Joint effects of heat-humidity compound events on drowning mortality in Southern China

BACKGROUND

Several previous studies have examined the association of ambient temperature with drowning. However, no study has investigated the effects of heat-humidity compound events on drowning mortality.

METHODS

The drowning mortality data and meteorological data during the five hottest months (May to September) were collected from 46 cities in Southern China (2013-2018 in Guangdong, Hunan and Zhejiang provinces). Distributed lag non-linear model was first conducted to examine the association between heat-humidity compound events and drowning mortality at city level. Then, meta-analysis was employed to pool the city-specific exposure-response associations. Finally, we analysed the additive interaction of heat and humidity on drowning mortality.

RESULTS

Compared with wet-non-hot days, dry-hot days had greater effects (excess rate (ER)=32.34%, 95% CI: 24.64 to 40.50) on drowning mortality than wet-hot days (ER=14.38%, 95%CI: 6.80 to 22.50). During dry-hot days, males (ER=42.40%, 95% CI: 31.92 to 53.72), adolescents aged 0-14 years (ER=45.00%, 95% CI: 21.98 to 72.35) and urban city (ER=36.91%, 95% CI: 23.87 to 51.32) showed higher drowning mortality risk than their counterparts. For wet-hot days, males, adolescents and urban city had higher ERs than their counterparts. Attributable fraction (AF) of drowning attributed to dry-hot days was 23.83% (95% CI: 21.67 to 26.99) which was significantly higher than that for wet-hot days (11.32%, 95% CI: 9.64 to 13.48%). We also observed that high temperature and low humidity had an additive interaction on drowning mortality.

CONCLUSION

We found that dry-hot days had greater drowning mortality risk and burden than wet-hot days, and high temperature and low humidity might have synergy on drowning mortality.

Analysis of risk factors for complications following transurethral resection of the prostate

OBJECTIVE

This study investigates the risk factors for complications following transurethral resection of the prostate and provides a reference for reducing postoperative complications.

PATIENTS AND METHODS

A retrospective analysis was conducted on 322 patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate from April 2015 to January 2022. Among them, 214 patients had complete clinical and follow-up data. Clinical and follow-up data were collected, and both univariate and multivariate logistic regression analyses were performed to identify factors influencing the occurrence of postoperation transurethral resection of the prostate complications.

RESULTS

The incidence of complications after transurethral resection of the prostate was 19.16% (41/214). Among them, the incidence of Grade I-II complications was 14.96% (32/214), and Grade III-IV complications were 4.2% (9/214). The preoperative Quality of Life score (p<0.001) was identified as an independent risk factor for the occurrence of Grade I-II complications after transurethral resection of the prostate. The International Prostate Symptom Score (p=0.006) was identified as an independent risk factor for the occurrence of Grade III-IV complications after transurethral resection of the prostate.

CONCLUSIONS

The preoperative Quality of Life score is an independent risk factor for the occurrence of Grade I-II complications after transurethral resection of the prostate. The International Prostate Symptom Score is an independent risk factor for the occurrence of Grade III-IV complications after transurethral resection of the prostate.

Ambient PM2.5 and cardiopulmonary mortality in the oldest-old people in China: A national time-stratified case-crossover study

BACKGROUND

Evidence on the associations of fine particulate matter (PM2.5) with cardiopulmonary mortality in the oldest-old (aged 80+ years) people remains limited.

METHODS

We conducted a time-stratified case-crossover study of 1,475,459 deaths from cardiopulmonary diseases in China to estimate the associations between short-term exposure to ambient PM2.5 and cardiopulmonary mortality among the oldest-old people.

FINDINGS

Each 10 μg/m3 increase in PM2.5 concentration (6-day moving average [lag05]) was associated with higher mortality from cardiopulmonary diseases (excess risks [ERs] = 1.69%, 95% confidence interval [CI]: 1.54%, 1.84%), cardiovascular diseases (ER = 1.72%, 95% CI: 1.54%, 1.90%), and respiratory diseases (ER = 1.62%, 95% CI: 1.33%, 1.91%). Compared to the other groups, females (ER = 1.94%, 95% CI: 1.73%, 2.15%) (p for difference test = 0.043) and those aged 95-99 years (ER = 2.31%, 95% CI: 1.61%, 3.02%) (aged 80-85 years old was the reference, p for difference test = 0.770) presented greater mortality risks. We found 14 specific cardiopulmonary causes associated with PM2.5, out of which emphysema (ER = 3.20%, 95% CI: 1.57%, 4.86%) had the largest association. Out of the total deaths, 6.27% (attributable fraction [AF], 95% CI: 5.72%, 6.82%) were ascribed to short-term PM2.5 exposure.

CONCLUSIONS

This study provides evidence of PM2.5-induced cardiopulmonary mortality and calls for targeted prevention actions for the oldest-old people.

FUNDING

This work was supported by the National Key Research and Development Program of China, the National Natural Science Foundation of China, the Foreign Expert Program of the Ministry of Science and Technology, the Natural Science Foundation of Guangdong, China, and the Science and Technology Program of Guangzhou.

The comparison of mortality burden between exposure to dry-cold events and wet-cold events: A nationwide study in China

BACKGROUND

Most previous studies have focused on the health effect of temperature or humidity, and few studies have explored the combined health effects of exposure to temperature and humidity. This study aims to estimate the relationship between humidity-cold events and mortality, and then to compare the mortality burden between exposure to dry-cold events and wet-cold events, and finally to explore whether there was an additive interaction of temperature and humidity on mortality.

METHODS

In the study, Daily mortality data during 2006-2017 were collected from Centers for Disease Control and Prevention in China, and daily mean temperature and daily mean relative humidity data from 698 weather stations in China were obtained from the China Meteorological Data Sharing Service system. We first employed time-series design with a distributed lag nonlinear model and a multivariate meta-analysis model to examine the association between humidity-cold events with mortality.

RESULTS

We found that humidity-cold events significantly increased mortality risk, and the effect of wet-cold events (RR:1.24, 95%CI:1.20,1.29) was higher than that of dry-cold events (RR:1.14, 95%CI:1.10,1.18). Dry-cold events and wet-cold events accounted for 2.41 % and 2.99 % excess deaths, respectively with higher burden for the elderly ≥85 years old, Central China and CVD. In addition, there is a synergistic additive interaction between low temperature and high humidity in winter.

CONCLUSION

This study showed that humidity-cold events significantly increased mortality risk, and the effect of wet-cold events was higher than that of dry-cold events.

The association of heatwave with drowning mortality in five provinces of China

Drowning is a serious public health problem in the world. Several studies have found that ambient temperature is associated with drowning, but few have investigated the effect of heatwave on drowning. This study aimed to explore the associations between heatwave and drowning mortality, and further estimate the mortality burden of drowning attributed to heatwave in China. Drowning mortality data were collected in 71 prefectures in China during 2013-2018 from provincial vital register system. Meteorological data at the same period were collected from European Centre for Medium-Range Weather Forecasts (ECMWF). A distributed lag non-linear model (DLNM) was first to explore the association between heatwave and drowning mortality in each prefecture. Secondly, the prefecture-specific associations were pooled using meta-analysis. Finally, attributable fractions (AFs) of drowning deaths caused by heatwave were estimated. Compared to normal day, the mortality risk of drowning significantly increased during heatwave (RR = 1.20, 95%CI: 1.18-1.23). Higher risks were observed in males (RR = 1.23, 95%CI: 1.20-1.27) than females (RR = 1.18, 95%CI: 1.13-1.23), in children aged 5-14 years old (RR = 1.24, 95%CI: 1.15-1.33) than other age groups, in urban city (RR = 1.32, 95%CI: 1.28-1.36) than rural area (RR = 1.09, 95%CI: 1.07-1.12) and in Jilin province (RR = 2.85, 95%CI: 1.61-5.06) than other provinces. The AF of drowning deaths due to heatwave was 11.4 % (95%CI: 10.0 %-12.9 %) during heatwave and 1.0 % (95%CI: 0.9 %-1.1 %) during study period, respectively. Moreover, the AFs during study period were higher for male (1.2 %, 95%CI: 1.0 %-1.3 %), children 5-14 years (1.1 %, 95%CI: 0.7 %-1.6 %), urban city (1.6 %, 95%CI: 1.4 %-1.8 %) than their correspondents. These differences were also observed in AFs during heatwave. We found that heatwave may significantly increase the mortality risk of drowning mortality, and its mortality burden attributable to heatwave was noteworthy. Targeted intervention should be carried out to decrease drowning mortality during heatwave.

