Nonrestorative Sleep and Type 2 Diabetes Incidence: the Aichi Workers' Cohort Study.

BACKGROUND: The term "nonrestorative sleep (NRS)" refers to unrefreshed feeling at wake-up and is a domain of poor sleep quality. Previous researches have demonstrated that NRS is linked to a number of diseases and adverse health outcomes, but less is known regarding the link between NRS and diabetes, particularly in Japanese. METHODS: We studied 3665 middle-aged male participants of the Aichi Workers' Cohort Study who were followed-up from 2002 to 2019. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of incident type 2 diabetes mellitus (T2DM) in relation to NRS adjusted for potential confounding variables. RESULTS: During a median follow-up of 14.6 years, 421 type 2 diabetes cases were identified. Participants with NRS had a higher crude incidence rate of T2DM (11.2/1,000 person-years), compared to participants without NRS (9.3/1,000 person-years). In the fully adjusted model, individuals who reported having NRS had a significantly higher risk of developing T2DM (HR: 1.36, 95% CI: 1.10-1.67). The association was observed only in participants under 50 years old (HR: 1.82, 95% CI: 1.36-2.43), not in the older (50 years or older) participants (P for interaction =0.025). In contrast, stratified analyses by the presence of shift work, obesity or sleep duration showed similar associations in all the strata. CONCLUSIONS: NRS was associated with higher risk of T2DM in middle-aged Japanese male workers independent of a variety of lifestyle factors and other sleep problems.

The effect of age on the relationship between body mass index and risks of incident stroke subtypes: The JPHC study.

OBJECTIVE: The associations between body mass index (BMI) and stroke subtypes, particularly intracerebral hemorrhage, have not been consistent. Such inconsistencies may be due to differences in the age at which BMI was obtained. We examined the possible age modifications in the association between BMI and stroke risk. MATERIALS AND METHODS: We followed 88,754 participants, aged 40-69 years at baseline (1990-1994), of the Japan Public Health Center-based prospective (JPHC) study for stroke incidence. BMI was obtained using self-reported body weight and height, which were categorized using the following cut-off points: 18.5, 21, 23, 25, 27.5, and 30 kg/m2. Time-dependent Cox proportional hazards models that updated BMI and covariates using 5- and 10-year questionnaire responses were used to estimate hazard ratios and 95 % confidence intervals. The analyses were stratified by age group (40-59 and ≥60 years) and the age of the individuals was updated. RESULTS: During the median follow-up period of 19 years, we documented 4,690 strokes, including 2,781 ischemic strokes and 1,358 intracerebral hemorrhages. After adjusting for sex, age, smoking, alcohol consumption, leisure-time physical activity, history of hypertension, dyslipidemia, and diabetes mellitus, we observed a positive linear association between BMI and ischemic stroke (linear trend, p < 0.001) in both age groups (interaction p>0.05). In contrast, a curvilinear association between BMI and intracerebral hemorrhage was observed in both the middle (curvilinear trend, p=0.017) and the older group (curvilinear trend, p=0.098) (interaction p>0.05). CONCLUSION: BMI and stroke associations did not vary significantly with age, although the association may differ according to subtype.

Risk and population attributable fraction of stroke subtypes in Japan.

BACKGROUND: Associations of major risk factors for stroke with total and each type of stroke as well as subtypes of ischemic stroke and their population attributable fractions had not been examined comprehensively. METHODS: Participants of the Japan Public Health Center-based prospective (JPHC) Study Cohort II without histories of cardiovascular disease and cancer (n=14,797) were followed from 1993 through 2012. Associations of current smoking, hypertension, diabetes, overweight (body mass index ≥ 25 kg/m2), non-high-density lipoprotein cholesterol (non-HDLC) categories, low HDLC (< 40 mg/dL), urine protein, and history of arrhythmia were examined in a mutually-adjusted Cox regression model that included age and sex. Population attributable fraction (PAF) was estimated using the hazard ratios and the prevalence of risk factors among cases. RESULTS: Subjects with hypertension were 1.63 to 1.84 times more likely to develop any type of stroke. Diabetes, low HDLC, current smoking, overweight, urine protein, and arrhythmia were associated with risk of overall and ischemic stroke. Hypertension and urine protein were associated with risk of intracerebral hemorrhage while current smoking, hypertension, and low non-HDLC were associated with subarachnoid hemorrhage. Hypertension alone accounted for more than a quarter of stroke incidence, followed by current smoking and diabetes. High non-HDLC, current smoking, low HDLC, and overweight contributed mostly to large-artery occlusive stroke. Arrhythmia explained 13.2% of embolic stroke. Combined PAFs of all the modifiable risk factors for total, ischemic and large-artery occlusive strokes were 36.7 and 44.5% and 61.5%, respectively. CONCLUSION: Although there are differences according to the subtypes, hypertension could be regarded as the most crucial target for preventing strokes in Japan.

