Lag effect of ambient temperature on respiratory emergency department visits in Beijing: a time series and pooled analysis.

BACKGROUND: Although the association between ambient temperature and mortality of respiratory diseases was numerously documented, the association between various ambient temperature levels and respiratory emergency department (ED) visits has not been well studied. A recent investigation of the association between respiratory ED visits and various levels of ambient temperature was conducted in Beijing, China. METHODS: Daily meteorological data, air pollution data, and respiratory ED visits data from 2017 to 2018 were collected in Beijing. The relationship between ambient temperature and respiratory ED visits was explored using a distributed lagged nonlinear model (DLNM). Then we performed subgroup analysis based on age and gender. Finally, meta-analysis was utilized to aggregate the total influence of ambient temperature on respiratory ED visits across China. RESULTS: The single-day lag risk for extreme cold peaked at a relative risk (RR) of 1.048 [95% confidence interval (CI): 1.009, 1.088] at a lag of 21 days, with a long lag effect. As for the single-day lag risk for extreme hot, a short lag effect was shown at a lag of 7 days with an RR of 1.076 (95% CI: 1.038, 1.114). The cumulative lagged effects of both hot and cold effects peaked at lag 0-21 days, with a cumulative risk of the onset of 3.690 (95% CI: 2.133, 6.382) and 1.641 (95% CI: 1.284, 2.098), respectively, with stronger impact on the hot. Additionally, the elderly were more sensitive to ambient temperature. The males were more susceptible to hot weather than the females. A longer cold temperature lag effect was found in females. Compared with the meta-analysis, a pooled effect of ambient temperature was consistent in general. In the subgroup analysis, a significant difference was found by gender. CONCLUSIONS: Temperature level, age-specific, and gender-specific effects between ambient temperature and the number of ED visits provide information on early warning measures for the prevention and control of respiratory diseases.

Targeting endothelial PDGFR-ß facilitates angiogenesis-associated bone formation through the PAK1/NICD axis.

The intricate orchestration of osteoporosis (OP) pathogenesis remains elusive. Mounting evidence suggests that angiogenesis-driven osteogenesis serves as a crucial foundation for maintaining bone homeostasis. This study aimed to explore the potential of the endothelial platelet-derived growth factor receptor-ß (PDGFR-ß) in mitigating bone loss through its facilitation of H-type vessel formation. Our findings demonstrate that the expression level of endothelial PDGFR-ß is reduced in samples obtained from individuals suffering from OP, as well as in ovariectomy mice. Depletion of PDGFR-ß in endothelial cells ameliorates angiogenesis-mediated bone formation in mice. The regulatory influence of endothelial PDGFR-ß on H-type vessels is mediated through the PDGFRß-P21-activated kinase 1-Notch1 intracellular domain signaling cascade. In particular, the endothelium-specific enhancement of PDGFR-ß facilitates H-type vessels and their associated bone formation in OP. Hence, the strategic targeting of endothelial PDGFR-ß emerges as a promising therapeutic approach for the management of OP in the near future.

Significant insights from a National survey in China: PrEP awareness, willingness, uptake, and adherence among YMSM students.

INTRODUCTION: Few studies focused on the Pre-Exposure Prophylaxis (PrEP) -related aspects, and the applicability of prior evidence to young men who have sex with men (YMSM) students was unknown. This study aimed to assess the awareness, willingness, uptake, and adherence (AWUA) to PrEP among YMSM students in China and to explore the associated factors with these stages. METHODS: A cross-sectional survey with a sizable sample of 1151 was conducted among YMSM students aged 16 and above, who self-identified as men who have sex with men(MSM) and resided in mainland China between October 20 and December 20, 2021. The chi-square test and Fisher's exact test were used for univariate analysis, followed by multivariable logistic regression analysis of influencing factors at all levels. RESULTS: According to the cascade analysis approach, 88.71% of the participants were aware of PrEP, among which 66.7% expressed willingness to use it. Among those who were willing to use PrEP, only 13.80% took it, and of those who took it, 44.68% adhered to it. The students taking PrEP were those with higher education (OR = 4.239, 95% CI: 1.334-13.467), residence in pilot cities (OR = 2.791, 95% CI: 1.498-5.198), residence in high-risk areas (OR = 5.082, 95% CI: 2.224-11.612), engagement in multi-person sexual behavior (OR = 2.186, 95% CI: 1.236-3.867), and substance use (OR = 1.908, 95% CI: 1.167-3.118). Furtherly, students with higher adherence to PrEP were likely to have receptive sexual behaviors (OR = 8.702, 95% CI: 2.070-36.592), absence of substance use (OR = 4.468, 95% CI: 1.371-14.561), and uptake of PrEP through daily oral route. (OR = 7.065, 95% CI: 1.699-29.371). CONCLUSION: YMSM students exhibit distinct patterns of "high awareness, low willingness, low uptake, and low adherence" to PrEP. Strategies for reduction in the acquisition of HIV prioritizing the current features of utilizing PrEP were urgently warranted.