Comparison of anal function and quality of life after conformal sphincter preservation operation and intersphincteric resection of very low rectal cancer: a multicenter, retrospective, case-control analysis

PURPOSE

Conformal sphincter preservation operation (CSPO) is a sphincter preservation operation for very low rectal cancers. Compared to intersphincteric resection (ISR), CSPO retains more dentate line and distal rectal wall, and also avoids damaging the nerves in the intersphincteric space. This study aimed to compare the postoperative anal function and quality of life between the CSPO and ISR.

METHOD

Patients with low rectal cancer undergoing CSPO (n = 117) and ISR (n = 66) were included from Changhai and Huashan Hospital, respectively, between 2011 and 2020. A visual analog scale (range 0-10) was utilized to evaluate satisfaction with anal function and quality of life. The anal function was evaluated with Wexner scores and low anterior resection syndrome (LARS) score. Quality of life was evaluated with the EORTC QLQ-C30 and QLQ-CR38.

RESULTS

The CSPO group had more male patients (65.8% vs. 50%, p = 0.042), more preoperative chemoradiotherapy (33.3% vs. 10.6%, p < 0.001), lower tumor position (3.45 ± 1.13 vs. 4.24 ± 0.86 cm, p < 0.001), and more postoperative chemotherapy (65% vs. 13.6%, p < 0.001) compared to the ISR group. In addition, CSPO patients had shorter postoperative stay (6.63 ± 2.53 vs. 7.85 ± 4.73 days, p = 0.003) and comparable stoma reversal rates within 1 year after surgery (92.16% vs. 96.97%, p = 0.318). Multivariable analysis showed that CSPO significantly contributed to higher satisfaction with anal function (beta = 1.752, 95% CI 0.776-2.728) and with quality of life (beta = 1.219, 95% CI 0.374-2.064), but not to Wexner, LARS score, or EORTC QLQ-C30 and QLQ-CR38.

CONCLUSION

CSPO improved the satisfaction with anal function and quality of life but utilized more preoperative chemoradiotherapy. CSPO may be an alternative choice for patients with very low rectal cancers in better physical health and with higher requirements for anal function and quality of life.

Impact of stress hyperglycemia ratio on mortality in patients with critical acute myocardial infarction: insight from american MIMIC-IV and the chinese CIN-II study

BACKGROUND

Among patients with acute coronary syndrome and percutaneous coronary intervention, stress hyperglycemia ratio (SHR) is primarily associated with short-term unfavorable outcomes. However, the relationship between SHR and long-term worsen prognosis in acute myocardial infarction (AMI) patients admitted in intensive care unit (ICU) are not fully investigated, especially in those with different ethnicity. This study aimed to clarify the association of SHR with all-cause mortality in critical AMI patients from American and Chinese cohorts.

METHODS

Overall 4,337 AMI patients with their first ICU admission from the American Medical Information Mart for Intensive Care (MIMIC)-IV database (n = 2,166) and Chinese multicenter registry cohort Cardiorenal ImprovemeNt II (CIN-II, n = 2,171) were included in this study. The patients were divided into 4 groups based on quantiles of SHR in both two cohorts.

RESULTS

The total mortality was 23.8% (maximum follow-up time: 12.1 years) in American MIMIC-IV and 29.1% (maximum follow-up time: 14.1 years) in Chinese CIN-II. In MIMIC-IV cohort, patients with SHR of quartile 4 had higher risk of 1-year (adjusted hazard radio [aHR] = 1.87; 95% CI: 1.40-2.50) and long-term (aHR = 1.63; 95% CI: 1.27-2.09) all-cause mortality than quartile 2 (as reference). Similar results were observed in CIN-II cohort (1-year mortality: aHR = 1.44; 95%CI: 1.03-2.02; long-term mortality: aHR = 1.32; 95%CI: 1.05-1.66). In both two group, restricted cubic splines indicated a J-shaped correlation between SHR and all-cause mortality. In subgroup analysis, SHR was significantly associated with higher 1-year and long-term all-cause mortality among patients without diabetes in both MIMIC-IV and CIN-II cohort.

CONCLUSION

Among critical AMI patients, elevated SHR is significantly associated with and 1-year and long-term all-cause mortality, especially in those without diabetes, and the results are consistently in both American and Chinese cohorts.

Proportion and number of incident cancer deaths in coronary artery disease

BACKGROUND

Globally, coronary artery disease (CAD) and cancer are the leading causes of death. Studies focusing on the proportion and spectrum of cancer mortality among CAD patients are lacking. We aim to characterize the proportion and spectrum of cancer-specific mortality among patients with CAD.

METHODS

We analyzed 93,797 hospitalized survivors with angiographically documented CAD between 2007 and 2020 (mean age: 62.8 ± 11.1 years, 24.7% female) from Cardiorenal ImprovemeNt II (CIN-II) cohort.

RESULTS

During the median follow-up of 4.8 years (IQR: 2.6-7.5), 13,162 (14.0%) patients died after discharge. A total of 1223/7703 (15.8% of cause-specific death) CAD patients died of cancer. The three most common types of cancer-specific death were lung (36.1%), liver (13.3%), and colorectum cancer (12.8%). Furthermore, male (adjusted HR 2.38, 95% CI: 1.99-2.85) and older (≥60 vs. <60 years, adjusted HR 3.25, 95%CI 2.72-3.88) patients had a significantly increased cancer-specific mortality.

CONCLUSIONS

Our data suggest that nearly one-sixth of death is accounted for cancer among CAD patients within a median follow-up of 4.8 years. Lung, liver, and colorectum cancer are top three cancer-specific mortality. Further studies are needed to reduce cancer mortality for CAD patients, especially in older and male ones.

TRAIL REGISTRATION

(ClinicalTrials.gov NCT05050877).

PD-L1 Inhibitors Combined with Thoracic Radiotherapy in First-Line Treatment of Extensive Stage Small Cell Lung Cancer: A Propensity Score-Matched, Real-World Study

PURPOSE/OBJECTIVE(S)

The CREST study showed that the addition of thoracic radiotherapy (TRT) could improve the survival of extensive stage small cell lung cancer (ES-SCLC), but whether TRT can bring survival benefit in the era of immunotherapy is controversial. This study aims to explore the efficacy and safety of adding TRT to the combination of PD-L1 inhibitors and chemotherapy.

MATERIALS/METHODS

Thepatients who received PD-L1 inhibitors combined with platinum-based chemotherapy as the first-line treatment of ES-SCLC from January 2019 to December 2021 were retrospectively collected. According to whether they received TRT, they were divided into two groups, and the follow-up analysis was performed. Propensity score matching (PSM) in with a 1:1 ratio was performed to balance the baseline characteristics of the two cohorts. The endpoints were progression-free survival (PFS) and OS.

RESULTS

A total of 211 patients with ES-SCLC were enrolled, of whom 70 (33.2%) patients received standard therapy plus TRT as first-line treatment, and 141 (66.8%) patients in the control group received PD-L1 inhibitors plus chemotherapy. After PSM, a total of 65 pairs of patients were enrolled in the analysis. There were no significant differences in baseline characteristics between the two groups of patients who received TRT and those who did not. In all patients, the median PFS (mPFS) in the TRT group and the non-TRT groupwere 9.5 months and 7.2 months, respectively, with HR = 0.60 (95% CI 0.41-0.87, p = 0.007). The median OS (mOS) in the TRT group was also significantly longer than that in the non-TRT group (24.1 months vs. 18.5 months, HR = 0.53, 95% CI 0.32-0.85, p = 0.009). Multivariable analysis showed that baseline liver metastasis and bone metastasis were independent prognostic factors for OS. In terms of safety, immunotherapy combined with thoracic radiotherapy increased the incidence of treatment-related pneumonia (p<0.001), most of which were grade 1-2.

CONCLUSION

This real-world study shows that adding TRT to durvalumab or atezolizumab plus chemotherapy significantly improves survival in ES-SCLC. It leads to more treatment-related pneumonia, but most of them can be relieved after symptomatic treatment. This treatment model deserves to be explored in prospective clinical trials.

Effect of cumulative radiation exposure from Coronary catheterization on lung cancer mortality

BACKGROUND

Coronary catheterization (CC) procedure inevitably exposes patients with cardiovascular disease (CVD) to radiation, while cumulative radiation exposure may lead to higher risk of cancer.

METHODS

This multi-center, retrospective study was based on the CC procedure in Cardiorenal ImprovemeNt II cohort (CIN-II, NCT05050877) among five regional central tertiary teaching hospitals in China between 2007 and 2020. Patients without known cancer were stratified according to the times they received CC procedure. Baseline information from their last CC procedure was analyzed. Cox regression and Fine-Gray competing risk models were used to assess the relationship between cumulative radiation exposure from CC procedures and cancer-specific, all-cause and cardiovascular mortality.

