Moraxella haemolytica sp. nov., isolated from a goat with respiratory disease.

An aerobic, haemolytic, Gram-negative and rod-shaped bacterial strain ZY171148T was isolated from the lung of a dead goat with respiratory disease in Southwest China. The strain grew at 24-39 °C, at pH 6.0-9.0 and in the presence of 0.5-2.0% (w/v) NaCl. Phylogenetic analysis of 16S rRNA gene sequences showed that the strain belongs to the genus Moraxella. The nucleotide sequence similarity analysis of the 16S rRNA gene showed that the strain has the highest similarity of 98.1% to Moraxella (M.) caprae ATCC 700019 T. Phylogenomic analysis of 800 single-copy protein sequences indicated that the strain is a member of the genus Moraxella and forms a separated branch on the Moraxella phylogenetic tree. The strain exhibited the highest orthologous average nucleotide identity (OrthoANI) and average amino acid identity (AAI) values of 77.0 and 77.9% to M. nasibovis CCUG 75921T and M. ovis CCUG 354T, respectively. The strain shared the highest digital DNA-DNA hybridization (dDDH) value of 26.2% to M. osloensis CCUG 350T. The genome G + C content of strain ZY171148T was 42.6 mol%. The strain had C18:1 ω9c (41.7%), C18:0 (11.2%), C16:0 (14.1%) and C12:0 3OH (9.7%) as the predominant fatty acids and CoQ-8 as the major respiratory quinone. The strain contained phosphatidylglycerol, phosphatidylethanolamine, cardiolipin, dilysocardiolipin, monolysocardiolipin and phosphatidic acid as the major polar lipids. ß-haemolysis was observed on Columbia blood agar. All results confirmed that strain ZY171148T represents a novel species of the genus Moraxella, for which the name Moraxella haemolytica sp. nov. is proposed, with strain ZY171148T = CCTCC AB 2021471T = CCUG 75920T as the type strain.

Antioxidant and Cytotoxic Activities of Distillates Purified by Means of Molecular Distillation from Ginger Extract Obtained with Supercritical CO2 Fluid.

The ginger extract obtained with supercritical CO2 fluid was purified by molecular distillation (MD), and the chemical compositions, antioxidant and cytotoxic activities of ginger extract and its distillates were investigated. Analysis revealed that the ginger extract was rich in terpene hydrocarbons, along with oxygenated terpenes and other non-volatile compounds. The MD distillates were prepared in a series of stages and the active compounds like terpenes and gingerols could be separated by MD. The major compounds of the distillates purified by MD at 40 °C, 80 Pa and 60 °C, 80 Pa were terpene hydrocarbons. Additional distillates obtained by MD at 80 °C, 80 Pa and 100 °C, 60 Pa were predominated by terpene hydrocarbons and oxygenated terpenes. Until the operating conditions of MD reached 150 °C and 2 Pa, some non-volatile compounds were concentrated in the final distillate. Moreover, antioxidant activities and the cytotoxic effects on three human cancer cells in final MD distillate were superior to other extracts, and this phenomenon could be mainly supported by the phenols. The MD could be used to prepare ginger distillates with better antioxidant and cytotoxic activities.

Plastrum Testudinis Extracts Promote BMSC Proliferation and Osteogenic Differentiation by Regulating Let-7f-5p and the TNFR2/PI3K/AKT Signaling Pathway.