Stoma creation is associated with a low incidence of midline incisional hernia after colorectal surgery: the "fighting over the fascia" theory concerning the incision and stoma hole.

PURPOSE: Parastomal hernia (PH) develops more frequently than incisional hernia (IH) after colorectal surgery with stoma. This study evaluated our hypothesis that inward traction of the fascia when closing a midline incision widens the stoma hole and increases the incidence of PH. METHODS: A total of 795 patients who underwent colorectal resection between 2006 and 2016 were retrospectively analyzed. The risk classification was constructed from IH risk factors extracted from the non-stoma group. Then, the classification was extrapolated to the stoma group for predicting midline IH and PH. RESULTS: The incidence of IH was 5.3% in the stoma group and 12.5% in the non-stoma group (p = 0.005). PH developed in 19.6% of 97 patients with permanent stoma. The risk classification was able to predict PH without a significant difference but was well balanced in patients with permanent stoma; however, it failed to predict IH in the stoma group. CONCLUSION: The risk classification constructed from the non-stoma group was useful for predicting not midline IH but PH, suggesting that the stoma site was the most vulnerable for herniation. The "fighting over the fascia" theory between the midline incision and stoma hole may explain the causal relationship between the midline IH and PH.

Pelvic exenteration associated with future renal dysfunction.

PURPOSE: This study aimed to clarify the long-term change in the renal function after pelvic exenteration (PE) and to evaluate the risk factors for any future dysfunction. METHODS: This study comprised 40 patients. A greater than 25% decline in the estimated glomerular filtration rate (eGFR) at 3 years was defined as early renal function disorder (ERFD), possibly predicting future chronic kidney disease (CKD). RESULTS: In the entire cohort, the median eGFR decreased by 23% at 3 years, and CKD developed in 50%. The patients were divided into the ERFD (n = 16) and non-ERFD (n = 24) groups. In the ERFD group, the eGFR significantly decreased by 28% during the first 1.5 years and continued to decline after that, resulting in 81.3% of patients reaching CKD, whereas it was 4% and 37.5%, respectively, in the non-ERFD group. In a growth model analysis, late urinary tract complications (UTC) and small bowel obstruction were shown to be risk factors for ERFD. CONCLUSION: Although PE was associated with a high incidence of future CKD, ERFD could predict it. Close observation of the eGFR decline over 1.5 years might be beneficial to identify ERFD patients. High-risk patients with late UTC and small bowel obstruction should, therefore, be observed carefully.

Exploring the Mechanism of a Chiral N-Alkyl Imine-Based Light-Driven Molecular Rotary Motor at MS-CASPT2//CASSCF and MS-CASPT2//(TD) DFT Levels.

The working mechanism including the photoisomerization and thermal isomerization steps of a chiral N-alkyl imine-based motor synthesized by Lehn et al. are revealed by MS-CASPT2//CASSCF and MS-CASPT2//(TD-)DFT methods. For the photoisomerization process of the imine-based motor, it involves both the bright (π,π*) state and the dark (n,π*) state. In addition, the MECI has similar geometry and energy to the minimum of the S1 state, which shows that the process is barrierless and keeps the unidirectionality of rotation well; the result confirms the imine-based motor is a good candidate for a light-driven molecular rotary motor. For the thermal isomerization process of the imine-based motor, there are two even isomerization paths: one with the mechanism of the in-plane N inversion, the energy barriers of which are 29.6 kcal mol-1 at MS3-CASPT2//CAM-B3LYP level and 29.2 kcal mol-1 at MS3-CASPT2//CASSCF level; the other with the mechanism of ring inversion of the cycloheptatriene moiety, with energy barriers of 28.1 kcal mol-1 at MS3-CASPT2//CAM-B3LYP level and 18.1 kcal mol-1 at MS3-CASPT2//CASSCF level. According to the structural feature of the stator moiety, the imine molecule can be used as a two-step or a four-step light-driven rotary motor.