RESULTS

Of 136,495 hospitalized survivors without cancer at baseline (mean age: 62.3 ± 11.1 years, 30.9% female), 116,992 patients (85.7%) underwent CC procedure once, 15,184 patients (11.1%) on twice, and 4,319 patients (3.2%) underwent CC procedure more than three times. During the median follow-up of 4.7 years (IQR: 2.5 to 7.4), totally 18,656 patients (13.7%) died after discharge, of which 617 (0.5%) died of lung cancer. Compared with the patients who underwent CC procedure once, the risk of lung cancer mortality increased significantly with the increase of the number of CC procedure (CC 2 times vs. 1 time: HR 1.42, 95% CI 1.13 to 1.78, P < 0.001; CC ≥ 3 times vs. 1 time: HR 1.64, 95%CI 1.13 to 2.39, P < 0.05). Similar results were observed in all-cause mortality and cardiovascular mortality, but not in other cancer-specific mortality.

CONCLUSIONS

Our data suggest that substantial proportion of CVD patients are exposed to multiple high levels of low-dose ionizing radiation from CC procedure, which is associated with an increased risk of cancer mortality in this population.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05050877; URL: http://www.

CLINICALTRIALS

gov ; 21/09/2021.

The Combined Effects of Short-Term Exposure to Multiple Meteorological Factors on Unintentional Drowning Mortality: Large Case-Crossover Study

BACKGROUND

Drowning is a serious public health problem worldwide. Previous epidemiological studies on the association between meteorological factors and drowning mainly focused on individual weather factors, and the combined effect of mixed exposure to multiple meteorological factors on drowning is unclear.

OBJECTIVE

We aimed to investigate the combined effects of multiple meteorological factors on unintentional drowning mortality in China and to identify the important meteorological factors contributing to drowning mortality.

METHODS

Unintentional drowning death data (based on International Classification of Diseases, 10th Edition, codes W65-74) from January 1, 2013, to December 31, 2018, were collected from the Disease Surveillance Points System for Guangdong, Hunan, Zhejiang, Yunnan, and Jilin Provinces, China. Daily meteorological data, including daily mean temperature, relative humidity, sunlight duration, and rainfall in the same period were obtained from the Chinese Academy of Meteorological Science Data Center. We constructed a time-stratified case-crossover design and applied a generalized additive model to examine the effect of individual weather factors on drowning mortality, and then used quantile g-computation to estimate the joint effect of the mixed exposure to meteorological factors.

RESULTS

A total of 46,179 drowning deaths were reported in the 5 provinces in China from 2013 to 2018. In an effect analysis of individual exposure, we observed a positive effect for sunlight duration, a negative effect for relative humidity, and U-shaped associations for temperature and rainfall with drowning mortality. In a joint effect analysis of the above 4 meteorological factors, a 2.99% (95% CI 0.26%-5.80%) increase in drowning mortality was observed per quartile rise in exposure mixture. For the total population, sunlight duration was the most important weather factor for drowning mortality, with a 93.1% positive contribution to the overall effects, while rainfall was mainly a negative factor for drowning deaths (90.5%) and temperature and relative humidity contributed 6.9% and -9.5% to the overall effects, respectively.

CONCLUSIONS

This study found that mixed exposure to temperature, relative humidity, sunlight duration, and rainfall was positively associated with drowning mortality and that sunlight duration, rather than temperature, may be the most important meteorological factor for drowning mortality. These findings imply that it is necessary to incorporate sunshine hours and temperature into early warning systems for drowning prevention in the future.

The airway microbiome mediates the interaction between environmental exposure and respiratory health in humans

Exposure to environmental pollution influences respiratory health. The role of the airway microbial ecosystem underlying the interaction of exposure and respiratory health remains unclear. Here, through a province-wide chronic obstructive pulmonary disease surveillance program, we conducted a population-based survey of bacterial (n = 1,651) and fungal (n = 719) taxa and metagenomes (n = 1,128) from induced sputum of 1,651 household members in Guangdong, China. We found that cigarette smoking and higher PM_2.5 concentration were associated with lung function impairment through the mediation of bacterial and fungal communities, respectively, and that exposure was associated with an enhanced inter-kingdom microbial interaction resembling the pattern seen in chronic obstructive pulmonary disease. Enrichment of Neisseria was associated with a 2.25-fold increased risk of high respiratory symptom burden, coupled with an elevation in Aspergillus, in association with occupational pollution. We developed an individualized microbiome-based health index, which covaried with exposure, respiratory symptoms and diseases, with potential generalizability to global datasets. Our results may inform environmental risk prevention and guide interventions that harness airway microbiome.

Mortality burden based on the associations of ambient PM2.5 with cause-specific mortality in China: Evidence from a death-spectrum wide association study (DWAS)

Although studies have estimated the associations of PM_2.5 with total mortality or cardiopulmonary mortality, few have comprehensively examined cause-specific mortality risk and burden caused by ambient PM_2.5. Thus, this study investigated the association of short-term exposure to PM_2.5 with cause-specific mortality using a death-spectrum wide association study (DWAS). Individual information of 5,450,764 deaths during 2013-2018 were collected from six provinces in China. Daily PM_2.5 concentration in the case and control days were estimated by a random forest model. A time-stratified case-crossover study design was applied to estimate the associations (access risk, ER) of PM_2.5 with cause-specific mortality, which was then used to calculate the population-attributable fraction (PAF) of mortality and the corresponding mortality burden caused by PM_2.5. Each 10 μg/m³ increase in PM_2.5 concentration (lag03) was associated with a 0.80 % [95 % confidence interval (CI): 0.73 %, 0.86 %] rise in total mortality. We found greater mortality effect at PM_2.5 concentrations < 50 μg/m³. Stratified analyses showed greater ERs in females (1.01 %, 95 %CI: 0.91 %, 1.11 %), children ≤ 5 years (2.17 %, 95 %CI: 0.85 %, 3.51 %), and old people ≥ 70 years. We identified 33 specific causes (level 2) of death which had significant associations with PM_2.5, including 16 circulatory diseases, 9 respiratory diseases, and 8 other causes. The PAF estimated based on the overall association between PM_2.5 and total mortality was 3.16 % (95 %CI: 2.89 %, 3.40 %). However, the PAF was reduced to 2.88 % (95 %CI: 1.88 %, 3.81 %) using the associations of PM_2.5 with 33 level 2 causes of death, based on which 250.15 (95 %CI: 163.29, 330.93) thousand deaths were attributable to short-term PM_2.5 exposure across China in 2019. Overall, this study provided a comprehensive picture on the death-spectrum wide association between PM_2.5 and morality in China. We observed robust positive cause-specific associations of PM_2.5 with mortality risk, which may provide more precise basis in assessing the mortality burden of air pollution.

Effect of integrated intervention to prevent child drowning in rural areas of Guangdong, China: a cluster randomized controlled trial

BACKGROUND

Drowning is the leading cause of death for children under the age of 15 years in Guangdong Province, China. This serious public health issue also exists in low- and middle-income countries (LMICs), which have few value-integrated intervention programs. The current study presents an integrated intervention project that aims to explore an effective pattern of prevention for child drowning in rural areas and feasibility to perform in other LMICs.

METHODS

We conducted a cluster randomized controlled trial by comparing the incidence of non-fatal drowning among children in two groups in rural areas of southern China. We recruited the participants in two phases and reached a total of 10 687 students from 23 schools at two towns in Guangdong Province, China. At the first and second phases, 8966 and 1721 students were recruited, respectively.

RESULTS

The final evaluation questionnaires were collected after 18 months of integrated intervention, where we obtained 9791 data from Grades 3-9. The incidence of non-fatal drowning between the intervention and control groups after intervention did not differ significantly from the baseline according to the total number of students, male students, female students and Grades 6-9 [0.81; 95% confidence interval (CI): [0.66, 1.00]; p = 0.05, 1.17; 95% CI: [0.90, 1.51]; p = 0.25, 1.40; 95% CI: [0.97, 2.02]; p = 0.07 and 0.97; 95% CI: [0.70, 1.34]; p = 0.86], except for Grades 3-5 (1.36; 95% CI: [1.02, 1.82]; p = 0.037). The study observed a significantly positive benefit of awareness and risk behaviours of non-fatal drowning between the intervention and control groups (0.27, 95% CI: [0.21, 0.33]; p = 0.00, -0.16; 95% CI: [-0.24, -0.08]; p = 0.00).

CONCLUSIONS

The integrated intervention exerted a significant impact on the prevention and management of child non-fatal drowning, especially in rural areas.