BACKGROUND/AIMS: Plastrum testudinis extracts (PTE) show osteoprotective effects on glucocorticoid-induced osteoporosis in vivo and in vitro. However, the underlying molecular mechanism of PTE in promoting osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) is unclear. METHODS: BMSC proliferation was investigated using the Cell Counting Kit-8 assay. BMSC differentiation and osteogenic mineralization were assayed using alkaline phosphatase and Alizarin red staining, respectively. The mRNA expression levels of Let-7f-5p, Tnfr2, Traf2, Pi3k, Akt, ß-catenin, Gsk3ß, Runx2, and Ocn were measured using real time quantitative polymerase chain reaction. Protein levels of TNFR2, TRAF2, p-PI3K, p-AKT, p-ß-CATENIN, and p-GSK3ß were analyzed by western blotting. The functional relationship of Let-7f-5p and Tnfr2 was determined by luciferase reporter assays. RESULTS: The optimum concentration for PTE was 30 µg/ml. PTE significantly promoted BMSC osteogenic differentiation and mineralization after 7 and 14 days in culture, respectively. The combination of PTE and osteogenic induction exhibited significant synergy. PTE upregulated Let-7f-5p, ß-catenin, Runx2, and Ocn mRNA expression, and downregulated Tnfr2, Traf2, Pi3k, Akt, and Gsk3ß mRNA expression. PTE inhibited TNFR2, TRAF2, and p-ß-CATENIN protein expression, and promoted p-PI3K, p-AKT, and p-GSK3ß protein expression. In addition, Tnfr2 was a functional target of Let-7f-5p in 293T cells. CONCLUSIONS: Our results suggested that PTE may promote BMSC proliferation and osteogenic differentiation via a mechanism associated with the regulation of Let-7f-5p and the TNFR2/PI3K/AKT signaling pathway.

Prevalence of Undernutrition and Related Dietary Factors among People Aged 75 Years or Older in China during 2010-2012.

OBJECTIVE: Undernutrition is highly prevalent among older people. The aim of this study was to estimate the prevalence of undernutrition in elderly Chinese residents and explore the relationship between undernutrition and dietary factors. METHODS: Data were collected from 2,552 elderly people aged 75 years and over from the Chinese Nutrition and Health Surveillance during 2010-2012 using questionnaires, anthropometric measurement, and individual consecutive 3-day 24-hour dietary records. RESULTS: The present study showed that 10.5% of participants had undernutrition. The prevalence was higher among the population living in rural areas, those living in the South region, those who smoked, and those with low income levels. Most participants failed to meet the Chinese Dietary Reference Intakes for energy (66.1%) and protein (72.1%). When comparing quartiles of food intake, high rice consumption [odds ratio (OR) = 2.44, 95% confidence interval (CI): 1.35-4.40)], animal oil intake (OR = 1.60, 95% CI: 1.18-2.17), and high fat intake from animal sources (OR = 1.56, 95% CI: 1.06-2.31) were positively associated with underweight whereas high wheat consumption (OR = 0.44, 95% CI: 0.26-0.74), a proper proportion (24%-32%) of energy intake from fat (OR = 0.54, 95% CI: 0.35-0.83), and high fat intake from plant sources (OR = 0.67, 95% CI: 0.46-0.99) were inversely related. CONCLUSION: The prevalence of undernutrition was high among elderly Chinese people, especially in rural areas. Dietary factors, such as high consumption of rice, were associated with undernutrition.

Measurement and Assessment of Physical Activity by Information and Communication Technology.

This study provides explorative insights into the information and communication technology (ICT) for promoting the physical activity level. ICT has provided innovative ideas and perspectives for PA measurement, assessment, evaluation and health intervention. ICT that aims to increase exercise for the entire population should be of a well-oriented and easy-to-use design with the options of tailored and personalized feedback, coaching, and ranking and supporting; it should be capable of setting goals and working with a schedule and be accompanied by a website to provide overviews of the users' exercise results and progress.

Changes in Waist Circumference and Abdominal Obesity among Chinese Adults over a Ten-year Period.

OBJECTIVE: The aim of this study was to describe changes in waist circumference (WC) and prevalence of abdominal obesity over a period of 10 years among Chinese adults in different socio-economic status (SES). METHODS: Data derived from the China Nutrition and Health Surveillance during 2002 and 2010-2012. We calculated the mean WC and the prevalence of abdominal obesity by gender, place of residence, SES indicators (education, income, and marital status), and body mass index (BMI) categoriesand used pooled t-tests to assess the differences between the two time periods. RESULTS: 26.0% of men and 25.3% of women had abdominal obesity in 2010-2012. The age-adjusted mean WC increased by 2.7 cm among men and 2.1 cm among women; the age-adjusted prevalence of abdominal obesity increased by 7.7% among men and 5.3% among women. The rising trends were observed in all subgroups except for a negative growth in high-income women. People living in rural areas with low education and income and with a BMI of 18.5 to 23.9 kg/m2 had a greater absolute and relative increase in WC. People living in rural areas with low income had a greater relative increase in abdominal obesity. CONCLUSION: The mean WC and prevalence of abdominal obesity among Chinese adults have increased during the past 10 years. Gender differences were noted using various SES indicators.