Cascade analysis of awareness, willingness, uptake and adherence with regard to PrEP among young men who have sex with men (YMSM) in China: A comparison between students and non-students.

INTRODUCTION: In China, young men who have sex with men (YMSM) are one of the groups most at risk of HIV/AIDS. The uptake of pre-exposure prophylaxis (PrEP) among YMSM has not been well documented. A cascade analysis of awareness, willingness, use and adherence with regard to PrEP was conducted separately among YMSM students and non-students. METHODS: From 20 October to 30 December 2021, all adolescents aged 16-24 years were selected for the study from among MSM recruited from 31 provincial administrative regions in mainland China. Participants were included in a cross-sectional study of awareness, willingness, use and adherence with regard to PrEP among YMSM. Logistic regression modelling was used to identify factors associated with the four outcomes. RESULTS: Among 1014 student and 866 non-student YMSMs, respectively, 88.07% and 81.64% had heard of PrEP; 58.16% and 50.35% were willing to use PrEP; 7.59% and 7.62% had used PrEP; and 3.16% and 3.58% had adhered to PrEP. Among students, those living in high-risk areas and pilot cities and those who had engaged in commercial sex and group sex had a positive effect on PrEP use, and the same trends were found among non-students living in high-risk areas and pilot cities and those who had engaged in group sex. 'Daily oral' and 'flexible' PrEP use positively influenced adherence among both groups. CONCLUSIONS: A differentiation strategy of PrEP promotion should be implemented among YMSM. Material support for students, such as financial resources, should increase, while non-students should increase their level of perception of HIV risk.

Impact of ambient temperature, diurnal temperature range on hyperventilation syndrome emergency admission: a time-series analysis in Beijing, China.

OBJECTIVES: To assess the association between ambient temperature and diurnal temperature range (DTR) on emergency admissions for hyperventilation syndrome (HVS). DESIGN: Distributed lag non-linear model design was used with a lag time to 5 days. SETTING: Emergency admission data used were from the Beijing Red Cross Emergency Centre (2017-2018). PARTICIPANTS AND EXPOSURE: Cases were those with emergency visits to the Beijing Emergency Center during the period 2017-2018 and who were given the primary outcome indicator defined as HVS according to the International Classification of Diseases, 10th edition code F45.303. Ambient temperature and DTR were used as exposure factors with adjustments for relative humidity, wind speed, precipitation, seasonality long-term trend and day of the week. MAIN OUTCOME MEASURE: We used the minimum emergency visits temperature as a reference to indicate the relative risk with 95% CI of exposure-response for the risk of HVS visits at different temperatures. RESULTS: A u-shape was described between ambient temperature and HVS visits, with a minimum risk at 12°C. Moderate heat (23°C) at lag (0-3) days, extreme heat at lag 0 days, had greatest relative risks on HVS visits, with 2.021 (95% CI 1.101 to 3.71) and 1.995 (95% CI 1.016 to 3.915), respectively. A stronger association between HVS visits and temperature was found in women and aged ≤44 years. Notably, the relationship between DTR and HVS visits appeared a reverse u-shaped. Low DTR (4°C) effect appeared at lag (0-1) days with 0.589 (95% CI 0.395 to 0.878), lasting until lag (0-3) days with 0.535 (95% CI 0.319 to 0.897) and was associated with a reduced risk of HVS visits in women and those aged ≤44 years. CONCLUSIONS: Ambient temperature and DTR were associated with HVS visits, appearing a differentiation in gender and age groups. Timely prevention strategies during high temperatures and control mild changes in temperature might reduce the risk of HVS.

Injectable Ozone-Rich Nanocomposite Hydrogel Loaded with D-Mannose for Anti-Inflammatory and Cartilage Protection in Osteoarthritis Treatment.

