Association Between Telomere Length and Risk of Lung Cancer in an Asian Population: A Mendelian Randomization Study.

Background: Several traditional observational studies and Mendelian randomization (MR) studies have indicated an association between leukocyte telomere length (LTL) and the risk of lung cancer in the European population. However, the results in the Asian population are still unclear. The objective was to reveal the genetic causal association between LTL and the risk of lung cancer in the Asian population. Methods: We conducted a two-sample MR analysis using summary statistics. Instrumental variables (IVs) were obtained from the genome-wide association studies (GWAS) of LTL (n = 23,096) and lung cancer (n = 212,453) of Asian ancestry. We applied the random-effects inverse-variance weighted (IVW) model as the main method. As well, several other models were performed as complementary methods to assess the impact of potential MR assumption violations, including MR-Egger regression, weighted median, and weighted mode models. Results: We included eight single-nucleotide polymorphisms (SNPs) as IVs for LTL and found that LTL was significantly associated with the risk of lung cancer in the IVW model (odds ratio (OR): 1.60; 95% confidence interval (CI): 1.31 - 1.97; P = 5.96 × 10-6), which was in line with the results in the weighted median and weighted mode models. However, the relationship was not statistically significant in the MR-Egger regression model (OR: 1.44; 95% CI: 0.92 - 2.26; P = 0.160). Sensitivity analyses indicated the robustness of the results. Conclusions: This two-sample MR study confirmed that longer telomere length significantly increased the risk of lung cancer in the Asian population, which was in accord with findings in the Western population.

A wide-range operating synaptic device based on organic ferroelectricity with low energy consumption.

In this work, a wide-range operating synaptic device based on organic ferroelectricity has been demonstrated. The device possesses a simple two-terminal structure by using a ferroelectric phase-separated polymer blend as the active layer and gold/indium tin oxide (ITO) as the top/bottom electrodes, and exhibits a distinctive history-dependent resistive switching behavior at room temperature. And the device with low energy consumption (∼50 fJ µm-2 per synaptic event) can provide a reliable synaptic function of potentiation, depression and the complex memory behavior simulation of differential responses to diverse stimulations. In addition, using simulations, the accuracy of 32 × 32 pixel image recognition is improved from 76.21% to 85.06% in the classical model Cifar-10 with 1024 levels of the device, which is an important step towards the higher performance goal in image recognition based on memristive neuromorphic networks.

[The effectiveness and safety of L-amlodipine besylate for blood pressure control in patients with mild to moderate essential hypertension].

OBJECTIVE: To evaluate the effectiveness and safety of L-amlodipine besylate for blood pressure control in patients with mild to moderate essential hypertension. METHOD: A total of 1051 mild to moderate essential hypertensives were recruited from 22 centers and randomized into three groups and were given low-dose L-amlodipine besylate (2.5 mg/d), high-dose L-amlodipine besylate (5.0 mg/d), and amlodipine maleate (5.0 mg/d) on the principle of open-label and parallel control. The study drugs were administered for 8 weeks. RESULTS: After 8 weeks treatments, the response rate of the three groups were 72.4%, 85.6%, and 76.2%, respectively. The rate difference between high-dose L-amlodipine besylate group and the other two groups were statistically significant (P < 0.01), while the rate difference between low-dose L-amlodipine besylate group and amlodipine maleate group was similar (P = 0.28). The event rates of the three groups were similar (4.3%, 4.6%, and 5.1%, respectively, P = 0.84). CONCLUSION: High-dose L-amlodipine besylate is superior to the other 2 groups on blood pressure control. The efficacy profiles of amlodipine maleate and low-dose L-amlodipine besylate are equivalent. Safety profiles of these three groups are comparable.

[The effect of pitavastatin on blood glucose and its efficacy in diabetic patients with hypercholesterolemia].