The impact of mortality underreporting on the association of ambient temperature and PM10 with mortality risk in time series study

Properly analyzing and reporting data remains a challenging task in epidemiologic research, as underreporting of data is often overlooked. The evaluation on the effect of underreporting remains understudied. In this study, we examined the effect of different scenarios of mortality underreporting on the relationship between PM₁₀, temperature, and mortality. Mortality data, PM₁₀, and temperature data in seven cities were obtained from Provincial Center for Disease Control and Prevention (CDC), China Meteorological Data Sharing Service System, and China National Environmental Monitoring Center, respectively. A time-series design with a distributed lag nonlinear model (DLNM) was used to examine the effects of five mortality underreporting scenarios: 1) Random underreporting of mortality; 2) Underreporting is monotonically increasing (MI) or monotonically decreasing (MD); 3) Underreporting due to holiday and weekends; 4) Underreporting occurs before the 20th day of each month, and these underreporting will be added after the 20th day of the month; and 5) Underreporting due to holiday, weekends, MI, and MD. We observed that underreporting at random (UAR) scenario had little effect on the association between PM₁₀, temperature, and daily mortality. However, other four underreporting not at random (UNAR) scenarios mentioned above had varying degrees of influence on the association between PM₁₀, temperature, and daily mortality. Additionally, in addition to imputation under UAR, the variation of minimum mortality temperature (MMT) and attributable fraction (AF) of mortality attributed to temperature in the same imputation scenarios is inconsistent in different cities. Finally, we observed that the pooled excess risk (ER) below MMT was negatively associated with mortality and the pooled ER above MMT was positively associated with mortality. This study showed that UNAR impacted the association between PM₁₀, temperature, and mortality, and potential underreporting should be dealt with before analyzing data to avoid drawing invalid conclusions.

Factors associated with the uptake of national essential public health service package for hypertension and type-2 diabetes management in China's primary health care system: a mixed-methods study

Background

China launched the primary health care (PHC) system oriented National Essential Public Health Service Package (NEPHSP) in 2009, to combat health challenges including the increasing burden from hypertension and type-2 diabetes (T2DM). In this study, the PHC system was assessed to understand factors influencing the uptake of the NEPHSP for hypertension and T2DM management.

Methods

A mixed-methods study was conducted in seven counties/districts from five provinces across the mainland of China. Data included a PHC facility level survey and interviews with policy makers, health administrators, PHC providers, and individuals with hypertension and/or T2DM. The facility survey used the World Health Organisation (WHO) service availability and readiness assessment questionnaire. Interviews were thematically analysed using the WHO health systems building blocks.

Findings

A total of 518 facility surveys were collected with over 90% in rural settings (n = 474). Forty-eight in-depth individual interviews and 19 focus-group discussions were conducted across all sites. Triangulating the quantitative and qualitative data found that China's continuous political commitment to strengthening the PHC system led to improvements in workforce and infrastructure. Despite this, many barriers were identified, including insufficient and under-qualified PHC personnel, remaining gaps in medicines and equipment, fragmented health information systems, residents' low trust and utilization of PHC, challenges in coordinated and continuous care, and lack of cross-sectorial collaborations.

Interpretation

The study findings provided recommendation for future PHC system strengthening, including improving the quality of NEPHSP delivery, facilitating resource-sharing across health facilities, establishing integrated care systems, and exploring mechanisms for better cross-sectorial engagement in health governance.

Funding

The study is supported by National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Disease funding (APP1169757).

Temperature-related mortality in China from specific injury

Injury poses heavy burden on public health, accounting for nearly 8% of all deaths globally, but little evidence on the role of climate change on injury exists. We collect data during 2013-2019 in six provinces of China to examine the effects of temperature on injury mortality, and to project future mortality burden attributable to temperature change driven by climate change based on the assumption of constant injury mortality and population scenario. The results show that a 0.50% (95% confident interval (CI): 0.13%-0.88%) increase of injury mortality risk for each 1 °C rise in daily temperature, with higher risk for intentional injury (1.13%, 0.55%-1.71%) than that for unintentional injury (0.40%, 0.04%-0.77%). Compared to the 2010s, total injury deaths attributable to temperature change in China would increase 156,586 (37,654-272,316) in the 2090 s under representative concentration pathways 8.5 scenario with the highest for transport injury (64,764, 8,517-115,743). Populations living in Western China, people aged 15-69 years, and male may suffer more injury mortality burden from increased temperature caused by climate change. Our findings may be informative for public health policy development to effectively adapt to climate change.

The joint and interaction effect of high temperature and humidity on mortality in China

BACKGROUND

Although many studies have reported the mortality effect of temperature, there were few studies on the mortality risk of humidity, let alone the joint effect of temperature and humidity. This study aimed to investigate the joint and interaction effect of high temperature and relative humidity on mortality in China, which will deepen understanding the health risk of mixture climate exposure.

METHODS

The mortality and meteorological data were collected from 353 locations in China (2013-2017 in Jilin, Hunan, Guangdong and Yunnan provinces, 2009-2017 in Zhejiang province, and 2006-2011 in other Provinces). We defined location-specific daily mean temperature ≥ 75th percentile of distribution as high temperature, while minimum mortality relative humidity as the threshold of high relative humidity. A time-series model with a distributed lag non-linear model was first employed to estimate the location-specific associations between humid-hot events and mortality, then we conducted meta-analysis to pool the mortality effect of humid-hot events. Finally, an additive interaction model was used to examine the interactive effect between high temperature and relative humidity.

RESULTS

The excess rate (ER) of non-accidental mortality attributed to dry-hot events was 10.18% (95% confidence interval (CI): 8.93%, 11.45%), which was higher than that of wet-hot events (ER = 3.21%, 95% CI: 0.59%, 5.89%). The attributable fraction (AF) of mortality attributed to dry-hot events was 10.00% (95% CI: 9.50%, 10.72%) with higher burden for females, older people, central China, cardiovascular diseases and urban city. While for wet-hot events, AF was much lower (3.31%, 95% CI: 2.60%, 4.30%). We also found that high temperature and low relative humidity had synergistic additive interaction on mortality risk.

CONCLUSION

Dry-hot events may have a higher risk of mortality than wet-hot events, and the joint effect of high temperature and low relative humidity may be greater than the sum of their individual effects.

Future injury mortality burden attributable to compound hot extremes will significantly increase in China

BACKGROUND

As climate change, compound hot extremes (CHEs), daytime and nighttime persistent hot extremes, are projected to become much more frequent and intense, which may pose a serious threat to human health. However, evidence on the impact of CHEs on injury is rare.

METHODS

We collected injury death data and daily meteorological data from six Chinese provinces during 2013-2018. A time-stratified case-crossover design with two-stage analytic approach was applied to assess the associations of CHEs with injury mortality by intention, mechanism, age and gender. Using the projected daily temperatures of five General Circulation Models (GCMs), we projected the frequency of CHEs and CHEs-attributable mortality burden of injury under three Representative Concentration Pathway (RCP) scenarios.

RESULTS

CHEs were significantly associated with increased injury mortality risk (RR = 1.14, 95%CI: 1.09-1.19), with strong effects on unintentional injuries (RR = 1.16, 95%CI:1.11,1.22) and intentional injuries (RR = 1.11, 95%CI:0.99,1.25). Female (RR = 1.21,95%CI: 1.13-1.29) and the elderly (RR = 1.30, 95%CI: 1.22-1.39) were more susceptible to CHEs. Both the frequency and injury mortality burden of CHEs showed a steep rising trend under RCP8.5 scenario, with a 7.37-fold and 8.22-fold increase respectively, by the end of the century, especially in southern, eastern, central and northwestern China.

CONCLUSION

CHEs were associated with increased injury mortality risk, and the CHEs-attributable injury mortality burden was projected to aggravate substantially in the future as global warming. It is urgent to develop targeted adaptation policies to alleviate the health burden of CHEs.

Isatuximab plus atezolizumab in patients with advanced solid tumors: results from a phase I/II, open-label, multicenter study

BACKGROUND

The anti-CD38 antibody isatuximab is approved for the treatment of relapsed/refractory multiple myeloma, but there are no data on its efficacy in solid tumors. This phase I/II study (NCT03637764) assessed the safety and activity of isatuximab plus atezolizumab (Isa + Atezo), an anti-programmed death-ligand 1 (PD-L1) antibody, in patients with immunotherapy-naive solid tumors: epithelial ovarian cancer (EOC), glioblastoma (GBM), hepatocellular carcinoma (HCC), and squamous cell carcinoma of the head and neck (SCCHN).