Osteoarthritis (OA) is a dynamic condition characterized by cartilage damage and synovial inflammation. Ozone (O3 ) shows potential therapeutic effects owing to its anti-inflammatory properties; however, its high reactivity and short half-life substantially limit its effectiveness in OA treatment. In this study, an ozone-rich thermosensitive nanocomposite hydrogel loaded with D-mannose is developed for OA treatment. Briefly, O3 is encapsulated in nanoparticles (NPs) composed of perfluorotributylamine and fluorinated hyaluronic acid to improve its stability. Next, D-mannose is conjugated with α-amino of the hydroxypropyl chitin (HPCH) via Schiff base to prepare MHPCH. These nanoparticles are encapsulated in MHPCH to produce O3 NPs@MHPCH. In vitro cell experiments demonstrate that the O3 NPs@MHPCH treatment significantly reduced VEGF and inflammation levels, accompanied by a decrease in inflammatory factors such as IL-1ß, IL-6, TNF-α, and iNOS. Furthermore, O3 NPs@MHPCH promotes the expression of collagen II and aggrecan and stimulates chondrocyte proliferation. Additionally, in vivo studies show that O3 NPs@MHPCH significantly alleviated OA by reducing synovial inflammation, cartilage destruction, and subchondral bone remodeling. O3 NPs@MHPCH offers a promising option for improving the efficacy of O3 therapy and reducing the risk of synovial inflammation and cartilage degeneration in OA.

Analysis of pre-exposure prophylaxis awareness, willingness, uptake patterns, barriers and needs among MSM students and its influencing factors / 中国学校卫生

Objective@#To explore the pre-exposure prophylaxis (PrEP) awareness, willingness, uptake patterns, barriers and needs among Chinese student men who have sex with men (MSM), so as to provide relevant evidence for targeted interventions with PrEP.@*Methods@#A proportional sampling method was used to conduct a cross sectional survey of MSM aged 16 years and older residing in 21 provinces, municipalities, and autonomous regions in mainland China between October 20 and December 20, 2021, to collect information on demographic and sexual behavioral characteristics, and 923 students of them were selected as the subjects of this study. The chi-square test and Fisher s test were used for univariate analysis, followed by multivariate Logistic regression to analyze the influencing factors of PrEP awareness and uptake.@*Results@#According to the cascade analysis method, the awareness, willingness, uptake and adherence rates of PrEP among the student MSM were obtained as 88.95%, 67.36%, 13.20% and 45.21 %, respectively. HIV testing more than once in the last 3 months, and all of them were aware of the HIV test results of their sexual partners, and those with high frequency of condom use had a higher rate of awareness ( OR =2.32, 1.79, 1.69, P <0.05). Willingness rates were higher for those from the pilot city, using substances, and HIV testing more than once in the last 3 months ( OR =2.13, 1.65, 1.69, P <0.05). Higher rates of uptake were found among those from high risk and pilot areas, presence of commercial sex, substance use, and high literacy ( OR =5.60, 3.54,2.81, 1.92, 4.54, P <0.05). Adherence rates were higher among those who used one pill per day or both ( OR =12.77, 13.26, P <0.05). The barriers and needs faced by student MSM were primarily personal concerns about medication side effects, preventative effects, and confidence in sexual behavioral styles, and the high cost of medication and related service costs.@*Conclusions@#The student MSM population in China is characterized by high awareness, low willingness, low uptake, and low adherence to PrEP. Targeted interventions should be considered and tailored by the departments to facilitate PrEP promotion among student MSM.

Economic Evaluation of the Comprehensive AIDS Prevention and Control Program - Tianjin Municipality, China, 2011-2022.

What is already known about this topic?: Acquired immunodeficiency syndrome (AIDS) represents a significant public health challenge globally, not only inflicting harm on the health of individuals but also placing a considerable economic strain on society. What is added by this report?: This study represents the inaugural report on the potential reduction in economic burden attributable to human immunodeficiency virus (HIV) prevention strategies in Tianjin. Between 2011 and 2022, it is estimated that effective measures could prevent 2,965 new HIV infections and avert 658 deaths, resulting in an economic benefit of approximately 14.437 billion Chinese Yuan. What are the implications for public health practice?: The findings of this study offer valuable evidence to inform the development of localized HIV prevention and control strategies, as well as to guide public health policymaking.

Association of cumulative resting heart rate exposure with rapid renal function decline: a prospective cohort study with 27,564 older adults.