Body Mass Index and Risks of Incident Ischemic Stroke Subtypes: The Japan Public Health Center-Based Prospective (JPHC) Study.

BACKGROUND: The association of body mass index (BMI) with risks of ischemic stroke subtypes have not been established. METHODS: Cumulative average BMI was calculated using self-reported body weight and height obtained from baseline (Cohort I in 1990, and Cohort II from 1993-1994) and 5- and 10-year questionnaire surveys of Japan Public Health Center-based prospective (JPHC) study. A total of 42,343 men and 46,413 women aged 40-69 years were followed-up for the incidence of lacunar, large-artery occlusive, and cardioembolic strokes. A sub-distribution hazard model was used to estimate sub-distribution hazard ratios (SHRs) and the 95% confidence intervals (CIs). RESULTS: During a median of 20.0 years of follow-up, we documented 809 and 481 lacunar, 395 and 218 large-artery occlusive, and 568 and 298 cardioembolic strokes in men and women, respectively. After adjustment for baseline age, updated smoking, alcohol consumption, leisure-time physical activity, and histories of hypertension, dyslipidemia, and diabetes mellitus, cumulative average BMI was positively linearly associated with lacunar (trend P = 0.007), large-artery occlusive (trend P = 0.002), and cardioembolic (trend P < 0.001) strokes in men, and with lacunar (trend P < 0.001) and large-artery occlusive (trend P = 0.003) strokes in women. There were approximately two-fold excess risk of cardioembolic stroke in both sexes and of lacunar and large-artery occlusive strokes in women for cumulative average BMI ≥30 kg/m2 compared to BMI 23-<25 kg/m2. CONCLUSION: Cumulative average BMI showed a positive linear effect on sub-distribution hazards of lacunar, large-artery occlusive, and cardioembolic strokes in both sexes, except for cardioembolic stroke in women.

A Point System for Predicting 10-Year Risk of Developing Type 2 Diabetes Mellitus in Japanese Men: Aichi Workers' Cohort Study.

BACKGROUND: Relatively little evidence exists for type 2 diabetes mellitus (T2DM) prediction models from long-term follow-up studies in East Asians. This study aims to develop a point-based prediction model for 10-year risk of developing T2DM in middle-aged Japanese men. METHODS: We followed 3,540 male participants of Aichi Workers' Cohort Study, who were aged 35-64 years and were free of diabetes in 2002, until March 31, 2015. Baseline age, body mass index (BMI), smoking status, alcohol consumption, regular exercise, medication for dyslipidemia, diabetes family history, and blood levels of triglycerides (TG), high density lipoprotein cholesterol (HDLC) and fasting blood glucose (FBG) were examined using Cox proportional hazard model. Variables significantly associated with T2DM in univariable models were simultaneously entered in a multivariable model for determination of the final model using backward variable selection. Performance of an existing T2DM model when applied to the current dataset was compared to that obtained in the present study's model. RESULTS: During the median follow-up of 12.2 years, 342 incident T2DM cases were documented. The prediction system using points assigned to age, BMI, smoking status, diabetes family history, and TG and FBG showed reasonable discrimination (c-index: 0.77) and goodness-of-fit (Hosmer-Lemeshow test, P = 0.22). The present model outperformed the previous one in the present subjects. CONCLUSION: The point system, once validated in the other populations, could be applied to middle-aged Japanese male workers to identify those at high risk of developing T2DM. In addition, further investigation is also required to examine whether the use of this system will reduce incidence.

Overexpression of Amyloid Precursor Protein Promotes the Onset of Seborrhoeic Keratosis and is Related to Skin Ageing.

Seborrhoeic keratosis (SK) is an age-related skin disease. Amyloid precursor protein (APP) plays an important role in the pathogenesis of age-related Alzheimer's disease. The aim of this study was to elucidate the expression characteristics of APP in SK tissues (n = 50), and explore whether the production of APP is related to the onset of SK and skin ageing, including ultraviolet (UV)-induced ageing, as observed in normal skin (n = 79). The results of immunohistochemistry, Western blotting and quantitative real-time PCR showed that APP and its downstream products (i.e. amyloid-ß42) were more highly expressed in SK than in paired adjacent normal skin tissues. In contrast, the expression of its key secretase (i.e. ß-secretase1) was generally low. Furthermore, APP expression was higher in UV-exposed than non-exposed skin sites, and expression in the older age group (61-85 years) was greater than that in the younger age group (41-60 years) in SK tissues (p<0.05). APP expression correlated positively with age in epidermis (p<0.05), but not in dermis. These findings suggest that overexpression of APP may promote the onset of SK and is a marker of skin ageing and UV damage. Further research will elucidate whether therapeutic mitigation of increased levels of APP in the skin might delay the onset of SK and skin ageing.