OBJECTIVE: To evaluate the effect of pitavastatin on blood glucose in patients with hypercholesterolemia, and to investigate the efficacy of pitavastatin in diabetic patients combined with hypercholesterolemia. METHOD: This study was a 12-week, multi-center, open-label, without parallel-group comparison, phase IV clinical trail. RESULTS: Contrasting to baseline, the prevalences at week 4 and 12 post-treatment of abnormal fasting plasma glucose (FPG) and glycosylated hemoglobin A1c (HbA1c) (FPG: 14.2%vs 14.1% and 11.0%; HbA1c: 14.3% vs 15.1% and 16.1%) in the safety set subjects without diabetes mellitus (DM), as well as in those with DM but not taking glucose-lowering drugs (FPG: 7/7 vs 4/7 and 5/7; HbA1c: 5/5 vs 4/4 and 5/5) had no significant changes (all P values > 0.05). Contrasting to baseline, the levels of TC [(6.51 ± 0.94) mmol/L vs (5.12 ± 0.93) mmol/L and (4.54 ± 1.00) mmol/L], LDL-C [(4.11 ± 0.79) mmol/L vs (3.02 ± 0.81) mmol/L and (2.51 ± 0.70) mmol/L] and TG [2.10 (1.53, 2.54) mmol/L vs 1.62 (1.26, 2.00) mmol/L and 1.35 (1.10, 1.86) mmol/L]at week 4 and 12 post-treatment in the per protocol set 55 subjects with DM were significantly reduced (all P values < 0.05); 33.3% of subjects at high risk and 10.0% of subjects at very high risk had achieved a TC target value; 55.6% of subjects at high risk and 40.0% of subjects at very high risk had achieved a LDL-C target value. CONCLUSION: Pitavastatin has a safe effect on blood glucose and it could be used to treat diabetic patients combined with hypercholesterolemia in China.

[Effect and risk factors of pitavastatin on high sensitivity C-reactive protein in patients with hypercholesterolemia: a multilevel models analysis].

OBJECTIVE: To evaluate the effect of pitavastatin on high sensitivity C-reactive protein (hsCRP) in patients with hypercholesterolemia, and determine risk factors for the effect. METHODS: This study was a 12-week, multicenter, open-label, without parallel-group comparison, phase IV clinical trail. RESULTS: There were 330 subjects in the per protocol set. Contrast to the baseline, the average levels of hsCRP in all of subjects and the group without a history of receiving previous statin medication at week 12 post-treatment decreased respectively 26.4% (1.20 mg/L vs 1.68 mg/L) and 27.5% (1.21 mg/L vs 1.97 mg/L, all P < 0.05). The results of multilevel models indicated that the average levels of hsCRP reduced with the passage of treatment time, the time-varying rate of per-visit was 0.97 mg/L (95% confidence interval 0.96 - 0.98). Controlled individual background covariates, the model predicted that pulse pressure and white blood cell count on the baseline had the significant positive effects on hsCRP (P < 0.01). CONCLUSIONS: Pitavastatin decreases hsCRP in patients with hypercholesterolemia. The main risk factors for the effect are pulse pressure and white blood cell count on the baseline.

[Safety and efficacy of pitavastatin in patients with hypercholesterolemia: a multicenter study].

OBJECTIVE: To evaluate the safety and efficacy of pitavastatin in patients with hypercholesterolemia in China under conditions of extensive usage. METHODS: This was a 12-week, multicenter, open-label, without parallel-group comparison, phase IV clinical trial. RESULTS: There were 427 subjects in the safety set. The adverse events mainly included vomiting, myalgia and the elevations of aspartate transaminase (AST), alanine transaminase (ALT) and creatine kinase (CK), etc. The incidence of drug-related adverse events was 4.22%. There were no significant differences between pre-exposure and post-exposure average levels of renal function indicators and blood routine examination item (all P > 0.05). None of them had a high AST/ALT value, i.e. > 3 times upper limits of normal (ULN), or had a high CK value, i.e. > 10 times ULN. There were 397 subjects in the per protocol set. At week 12 post-treatment, the blood levels of total cholesterol and low density lipoprotein cholesterol (LDL-C) in subjects without previous treatment decreased 24.6% and 31.0% respectively, that of high density lipoprotein cholesterol (HDL-C) in subjects with HDL-C < 1.04 mmol/L increased 60.1% while that of triglyceride (TG) in subjects with TG > 1.70 mmol/L decreased 22.5% (P < 0.05). And 207 (92.3%) subjects were at a low risk, 46 (76.1%) subjects at an intermediate risk, 134 (47.8%) subjects at a high risk and 10 (40.0%) of subjects at a very high risk had achieved a LDL-C target value; the LDL-C goal achievement rate after switching from previous medication to pitavastatin was significant higher than that of pre-switching. CONCLUSION: Pitavastatin demonstrates positive safety and efficacy. It may be used for the treatment of patients with hypercholesterolemia in China.