OBJECTIVE: To evaluate the prospective association between cumulative resting heart rate (cumRHR) and rapid renal function decline (RRFD) in a cohort of individuals aged 60 and older. METHODS: In the Tianjin Chronic Kidney Disease Cohort Study, the individuals who underwent three consecutive physical examinations between 2014 and 2017, with estimated glomerular filtration rate (eGFR) greater than 60 mL/min per 1.73 m2 and aged 60 years or older were enrolled. A total of 27,564 patients were prospectively followed up from January 1, 2017 to December 31, 2020. The 3-year cumRHR was calculated. The primary outcome was RRFD, defined as an annualized decline in eGFR of 5 mL/min per 1.73 m2 or greater. Logistic and restricted spline regression models and subgroup analysis were used to investigate the association of cumRHR with RRFD after adjusting for all confounders. RESULTS: During a median follow-up of 3.2 years, a total of 4,347 (15.77%) subjects developed RRFD. In fully-adjusted models, compared with the lowest quartile of cumRHR, the odds ratio (OR) for the highest was 1.44 (1.28-1.61), P < 0.001. Furthermore, each 1-standard deviation (27.97 beats/min per year) increment in cumRHR was associated with a 17% (P < 0.001) increased risk of RRFD, with a linear positive correlation (P for non-linear = 0.803). Participants with a 3-year cumRHR ≥ 207 (beats/min) * year (equivalent to ≥ 69 beats/min per year in 3 years) were found to be at a higher risk of RRFD. CONCLUSIONS: The cumRHR is significantly associated with a higher risk of RRFD among older adults. These results might provide an effective goal for managing and delaying the decline of renal function in the older adults.

Association of Anemia with Cognitive Function and Dementia Among Older Adults: The Role of Inflammation.

BACKGROUND: The association of anemia with cognitive function and dementia remains unclear. OBJECTIVE: We aimed to investigate the association of anemia with cognitive function and dementia risk and to explore the role of inflammation in these associations. METHODS: Within the UK Biobank, 207,203 dementia-free participants aged 60+ were followed for up to 16 years. Hemoglobin (HGB) and C-creative protein (CRP) were measured from blood samples taken at baseline. Anemia was defined as HGB <13 g/dL for males and <12 g/dL for females. Inflammation was categorized as low or high according to the median CRP level (1.50 mg/L). A subset of 18,211 participants underwent cognitive assessments (including global and domain-specific cognitive). Data were analyzed using linear mixed-effects model, Cox regression, and Laplace regression. RESULTS: Anemia was associated with faster declines in global cognition (ß= -0.08, 95% confidence interval [CI]: -0.14, -0.01) and processing speed (ß= -0.10, 95% CI: -0.19, -0.01). During the follow-up of 9.76 years (interquartile range 7.55 to 11.39), 6,272 developed dementia. The hazard ratio of dementia was 1.57 (95% CI: 1.38, 1.78) for people with anemia, and anemia accelerated dementia onset by 1.53 (95% CI: 1.08, 1.97) years. The risk of dementia tended to be higher in people with both anemia and high CRP (1.89, 95% CI: 1.60, 2.22). There was a statistically significant interaction between anemia and CRP on dementia risk (p-interaction = 0.032). CONCLUSIONS: Anemia is associated with cognitive decline (specifically for processing speed) and increased risk of dementia, especially in people with high inflammation.

Effect of short-term exposure to ambient air pollutants on non-accidental mortality in emergency department visits: a time-series study.

Objectives: Exposure to air pollution has been linked to an increased risk of premature mortality. However, the acute effects of air pollution on the risk of non-accidental mortality have not been extensively researched in developing countries, and the findings thus far have been inconsistent. Therefore, this study aimed to examine the association between short-term exposure to six pollutants (PM2.5, PM10, SO2, NO2, O3, and CO) and non-accidental mortality in Beijing, China. Methods: Daily data on non-accidental deaths were gathered from 1 January 2017 to 31 December 2018. Air pollution data for the same period were collected from 35 fixed-site air quality monitoring stations in Beijing. Generalized additive models (GAM) based on Poisson regression were used to investigate the association between non-accidental mortality in emergency department visits and the daily average levels of air pollutants. Results: There were 8,676 non-accidental deaths recorded during 2017-2018. After sensitivity analysis, short-term exposure to air pollutants, particularly gaseous pollutants, was linked to non-accidental mortality. Specifically, for every 10 µg/m3 increase (5 µg/m3 in SO2, 0.5 mg/m3 in CO) of SO2 (lag 04), NO2 (lag 04), O3 (lag 05), and CO (lag 04), the relative risk (RR) values were 1.054 (95% CI: 1.009, 1.100), 1.038 (95% CI: 1.013, 1.063), 1.032 (95% CI: 1.011, 1.054), and 1.034 (95% CI: 1.004, 1.066), respectively. In terms of causes of death, short-term exposure to NO2, SO2, and O3 increased the risk of circulatory mortality. Further stratified analysis revealed that the stronger associations were presented in females for O3 while in males for CO. People aged 65 and over were strongly associated with ambient air pollution. Conclusions: Our study showed that ambient air pollutants were associated with non-accidental mortality. Our findings suggested that efforts to control gaseous pollution should be stepped up, and vulnerable groups should be the focus of health protection education.