PATIENTS AND METHODS

Phase I assessed safety, tolerability, pharmacokinetics, pharmacodynamics, and the recommended phase II dose (RP2D) of isatuximab 10 mg/kg intravenously (i.v.) every week for 3 weeks followed by once every 3 weeks + atezolizumab 1200 mg i.v. every 3 weeks. Phase II used a Simon's two-stage design to assess the overall response rate or progression-free survival rate at 6 months (GBM cohort). Interim analysis was carried out at 6 months following first dose of the last enrolled patient in each cohort. Pharmacodynamic biomarkers were tested for CD38, PD-L1, tumor-infiltrating immune cells, and FOXP3+ regulatory T cells (Tregs) in the tumor microenvironment (TME).

RESULTS

Overall, 107 patients were treated (EOC, n = 18; GBM, n = 33; HCC, n = 27; SCCHN, n = 29). In phase I, Isa + Atezo showed an acceptable safety profile, no dose-limiting toxicities were observed, and RP2D was confirmed. Most patients experienced ≥1 treatment-emergent adverse event (TEAE), with ≤48.5% being grade ≥3. The most frequent TEAE was infusion reactions. The study did not continue to stage 2 based on prespecified targets. Tumor-infiltrating CD38+ immune cells were reduced and almost cleared after treatment. Isa + Atezo did not significantly modulate Tregs or PD-L1 expression in the TME.

CONCLUSIONS

Isa + Atezo had acceptable safety and tolerability. Clinical pharmacodynamic evaluation revealed efficient target engagement of isatuximab via treatment-mediated reduction of CD38+ immune cells in the TME. Based on clinical data, CD38 inhibition does not improve responsiveness to PD-L1 blockade in these patients.

Non-Fatal Drowning Risk Prediction Based on Stacking Ensemble Algorithm

Drowning is a major public health problem and a leading cause of death in children living in developing countries. We seek better machine learning (ML) algorithms to provide a novel risk-assessment insight on non-fatal drowning prediction. The data on non-fatal drowning were collected in Qingyuan city, Guangdong Province, China. We developed four ML models to predict the non-fatal drowning risk, including a logistic regression model (LR), random forest model (RF), support vector machine model (SVM), and stacking-based model, on three primary learners (LR, RF, SVM). The area under the curve (AUC), F1 value, accuracy, sensitivity, and specificity were calculated to evaluate the predictive ability of the different learning algorithms. This study included a total of 8390 children. Of those, 12.07% (1013) had experienced non-fatal drowning. We found the following risk factors are closely associated with the risk of non-fatal drowning: the frequency of swimming in open water, distance between the school and the surrounding open waters, swimming skills, personality (introvert) and relationality with family members. Compared to the other three base models, the stacking generalization model achieved a superior performance in the non-fatal drowning dataset (AUC = 0.741, sensitivity = 0.625, F1 value = 0.359, accuracy = 0.739 and specificity = 0.754). This study indicates that applying stacking ensemble algorithms in the non-fatal drowning dataset may outperform other ML models.

The Spring Festival Is Associated With Increased Mortality Risk in China: A Study Based on 285 Chinese Locations

Background

The Spring Festival is one of the most important traditional festivals in China. This study aimed to estimate the mortality risk attributable to the Spring Festival.

Methods

Between 2013 and 2017, daily meteorological, air pollution, and mortality data were collected from 285 locations in China. The Spring Festival was divided into three periods: pre-Spring Festival (16 days before Lunar New Year's Eve), mid-Spring Festival (16 days from Lunar New Year's Eve to Lantern Festival), and post-Spring Festival (16 days after Lantern Festival). The mortality risk attributed to the Spring Festival in each location was first evaluated using a distributed lag nonlinear model (DLNM), and then it was pooled using a meta-analysis model.

Results

We observed a dip/rise mortality pattern during the Spring Festival. Pre-Spring Festival was significantly associated with decreased mortality risk (ER: −1.58%, 95%CI: −3.09% to −0.05%), and mid-Spring Festival was unrelated to mortality risks, while post-Spring Festival was significantly associated with increased mortality risk (ER: 3.63%, 95%CI: 2.15–5.12%). Overall, a 48-day Spring Festival period was associated with a 2.11% (95%CI: 0.91–3.33%) increased mortality. We also found that the elderly aged over 64 years old, women, people with cardiovascular disease (CVD), and people living in urban areas were more vulnerable to the Spring Festival.

Conclusion

Our study found that the Spring Festival significantly increased the mortality risk in China. These findings suggest that it is necessary to develop clinical and public health policies to alleviate the mortality burden associated with the Spring Festival.

Prevalence of Osteoporosis and Fracture in China: The China Osteoporosis Prevalence Study

IMPORTANCE

The aging of the population is associated with an increasing burden of fractures worldwide. However, the epidemiological features of fractures in mainland China are not well known.

OBJECTIVE

To assess the prevalence of and factors associated with osteoporosis, clinical fractures, and vertebral fractures in an adult population 40 years or older in mainland China.

DESIGN, SETTING. AND PARTICIPANTS

This cross-sectional study, the China Osteoporosis Prevalence Study, was conducted from December 2017 to August 2018. A random sample of individuals aged 20 years or older who represented urban and rural areas of China were enrolled, with a 99% participation rate.

MAIN OUTCOMES AND MEASURES

Weighted prevalence of osteoporosis, clinical fracture, and vertebral fracture by age, sex, and urban vs rural residence as determined by x-ray absorptiometry, questionnaire, and radiography.

RESULTS

A total of 20 416 participants were included in this study; 20 164 (98.8%; 11 443 women [56.7%]; mean [SD] age, 53 [13] years) had a qualified x-ray absorptiometry image and completed the questionnaire, and 8423 of 8800 (95.7%) had a qualified spine radiograph. The prevalence of osteoporosis among those aged 40 years or older was 5.0% (95% CI, 4.2%-5.8%) among men and 20.6% (95% CI, 19.3%-22.0%) among women. The prevalence of vertebral fracture was 10.5% (95% CI, 9.0%-12.0%) among men and 9.7% (95% CI, 8.2%-11.1%) among women. The prevalence of clinical fracture in the past 5 years was 4.1% (95% CI, 3.3%-4.9%) among men and 4.2% (95% CI, 3.6%-4.7%) among women. Among men and women, 0.3% (95% CI, 0.0%-0.7%) and 1.4% (95% CI, 0.8%-2.0%), respectively, with osteoporosis diagnosed on the basis of bone mineral density or with fracture were receiving antiosteoporosis treatment to prevent fracture.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of an adult population in mainland China, the prevalence of osteoporosis and vertebral fracture were high and the prevalence of vertebral fracture and clinical fracture was similarly high in men and women. These findings suggest that current guidelines for screening and treatment of fractures among patients in China should focus equally on men and women and should emphasize the prevention of vertebral fractures.

The association of compound hot extreme with mortality risk and vulnerability assessment at fine-spatial scale

The frequency and intensity of compound hot extremes will be likely to increase in the context of global warming. Epidemiological studies have demonstrated the adverse effect of simple hot extreme events on mortality, but little is known about the effects of compound hot extremes on mortality. Daily meteorological, demographic, and mortality data during 2011-2017 were collected from 160 streets in Guangzhou City, China. We used distributed lag non-linear model (DLNM) to analyze the associations of different hot extremes with mortality risk in each street. Street-specific associations were then combined using a meta-analysis approach. To assess the spatial distribution of vulnerability to compound hot extremes, vulnerable characteristics at street level were selected using random forest model, and then we calculated and mapped spatial vulnerability index (SVI) at each street in Guangzhou. At street level, compared with normal day, compound hot extreme significantly increased mortality risk (relative risk(RR)=1.43, 95%CI:1.28-1.59) with higher risk for female (RR=1.54 [1.35-1.76]) and the elderly(RR for aged 65-74=1.41 [1.14-1.74]; RR for ≥75years=1.63 [1.45-1.84]) than male (RR=1.32 [1.15-1.52]) and population <65 years (RR=1.01 [0.83-1.22]). Areas with high vulnerability were in the urban center and the edge of suburban. High proportion of population over 64 years old in urban center, and high proportions of outdoor workers and population with illiteracy in suburban areas were the determinants of spatial vulnerability. We found that compound hot extreme significantly increased mortality risk at street level, which is modified by socio-economic and demographic factors. Our findings help allocate resources targeting vulnerable areas at fine-spatial scale.°.

5-aza-2'-deoxycytidine may regulate the inflammatory response of human odontoblast-like cells through the NF-κB pathway

AIM

To explore the role of DNA methylation in the innate immunity of the dental pulp, this study investigated the effect of 5-aza-2'-deoxycytidine (AZA) on lipoteichoic acid (LTA)-induced cytokine production and related intracellular signalling pathways in human odontoblast-like cells (hOBs).

