Prevalence of tobacco dependence and associated factors in China: Findings from nationwide China Health Literacy Survey during 2018-19.

Background: Tobacco dependence is the key barrier to successful smoking cessation. However, little is known about its prevalence, sociodemographic characteristics and determinants. We aimed to estimate the prevalence, associated factors and burden of tobacco dependence in China. Methods: During 2018-2019, the nationally representative 2018 China Health Literacy Survey (2018 CHLS) invited 87,708 participants to participate using a multistage stratified sampling method from 31 provinces (or equivalent) in mainland China, and 84,839 participants aged 20-69 with valid data were included in the analysis. We diagnosed tobacco dependence based on international criteria (ICD-10, DSM-4) and tailored to Chinese population according to China Clinical Guideline for Tobacco Cessation (2015 version). The prevalence of tobacco dependence was estimated overall and by sociodemographic factors. The Logistic regression was conducted to estimate odds ratios (OR) and 95% confidence intervals (CIs) for tobacco dependence and success of smoking cessation (being ex-smokers), with different levels of adjustment. These were used to estimate the total number of adults who were tobacco dependent in China. Findings: In China, the estimated prevalence of current smoking was 25.1%, significantly higher in men than in women (47.6% vs 1.9%). The prevalence of current smoking varied approximately 3-fold (12.9% to 37.9%) across 31 provinces of China. Among general population aged 20-69 years, the prevalence of tobacco dependence was 13.1% (95% CI:12.2-14.1). Among current smokers, the prevalence of tobacco dependence was 49.7% (46.5-52.9%), with no difference between men and women (49.7% vs 50.8%). The prevalence of tobacco dependence was associated significantly with smoking intensity, defined by pack-years (1.62 [1.54-1.70] per 10 pack-years), cigarettes smoked per day (2.01 [1.78, 2.27] per 10 cigarettes), and smoking starting age (0.93 [0.90, 0.97] per 5 years). Given smoking intensity, the prevalence of tobacco dependence also varied by age, gender, certain socioeconomic status and regions. Compared with those without tobacco dependence, ever smokers with tobacco dependence were less likely to be ex-smokers (2.88, 2.59-3.21). In China, 183.5 (170.4-197.4) million adults (177.5 million were men) were tobacco dependent in 2018. Interpretation: In China, tobacco dependence is highly prevalent, with approximately half of current smokers being addictive, highlighting the need for coordinated effort to improve awareness, diagnosis and treatment of tobacco dependence. Funding: Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (CAMS 2021-I2M-1-010), National Key R&D Program of China (grant no 2017YFC1309400), and National Natural Science Foundation of China (grant no 81720108001). Note: Chinese translation of abstract is available in appendix section.

Construction of the National Brain Tumor Registry of China for better management and more efficient use of data: a protocol.

INTRODUCTION: Brain tumours encompass a complex group of intracranial tumours that mostly affect young adults and children, with a high incidence rate and poor prognosis. It remains impossible to systematically collect data on patients with brain tumours in China and difficult to perform in-depth analysis on the status of brain tumours, medical outcomes or other important medical issues through a multicentre clinical study. This study describes the first nation-wide data platform including the entire spectrum of brain tumour entities, which will allow better management and more efficient application of patient data in China. METHODS AND ANALYSIS: The National Brain Tumor Registry of China (NBTRC) is a registry of real-word clinical data on brain tumours. It is established and managed by the China National Clinical Research Center for Neurological Diseases and administered by its scientific and executive committees. The 54 participating hospitals of the NBTRC are located in 27 provinces/municipalities, performing more than 40 000 brain tumour surgeries per year. The data consist of in-hospital medical records, images and follow-up information after discharge. Data can be uploaded in three ways: the web portal, remote physical servers and offline software. The data quality control scheme is seven-dimensional. Each participating hospital could focus on a single pathology subtype and public subtypes of brain tumour for which they expect to conduct related multicentre clinical research. The standardised workflow to conduct clinical research is based on the benefit-sharing mechanism. Data collection will be conducted continuously from 1 February 2019 to 31 January 2024. ETHICS AND DISSEMINATION: Informed consent will be obtained from all participants. Consent for the adolescents' participation will be also obtained from their guardians via written consent. The results will be published in professional journals, in both Chinese and English. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry (ChiCTR1900021096).

Allogeneic bone marrow mesenchymal stem cell transplantation in patients with UDCA-resistant primary biliary cirrhosis.

The objective of this study was to evaluate the safety and efficacy of allogeneic bone marrow mesenchymal stromal/stem cell transplantation (BM-MSCT) for patients with ursodeoxycholic acid (UDCA)-resistant primary biliary cirrhosis (PBC). Ten patients were enrolled in this trial of BM-MSCT. All patients were permitted to concurrently continue their previous UDCA treatment. The efficacy of BM-MSCT in UDCA-resistant PBC was assessed at various time points throughout the 12-month follow up. No transplantation-related side effects were observed. The life quality of the patients was improved after BM-MSCT as demonstrated by responses to the PBC-40 questionnaire. Serum levels of ALT, AST, γ-GT, and IgM significantly decreased from baseline after BM-MSCT. In addition, the percentage of CD8+ T cells was reduced, while that of CD4+CD25+Foxp3+ T cells was increased in peripheral lymphocytic subsets. Serum levels of IL-10 were also elevated. Notably, the optimal therapeutic outcome was acquired in 3 to 6 months and could be maintained for 12 months after BM-MSCT. In conclusion, allogeneic BM-MSCT in UDCA-resistant PBC is safe and appears to be effective.