Gender-specific Association of Sleep Duration with Body Mass Index, Waist Circumference, and Body Fat in Chinese Adults.

OBJECTIVE: To examine the association between habitual sleep duration and obesity among Chinese adults. METHODS: The association of sleep duration and obesity was investigated among 7,094 community-dwelling Chinese adults. Sleep duration was self-reported. In this study, obesity was defined as follows: body mass index (BMI) ⋝ 28 kg/m2, waist circumference (WC) ⋝ 85 cm in men and ⋝ 80 cm in women, and percent body fat (%BF) ⋝ 25 in men and ⋝ 35 in women. Logistic and quantile regressions were employed to examine relationships of interest. RESULTS: Overall, 6.42% of the participants reported short sleep durations (< 6 h/d) while 14.71% reported long (⋝ 9 h/d) sleep durations. Long sleepers (⋝ 9 h/d) represented a greater frequency of women with obesity [odds ratio (OR): 1.30; 95% confidence interval (CI), 1.02-1.67] and high body fat (1.43, 1.04-1.96) than those who slept 7-8 h/d. An association between long sleep times and higher BMI estimations was found across the 10th-75th percentile of the BMI distribution. Among men, long sleepers (⋝ 9 h/d) presented lower risks of developing abdominal obesity compared with individuals who slept 7-8 h/d (OR = 0.79, 95% CI: 0.44-0.99). CONCLUSION: Our study suggests that long sleep durations are associated with general obesity in Chinese women but reduced waist circumferences in men. Confirmatory studies are needed to determine the heterogeneous association of sleep time and obesity by gender.

Prediction of 10-year Atherosclerotic Cardiovascular Disease Risk among Adults Aged 40-79 Years in China: a Nationally Representative Survey.

OBJECTIVE: To establish the distribution of 10-year atherosclerotic cardiovascular disease (ASCVD) risk among Chinese adults. METHODS: We estimated the 10-year ASCVD risk by applying the 2013 American College of Cardiology/ American Heart Association pooled cohort equations (PCEs) to the data obtained from the 2010 China Chronic Disease and Risk Factor Surveillance that involved 61,541 participants (representing 520,158,652 Chinese adults) aged 40-79 years. We also compared the ASCVD risk with the 10-year ischemic cardiovascular disease (ICVD) risk, which was calculated using the simplified scoring tables recommended by the Chinese Guidelines for Prevention of Cardiovascular Diseases (Chinese model). RESULTS: Based on the PCEs, the average 10-year ASCVD risk among adults without self-reported stroke or myocardial infraction was 12.5%. Approximately 247 million (47.4%) and 107 million (20.6%) adults had ⋝ 7.5% and > 20% 10-year ASCVD risks, respectively. The 10-year ASCVD risk > 20% was higher among men, less educated individuals, smokers, drinkers, and physically inactive individuals than among their counterparts. Overall, 29.0% of adults categorized using the Chinese model were overclassified with the PCEs. CONCLUSION: Our results define the distribution of 10-year ASCVD risk among Chinese adults. The 10-year ASCVD risk predicted by the PCEs was higher than the ICVD risk predicted by the Chinese model.