[Relationship and interactions between elevated fasting glucose and hypertension for cardiocerebral vascular disease].

OBJECTIVE: To explore the relationship and interaction of elevated fasting glucose and hypertension on cardiocerebral vascular disease. METHODS: 10 054 males and females were recruited for our cross-sectional study during May 2007 to August 2007. Unconditional logistic regression was used to analysis the relationship between fasting glucose and hypertension on cardiocerebral vascular disease. A product of fasting glucose and hypertension was added to the logistic regression model to evaluate the multiplicative interaction and relative excess risk of interaction (RERI), attributable proportion (AP) of interaction and synergy index (S) was applied to evaluate the additive interaction of the two factors. Bootstrap was used to calculate 95% confidence intervals (CI) of RERI, AP and S. RESULTS: After adjusting age, gender, smoking, drinking, body mass index (BMI) and region, the product of fasting glucose and hypertension was not statistically significant, which means there was no multiplicative interaction between the two. But the additive indexes RERI, AP and S with 95%CI of diabetes and hypertension were 0.64 (0.03, 1.25), 0.27 (0.01, 0.47) and 1.83 (1.02, 5.13) respectively, which means significant additive interaction was shown between the two on cardiovascular disease but not no stroke. And there were no additive interaction between impaired fasting glucose on cardiovascular disease or stroke. CONCLUSIONS: Hypertension was independently related to cardiovascular disease and stroke in Beijing citizens, and diabetes were independently related to stroke. There was additive interaction between diabetes and hypertension on cardiovascular disease.

[The association of target organ damage with abnormal ankle brachial index in hypertensive patients].

OBJECTIVE: To investigate the association of hypertensive target organ damage with abnormal ankle brachial index (ABI) in high-risk hypertensive patients. METHODS: During December 2008 to May 2009, a cross-sectional study was conducted to investigated the prevalence of abnormal ABI (ABI < 0.90) in 2674 community-dwelling, hypertensive patients, who aged > 40 years, without coronary heart disease, stroke/transient ischemic attack or known arteriosclerosis, from 18 centers in China. Data were acquired through history, physical examination, laboratory and other diagnostic tests. RESULTS: There were 2615 subjects eligible for the full analysis set. The high-risk hypertensive patients with arterial wall thickening, arterial wall thickening and slightly elevated serum creatinine had a higher prevalence of abnormal ABI than their counterparts respectively (P < 0.05). Compared with the normal group, the abnormal ABI group had a higher serum creatinine level on average (P < 0.01). After adjustment for certain factors including investigation center, demographic factors, cardiovascular disease (CVD) risk and CVD risk factors using an unconditional logistic regression model, arterial wall thickening (OR 2.416, 95%CI 1.395 - 4.183, P = 0.0016) and slightly elevated serum creatinine (OR 3.377, 95%CI 1.267 - 8.997, P = 0.0149) were positively associated with abnormal ABI. However, arterial wall thickening (OR 0.988, 95%CI 0.576 - 1.695, P = 0.9664) and microalbuminuria (OR 1.389, 95%CI 0.685 - 2.817, P = 0.3621) were irrelevant to abnormal ABI. CONCLUSIONS: So far as a high-risk hypertensive patient is concerned, there are significant statistical correlations between arterial wall thickening and/or slightly elevated serum creatinine and an abnormal ABI, but no significant statistical correlations between arterial wall thickening or microalbuminuria and an abnormal ABI is observed.

