with SPLCGV revealed an 18 nucleotide insertion between AV-1 and AC-3. The results confirmed that the sweet potato sample from which SPLCGV-China: Hebei: 2011 was obtained was infected with SPLCGV. To our knowledge, this is the first report of the natural occurrence of SPLCGV in China. This study will assist with understanding the presence of this virus and genetic diversity of sweepoviruses in China. References: (1) H. P. Bi and P. Zhang. Arch. Virol. 157:441, 2012. (2) R. W. Briddon and P. G. Markham. Mol. Biotechnol. 1:202, 1994. (3) Y. S. Luan et al. Virus Genes 35:379, 2007.

Prediction of outcome in critically ill elderly patients using APACHE II and SOFA scores

OBJECTIVE

Performances of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the Sequential Organ Failure Assessment (SOFA) score were assessed in predicting mortality outcome in critically ill elderly patients.

METHODS

Mean APACHE II and SOFA scores were compared in 106 intensive care unit patients aged > 65 years classified as survivors or deaths. The discriminatory ability of the scores was evaluated using the area under the receiver operating characteristic (ROC) curve. Calibration was assessed using the Hosmer-Lemeshow test.

RESULTS

Mean APACHE II and SOFA scores in survivors were lower than in those who died. There was a positive correlation between the APACHE II and SOFA scores. The area under the ROC curve was 0.76 for the APACHE II score and ranged from 0.74 for the initial SOFA score to 0.98 for the maximum SOFA score. Hosmer-Lemeshow values for the APACHE II score and various SOFA scores indicated that predictions based on these scores closely fit the observed outcomes.

CONCLUSIONS

APACHE II and SOFA scores can accurately predict mortality outcome in critically ill elderly patients, especially the maximum SOFA score and the difference between the maximum and initial SOFA scores.

Diabetes self-risk assessment questionnaires coupled with a multimedia health promotion campaign are cheap and effective tools to increase public awareness of diabetes in a large Chinese population

AIMS

To evaluate costs and effectiveness of implementing a diabetes self-risk assessment (Diabetes Risk Score) questionnaire coupled with a multimedia health promotion campaign on changes in diabetes awareness in a large diabetes prevention programme.

METHODS

Between 2007 and 2010, a multimedia health promotion campaign was conducted targeting the 1.94 million population of Qingdao, China, using newspapers, radio programmes, distribution of free booklets and Diabetes Risk Score flyers. Diabetes awareness questionnaires filled out by people first interviewed in 2006 (survey A), before the initiation of the campaign, were compared with those first interviewed between 2007 and 2010 during the campaign period (survey B). The rates of diabetes awareness in both surveys were studied amongst adults aged 35-74 years without a prior history of diabetes, but with a Diabetes Risk Score of ≥ 14.

RESULTS

In survey B, 85, 82 and 76% of the urban participants correctly recognized obesity, family history of diabetes and physical inactivity, respectively, as important risk factors for diabetes; while the awareness rates were 43, 46 and 25%, respectively, in survey A (P < 0.001). The corresponding figures among rural participants were 65, 63 and 53% in survey B and 29, 22 and 11% in survey A (P < 0.001). To cover 1000 individuals, the programme spent €5.4 on the use of the Diabetes Risk Score flyer, €31.3 on the education booklet, €7.7 on the newspaper campaign and €37.5 on radio programmes.

CONCLUSIONS

The combination of a Diabetes Risk Score questionnaire with a multimedia health promotion campaign is a cheap and effective health promotion tool to raise public awareness of diabetes.

Observations of Co4+ in a higher spin state and the increase in the Seebeck coefficient of thermoelectric Ca3Co4O9

Ca3Co4O9 has a unique structure that leads to exceptionally high thermoelectric transport. Here we report the achievement of a 27% increase in the room-temperature in-plane Seebeck coefficient of Ca3Co4O9 thin films. We combine aberration-corrected Z-contrast imaging, atomic-column resolved electron energy-loss spectroscopy, and density-functional calculations to show that the increase is caused by stacking faults with Co4+-ions in a higher spin state compared to that of bulk Ca3Co4O9. The higher Seebeck coefficient makes the Ca3Co4O9 system suitable for many high temperature waste-heat-recovery applications.