Smoking and Its Relation to Metabolic Status among Chinese Adults: Analysis of a Nationwide Survey

OBJECTIVE: To update the estimated prevalence rates of smoking and examine major metabolic diseases associated with smoking status in Chinese adults. METHODS: Using a complex, multistage, probability sampling design, we recruited a nationally representative sample of 98,658 Chinese adults aged ⋝18 years in 2010. Information on current, former, never, and passive smoking status was obtained using a standard questionnaire. All estimates were weighted to represent the overall Chinese adult population. RESULTS: The estimated proportion of current smokers was 28.3% for Chinese adults aged ⋝18 years. The corresponding values of former and passive smokers were 5.1% and 21.4%, respectively. Additionally, former smokers were found to have a less favorable metabolic risk profile among all categories of smoking status in both men and women. The prevalence of metabolic diseases such as diabetes and hypertension also increased with a greater number of smoking pack-years in men. CONCLUSION: The prevalences of current smoking and passive smoking remain high in Chinese adults.

Comparison of Undernutrition Prevalence of Children under 5 Years in China between 2002 and 2013.

OBJECTIVE: To describe the undernutrition status of children under 5-year in China, and study the trend between 2002 and 2013). METHODS: The study was based on two national surveys. Undernutrition was determined against WHO's 2006 growth standards. The prevalence in 2013 and 2002 was weighted by China sixth National Population Census (2010). The relationship between undernutrition and gender/age groups/different areas use weighted logistic regression. RESULTS: The results indicated the overall prevalence of stunting, underweight, and wasting of Chinese children under 5-year was 8.1%, 2.4%, and 1.9% in 2013, respectively. The prevalence of stunting was higher for children aged 12-47 month, while underweight was higher for children aged 48-59 month. The prevalence of undernutrition was higher in rural areas than in urban areas, especially in poor rural areas. There was a decline of stunting, underweight, and wasting between 2002 and 2013 among the children, with greater reduction in rural areas than in urban areas. CONCLUSION: The prevalence of undernutrition of children under 5-year remains high in rural areas especially in poor rural areas in China. It is urgent to take action to control undernutrition in the vulnerable areas and subgroups.

Hypertension Screening and Follow-up Management by Primary Health Care System among Chinese Population Aged 35 Years and Above.

OBJECTIVE: To describe hypertension screening and follow-up management among Chinese population aged 35 years and above within the primary health care system. METHODS: Data from 2010 China Chronic Disease and Risk Factor Surveillance System were used. We investigated previous hypertension diagnosis, screening, and follow-up assessments within the primary health care system. The prevalence of self-reported and criterion-based hypertension, screening rates, demographic and socioeconomic characteristics associated with screening, and patterns of follow-up assessments were recorded. The SAS software system was used for statistical analyses. RESULTS: About 17.1% reported a previous hypertension diagnosis. The rate difference between the two measures of prevalence was 27.2%. Among those without self-reported hypertension, 27.7% reported never visiting a clinic during the past 1 year and 60.4% of those attending a clinic reported ever being screened. Younger age group was associated with lower screening proportion; odds ratios of 35-, 45-, 55-, and ⋝65 years were 1.7 (95% CI: 1.5-1.9), 1.5 (95% CI: 1.3-1.7), 1.3 (95% CI: 1.2-1.4), and 1.0, respectively. About 35.1% of the patients had undergone follow-up assessments four or more times during the past 1 year. CONCLUSION: Majority of the Chinese population aged 35 years and above, particularly the less educated, elderly population, and rural residents were unaware of that they were suffering from hypertension. Most patients did not receive enough management services by the primary health care system. Thus, strengthening both the screening and follow-up management is needed.

Negative Association of Domestic Activity and Active Commuting with Metabolic Syndrome in a Chinese Population Aged 35-64 Years.