METHODOLOGY

hOBs were cultured and differentiated from human dental pulp tissue, and the odontoblastic phenotype of the cells was detected using immunofluorescence, qRT-PCR and Western blotting. hOBs were pretreated with AZA and then stimulated with 10 μg mL^-1 LTA. The levels of 42 cytokines related to immunity and inflammation were examined using a cytokine antibody array and verified using qRT-PCR and ELISA. The effect of AZA on the LTA-induced NF-κB and MAPK signalling pathways was explored using Western blotting. The cells were treated with the specific NF-κB inhibitor PDTC and MAPK inhibitors (the ERK inhibitor U0126, the p38 inhibitor SB203580, and the JNK inhibitor SP600125) to further confirm the role of the signalling pathways in LTA-treated hOBs. DNA immunoprecipitation-PCR was used to examine the dynamic methylation status of the gene promoters of myeloid differentiation primary response 88 (MyD88) and tumour necrosis factor receptor-associated factor 6 (TRAF6) in the LTA-induced hOBs. Statistical analyses of the differences between two groups were performed using Student's t-test. One-way analysis of variance (anova) or repeated-measures anova with a post hoc Dunnett's test was used to assess the differences between multiple sets of data. P < 0.05 was considered to be statistically significant.

RESULTS

The odontoblastic markers were significantly higher in hOBs than those in human dental pulp cells (hDPCs) (P < 0.05). According to the cytokine antibody array results, hOBs pretreated with AZA had significantly increased production of several inflammatory cytokines (P < 0.05), in which the expression levels of IL-6 and IL-8 were the most dramatically increased upon LTA stimulation (P < 0.01). Furthermore, AZA resulted in the significant upregulation of p-IKKα/β, p-IκBα, p-p65, p-p38 and p-ERK in LTA-stimulated hOBs (P < 0.01). Treatment with the NF-κB pathway inhibitor suppressed both IL-6 and IL-8 expression (P < 0.05), whereas inhibitors of the MAPK pathway (SB203580 and SP600125) did not. In LTA-treated hOBs, AZA significantly increased the expression levels of TRAF6 and MyD88 (P < 0.05). AZA induced MyD88 promoter hypomethylation but did not affect TRAF6 methylation.

CONCLUSION

AZA regulated the LTA-induced inflammatory response through the NF-κB signal pathway in hOBs. This study highlights the important role of DNA methylation in the immunity defence of odontoblasts during the dental pulp immunity response to caries.

MiRNA-7b-5p attenuates the progression of osteoporosis by inhibiting adipose differentiation of hMSCs via regulating IRS2

OBJECTIVE

To elucidate whether microRNA-7b-5p (miRNA-7b-5p) could inhibit adipose differentiation of human bone marrow-derived mesenchymal stem cells (hMSCs) through regulating IRS2, thereby alleviating the progression of osteoporosis.

MATERIALS AND METHODS

Expression levels of miRNA-7b-5p and IRS2 in hMSCs at different stages of adipogenic differentiation and osteogenic differentiation were detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) and Western blot. After transfection of miRNA-7b-5p mimic or pcDNA-IRS2 in hMSCs, lipid droplet formation in cells was observed by oil red O staining. Expressions of C/EBPα and PPARγ were detected by qRT-PCR and Western blot. The potential target gene of miRNA-7b-5p was predicted by bioinformatics and verified by dual-luciferase reporter gene assay. Finally, expressions of IRS2 in hMSCs transfected with miRNA-7b-5p-NC, miRNA-7b-5p mimic or co-transfected with miRNA-7b-5p mimic and pcDNA-IRS2 were examined.

RESULTS

Expressions of miRNA-7b-5p and IRS2 gradually decreased with the prolongation of adipogenic differentiation, but increased during osteogenic differentiation of hMSCs. Transfection of miRNA-7b-5p mimic reduced oil red O staining after adipogenic differentiation and downregulated mRNA and protein levels of C/EBPα and PPARγ. Transfection of pcDNA-IRS2 increased oil red O staining after osteogenic differentiation and upregulated mRNA and protein levels of C/EBPα and PPARγ. Dual-luciferase reporter gene results showed that miRNA-7b-5p could bind to IRS2. Overexpression of IRS2 reversed the downregulated mRNA and protein levels of adipogenic-related genes C/EBPα and PPARγ due to the overexpression of miRNA-7b-5p.

CONCLUSIONS

MiRNA-7b-5p inhibits the adipogenic differentiation of hMSCs through IRS2, thus alleviating the development of osteoporosis.

MicroRNA-330-5p promotes the development of osteosarcoma by regulating SPRY2

OBJECTIVE

MicroRNA is an endogenous, non-coding small RNA that has a significant role in regulating organisms and pathology. Previous studies have demonstrated that microRNA-330-5p was a cancer-promoting gene. However, the role of microRNA-330-5p in osteosarcoma (OS) has not been reported. The aim of this work was to explore the characteristics of microRNA-330-5p expression in OS, and to further study its expression in OS and its relationship with clinicopathological parameters and prognosis.

PATIENTS AND METHODS

Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was performed to investigate the expression of microRNA-330-5p in 48 pairs of OS tissues and paracancer tissues, and to analyze the relationship between the expression of microRNA-330-5p and OS clinical indicators and patient prognosis. Meanwhile, qRT-PCR was performed to verify the microRNA-330-5p expression in OS cells. In addition, the microRNA-330-5p knockdown expression model was constructed using lentivirus in OS cell lines U2OS and MG63. The effects of microRNA-330-5p on the biological function of OS cells were analyzed by Cell Counting Kit-8 (CCK-8) and transwell experiments. The potential mechanism was explored by Western blot.

RESULTS

In this paper, qRT-PCR results showed that the expression of microRNA-330-5p in OS was higher than that in paracancer tissues, and the difference was statistically significant. Compared with microRNA-330-5p low expression group, patients with high expression of microRNA -330-5p had a higher prevalence of distant metastasis and a lower overall survival rate. In vitro experiment showed that the proliferation, invasion and metastasis abilities of the cells in the microRNA-330-5p silencing group were markedly decreased compared with the negative control group (NC group). Western blot results demonstrated that microRNA-330-5p inhibitor can activate SPRY2 and regulate the expression of key proteins, such as p-Smad2, p-Smad3, TGF-β1, MMP9 and Vimentin in the TGF-β1/Smad signaling pathway. It was found that there was a mutual regulation between microRNA-330-5p and SPRY2, which promoted the malignant progression of OS.

CONCLUSIONS

The expression of microRNA-330-5p was markedly increased in OS, which was associated with distant metastasis and poor prognosis. Furthermore, we found that microRNA-330-5p may promote the vicious progression of OS by inter-modulating SPRY2 and the TGF-β1/Smad signaling pathways.

miR-129-5p suppresses breast cancer proliferation by targeting CBX4

Deregulation of microRNA (miRNA) is closely related to cancer development and progression. Our previous study identified that miR-129-5p suppresses proliferation and metastasis in breast cancer cells. Herein, we determined that CBX4 is a miR-129-5p target gene. CBX4 is up-regulated in breast cancer tissues and while its over-expression promotes cell proliferation, its knockdown suppresses cell proliferation in breast cancer cells. Furthermore, CBX4 mediates miR-129-5p-induced inhibition of cell proliferation and negatively correlates with the expression of miR-129-5p expression. These combined results suggest that CBX4 is an oncogene in breast cancer cells, and that it may provide a novel therapeutic strategy for breast cancer treatment.

Self-compassion may reduce anxiety and depression in nursing students: a pathway through perceived stress

OBJECTIVES

Nursing students report high levels of anxiety and depression, which requires urgent attention. A growing amount of evidence indicates that self-compassion may indirectly (through perceived stress) and directly influence anxiety and depression, yet the research to date has not fully examined the reasons for this association. The present study examines the effects of self-compassion on anxiety and depression through perceived stress and may thus provide an innovative starting point for developing effective interventions for affected nursing students.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Using structural equation modelling (SEM), we estimated the strength of the pathways between self-compassion, perceived stress and anxiety and depression among 1453 nursing students in Ningbo, China. The measurements included demographics, the Self-Compassion Scale-Short Form, the Chinese version of the Perceived Stress Questionnaire and the Goldberg Anxiety and Depression Scale.

RESULTS

Nursing students had an average score of 4.50 ± 2.44 on the Goldberg Anxiety Scale (GAS) and 3.58 ± 2.34 on the Goldberg Depression Scale (GDS), indicating high levels of anxiety and depression. The GAS and GDS scores were significantly different by the academic year, part-time employment and career prospects. The average scores for self-compassion and perceived stress were 38.99 ± 4.55 and 0.40 ± 0.14, respectively. The SEM results suggested that self-compassion was negatively associated with anxiety and depression (-0.44, P < 0.001). Perceived stress was positively associated with anxiety and depression (0.64, P < 0.001). Self-compassion was negatively associated with perceived stress (-0.65, P < 0.001). Self-compassion had no significant correlation with anxiety and depression in the effect of perceived stress (-0.14, P = 0.127). Thus, self-compassion indirectly influences anxiety and depression through perceived stress.