Effect of substrate on the atomic structure and physical properties of thermoelectric Ca₃Co₄O₉ thin films

The incommensurately layered cobalt oxide Ca(3)Co(4)O(9) exhibits an unusually high Seebeck coefficient as a polycrystalline bulk material, making it ideally suited for many high temperature thermoelectric applications. In this paper, we investigate properties of Ca(3)Co(4)O(9) thin films grown on cubic perovskite SrTiO(3), LaAlO(3), and (La(0.3)Sr(0.7))(Al(0.65)Ta(0.35))O(3) substrates and on hexagonal Al(2)O(3) (sapphire) substrates using the pulsed laser deposition technique. X-ray diffraction and transmission electron microscopy analysis indicate strain-free growth of films, irrespective of the substrate. However, depending on the lattice and symmetry mismatch, defect-free growth of the hexagonal CoO(2) layer is stabilized only after a critical thickness and, in general, we observe the formation of a stable Ca(2)CoO(3) buffer layer near the substrate-film interface. Beyond this critical thickness, a large concentration of CoO(2) stacking faults is observed, possibly due to weak interlayer interaction in this layered material. We propose that these stacking faults have a significant impact on the Seebeck coefficient and we report higher values in thinner Ca(3)Co(4)O(9) films due to additional phonon scattering sites, necessary for improved thermoelectric properties.

Prevalence of metabolic syndrome in rural and urban Chinese population in Qingdao

AIMS

To investigate the prevalence of metabolic syndrome and its components in both rural and urban Chinese population.

SUBJECTS AND METHODS

A population-based crosssectional survey was conducted in Qingdao, China in 2006 with 6100 Chinese aged 35-74 yr invited and 5355 who attended; 3357 subjects, 1562 urban (46.5%) and 1795 rural residents (53.5%) met the inclusion criteria for the current data analysis. The metabolic syndrome definitions of National Cholesterol Education Program Adult Treatment Expert Panel III (NCEPATPIII) 2004, NCEP 2005 and International Diabetes Federation (IDF) were used.

RESULTS

The age-standardized prevalences of metabolic syndrome were 16.2%, 32.2%, and 28.3% in men and 26.8%, 37.2%, and 34.6%in women, according to the definitions of the NCEP 2004, NCEP 2005, and IDF, respectively. Urban men have more risk factors and higher prevalence of the metabolic syndrome than rural men, but the differences in women were not that striking. Elevated blood pressure (62.6%) was, among risk factors, most common in the study population, followed by central obesity (53.4%), and hyperglycemia (52.2%) defined using the NCEP 2005 criteria.

CONCLUSIONS

Metabolic disorders were common among adult Chinese in both rural and urban areas in Qingdao.

The association of gamma-glutamyltransferase and C-reactive protein with IFG/IGT in Chinese adults in Qingdao, China

BACKGROUND

Serum gamma-glutamyltransferase (GGT) and C-reactive protein(CRP) have been previously shown to be associated with impaired fasting glucose/impaired glucose tolerance (IFG/IGT), but such an association has not been well verified, and is examined in a non-diabetic Chinese population.

METHODS

A population-based cross-sectional study was conducted in 2006 in Qingdao, China. Data of 1143 men and 1689 women aged 35-74 years and free of diabetes at baseline were analyzed. Multivariable logistic regression analysis was performed to estimate the odds ratio (OR) and its 95% confidence interval (CI).

RESULTS

Compared with the lowest quartile, the ORs (95%CI) for IFG/IGT corresponding to the highest quartile were 0.89(0.61,1.28) in men and 0.87(0.64,1.18) in women for CRP and 2.12(1.40,3.38) and 1.87(1.32,2.62) for GGT, when the two were fitted simultaneously in a model adjusting for age, school years, alcohol-drinking, smoking, family history of diabetes, systolic blood pressure, waist circumference, triglycerides and high-density lipoprotein.

CONCLUSIONS

The elevated GGT, but not CRP, was independently associated with the presence of the IFG/IGT in both genders in this Chinese population.