OBJECTIVE: To understand the associations of physical activity domains with metabolic syndrome among a middle-aged Chinese population. METHODS: In all, 3326 professional adults aged 35-64 years from Beijing and Zhejiang province were recruited with a cluster random sampling method. The Global Physical Activity Questionnaire was modified, and the recommended Asia-Pacific cut-offs of waist circumstance were introduced into the criteria for metabolic syndrome from the Adult Treatment Panel III. A binary logistic regression model was applied to examine the association of all physical activity domains with the risk of the syndrome. RESULTS: Participants who engaged in domestic activity for ⋜1176 MET-min/week had a 41.6% less chance of having metabolic syndrome [odds ratio (OR), 0.584; 95% confidence interval (CI), 0.480-0.710] than those without this activity. In adjusted models, adults who actively commuted for ⋜33 MET-min/week but <528 MET-min/week had a 25% less chance of having the syndrome (OR, 0.750; 95% CI, 0.582-0.966) than those who did not. No interaction was detected between the two domains of activity and the syndrome. CONCLUSION: This study highlighted the independently negative association of traffic and house activity with the prevalence of the syndrome in this sample with a generally low level of moderate activity.

Inaccuracy of Self-reported Low Sodium Diet among Chinese: Findings from Baseline Survey for Shandong & Ministry of Health Action on Salt and Hypertension (SMASH) Project.

This study was aimed to evaluate the agreement between the self-reported sodium intake level and 24-h urine sodium excretion level in Chinese. The 24-h urine collection was conducted among 2112 adults aged 18-69 years randomly selected in Shandong Province, China. The subjects were asked whether their sodium intake was low, moderate, or high. The weighted kappa statistics was calculated to assess the agreement between 24-h urine sodium excretion level and self-reported sodium intake level. One third of the subjects reported low sodium intake level. About 70% of the subjects had mean 24-h sodium excretion>9 g/d, but reported low or moderate sodium intake. The agreement between self-reported sodium intake level and 24-h urine sodium excretion level was low in both normotensive subjects and hypertensive subjects. These findings suggested that many subjects who reported low sodium intake had actual urine sodium excretion>9 g/d. Sodium intake is often underestimated in both hypertensive and normotensive participants in China.

Effectiveness analysis on the physical activity and the health benefit of a community population based program.

OBJECTIVE: To evaluate the community-based health promotion effect of physical activity. METHODS: The residents aged 18 and above from two communities in Gongshu District of Hangzhou City, Zhejiang province, were randomly selected and recruited for the multi-strategy and comprehensive physical activity intervention. Questionnaire survey, physical check up and blood biochemistry were conducted. RESULTS: After this two-year intervention, the time of the participant spent on weekly physical activity of moderate intensity increased from 464 min to 542 min (P<0.05), with an average increase of 78 min. Time spent in walking every week increased from 533 min to 678 min (P<0.05), with an average increase of 145 min. The body weight, waistline, blood pressure and heart rate all reduced significantly (P<0.05); the vital capacity increased significantly (P<0.05); and the related biochemical indicators were also improved. CONCLUSION: Comprehensive and evidence-based physical activity interventions targeting community population can improve the levels of physical activity, related body measurement and biochemical indicators.

BMI, WC, WHtR, VFI and BFI: which indictor is the most efficient screening index on type 2 diabetes in Chinese community population.

OBJECTIVE: Obesity is a major risk factor for type 2 diabetes, many indexes can be used to describes obesity and predict diabetes. This research attempts to identify the best indicator of obesity to screening diabetes in Chinese population. METHODS: A cross-sectional data of 8121 subjects aged 35-60 years were included in this research belongs to the Diabetes Appropriate Technology Intervention Study. Anthropometric indicators including body weight, height, waist circumferences (WC), body fat index (BFI) and visceral fat index (VFI) and blood biochemical indicators after an overnight fast [fasting blood glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, and triacylglycerol] were measured. BMI (body mass index) and Weight to Height Ratio was calculated. RESULTS: Subjects with obesity had a higher risk of physician diagnosed diabetes (OR=2.50, 95% CI 1.83-3.43), new diagnosed diabetes (OR=4.23, 95% CI 2.91-6.15) and pre-diabetes (OR=1.75, 95% CI 1.31-2.34) compared to those with normal Body mass index (BMI). There was a significant trend of increased risk of all diabetes status with increased waist circumference (WC). The waist-to-height ratio (WHtR) yielded the most significant association with new diagnosed diabetes and physician diagnosed diabetes than other indices. CONCLUSION: Central obesity is significantly correlated with diabetes. VFI was most correlated with pre-diabetes while WHtR is an efficient screening index than BMI and WC in Chinese community diabetes screening.