The level of serum total bile acid is related to atherosclerotic lesions, prognosis and gut Lactobacillus in acute coronary syndrome patients.

BACKGROUND: Bile acids play crucial roles in various metabolisms, as well as Lactobacillus in the intestine. But studies on their roles in acute coronary syndrome (ACS) are still insufficient. The aim of this study was to investigate their role and potential association with the severity of coronary lesions and the prognosis of ACS. METHODS: Three hundred and sixty ACS patients were selected. Detection of gut Lactobacillus levels was done through 16S rDNA sequence analysis. Evaluation of the extent of lesions was done using the SYNTAX (SS) score. Mediation analysis was used to assess the relationship between serum total bile acid (TBA), Lactobacillus, atherosclerotic lesions and prognosis of ACS. RESULTS: Logistic regressive analysis disclosed that serum TBA and Lactobacillus were independent predictors of coronary lesions (high vs. low SS: serum TBA adjusted odds ratio (aOR) = 0.8, 95% confidence interval (CI): 0.6-0.9, p < .01; Lactobacillus: aOR = 0.9, 95% CI: 0.9-1.0, p = .03). According to multivariate Cox regression analysis, they were negatively correlated with the overall risk of all-cause death (serum TBA: adjusted hazard ratio (aHR) = 0.1, 95% CI: 0.0-0.6, p = .02; Lactobacillus: aHR = 0.6, 95% CI: 0.4-0.9, p = .01), especially in acute myocardial infarction (AMI) but not in unstable angina pectoris (UAP). Ulteriorly, mediation analysis showed that serum TBA played an important role as a mediation effect in the following aspects: Lactobacillus (17.0%, p < .05) â†’ SS association (per 1 standard deviation (SD) increase), Lactobacillus (43.0%, p < .05) â†’ all-cause death (per 1 SD increase) and Lactobacillus (45.4%, p < .05) â†’ cardiac death (per 1 SD increase). CONCLUSIONS: The lower serum TBA and Lactobacillus level in ACS patients, especially in AMI, was independently linked to the risk of coronary lesions, all-cause death and cardiac death. In addition, according to our mediation model, serum TBA served as a partial intermediate in predicting coronary lesions and the risk of death by Lactobacillus, which is paramount to further exploring the mechanism of Lactobacillus and bile acids in ACS.KEY MESSAGESLower level of serum total bile acid (TBA) was highly associated with the severity of coronary lesions, myocardial damage, inflammation and gut Lactobacillus in acute coronary syndrome (ACS) patients, especially in acute myocardial infarction (AMI).Lower level of serum TBA was highly associated with mortality (including all-cause death and cardiac death) in patients with ACS, especially with AMI.Serum TBA had a partial mediating effect rather than regulating effect between gut Lactobacillus and coronary lesions and prognosis of ACS.

Association between Systemic Immunity-Inflammation Index and Hyperlipidemia: A Population-Based Study from the NHANES (2015-2020).

The systemic immunity-inflammation index (SII) is a novel inflammatory marker, and aberrant blood lipid levels are linked to inflammation. This study aimed to look at the probable link between SII and hyperlipidemia. The current cross-sectional investigation was carried out among people with complete SII and hyperlipidemia data from the 2015-2020 National Health and Nutrition Examination Survey (NHANES). SII was computed by dividing the platelet count × the neutrophil count/the lymphocyte count. The National Cholesterol Education Program standards were used to define hyperlipidemia. The nonlinear association between SII and hyperlipidemia was described using fitted smoothing curves and threshold effect analyses. A total of 6117 US adults were included in our study. A substantial positive correlation between SII and hyperlipidemia was found [1.03 (1.01, 1.05)] in a multivariate linear regression analysis. Age, sex, body mass index, smoking status, hypertension, and diabetes were not significantly correlated with this positive connection, according to subgroup analysis and interaction testing (p for interaction > 0.05). Additionally, we discovered a non-linear association between SII and hyperlipidemia with an inflection point of 479.15 using a two-segment linear regression model. Our findings suggest a significant association between SII levels and hyperlipidemia. More large-scale prospective studies are needed to investigate the role of SII in hyperlipidemia.