First Report of Sweet potato chlorotic stunt virus Infecting Sweet Potato in China

Sweet potato chlorotic stunt virus (SPCSV) (genus Crinivirus, family Closteroviridae) is a whitefly-transmitted co-infectant of the sweet potato virus disease (SPVD), which can cause severe yield losses in sweet potato (Ipomoea batatas (L.) Lam.) (2,3). One isolate was obtained in Guangdong Province in August 2009 from sweet potato plants of cv. Guangshu No. 87 exhibiting symptoms typical of SPVD, including stunting, leaf distortion, vein clearing, and chlorosis. Leaf extracts from the symptomatic plants tested positive for SPCSV by nitrocellulose membrane ELISA with antisera specific for SPCSV obtained from the International Potato Center. Total RNA was extracted from young leaves of sweet potato and reverse transcription-PCR was performed by using primer pairs SPSP1 (5'-ATGRMTACTGRCAAAGTAAACGATG-3') and SPSP4 (5'-TCAACAGTGAAGACCRGYACCRGTCAA-3') corresponding to the capsid protein (CP) gene of SPCSV. Expected DNA fragments of 774 bp were obtained from symptomatic plants but not from control plants. The 774-bp fragments obtained by amplification were purified and cloned into the PMD19-T vector (TaKaRa, Dalian, China). Recombinant plasmids were then transformed into competent cells of Escherichia coli strain Jm109. Sequencing of the fragments from two individually clones plasmids yielded a nucleotide sequence (GenBank Accession No. HM773432) with 97.4 to 98.7% similarity to the CP gene of East African SPCSV isolates (1). To our knowledge, this is the first report of SPCSV in sweet potato fields from China. This virus may threaten sweet potato production in China, so cultivars and germplasm should be evaluated for resistance. References: (1) V. Aritua et al. J. Phytopathol. 156:181, 2008. (2) R. W. Njeru et al. Ann. Appl. Biol. 145:71, 2004. (3) G. A. Schaefer and E. R. Terry. Phytopathology 66:642, 1976.

Diabetes, prediabetes and cancer mortality

AIMS/HYPOTHESIS

We aimed to investigate the risk of cancer mortality in relation to the glucose tolerance status classified according to the 2 h OGTT.

METHODS

Data from 17 European population-based or occupational cohorts involved in the DECODE study comprising 26,460 men and 18,195 women aged 25-90 years were collaboratively analysed. The cohorts were recruited between 1966 and 2004 and followed for 5.9 to 36.8 years. Cox proportional hazards analysis with adjustment for cohort, age, BMI, total cholesterol, blood pressure and smoking status was used to estimate HRs for cancer mortality.

RESULTS

Compared with people in the normal glucose category, multivariable adjusted HRs (95% CI) for cancer mortality were 1.13 (1.00, 1.28), 1.27 (1.02, 1.57) and 1.71 (1.35, 2.17) in men with prediabetes, previously undiagnosed diabetes and known diabetes, respectively; in women they were 1.11 (0.94, 1.30), 1.31 (1.00, 1.70) and 1.43 (1.01, 2.02), respectively. Significant increases in deaths from cancer of the stomach, colon-rectum and liver in men with prediabetes and diabetes, and deaths from cancers of the liver and pancreas in women with diabetes were also observed. In individuals without known diabetes, the HR (95% CI) for cancer mortality corresponding to a one standard deviation increase in fasting plasma glucose was 1.06 (1.02, 1.09) and in 2 h plasma glucose was 1.07 (1.03, 1.11).

CONCLUSIONS/INTERPRETATION

Diabetes and prediabetes were associated with an increased risk of cancer death, particularly death from liver cancer. Mortality from all cancers rose linearly with increasing glucose concentrations.

Does abnormal insulin action or insulin secretion explain the increase in prevalence of impaired glucose metabolism with age in populations of different ethnicities?

BACKGROUND

Age is associated with both impaired glucose and insulin metabolism. To what extent the age-related changes in insulin resistance (IR) and beta-cell function contribute to the increase in prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) is less known, and this is investigated in this study.

METHODS

This study included 6610 men and 7664 women of different ethnic groups aged 30-69 years. IR and beta-cell function were examined by the homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of beta-cell function (HOMA-B). Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression analysis adjusting for body mass index and study.