CONCLUSIONS

Self-compassion might reduce nursing students' anxiety and depression through perceived stress. Interventionists can consider using self-compassion training to alleviate perceived stress, anxiety and depression in nursing students.

An exploratory model for the non-fatal drowning risks in children in Guangdong, China

Background

Drowning is a leading cause of accidental death in children under 14 years of age in Guangdong, China. We developed a statistical model to classify the risk of drowning among children based on the risk factors.

Methods

A multiple-stage cluster random sampling was employed to select the students in Grades 3 to 9 in two townships in Qingyuan, Guangdong. Questionnaire was a self-reported measure consisting of general information, knowledge, attitudes and activities. A univariate logistic regression model was used to preliminarily select the independent variables at a P value of 0.1 for multivariable model. Three-quarters of the participants were randomly selected as a training sample to establish the model, and the remaining were treated as a testing sample to validate the model.

Results

A total of 8390 children were included in this study, about 12.18% (1013) experienced drowning during the past one year. In the univariate logistic regression model, introvert personality, unclear distributions of water areas on the way to school, and bad relationships with their classmates and families were positively associated with drowning. However, females, older age and lower swimming skills were negatively associated with drowning. After employing the prediction model with these factors to estimate drowning risk of the students in the testing samples, the results of Hosmer-Lemeshow tests showed non-significant differences between the predictive results and actual risk (χ2 = 5.97, P = 0.65).

Conclusions

Male, younger children, higher swimming skills, bad relationship with their classmates and families, introvert personality and unclear distributions of water areas on the way to school were important risk factors of non-fatal drowning among children. The prediction model based on these variables has an acceptable predictive ability.

High-performance nanoporous-GaN metal-insulator-semiconductor ultraviolet photodetectors with a thermal oxidized β-Ga2O3 layer

We report on the high-performance nanoporous (NP) GaN-based metal-insulator-semiconductor (MIS) ultraviolet (UV) photodetectors (PDs) with a thermal oxidized β-Ga₂O₃insulating layer. The devices show a high responsivity of 4.5×10⁵  A/W and maximum external quantum efficiency of 1.55×10⁸% at 360 nm under a 10 V applied bias, which are attributed to the trap-assisted tunneling induced internal gain mechanism. Correspondingly, a specific detectivity of 8.27×10¹⁵ Jones and excellent optical switching repeatability are also observed in our fabricated PDs. The NP-GaN/β-Ga₂O₃ MIS UV PD may act as an excellent candidate for the application in UV photodetection due to the high performance and simple fabrication process.

Epidemiological characteristics of injury mortality in Guangdong Province, China, 2015

BACKGROUND

As the fourth leading cause of death, injury is an important public health concern in Guangdong Province, China. The epidemiological characteristics of injury mortality is changing along with the social development. This study described the epidemiological characteristics of injury mortality in Guangdong Province by analyzing the death surveillance data in a few areas in Guangdong Province in 2015.

METHODS

Using the mortality data from the Disease Surveillance Points (DSP) system, injury deaths were classified according to the International Classification of Disease-10th Revision (ICD-10). The data were stratified by areas (urban/rural), gender, age groups, injury types, and then overall and type-specific injury mortality rates were estimated for the whole Guangdong Province, China.

RESULTS

We estimated that about 38,200 individuals died from injury in Guangdong Province in 2015, producing a mortality rate of 43.11/100,000. The overall age-standardized injury mortality in men was higher in rural areas compared with urban areas (41.29/100,000 versus 24.89/100,000). In terms of injury intent, unintentional injuries were the commonnest injury type, which accounted for 83.93% of the overall injury deaths, however, the deaths caused by suicide should not be ignored, which occupied 12.67% of the total injury deaths. In terms of injury cause type, falls, road-traffic accidents, suicide, drowning, and accidental poisoning were the top five leading types of injury deaths.

CONCLUSIONS

In Guangdong Province, injury is an important cause of death. Road-traffic accidents, falls, suicide, drowning, and accidental poisoning should be the priorities of intervention. Moreover, in rural areas, the men were the most targeted subpopulation of the prevention activities.

A phase II, randomised study of mFOLFOX6 with or without the Akt inhibitor ipatasertib in patients with locally advanced or metastatic gastric or gastroesophageal junction cancer

BACKGROUND

Akt activation is common in gastric/gastroesophageal junction cancer (GC/GEJC) and is associated with chemotherapy resistance. Treatment with ipatasertib, a pan-Akt inhibitor, may potentiate the efficacy of chemotherapy in GC/GEJC.

PATIENTS AND METHODS

In this randomised, double-blind, placebo-controlled, multicentre, phase II trial, patients with locally advanced or metastatic GC/GEJC not amenable to curative therapy were randomised 1:1 to receive ipatasertib or placebo, plus mFOLFOX6 (modified regimen of leucovorin, bolus and infusional 5-fluorouracil [5-FU], and oxaliplatin). The co-primary end-point was progression-free survival (PFS) in the intent-to-treat (ITT) population and in phosphatase and tensin homolog (PTEN)-low patients. Secondary end-points included PFS in patients with PI3K/Akt pathway-activated tumours; overall survival, investigator-assessed objective response rate and duration of response in the ITT population; and safety assessments.

RESULTS

In 153 enrolled patients, the median PFS (ITT) was 6.6 months (90% confidence interval [CI], 5.7-7.5) with ipatasertib/mFOLFOX6 versus 7.5 months (90% CI, 6.2-8.1) with placebo/mFOLFOX6 (hazard ratio, 1.12; 90% CI, 0.81-1.55; P = 0.56). No statistically significant PFS benefit was observed in biomarker-selected patient subgroups (PTEN-low and PI3K/Akt pathway-activated tumours) with ipatasertib/mFOLFOX6 versus placebo/mFOLFOX6. Other secondary end-points did not favour the ipatasertib/mFOLFOX6 treatment arm. The percentages of patients with ≥1 adverse event (AE, 100% versus 98%) and grade ≥3 AEs (79% versus 74%) were similar between arms. Higher rates of AEs leading to treatment withdrawal (16% versus 6%) and serious AEs were reported in the ipatasertib arm (54% versus 43%). Thirty-nine and 29 deaths occurred in the ipatasertib and placebo arms, respectively.

CONCLUSIONS

Ipatasertib/mFOLFOX6 compared with placebo/mFOLFOX6 did not improve PFS in unselected or biomarker-selected patients. No unexpected safety concerns were observed.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT01896531).

Protective effects of trehalose on frozen-thawed ovarian granulosa cells of cattle

In this study, trehalose was investigated for its cryoprotective effects on ovarian granulosa cells (bGCs) of cattle. Five concentrations of trehalose at 0, 0.2, 0.4, 0.6 and 0.8 mol/L were added to the cryopreservation medium of bGCs, and the effects on the quality of frozen-thawed bGCs were assessed. The results indicate that the use of cryopreservation medium containing 0.2 and 0.4 mol/L of trehalose resulted in a greater rate of bGC viability compared to those of other groups (P<0.05). Culturing with trehalose at 0.2 and 0.4 mol/L increased 17β- estradiol (E₂)and decreased progesterone (P₄)production (P < 0.05) in post-thawed bGCs. Compared with the control group, the intracellular Ca²⁺ concentrations of frozen-thawed bGCs were less in all treatment groups (P<0.05), and the least Ca²⁺ concentration was observed in the group containing 0.4 mol/L trehalose. The plasma membrane potentials of frozen-thawed bGCs were greater in the groups with 0.2 and 0.4 mol/L trehalose, and the group treated with 0.4 mol/L trehalose had the greatest membrane potential in comparison to other groups (P < 0.05). The relative abundance of the CYP19 mRNA in frozen-thawed bGCs was greater in the groups containing 0.2, 0.4 and 0.6 mol/L trehalose, and relative abundances of FSHR and BCL2 mRNA were greater in the group of bGCs treated with 0.2 mol/L trehalose (P<0.05). Trehalose treatment at 0.4, 0.6 and 0.8 mol/L had an inhibitory effect on BAX gene transcription in frozen-thawed bGCs (P<0.05). In summary, trehalose exhibited a greater cryoprotective effect on bGCs than basic cryopreservation medium.