[Relationship between prevalent features of central obesity and clustering of cardiometabolic diseases among Chinese elder people].

OBJECTIVE: To study the relationship between prevalence of central obesity and clustering of cardiometabolic diseases among Chinese elder people over 60 years old. METHODS: A complex multistage stratified sampling survey on chronic diseases was conducted in 162 surveillance points, 31 provinces, China in 2010 by China CDC. The survey included face-to-face interview, physical measurement (body height, weight, waist circumference (WC) and blood pressure) and laboratory test (blood sugar, blood lipid and hemoglobin A1C), to collect the information about the prevalence of the risk factors as smoking, drinking, diet and physical activities and the prevalence of hypertension, diabetes and dyslipidemia. The survey selected 19 966 subjects who were over 60 years old. Central obesity was defined as WC ≥ 85 cm in males or ≥ 80 cm in females. The prevalence of central obesity among the elder people over 60 years old in different districts and populations was calculated; and the proportion of cardiometabolic diseases in groups of different WC was then analyzed. RESULTS: The prevalence of central obesity among elderly population over 60 years old was 48.6% (95%CI:46.1%-51.2%), including 39.7% (95%CI:37.2%-42.2%) males and 57.3% (95%CI:54.5%-60.1%) females. The proportion of females was higher than that of males (χ(2) = 474.63, P < 0.01). The higher the education level, the higher the prevalence of central obesity among elderly men. There was no significant association among females. The higher the family income, the higher the prevalence of central obesity. The prevalence of central obesity was 59.2% in urban area, which was much higher than that in rural area (43.5%) (χ(2) = 50.06, P < 0.01). The proportion of hypertension, diabetes and clustering of cardiometabolic disease was separately 18.8% (95%CI:16.1%-21.5%) , 66.2% (95%CI:63.0%-69.4%) and 47.5% (95%CI:44.1%-50.8%) among elderly men with WC between 85 and 89 cm, and separately 24.0% (95%CI:21.2%-26.8%), 78.2% (95%CI:75.6%-80.8%) and 64.0% (95%CI:60.3%-67.6%) among elderly men with WC ≥ 90 cm; which were both higher than those among elderly men with WC < 85 cm (separately 13.4% (95%CI:11.5%-15.3%) , 58.3% ( 95%CI:55.5%-60.1%) and 30.8% (95%CI:28.7%-32.9%) ). The proportion of hypertension, diabetes and clustering of cardiometabolic disease was 20.1% (95%CI:17.4%-22.7%) , 68.6% (95%CI:65.5%-71.8%) and 48.1% (95%CI:44.6%-51.6%) among elderly women with WC between 80 and 84 cm, and separately 31.7% (95%CI:28.9%-34.4%) , 81.0% (95%CI:78.5%-83.5%) and 61.8% (95%CI:58.9%-64.8%) among elderly women with WC ≥ 85 cm; which were both higher than those among elderly women with WC < 80 cm (separately 12.8% (95%CI:10.8%-14.8%) , 60.1% (95%CI:57.1%-63.0%) and 30.4% (95%CI:27.3%-33.5%)). CONCLUSION: Nearly half of the Chinese elder people were central obese. The proportion of cardiometabolic diseases among central obesity was significantly higher than that among non-obese population. We should pay more concern about them in the future prevention and control of chronic diseases.

[The relationship between socioeconomic status and overweight and obesity among elementary school children in China].