Combining the Advantages of Alkene and Azo E-Z Photoisomerizations: Mechanistic Insights into Ketoimine Photoswitches.

We carried out CASPT2//(TD)DFT and CASPT2//CASSCF studies on the working mechanism of imine switches, including a camphorquinone-derived ketoimine (shortened as k-Imine) switch designed by Lehn as well as a model camphorquinone alkene-imine (a-Imine) proposed in this study. Under the experimental conditions (light irradiation with 455 and 365 nm for E and Z, respectively), k-Imine is excited to the S1:(nN,π*) state and then decays toward a perpendicular intermediate following the C═N bond rotation coordinate. During the bond rotation, a mild energy barrier caused by the strong interaction of S1:(nN,π*) and S2:(nO,π*) states will more or less slow down the rotation speed of k-Imine. The large difference in irradiation light wavelength supports k-Imine as a two-way photoswitch. The photoisomerization of a-Imine obeys a similar but fully barrierless pattern while requiring a higher excitation energy to reach the (nN,π*) state. The good directionality of thermal isomerization toward E(a-Imine), plus the barrierless photoisomerization, allows for the design of a thermal and photo-operated switch. For both imines, a minimal-energy crossing point (MECI) located at the perpendicular region, with low relative energy and close to the rotary path, ensures the directionality of C═N bond rotation and confirms imines as optimal candidates for photoswitches and motors.

[Fast Classification of Complex Sulphide Ore Based on Raman Spectroscopy].

The regional features, metallogenitic regularities and mineral composition of the hydrothermal sulphide ore have been preliminarily studied. According to the different mineralization period, the patterns of valuable minerals disseminated in ore are complicated, which causes the large changes in the properties of the sulphide ore. The different properties of the sulphide ore may increase the difficulty of the mineral processing and reduce the recovery rate of valuable minerals. Therefore a simple method for rapidly classification of sulphide ore is required to optimize mineral processing flowsheet. Laser Raman spectrometry, as an effective method to analyze the structure of the material is used to identify the component and structure of minerals. The research on the Laser Raman spectra of the large number of sulphide ore samples can reveal the reasons for the difference of the Raman spectra. A new method for classifying the complex sulphide ore using Raman spectroscopy is proposed. The experiment results demonstrate that the properties of the sulphide ore in different mineralization period vary greatly and the fluorescent scattering is mainly produced by gangue minerals. The measured Raman spectral after quenching the fluorescence scattering show the peaks of Raman spectra at 201.62, 242.54, 288.38 and 309.77 cm-1 can be used to identify this kind of complex sulphide ore. The raw ore can be divided into three categories based on the difference of the intensity of fluorescence scattering and the ratio of fluorescence and Raman intensity. The accuracy of the classification method is further validated by the industrial tests. The findings demonstrate the close relationship between Raman spectra and the properties of sulphide ore. The proposed method, which can fast classify the sulphide ore, don't need complex chemical pretreatment before spectra collection. Therefore, this method will have important application value for improving the efficiency of mineral processing.

Development of a Risk Equation for the Incidence of Coronary Artery Disease and Ischemic Stroke for Middle-Aged Japanese　- Japan Public Health Center-Based Prospective Study.