The risk of acute and early HIV (AEH) infection among MSM with different behaviour trajectories: an open cohort study in Tianjin, China, 2011-2019.

BACKGROUND: Acute and early HIV (AEH) infection is characterized by a high viral load and infectivity. Approximately 50% of cases of HIV-1 transmission occur during AEH. Understanding sexual behaviour trajectories would be useful for predicting changes in the risk of HIV acquisition. However, few studies have investigated sexual behaviour trajectories and their association with AEH acquisition. This study identified behaviour trajectories among men who have sex with men (MSM), determined the risk of AEH infection, and compared risk factors between different behaviour trajectories. METHODS: The study was based on an ongoing prospective open cohort of voluntary HIV counselling and testing (VHCT) among MSM in Tianjin, China. From 2011 to 2019, 1974 MSM were recruited. Group-based trajectory modelling (GBTM) was used to identify behaviour trajectories by constructing a sexual risk behaviour score. Logistic regression and generalized estimating equation (GEE) were used to compare the risk of AEH infection and risk factors for different behaviour trajectories. All data analyses were performed using SAS 9.4. RESULTS: The incidence of AEH infection was 1.76/100 person-years, with 64 AEH infections documented in 3633 person-years of follow-up. Three sexual behaviour trajectories were identified: CL (consistently low risk, 35.46%), CH (consistently high risk, 42.71%) and HTL (high to low risk, 21.83%). MSM in the HTL and CH groups had higher AEH infection rates than MSM in the CL group (6.73%, 3.08% and 1.28%, respectively), with ORs of 5.54 (2.60, 11.82) and 2.44 (1.14, 5.25), respectively. MSM aged 30-50 years old and MSM who underwent HIV testing in the last year were more likely to be in the CH group and HTL group. In addition, the HTL group was characterized by a lower likelihood of local registration and a higher likelihood of working as a MSW. CONCLUSION: MSM in the CH group and the HTL group had a higher risk of AEH infection. In the future, VHCT should be performed more often among younger MSM, and HIV counselling should be given the same priority as HIV testing. In addition, VHCT combined with PrEP may have a better preventive impact on MSM with a high risk of AEH infection.

The association between air pollutants, meteorological factors and tuberculosis cases in Beijing, China: A seven-year time series study.

BACKGROUND: Tuberculosis (TB) is a severe public health problem globally. Previous studies have revealed insufficient and inconsistent associations between air pollutants, meteorological factors and TB cases. Yet few studies have examined the associations between air pollutants, meteorological factors and TB cases in Beijing. OBJECTIVE: The purpose of this study was to explore the impact of air pollutants and meteorological factors on TB in Beijing, and to provide novel insights into public health managers to formulate control strategies of TB. METHODS: Data on the daily case of TB in Beijing during 2014-2020 were obtained from Chinese tuberculosis information management system. Concurrent data on the daily PM10, PM2.5, SO2, NO2, CO and O3, were obtained from the online publication platform of the Chinese National Environmental Monitoring Center. Daily average temperature, average wind speed, relative humidity, sunshine duration and total precipitation were collected from the China Meteorological Science Data Sharing Service System. A distributed lag non-linear model was fitted to identify the non-linear exposure-response relationship and the lag effects between air pollutions, meteorological factors and TB cases in Beijing. RESULTS: In the single-factor model, the excess risk (ER) of TB was significantly positively associated with every 10 µg/m3 increase in NO2 in lag 1 week (ER: 1.3%; 95% confidence interval [CI]: 0.4%, 2.3%) and every 0.1 m/s increase in average wind speed in lag 5 weeks (ER: 0.3%; 95% CI: 0.1%, 0.5%), and was negatively associated with every 10 µg/m3 increase in O3 in lag 1 week (ER: -1.2%; 95% CI: -1.8%, -0.5%), every 5 °C increase in average temperature (ER: -1.7%; 95% CI: -2.9%, -0.4%) and every 10% increase in average relative humidity (ER: -0.4%; 95% CI: -0.8%, -0.1%) in lag 10 weeks, respectively. In the multi-factor model, the lag effects between TB cases and air pollutants, meteorological factors were similar. The subgroup analysis suggests that the effects of NO2, O3, average wind speed and relative humidity on TB were greater in male or labor age subgroup, while the effect of CO was greater in the elderly. In addition, no significant associations were found between PM2.5, SO2, sunshine duration and TB cases. CONCLUSION: Our findings provide a better understanding of air pollutants and meteorological factors driving tuberculosis occurrence in Beijing, which enhances the capacity of public health manager to target early warning and disease control policy-making.