Burden of pneumonia and meningitis caused by Streptococcus pneumoniae in China among children under 5 years of age: a systematic literature review.

BACKGROUND AND METHODS: To understand the burden and epidemiology of Streptococcus pneumoniae disease among children between 1 and 59 months of age in China, we conducted a review of literature published between 1980 and 2008 applying standardized algorithms. Because of the absence of population-based surveillance for pneumococcal disease (PD), we identified all-cause pneumonia, bacteremia and meningitis burden, syndromes most commonly associated with S. pneumoniae, and applied the proportion of disease attributable to S. pneumoniae from studies that determined the etiology of these three syndromes to calculate PD burden. Because of the microbiologic difficulties in identifying S. pneumoniae-attributable pneumonia which likely underestimates the pneumonia burden, we also used the proportion obtained from vaccine efficacy trials. RESULTS: Between 1980 and 2008, there were 12,815 cases/100,000/year of all-cause pneumonia among children between 1 month and 59 months, with 526 deaths/100,000 annually. There were 14 meningitis cases/100,000/year. We estimate that as of 2000, there were 260,768 (113,000 to 582,382) and 902 (114-4,463) cases of pneumococcal pneumonia and meningitis, respectively with 10,703 (4,638-23,904) and 75 (9-370) pneumococcal pneumonia and meningitis deaths, respectively. Pneumococcal pneumonia cases and deaths were more than two-fold higher, 695,382 (173,845-1,216,918) and 28,542 (7,136-49,949), respectively, when parameters from efficacy trials were used. Serotypes 19F, 19A and 14 were the most common serotypes obtained from pneumonia/meningitis patients. Currently available vaccines are expected to cover 79.5% to 88.4% of the prevalent serotypes. With high antibiotic resistance, introducing pneumococcal vaccines to the routine immunization program should be considered in China. Population-based studies are warranted.

[Hypertension and cardiovascular risk evaluation of Chinese cardiovascular physicians].

OBJECTIVE: To observe the prevalence, awareness, treatment and control rate of hypertension and to evaluate the 10-year absolute risk of coronary heart disease(CHD) and ischemic cardiovascular disease(ICVD) in Chinese cardiovascular physicians. METHODS: A total of 4032 cardiovascular physicians (28 to 79 years old) from 386 hospitals in 31 provinces, autonomous regions and municipalities were randomly selected and received an epidemiologic survey of prevalence, awareness, and control of hypertension and evaluations of CHD and ICVD risk. RESULTS: The prevalence of hypertension in Chinese cardiovascular physicians was 13.1%. The awareness rate of hypertension in Chinese cardiovascular physicians was 81.7%. Hypertension treatment rate was 69.6% and blood pressure control rate was 44.6%. The prevalence of hypertension was higher in male physicians than in female physicians before the age of 55 years old. Ten-year absolute risk of CHD and ICVD was 0.08 and 0.03 in hypertensive physicians compared to 0.03 and 0.01 in non-hypertensive physicians. CONCLUSIONS: The results show suboptimal awareness, treatment and control rate in Chinese cardiovascular physicians for their own hypertension status.Physicians suffering from hypertension face higher risk for cardiovascular disease. It is therefore necessary to improve the self-monitoring of blood pressure in Chinese cardiovascular physicians.

[Smoking cessation rate in cardiovascular patients after percutaneous coronary intervention].