BACKGROUND: Global risk assessment for the prevention of atherosclerotic cardiovascular diseases helps guide the intensity of behavioral and pharmacological interventions. METHODS AND RESULTS: The Japan Public Health Center-based prospective (JPHC) Study Cohort II (age range: 40-69 years at baseline in 1993-1994, n=15,672) was used to derive the risk equations for coronary artery disease (CAD) and ischemic stroke incidence via hazard regression. The model discrimination was evaluated by the area under the receiver-operating curve (AUC), and model goodness-of-fit by the Grønnesby-Borgan chi-squared statistic. During a mean of 16.4 years of follow up, 192 incident CAD cases and 552 ischemic stroke cases occurred. Variables selected for the CAD equation were age, sex, current smoking, systolic blood pressure, antihypertensive medication use, diabetes, and high-density lipoprotein cholesterol (HDLC) and non-HDLC. The same variables, except non-HDLC, were selected for the ischemic stroke equation. The equations discriminated incidence reasonably well (AUC: 0.81 for CAD, 0.78 for ischemic stroke). The AUC of the equation applied externally to Cohort I (n=11,598) was also good: 0.77 and 0.76 for CAD and ischemic stroke, respectively. Risk calculator application and color charts to visualize estimated risk according to the combinations of risk factors were prepared. CONCLUSIONS: Risk equations were developed to estimate the 10-year probability of CAD and ischemic stroke in Japanese people, using variables that are routinely obtained. (Circ J 2016; 80: 1386-1395).

Different conical intersections control nonadiabatic photochemistry of fluorene light-driven molecular rotary motor: A CASSCF and spin-flip DFT study.

We report the light-driven isomerization mechanism of a fluorene-based light-driven rotary motor (corresponding to Feringa's 2nd generation rotary motor, [M. M. Pollard et al., Org. Biomol. Chem. 6, 507-512 (2008)]) at the complete active space self-consistent field (CASSCF) and spin-flip time-dependent density functional theory (TDDFT) (SFDFT) levels, combined with the complete active space second-order perturbation theory (CASPT2) single-point energy corrections. The good consistence between the SFDFT and CASSCF results confirms the capability of SFDFT in investigating the photoisomerization step of the light-driven molecular rotary motor, and proposes the CASPT2//SFDFT as a promising and effective approach in exploring photochemical processes. At the mechanistic aspect, for the fluorene-based motor, the S1/S0 minimum-energy conical intersection (MECIs) caused by pyramidalization of a fluorene carbon have relatively low energies and are easily accessible by the reactive molecule evolution along the rotary reaction path; therefore, the fluorene-type MECIs play the dominant role in nonadiabatic decay, as supported by previous experimental and theoretical works. Comparably, the other type of MECIs that results from pyramidalization of an indene carbon, which has been acting as the dominant nonadiabatic decay channel in the stilbene motor, is energetically inaccessible, thus the indene-type MECIs are "missing" in previous mechanistic studies including molecular dynamic simulations. A correlation between the geometric and electronic factors of MECIs and that of the S1 energy profile along the C═C rotary coordinate was found. The findings in current study are expected to deepen the understanding of nonadiabatic transition in the light-driven molecular rotary motor and provide insights into mechanistic tuning of their performance.

Association between parental history of diabetes and the incidence of type 2 diabetes mellitus differs according to the sex of the parent and offspring's body weight: A finding from a Japanese worksite-based cohort study.

OBJECTIVE: To investigate differences in the association of parental history of diabetes with the risk of type 2 diabetes mellitus (T2DM) in the offspring according to the sex of the parent and the offspring's body weight. METHODS: A prospective cohort study of 4446 middle-aged non-diabetic Japanese men and women were followed in Aichi Prefecture, central Japan, from 2002 to 2011. Subjects were categorized by their self-reported parental history of diabetes ("no parental history," "father only," "mother only," and "both"). The association of parental history of diabetes and incidence in the offspring was examined according to overweight status adjusted for age, sex, birth weight, smoking, alcohol consumption, physical activity, total energy intake, body mass index, and number of metabolic syndrome components. RESULTS: During follow-up (median 8.9 years), 277 subjects developed T2DM. Parental history of diabetes was positively associated with T2DM incidence. However, stratified analysis by overweight status revealed that only maternal history was associated with increased T2DM incidence in non-overweight subjects (hazard ratio=2.35, 95% confidence interval: 1.41-3.91). While in overweight subjects, paternal history was significantly associated with higher T2DM incidence (hazard ratio=1.98, 95% confidence interval: 1.19-3.28). CONCLUSIONS: Our results suggest that parental history of diabetes mellitus is associated with the incidence of T2DM in offspring differently according to the sex of the affected parent and the offspring's body weight.

Smoking and diabetes: is the association mediated by adiponectin, leptin, or C-reactive protein?