RESULTS

In Chinese men, the ORs (95% CIs) for IFG were 2.69 (1.70, 4.26), 2.51 (1.49, 4.21) and 2.89 (1.68, 4.97), respectively, in age groups of 40-49, 50-59 and 60-69 years compared with 30-39 years (p < 0.001 for trend); the corresponding figures for IGT were 1.73 (1.25, 2.38), 2.54 (1.78, 3.63) and 3.57 (2.46, 5.19) (p < 0.001 for trend). Similar trends for IGT were observed also in Chinese women and other ethnic groups, but not for IFG in Mauritius Indian and Creole men. Adjustment for HOMA-IR and HOMA-B reduced the ORs in all age groups of all ethnicities for both IFG and IGT, but the risk gradient between age groups remained particularly for the IGT.

CONCLUSIONS

The age-related increase in glucose intolerance may not be fully explained by the defect in HOMA-IR and HOMA-B. As HOMA-IR and HOMA-B are only surrogate measures of insulin sensitivity and insulin secretion, the results need to be further investigated.

The metabolic syndrome: useful concept or clinical tool? Report of a WHO Expert Consultation

This article presents the conclusions of a WHO Expert Consultation that evaluated the utility of the 'metabolic syndrome' concept in relation to four key areas: pathophysiology, epidemiology, clinical work and public health. The metabolic syndrome is a concept that focuses attention on complex multifactorial health problems. While it may be considered useful as an educational concept, it has limited practical utility as a diagnostic or management tool. Further efforts to redefine it are inappropriate in the light of current knowledge and understanding, and there is limited utility in epidemiological studies in which different definitions of the metabolic syndrome are compared. Metabolic syndrome is a pre-morbid condition rather than a clinical diagnosis, and should thus exclude individuals with established diabetes or known cardiovascular disease (CVD). Future research should focus on: (1) further elucidation of common metabolic pathways underlying the development of diabetes and CVD, including those clustering within the metabolic syndrome; (2) early-life determinants of metabolic risk; (3) developing and evaluating context-specific strategies for identifying and reducing CVD and diabetes risk, based on available resources; and (4) developing and evaluating population-based prevention strategies.

A simple Chinese risk score for undiagnosed diabetes

AIMS

A diabetes risk score for screening undiagnosed diabetes was constructed and validated in Chinese adults.

METHODS

Two consecutive population-based diabetes surveys among Chinese adults aged 20-74 years were conducted in 2002 (n = 1986) and 2006 (n = 4336). Demographic and anthropometric measures were collected following similar procedures. Standard 2-h 75-g oral glucose tolerance tests (OGTTs) were performed to diagnose diabetes in both surveys. Fasting capillary plasma glucose (FCG) and glycated haemoglobin (HbA(1c)) were also measured together with the OGTTs on the same day of the 2006 survey. Beta coefficients estimated using logistic regression analysis derived from data of the 2002 survey were used to develop the risk assessment algorithm. The performance of the algorithm was validated in the study population of the 2006 survey.

RESULTS

Of all the variables tested, waist circumference, age and family history of diabetes were significant predictors of diabetes and were used to construct the risk assessment score. The score, ranging from 3 to 32, performed well when applied to the study population of the 2006 survey. The area under the receiver operating characteristic curve was 67.3% (95% CI, 64.9-69.7%) for the score, while it was 76.3% (73.5-79.0%) for FCG alone and 67.8% (64.9-70.8%) for HbA(1c) alone. At a cut-off point of 14, the sensitivity and specificity of the risk score were 84.2% (81.0-87.5%) and 39.8% (38.2-41.3%).

CONCLUSIONS

The risk score based on age, waist circumference and family history of diabetes is efficient as a layperson-oriented diabetes screening tool for health promotion and for population-based screening programmes.

Increasing trend in the prevalence of Type 2 diabetes and pre-diabetes in the Chinese rural and urban population in Qingdao, China

AIMS

To determine the secular trend of prevalence of Type 2 diabetes and pre-diabetes in a Chinese population from 2001 to 2006.

METHODS

Two consecutive population-based surveys for diabetes were conducted in a randomly selected population aged 35-74 years and living in Qingdao, China in 2001-2002 (n = 10854) and 2006 (n = 4416). All participants underwent standardized 2-h 75-g oral glucose tolerance tests (OGTTs), along with fasting capillary plasma glucose (FCG) tests in 2006. One urban community underwent OGTTs directly in 2002 (n = 1815), while a two-step screening strategy using FCG as a first-line screening test followed by OGTTs was used in 9039 individuals in 2001. Diabetes and pre-diabetes was defined according to the 2006 World Health Organization/International Diabetes Federation criteria.