A case-control study on risk factors of breast cancer in China.

INTRODUCTION: To screen the risk factors associated with breast cancer among Chinese women in order to evaluate the individual risk of developing breast cancer among women in China. MATERIAL AND METHODS: A case-control study on 416 breast cancer patients and 1156 matched controls was conducted in 14 hospitals in 8 provinces of China in 2008. Controls were age- and region-matched to the cases. Clinicians conducted in-person interviews with the subjects to collect information on demographics and suspected risk factors for breast cancer that are known worldwide. Conditional logistic regression was used to derive odds ratios (OR) and 95% confidence intervals (CI) for the associations between risk factors and breast cancer. RESULTS: Compared with matched controls, women with breast cancer were significantly more likely to have higher body mass index (BMI, OR = 4.07, 95% CI: 2.98-5.55), history of benign breast disease (BBD) biopsy (OR = 1.68, 95% CI: 1.19-2.38), older age of menarche (AOM) (OR = 1.41, 95% CI: 1.07-1.87), stress anticipation (SA), for grade 1-4, OR = 2.15, 95% CI: 1.26-3.66; for grade 5-9, OR = 3.48, 95% CI: 2.03-5.95) and menopause (OR = 2.22, 95% CI: 1.50-3.282) at the level of p < 0.05. Family history of breast cancer (FHBC) in first-degree relatives (OR = 1.66, 95% CI: 0.77-3.59) and use of oral contraceptives (OC) (OR = 1.59, 95% CI: 0.83-3.05) were associated with an increased risk of breast cancer at the level of p < 0.20. CONCLUSIONS: Our results showed that BMI, history of BBD biopsy, older AOM, SA and menopause were associated with increased risk of breast cancer among Chinese women. The findings derived from the study provided some suggestions for population-based prevention and control of breast cancer in China.

[Clinical characteristics of McCune-Albright syndrome in Chinese patients].

OBJECTIVE: To present the ophthalmological characteristics of McCune-Albright syndrome (MAS). METHODS: Case series study. Best corrected visual acuity (BCVA), visual field, color vision, retinal nerve fiber layer (RNFL) thickness, visual evoked potentials (VEP), fundus examination, computed tomography (CT) imaging of the optic canal, follow up results of multidisciplinary comprehensive treatments were analyzed. RESULTS: Of the 6 patients, three were male and three were female. Their age were between 4 to 43 years old (median, 16 years old). Based on CT imaging of the optic canal, encasement of the optic canal was found in all 6 patients (12 eyes); three patients (6 eyes) had circumferential encasement of the optic canal; the remaining 3 patients (6 eyes) had partial encasement of the optic canal. Two patients (3 eyes) with circumferential encasement of the optic canal had optic neuropathy versus none in the remaining 9 eyes with circumferential or partial optic canal encasement. In addition, lengthening of the optic nerve was found in all 4 patients (8 eyes). CONCLUSION: Optic canal encasement and lengthening of the optic nerve are common in MAS patients, which is worthy of attention in clinical practice.

[A research on prevalence and risk factors of type 2 diabetes mellitus in the farmers and immigrants of Yi people in Liangshan, Sichuan province, China].

OBJECTIVE: To explore the difference on the prevalence and the risk factors of type 2 diabetes(T2DM) between Yi farmer and immigrants in Liangshan, Sichuan province. METHODS: A representative sample of 2878 Yi people (including 1549 farmers and 1329 immigrants) aged from 16 to 76 was selected by the method of multistage and cluster sampling in Liangshan, Sichuan province, China, during 2007 - 2008. The samples were divided into 5 groups by the factor of age (16-, 25-, 35-, 45- and 55-76). The standardized prevalence of T2DM was calculated by the national census data in 2000. Logistic regression analysis was used to study the related risk factors of T2DM. RESULTS: The prevalence of Yi farmer was 4.33% (67/1549) (male: 6.15% (42/683), female: 2.89% (25/866)), and that of Yi migrants was 9.03% (120/1329) (male: 11.31% (88/778), female: 5.81% (32/551)). The standardized prevalence (SP) was calculated by the data of national census 2000. The SP of Yi farmer was 5.97%in male, and that of the female was 2.40%. The SP of Yi migrant was 10.25% in male, and that of the female was 6.29%. For Yi people, sex (male versus female, OR = 1.69, 95%CI: 1.02 - 2.81), age (versus the group aged 16- and 25-, group aged 35 to 54: OR = 5.04, 95%CI: 2.93 - 8.69; group aged above 54: OR = 6.19, 95%CI: 3.23 - 11.86), hypertension (versus normal group, borderline hypertension value: OR = 1.61, 95%CI: 1.08 - 2.38; hypertension group: OR = 2.40, 95%CI: 1.37 - 4.22), smoking (OR = 1.55, 95%CI: 1.01 - 2.37), triglyceride (TG) level (OR = 1.65, 95%CI: 1.10 - 2.46) and high-density lipoprotein cholesterol (HDL-C) level (OR = 1.64, 95%CI: 1.13 - 2.37) were the positive factors correlated with T2DM, and drinking (the alcohol volume from 22.67 to 52.50 g/d ) was negative factor (OR = 0.53, 95%CI: 0.30 - 0.95) correlated with T2DM. CONCLUSION: The prevalence of T2DM in Yi immigrants was higher than that in Yi farmers;sex, age, blood pressure, smoking, TG, HDL-C, drinking were influencing factors of T2DM.