BACKGROUND: Although the association between cigarette smoking and risk of type 2 diabetes is well established, its mechanisms are yet to be clarified. This study examined the possible mediating effects of adiponectin, leptin, and C-reactive protein (CRP) concentrations on the smoking-diabetes association. METHODS: Between 2002 and 2011, we followed 3338 Japanese workers, aged 35-66 years, who were enrolled in the second Aichi workers' cohort study. We used multivariable-adjusted Cox regression models to determine the hazard ratios and respective 95% confidence intervals (CIs) of the association between smoking status and risk of diabetes. A multiple mediation model with bootstrapping was used to estimate the magnitude and the respective bias-corrected (BC) 95% CIs of the indirect effects of smoking on diabetes through the three biomarkers. RESULTS: Relative to never smokers, the risk of diabetes was significantly elevated in current (hazard ratio 1.75, 95% CI 1.25-2.46) and ex-smokers (hazard ratio 1.54, 95% CI 1.07-2.22). The indirect effects of smoking on diabetes through adiponectin levels were statistically significant among light (point estimate 0.033, BC 95% CI 0.005-0.082), moderate (point estimate 0.044, BC 95% CI 0.010-0.094), and heavy smokers (point estimate 0.054, BC 95% CI 0.013-0.113). In contrast, neither the indirect effects of smoking on diabetes through leptin nor CRP levels were significant, as the corresponding BC 95% CIs included zero. CONCLUSIONS: In our analysis, adiponectin concentration appeared to partially mediate the effect of smoking on diabetes, while leptin and CRP levels did not.

Breakfast Skipping is Positively Associated With Incidence of Type 2 Diabetes Mellitus: Evidence From the Aichi Workers' Cohort Study.

BACKGROUND: Skipping breakfast has been suspected as a risk factor for type 2 diabetes (T2DM), but the associations are not entirely consistent across ethnicities or sexes, and the issue has not been adequately addressed in the Japanese population. METHODS: We followed 4631 participants (3600 men and 1031 women) in a work-site cohort of participants aged 35-66 years in 2002 through 2011 for T2DM development. Frequency of eating breakfast was self-reported and was subsequently dichotomized to breakfast skippers, who eat breakfast 3-5 times/week or less, and to eaters. Cox proportional hazards models were used to adjust for potential confounding factors, including dietary factors, smoking and other lifestyles, body mass index (BMI), and fasting blood glucose (FBG) at baseline. RESULTS: During 8.9 years of follow-up, 285 T2DM cases (231 men and 54 women) developed. Compared to participants who reported eating breakfast every day, maximally-adjusted hazard ratios and 95% confidence intervals (CI) of those with the frequency of almost every day and 3-5, 1-2, and 0 days/week were: 1.06 (95% CI, 0.73-1.53), 2.07 (95% CI, 1.20-3.56), 1.37 (95% CI, 0.82-2.29), and 2.12 (95% CI, 1.19-3.76), respectively. In a dichotomized analysis, breakfast skipping was positively associated with T2DM incidence (maximally-adjusted hazard ratio 1.73; 95% CI, 1.24-2.42). The positive associations were found in both men and women, current and non-current smokers, normal weight and overweight (BMI ≥ 25 kg/m(2)), and normal glycemic status and impaired fasting glycemic status (FBG 110 to <126 mg/dL) individuals at baseline (Ps for interaction all >0.05). CONCLUSIONS: The present study in middle-aged Japanese men and women suggests that skipping breakfast may increase the risk of T2DM independent of lifestyles and baseline levels of BMI and FBG.

Profile of Non-communicable Disease Risk Factors Among Young People in Palau.

BACKGROUND: Although non-communicable diseases (NCDs) have become the predominant health problems of Palauan society, there have been no comprehensive data on NCD risk factors available to develop effective control strategies. Therefore, the first Palauan national STEPwise approach to risk factor Surveillance (STEPS) was completed in mid-2013 to provide information on its adult population aged 25 to 64 years. This study aims to obtain corresponding data from the younger adults aged 18 to 24 years, who remained to be surveyed. METHODS: We conducted an epidemiological study, targeting the 18- to 24-year-old age group. A survey station and a mobile team were established to recruit voluntary participants dwelling in Koror. A slightly modified WHO STEPS instrument was used, including a structured questionnaire for behavioral risk factors, physical measurements, and blood tests. RESULTS: A total of 356 young people were recruited during the survey. In both sexes, nearly half of the participants were overweight/obese. The prevalence of hypertension was higher in men than in women (17.6% vs 1.7%). Raised blood glucose and impaired fasting glucose were observed in 3.5% and 5.2% of the total participants, respectively. About 36% of the subjects were observed to have raised levels of total cholesterol. More than 70% of the young people were current tobacco users, in terms of all kinds of tobacco products. CONCLUSIONS: The current survey, for the first time, revealed a high prevalence of NCD risk factors, especially overweight/obesity and tobacco use, among young people in Palau. This indicates that swift measures against NCDs are required even in this young age group.