A five-parameter score for predicting saphenous vein graft degenerative and/or occlusive disease in recurring ischemic symptoms after one year post coronary artery bypass grafting.

BACKGROUND: The recurrence rate of ischemic symptoms after coronary artery bypass grafting (CABG) is increasing in recent years. How to prevent and treat saphenous vein graft disease (SVGD [symptomatic ⩾50% stenosis in at least one Saphenous vein graft]) has been a clinical challenge to date. Different pathogenesis may exist in SVGD of different periods. There are currently few available scores for estimating the risk of SVGD after one year post CABG. OBJECTIVE: We sought to develop and validate a simple predictive clinical risk score for SVGD with recurring ischemia after one year post CABG. METHODS AND RESULTS: This was a cross-sectional study and the results were validated using bootstrap resampling on a separate cohort. A nomogram and risk scoring system were developed based on retrospective data from a training cohort of 606 consecutive patients with recurring ischemia >1 year after CABG. Logistic regression model was used to find the predictive factors and to build a nomogram. To assess the generalization, models were validated using bootstrap resampling and an external cross-sectional study of 187 consecutive patients in four other hospitals. In multivariable analysis of the primary cohort, native lesion vessel number, SVG age, recurring ischemia type, very low-density lipoprotein level, and left ventricular end-diastolic diameter were independent predictors. A summary risk score was derived from nomogram, with a cut-off value of 15. In internal and external validation, the C-index was 0.86 and 0.82, indicating good discrimination. The calibration curve for probability of SVGD showed optimal agreement between actual observations and risk score prediction. CONCLUSION: A simple-to-use risk scoring system based on five easily variables was developed and validated to predict the risk of SVGD among patients who recurring ischemia after one year post CABG. This score may be useful for providing patients with individualized estimates of SVGD risk.

Effect of ambient temperature and other environmental factors on stroke emergency department visits in Beijing: A distributed lag non-linear model.

Background: Most studies have focused on the relationship between ambient temperature and stroke mortality, but studies on the relationship between ambient temperature and stroke occurrence are still limited and inconsistent. Objective: This study aimed to analyze the effect of ambient temperature and other environmental factors on emergency stroke visits in Beijing. Methods: Our study utilized stroke visit data from the Beijing Red Cross Emergency Medical Center during 2017-2018, and applied a generalized additive model (GAM) as well as a distributed lag non-linear model (DLNM), respectively, regarding the direct, lagged, and cumulative effects of ambient temperature alone and with correction for other environmental factors on stroke occurrence. Results: With a total of 26,984 emergency stroke patients in 2017-2018, both cold and hot effects were observed and weakened after correction for other environmental factors. Compared to the reference temperature, in the multi-factor model, extreme cold (-10°C) reached a maximum relative risk (RR) of 1.20 [95% Confidence Interval (CI): 1.09, 1.32] at lag 14 days, and extreme hot (30°C) had a maximum RR of 1.07 (95% CI: 1.04, 1.11) at lag 6 days. The cumulative effect of extreme cold reached a maximum of 2.02 (95% CI: 1.11, 3.67) at lag 0-14 days, whereas the cumulative effect of extreme hot temperature is greatest at lag 0-10 days, but no statistically significant effect was found. In addition, ischemic stroke patients, the elderly, and males were more susceptible to the effects of cold temperature. Conclusions: There is a non-linear relationship between ambient temperature and stroke occurrence, with cold temperature having a greater and longer-lasting impact than hot temperature.

Prostate Cancer Risk Prediction and Online Calculation Based on Machine Learning Algorithm.

Objective To build a prostate cancer (PCa) risk prediction model based on common clinical indicators to provide a theoretical basis for the diagnosis and treatment of PCa and to evaluate the value of artificial intelligence (AI) technology under healthcare data platforms. Methods After preprocessing of the data from Population Health Data Archive, smuothly clipped absolute deviation (SCAD) was used to select features. Random forest (RF), support vector machine (SVM), back propagation neural network (BP), and convolutional neural network (CNN) were used to predict the risk of PCa, among which BP and CNN were used on the enhanced data by SMOTE. The performances of models were compared using area under the curve (AUC) of the receiving operating characteristic curve. After the optimal model was selected, we used the Shiny to develop an online calculator for PCa risk prediction based on predictive indicators. Results Inorganic phosphorus, triglycerides, and calcium were closely related to PCa in addition to the volume of fragmented tissue and free prostate-specific antigen (PSA). Among the four models, RF had the best performance in predicting PCa (accuracy: 96.80%; AUC: 0.975, 95% CI: 0.964-0.986). Followed by BP (accuracy: 85.36%; AUC: 0.892, 95% CI: 0.849-0.934) and SVM (accuracy: 82.67%; AUC: 0.824, 95% CI: 0.805-0.844). CNN performed worse (accuracy: 72.37%; AUC: 0.724, 95% CI: 0.670-0.779). An online platform for PCa risk prediction was developed based on the RF model and the predictive indicators. Conclusions This study revealed the application value of traditional machine learning and deep learning models in disease risk prediction under healthcare data platform, proposed new ideas for PCa risk prediction in patients suspected for PCa and had undergone core needle biopsy. Besides, the online calculation may enhance the practicability of AI prediction technology and facilitate medical diagnosis.