OBJECTIVE: To analyze the relationship between socioeconomic status (SES) and overweight and obesity among elementary school children. METHODS: This cross-sectional study was conducted from September to November, 2010. A stratified random cluster sampling was used from sampling frame of eight provinces by the geographical and economic development distributions in mainland China. A total of 19 934 students aged 7-12 years old participated in this study. All subjects were evaluated the status of overweight and obesity. Green's scoring SES was used to evaluate the SES of the participants. Multivariate logistic regression analysis was performed to examine the relationship between SES and overweight and obesity among children. RESULTS: According to the scores of Green's SES, the participants' SES were divided into three levels, the prevalence of overweight were 7.4% (538/7295), 9.3% (560/6013) and 12.6% (832/6626), and the prevalence of obesity were 4.4% (321/7295) , 6.4% (387/6013) and 10.2% (677/6626) from low to high SES level, respectively (χ(2) value were 133.82, 180.27, respectively, P < 0.01). After adjusted by age, urban and rural and economic regions, compared with the participants with low SES, the OR (95%CI) of having overweight and obesity among participants with high SES were 1.83(1.61-2.08) for boys and 1.67(1.42-2.00) for girls; the OR (95%CI) with middle SES were 1.30(1.15-1.48) for boys and 1.23(1.04-1.46) for girls. CONCLUSION: The prevalence of overweight and obesity rises with the family's SES levels. There was a positive correlation between SES and overweight and obesity among school-aged children.

Efficacy of First-Line Immunotherapy Combined With Chemotherapy in Extensive-Stage Small Cell Lung Cancer Patients With Different Brain Metastases Status: A Systematic Review and Meta-Analysis.

Background: This study aims to evaluate the efficacy of first-line immunotherapy combined with chemotherapy in extensive-stage small cell lung cancer (ES-SCLC) patients with differing brain metastasis statuses. Methods: We conducted a comprehensive search in public databases, such as PubMed, EMBASE, and the Cochrane Library, to identify randomized controlled trials involving ES-SCLC patients, with or without brain metastases, who underwent first-line immunotherapy combined with chemotherapy. The primary outcome measure was progression-free survival (PFS), and the secondary outcome measure was overall survival (OS). Results: Our analysis incorporated seven high-quality randomized controlled trials, encompassing 398 patients with brain metastases and 3,533 without. Among patients without brain metastases, the combination of immunotherapy and chemotherapy led to significantly improved PFS (hazard ratio (HR) = 0.72, 95% confidence interval (CI): 0.62 - 0.84, P < 0.001) and OS (HR = 0.77, 95% CI: 0.67 - 0.88, P < 0.001) in comparison to chemotherapy alone. Conversely, for patients with brain metastases, the addition of immunotherapy to chemotherapy did not result in a significant improvement in PFS (HR = 1.03, 95% CI: 0.66 - 1.61, P = 0.887) or OS (HR = 1.03, 95% CI: 0.82 - 1.31, P = 0.776) when compared to chemotherapy alone. Conclusions: In ES-SCLC patients without brain metastases, first-line immunotherapy combined with chemotherapy demonstrated improved PFS and OS in contrast to chemotherapy alone. However, patients with brain metastases did not experience similar benefits.

Effect of Age and Sex on Stroke Mortality of Young and Middle-aged Adults in China, 2002-2019, and Predictions to 2030.

Objective: This study aimed to examine the trends in stroke mortality among young and middle-aged adults in China. Methods: Data were obtained from the China national vital registration system. Significant changes in mortality were assessed by Joinpoint regression. Age-period-cohort analysis was used to explain the reasons for the changes. Future mortality and counts were predicted by the Bayesian age-period-cohort model. Results: Between 2002 and 2019, a total of 6,253,951 stroke mortality in young and middle-aged adults were recorded. The age-adjusted mortality rates (AAMRs) of women showed a downward trend. The annual percent changes (APC) were -3.5% (-5.2%, -1.7%) for urban women and -2.8% (-3.7%, -1.9%) for rural women. By contrast, the AAMRs per 100,000 for rural men aged 25-44 years continued to rise from 9.40 to 15.46. The AAMRS for urban men aged 25-44 years and urban and rural men aged 45-64 years did not change significantly. Between 2020 and 2030, the projected stroke deaths are 1,423,584 in men and 401,712 in women. Conclusion: Significant sex and age disparities in the trends of stroke mortality among young and middle-aged adults were identified in China. Targeted health policy measures are needed to address the burden of stroke in the young generation, especially for rural men, with a focus on the prevention and management of high risk factors.