Global trend in overweight and obesity and its association with cardiovascular disease incidence.

Although the global prevalence of both the overweight and obese is on the rise, there are variations among regions or countries, and sexes. Approximately half or more than half of the population are overweight/obese defined as body mass index ≥25 kg/m(2)in the Americas (61.1%), Europe (54.8%), and Eastern Mediterranean (46.0%) according to the World Health Organization, while a much lower prevalence is observed in Africa (26.9%), South-East Asia (13.7%), and the Western Pacific (25.4%). Females are more likely to be overweight/obese in the Eastern Mediterranean, Africa, South-East Asia and the majority of countries in the Americas and Western Pacific but not in the most of the countries in Europe. These region-sex-ethnicity differences in prevalence may be a clue to the causes of the obesity epidemic. Epidemiological studies done in the USA, Europe, and Asia found that higher BMI was significantly associated with increased incidence of coronary artery disease (CAD) and ischemic stroke, but the association with hemorrhagic stroke incidence was not always consistent. The association of BMI with CAD and ischemic stroke was generally independent of known mediators, which would indicate the importance of controlling or preventing overweight/obesity for the prevention of cardiovascular disease.

Prevalence, severity, and risk factors of cancer-related fatigue among working cancer survivors: a systematic review and meta-analysis.

PURPOSE: The aim of this study is to evaluate the prevalence, severity, and risk factors of cancer-related fatigue among currently working cancer survivors. METHODS: We searched the PubMed, Embase, Scopus, CINAHL, Cochrane Library, and ICHUSHI databases. The risk of bias was evaluated independently using the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS). A meta-analysis was conducted to determine the prevalence, severity, and related factors associated with cancer-related fatigue among currently working cancer survivors. RESULTS: Our meta-analysis included 18 studies and revealed that 42.2% of currently working cancer survivors experience cancer-related fatigue. The fatigue severity in this group was significantly higher than that in workers without cancer (absolute standardized mean difference (SMD) = 0.67), but lower than that in cancer survivors who had previously worked and were not currently working (absolute SMD = 0.72). Distress was identified as a potential risk factor for cancer-related fatigue in working cancer survivors (partial correlation coefficient = 0.38). CONCLUSIONS: The high prevalence of cancer-related fatigue among employed cancer survivors underscores the need for targeted workplace interventions and fatigue management strategies. While the severity of fatigue is less than that seen in non-working survivors, the comparison with the general working population highlights a significant health disparity. The association between distress and fatigue suggests the necessity for a holistic approach to fatigue management that considers both physical and mental factors in working cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Our findings highlight the critical need for healthcare professionals and employers to monitor fatigue levels among working cancer survivors and offer appropriate support.

Bioinspired cytomembrane coating besieges tumor for blocking metabolite transportation.

The metabolite transport inhibition of tumor cells holds promise to achieve anti-tumor efficacy. Herein, we presented an innovative strategy to hinder the delivery of metabolites through the in-situ besieging tumor cells with polyphenolic polymers that strongly adhere to the cytomembrane of tumor cells. Simultaneously, these polymers underwent self-crosslinking under the induction of tumor oxidative stress microenvironment to form an adhesive coating on the surface of the tumor cells. This polyphenol coating effectively obstructed glucose uptake, reducing metabolic products such as lactic acid, glutathione, and adenosine triphosphate, while also causing reactive oxygen species to accumulate in the tumor cells. The investigation of various tumor models, including 2D cells, 3D multicellular tumor spheroids, and xenograft tumors, demonstrated that the polyphenolic polymers effectively inhibited the growth of tumor cells by blocking key metabolite transport processes. Moreover, this highly adhesive coating could bind tumor cells to suppress their metastasis and invasion. This work identified polyphenolic polymers as a promising anticancer candidate with a mechanism by impeding the mass transport of tumor cells.