RESULTS

Based on the results of direct OGTTs, the age-standardized prevalence of diabetes and pre-diabetes in urban areas was 12.2 and 15.4% in 2002, whereas the prevalences were 18.8 and 28.7% in urban areas and 14.1 and 20.2% in rural areas in 2006 (P < 0.001, in urban areas). Using the two-step screening strategy, the prevalence of diabetes in 2001 was 10.1% in urban and 7.7% in rural areas and 13.8% in urban and 12.2% in rural areas in 2006 (P < 0.001). Based on the data of the 2006 survey, the two-step screening strategy missed 30.2% of diabetes cases when compared with the number defined by the direct OGTT approach.

CONCLUSIONS

Qingdao has experienced a marked increase in the prevalence of diabetes and pre-diabetes in the past 5 years. Intervention to prevent a further increase in the prevalence of diabetes is urgently required.

Performance of HbA(1c) for detecting newly diagnosed diabetes and pre-diabetes in Chinese communities living in Beijing

AIM

To determine the performance of glycated haemoglobin (HbA(1c)) as a screening tool for detecting newly diagnosed diabetes (NDM) and pre-diabetes.

METHODS

A diabetes survey was conducted in Beijing among community dwellers who were willing to participate in the survey. Included in the survey were 903 individuals aged 21-79 years without previously diagnosed diabetes and in whom HbA(1c) and other required covariates had been measured. NDM and pre-diabetes (impaired glucose tolerance + impaired fasting glucose) were defined according to the World Health Organization 1999 criteria based on 75-g oral glucose tolerance test. Receiver operating characteristic curve (ROC) was plotted to determine the performance of HbA(1c).

RESULTS

The prevalence of NDM and pre-diabetes was 11.1% and 22.4%, respectively. At an optimal HbA(1c) cut-off point of > or = 6.0%, the test gave a sensitivity of 80.0% and a specificity of 89.8% for diagnosing NDM; at an optimal cut-off point of > or = 5.7%, the sensitivity was 59.4% and specificity 73.9% for diagnosing pre-diabetes. Individuals with HbA(1c)> or = 6.0% tended to be more obese than those with HbA(1c) < 6.0%, but blood pressure and lipid profiles did not differ between the two groups.

CONCLUSIONS

HbA(1c) as a single screening test is adequate to detect newly diagnosed diabetes but is not able to identify pre-diabetes in this obese Chinese population.

Risk prediction models for the development of diabetes in Mauritian Indians

AIMS

To develop risk prediction models of future diabetes in Mauritian Indians.

METHODS

Three thousand and ninety-four Mauritian Indians (1141 men, aged 20-65 years) without diabetes in 1987 or 1992 were followed up to 1992 or 1998. Subjects underwent repeated oral glucose tolerance tests and diabetes was diagnosed according to 2006 World Health Organization/International Diabetes Federation criteria. Cox regression models for interval censored data were performed using data from 1544 randomly selected participants. Predicted probabilities for diabetes were calculated and validated in the remaining 1550 subjects.

RESULTS

Over 11 years of follow-up, there were 511 cases of diabetes. Among variables tested, family history of diabetes, obesity (body mass index, waist circumference) and glucose were significant predictors of diabetes. Predicted probabilities derived from a simple model fitted with sex, family history of diabetes and obesity ranged from 0.05 to 0.64 in men and 0.03 to 0.49 in women. To predict the onset of diabetes, area under the receiver operating characteristic (ROC) curve (AROC) of predicted probabilities was 0.62 (95% confidence interval, 0.56-0.68) in men and 0.64 (0.59-0.69) in women. At a cut-off point of 0.12, the sensitivity and specificity were 0.72 (0.71-0.74) and 0.47 (0.45-0.49) in men and 0.77 (0.75-0.78) and 0.50 (0.48-0.52) in women, respectively. Addition of fasting plasma glucose (FPG) to the model improved the prediction slightly [AROC curve 0.70 (0.65-0.76) in men, 0.71 (0.67-0.76) in women].

CONCLUSIONS

A diabetes prediction model based on obesity and family history yielded moderate discrimination in Mauritian Indians, which was slightly inferior to the model with the FPG but may be useful in low-income countries to promote identification of people at high risk of diabetes.