Circ-ITCH regulates triple-negative breast cancer progression through the Wnt/β-catenin pathway

Recent studies indicate that circular RNA (circRNA) is involved in tumorigenesis, but its role in triple-negative breast cancer (TNBC) remains largely unknown. In this study, we characterized the role of circ-ITCH in TNBC and found that circ-ITCH was significantly down-regulated in TNBC tissues and cell lines and closely associated with poor prognosis. We therefore constructed the MDA-MB-231 and BT-549 TNBC cell lines stably expressing circ-ITCH by lentiviral vectors to determine its underlying mechanisms in TNBC progression. Most importantly, over-expression of circ-ITCH remarkably inhibited TNBC proliferation, invasion and metastasis both in vitro and in vivo. Mechanistically, we found that circ-ITCH acts as a sponge for miR-214 and miR-17 to increase expression of its ITCH linear isoform, thereby inactivating Wnt/β-catenin signaling. Our combined results show for the first time that circ-ITCH is a tumor suppressor, a promising prognostic biomarker in TNBC and that its restoration could well be a successful strategy in TNBC.

mRNA and protein expression of sarcKATP channel subunit Kir6.2 after exercise-induced myocardial injury in rats

OBJECTIVE

To investigate the expression of kir6.2 subunit of the sarcKATP channel in exercise-induced myocardial injury and to elucidate the underlying mechanism of myocardial protection by sarcKATP channels.

MATERIALS AND METHODS

Healthy male Sprague Dawley(SD) rats were divided into the Control (C) and the Exhaustive Exercise (EE) group. The one-time exhaustive exercise-induced myocardial injury model was established on a treadmill at a speed of 35 m/min. Alterations in myocardial ischemia and hypoxia were examined by hematoxylin-basic fuchsin-picric acid (HBFP) staining and the concentration of cardiac Troponin I (cTnl), a sensitive and specific marker for myocardial injury, was detected using immunochemiluminescence analysis. The mRNA expression level, localization, and protein expression of sarcKATP channel subunit kir6.2 were determined by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR), immunofluorescence, and Western blot analysis, respectively.

RESULTS

When compared to Group C, rats in Group EE demonstrated significantly increased areas of myocardial ischemia and hypoxia. Moreover, increased serum levels of cTnI were detected. Increased kir6.2 expression was found on the surface of cardiomyocytes and kir6.2 protein expression was also significantly increased.

CONCLUSIONS

Exercise-induced myocardial injury did not result in noticeable alterations in kir6.2 mRNA expression. However, kir6.2 protein expression was significantly increased and resulted in increased numbers of sarcKATP channel openings in the myocardium, thereby further inhibiting exercise-induced myocardial injury.

A Novel, Dynamic Statistical Model for Predicting Patient Satisfaction with Fundoplication Based on Pre-Operative Symptom Patterns

BACKGROUND

Fundoplication provides excellent control of gastro-oesophageal reflux disease (GORD), but there remain a number of unsatisfied patients who have proven difficult to identify pre-operatively. We hypothesised that pre-operative symptom patterns can predict of the risk of post-operative dissatisfaction.

METHODS

Pre-operative symptoms and post-operative satisfaction were measured using standardised questionnaires along with routine investigations. These data were used to calculate our novel pre-operative risk of dissatisfaction (PROD) score. Potential pre-operative prognostic markers were tested against the post-operative satisfaction data, including the objective investigations and the PROD score. The prognostic utility of the PROD score and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guideline was tested using receiver operating characteristic analysis to determine the area under the curve (AUC).

RESULTS

An association was found between our PROD score and each of the satisfaction measures (n = 225, p < 0.001) which is likely to be of prognostic utility (AUC = 0.67-0.79). No such association was found between the routine investigations and post-operative satisfaction. The PROD score was found to be of greater prognostic utility than the SAGES guideline (n = 166, p < 0.001).

CONCLUSIONS

The PROD score is a novel, easy-to-use test that can predict individual patient satisfaction with fundoplication.

Intracranial hypertension induced by internal jugular vein stenosis can be resolved by stenting

BACKGROUND AND PURPOSE

Idiopathic intracranial hypertension (IIH) is characterized by abnormally elevated intracranial pressure (ICP) without identifiable etiology. Recently, however, a subset of patients with presumed IIH have been found with isolated internal jugular vein (IJV) stenosis in the absence of intracranial abnormalities.

METHODS

Fifteen consecutive patients were screened from 46 patients suspected as IIH and were finally confirmed as isolated IJV stenosis. The stenotic IJV was corrected with stenting when the trans-stenotic mean pressure gradient (∆MPG) was equal to or higher than 5.44 cmH₂ O. Dynamic magnetic resonance venography, computed tomographic venography and digital subtraction angiography of the IJV, ∆MPG, ICP, Headache Impact Test 6 and the Frisén papilledema grade score before and after stenting were compared.

RESULTS

All the stenotic IJVs were corrected by stenting. ∆MPG decreased and the abnormal collateral veins disappeared or shrank immediately. Headache, tinnitus, papilledema and ICP were significantly ameliorated at 14 ± 3 days of follow-up (all P < 0.01). At 12 ± 5.6 months of outpatient follow-up, headache disappeared in 14 out of 15 patients (93.3%), visual impairments were recovered in 10 of 12 patients (83.3%) and tinnitus resolved in 10 out of 11 patients (90.9%). In 12 out of 15 cases, the Frisén papilledema grade scores declined to 1 (0-2). The stented IJVs in all 15 patients kept to sufficient blood flows on computed tomographic venography follow-up without stenting-related adverse events.

CONCLUSIONS

Non-thrombotic IJV stenosis may be a potential etiology of IIH. Stenting seems to be a promising option to address the issue of intracranial hypertension from the etiological level, particularly after medical treatment failure.

[The underlying mechanisms of overcoming EGFR-TKIs resistance by casein kinase 2 inhibitor]

Nowadays, EGFR-TKIs are important treatment strategy in lung cancer, but the resistance to EGFR-TKIs remains an unsolved issue preventing the patients from further benefits. Recent studies have shown that casein kinase (CK2) plays an important role in carcinogenesis and development of cancer. CK2 inhibitor has also demonstrated anti-tumor effects. Here we reviewed the mechanism of EGFR-TKIs and the potential reasons of resistance. Interestingly, there is a crosstalk between CK2 and EGFR downstream signaling pathways, therefore, it may be possible that CK2 inhibitor can overcome the EGFR-TKIs resistance.

Cancer incidence and mortality in Guangdong province, 2012

Objective

To estimate the cancer incidence and mortality in 2012 in Guangdong province by analyzing the cancer data of selected population-based cancer registries in Guangdong province in 2012.

Methods

Eight of nine population-based cancer registries submitted cancer data to the Guangdong Provincial Centre for Disease Control and Prevention (Guangdong CDC), whose data met the data quality criteria were included for analysis. The statistics of selected registries, stratified by areas, gender, age and cancer types, were used to estimate the cancer incidence and mortality in 2012 in Guangdong province according to the population data in Guangdong province. Segi’s population and the national census population in 2000 were used for calculating the age-standardized rates (ASR).

Results

A total of 15,084,942 people, accounted for 17.47% of all population in Guangdong province, were covered in 8 selected population-based cancer registries in 2012. The percentage of cases morphologically verified (MV%) and the percentage of death certificate-only cases (DCO%) were 72.84% and 0.87%, respectively, and the mortality/incidence (M/I) ratio was 0.56. It was estimated that there were 211,300 new cancer cases and 117,300 cancer deaths. The incidence crude rate (CR), the ASR by Chinese standard population (ASRC) and by world standard population (ASRW), and the accumulated rate (AR) (0.74 years) were 250.20/100,000 (265.39/100,000 in males, 234.29/100,000 in females), 207.04/100,000, 201.34/100,000 and 22.91%, respectively, in Guangdong province in 2012. The incidence CR and ASRC were 267.25/100,000 and 221.43/100,000 in urban areas, and 215.51/100,000 and 178.77/100,000 in rural areas, respectively. The death CR, ASRC, ASRW and AR (0.74 years) were 148.44/100,000 (190.95/100,000 in males, 105.06/100,000 in females), 103.73/100,000, 102.44/100,000 and 11.68%, respectively, in Guangdong province in 2012. The death CR and ASRC were 164.57/100,000 and 105.46/100,000 in urban areas, and 124.63/100,000 and 99.97/100,000 in rural areas, respectively. Top 5 cancers were lung cancer, liver cancer, female breast cancer, colon cancer and nasopharyngeal cancers (NPC), and top 5 death cancers were lung cancer, liver cancer, colon cancer, stomach cancer, and NPC in Guangdong province in 2012.

Conclusions

Lung cancer, liver cancer, female breast cancer, colon cancer and NPC were the major economic cancer burdens and health concerns in Guangdong province in 2012. Early prevention, diagnosis and treatment of different cancers, survival quality improvement and cancer burden reduction, are important issues we faced in cancer control and prevention.