OBJECTIVE: To investigate the smoking cessation rate and its related factors in cardiovascular patients after percutaneous coronary intervention. METHODS: A cross-sectional survey of 1241 outpatients or inpatients fulfilling the inclusion criteria was conducted at 14 hospitals across China. RESULTS: The survey population mainly consisted of middle-aged male patients with an average age of (59.9 ± 10.7) years old. Their median time after surgery was 1.5 years. Among them, 77.4% tried to quit smoking while 55.4% succeed. The elder men were more likely to try to quit smoking and succeed eventually (OR values: 1.02 vs 1.03). The higher number of cigarettes smoked daily, the greater possibility of trying to quit smoking (OR = 1.03), but less likely to quit smoking eventually (OR = 0.97). Furthermore the years of smoking and cessation motivation had impacts on the cessation behaviors as well. CONCLUSION: Smoking cessation was achieved in more than half of the patients at one year after PCI. Age, years of smoking, daily number of cigarettes, concurrent diseases and physician recommendations are the influencing factors of smoking cessation.

[Association between marital status and prevalence of peripheral arterial disease among Beijing residents: a cross-sectional study].

OBJECTIVE: To investigate the relationship between marital status and prevalence of peripheral arterial disease (PAD) among Beijing residents. METHODS: From May to August 2007, 10 054 residents were interviewed to collect demographic and biochemistry information. Generalized linear mixed model was used to determine the relationship between marital status and prevalence of PAD in terms of OR and corresponding 95% confidence intervals. RESULTS: After adjusting the traditional risk factors including age, area, lipid, serum glucose, blood pressure, central obesity, smoking, drinking and physical activities for PAD, relationship between marital status and prevalence of PAD was found both at the female and male groups of those with 45 years or older. Compared with married men, OR and 95% confidence interval of PAD for unmarried men were 1.56 (0.39 - 6.35) and 1.61 (0.77 - 3.35) for those with 45 years younger and older respectively, while compared with married women, OR and 95% confidence interval of PAD for unmarried women were 0.75 (0.22 - 2.57) and 1.78 (1.23 - 2.58) for those with 45 years younger and older respectively. Significant differences (all P < 0.01) were found between married and unmarried women of 45 years or older in terms of age, waist circumstances, systolic blood pressure, fasting glucose, total cholesterol, low-density lipoprotein and smoking. CONCLUSIONS: Peripheral arterial disease was related to marital status for women of 45 years or older among Beijing residents. Estrogen level and the distribution of other PAD risk factors might contribute to the observed finding.

[Relevance of cardiovascular disease risk and abnormal ankle brachial index in hypertensive patients:a multicentre study].

OBJECTIVE: To evaluate the relevance of cardiovascular disease (CVD) risk and abnormal ankle brachial index (ABI) in high-risk and very high-risk hypertensive patients and explore the strategies of prevention and treatment for peripheral arterial disease according to the CVD risk. METHODS: Between December 2008 and May 2009, the cross-sectional study investigated the prevalence of abnormal ABI (ABI < 0.90) in 2674 community-dwelling, hypertensive patients, aged ≥ 40 years old, without coronary heart disease, stroke/transient ischemic attack or known arteriosclerosis, from 18 centers in China. The relevant data were acquired through history, physical examination, laboratory examinations and other diagnostic tests. RESULTS: The number of subjects available for the full-analysis set was 2615. There was a rising prevalence of abnormal ABI with the advancing age in high-risk hypertensive patients and very high-risk ones (P < 0.001). Compared with the high-risk group, the 60 years (1.3% vs 5.1%) and 70 years (4.1% vs 10.5%) age sub-groups of the very high-risk group had a significantly higher prevalence of abnormal ABI (P < 0.05). After adjusting for such factors as investigational center, target organ damage, CVD risk and demographics, an unconditional Logistic regression model revealed that CVD risk was positively correlated with abnormal ABI (odds ratio 1.874, 95% confidence interval 1.153 - 3.045, P = 0.0112). A very high-risk hypertensive patient was 1.874 times more likely than a high-risk one to have an abnormal ABI. CONCLUSION: A high-risk hypertensive patient with a higher CVD risk is more prone to have an abnormal ABI. Among the high-risk hypertensive patients in the 60 years and 70 years age sub-groups, such a positive correlation is especially pronounced.