Triglyceride-glucose index is significantly associated with the risk of hyperuricemia in patients with diabetic kidney disease.

Triglyceride-glucose (TyG) index has been proposed to be a simple, economical, and reliable marker of insulin resistance. We aimed to investigate whether TyG is an independent predictor of hyperuricemia in diabetic kidney disease (DKD) populations by conducting a cross-sectional and longitudinal study. A total of 6,471 patients were enrolled in cross-sectional analysis, and 3,634 patients without hyperuricemia at the baseline were included in longitudinal analysis and were followed up for a median of 23.0 months. Hyperuricemia was categorized as a serum uric acid level ≥ 420 umol/L (7 mg/dL). In this study, 19.58% of participants had hyperuricemia. In the cross-sectional analysis, multivariate logistics regression analysis showed that the ORs (95% CI) for hyperuricemia in the second, third, and fourth TyG quartiles were 1.40 (95% CI 0.73-2.65), 1.69 (95% CI 0.90-3.18), and 4.53 (95% CI 2.39-8.57), respectively, compared with the first quartile. Longitudinally, the Kaplan-Meier survival analysis showed that higher TyG levels predicted higher incidence of hyperuricemia. Multivariate Cox regression model revealed that the hazard ratios for hyperuricemia in the upper quartiles of the TyG index were 1.69 (95% CI 0.97-2.93), 2.23 (95% CI 1.33-3.75), and 2.50 (95% CI 1.46-4.27), respectively, compared with the first quartile. Moreover, the subgroup analyses revealed that the relationship between TyG levels and hyperuricemia was robust in DKD patients. Our findings indicate a significant independent correlation between the TyG index and the risk of hyperuricemia in DKD patients.

Joint exposure to outdoor ambient air pollutants and incident chronic kidney disease: A prospective cohort study with 90,032 older adults.

Objectives: There is paucity of studies to investigate the association between combined and long-term exposure to air pollution and the risk of incident chronic kidney disease (CKD) in older adults. Methods: A prospective cohort of 90,032 older adults who did not have CKD at baseline were followed up from January 1, 2017, to December 31, 2019. Various pollutant data, including particulate matter with diameters ≤ 2.5 mm (PM2.5), ≤ 10 mm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), Ozone (O3), and carbon monoxide (CO), from all monitoring stations in Binhai New Area, Tianjin were considered in calculating the mean exposure concentration of each pollutant over 2 years. By summing each pollutant concentration weighted by the regression coefficients, we developed an air pollution score that assesses the combined exposure of these air pollutants. Due to the strong correlation between air pollutants, Principal Component Analysis (PCA) score was also developed. The association between air pollutants and incident CKD in the elderly was analyzed. Results: A total of 90,032 subjects participated in this study with a median follow-up of 545 days. Among them, 22,336 (24.8%) developed CKD. The HR (95% CI) for air pollution score and incidence of CKD was 1.062 (1.060-1.063) and p <0.001 after adjusting for all confounders. The adjusted HRs for the quartile subgroups of combined air pollution score were: Q2: 1.064 (1.013-1.117); Q3: 1.141 (1.088-1.198); and Q4: 3.623 (3.482-3.770), respectively (p for trend <0.001). The adjusted HRs for the quartile subgroups of air quality index (AQI) were: Q2: 1.035 (0.985-1.086); Q3: 1.145 (1.091-1.201); and Q4: 3.603 (3.463-3.748), respectively (p for trend <0.001). When the risk score was over 86.9, it significantly rose in a steep curve. The subgroup analysis showed that male, younger or exercise were more likely to develop CKD. Conclusion: Combined air pollution score, AQI, and PCA score were associated with an increased risk of CKD in an exposure-response relationship. Our current results might also provide evidence for developing environmental protection policies.