Isotemporal Substitution Modeling on Sedentary Behaviors and Physical Activity With Mortality Among People With Different Diabetes Statuses: A Prospective Cohort Study From the National Health and Nutrition Examination Survey Analysis 2007-2018.

BACKGROUND: To assess the associations of replacing sedentary behavior with different types of physical activity with mortality among the US adults of varying diabetes statuses. METHODS: This prospective cohort study included 21,637 participants (mean age, 48.5 y) from the National Health and Nutrition Examination Survey 2007-2018. Physical activity including leisure-time moderate-vigorous-intensity activity (MVPA), walking/bicycling, worktime MVPA, and sedentary behavior. We conducted an isotemporal substitution analysis using Cox regression to estimate the associations between replacements and mortality risks. RESULTS: We found significant protective associations between replacing 30 minutes per day sedentary behavior with 3 types of physical activity and all-cause, cardiovascular disease (CVD) mortality risk (except worktime MVPA for CVD mortality) among total participants, with hazard ratio (HR; 95% confidence interval [CI]) ranging from 0.86 (0.77-0.95) to 0.96 (0.94-0.98). Among participants with diagnosed diabetes, replacing sedentary behavior with leisure-time MVPA was associated with a lower all-cause mortality risk (HR 0.81, 95% CI, 0.70-0.94), which was also observed in other subgroups, with HRs (95% CI) ranging from 0.87 (0.80-0.94) to 0.89 (0.81-0.99). Among those with prediabetes/undiagnosed diabetes, replacing sedentary behavior with walking/bicycling was associated with lower CVD mortality risk, and replacement to work-time MVPA was associated with lower all-cause and CVD mortality risk, with HRs (95% CI) ranging from 0.72 (0.63-0.83) to 0.96 (0.92-0.99). CONCLUSIONS: Replacing sedentary behaviors with 30 minutes per day leisure-time MVPA was associated with lower all-cause mortality, regardless of diabetes statuses. Among people with prediabetes/undiagnosed diabetes, walking/bicycling was additionally associated with lower CVD mortality, and worktime MVPA was associated with lower all-cause and CVD mortality.

Association of white matter hyperintensities with BMD, incident fractures, and falls in the UK Biobank cohort.

Osteoporosis is the most common metabolic bone disease globally, which increases the healthcare service burden. Recent studies have linked higher white matter hyperintensities (WMH) to reduced BMD, increasing the risk of fractures and falls in older adults. However, limited evidence exists regarding the dose-response relationship between WMH and bone health in a larger and younger population. Our study aimed to examine the association of WMH volume with BMD, incident fractures and falls, focusing on dose-response relationship with varying levels of WMH volume. We included 26 410 participants from the UK Biobank. The association between WMH volume and BMD was analyzed using multiple linear regression. Cox regression models were used to estimate the hazard ratios of incident fractures and falls. Restricted cubic spline (RCS) fitted for linear and Cox regression models were employed to explore potential non-linearity. Over a mean follow-up time of 3.8 yr, we documented 59 hip fractures, 392 all fractures, and 375 fall incidents. When applying RCS, L-shaped relationships were identified between WMH volume and BMD across all 4 sites. Compared with those in the lowest fifth of WMH volume, individuals in the second to the highest fifths were associated with a reduction of 0.0102-0.0305 g/cm2 in femur neck BMD, 0.0075-0.0273 g/cm2 in femur troch BMD, 0.0173-0.0345 g/cm2 in LS BMD, and 0.0141-0.0339 g/cm2 in total body BMD. The association was more pronounced among women and younger participants under age 65 (Pinteraction < .05). Per 1 SD increment of WMH volume was associated with 36.9%, 20.1%, and 14.3% higher risks of incident hip fractures, all fractures, and falls. Genetically determined WMH or apolipoprotein E genotypes did not modify these associations. We demonstrated that a greater WMH was associated with BMD in an L-shaped dose-response manner, especially in women and those under 65 yr.

This study investigated the association between white matter hyperintensities (WMH) and bone health, focusing on BMD, incident fractures and falls. We included 26 410 participants from the UK Biobank and found that a greater WMH volume was associated with BMD in an L-shaped dose­response manner, especially in women and those under 65 yr. Additionally, per 1 SD increment of WMH volume was associated with 36.9%, 20.1%, and 14.3% higher risks of incident hip fractures, all fractures, and falls. These findings emphasize the significance of considering brain health when evaluating bone health.

An automated deep learning pipeline for EMVI classification and response prediction of rectal cancer using baseline MRI: a multi-centre study.

The classification of extramural vascular invasion status using baseline magnetic resonance imaging in rectal cancer has gained significant attention as it is an important prognostic marker. Also, the accurate prediction of patients achieving complete response with primary staging MRI assists clinicians in determining subsequent treatment plans. Most studies utilised radiomics-based methods, requiring manually annotated segmentation and handcrafted features, which tend to generalise poorly. We retrospectively collected 509 patients from 9 centres, and proposed a fully automated pipeline for EMVI status classification and CR prediction with diffusion weighted imaging and T2-weighted imaging. We applied nnUNet, a self-configuring deep learning model, for tumour segmentation and employed learned multiple-level image features to train classification models, named MLNet. This ensures a more comprehensive representation of the tumour features, in terms of both fine-grained detail and global context. On external validation, MLNet, yielding similar AUCs as internal validation, outperformed 3D ResNet10, a deep neural network with ten layers designed for analysing spatiotemporal data, in both CR and EMVI tasks. For CR prediction, MLNet showed better results than the current state-of-the-art model using imaging and clinical features in the same external cohort. Our study demonstrated that incorporating multi-level image representations learned by a deep learning based tumour segmentation model on primary MRI improves the results of EMVI classification and CR prediction with good generalisation to external data. We observed variations in the contributions of individual feature maps to different classification tasks. This pipeline has the potential to be applied in clinical settings, particularly for EMVI classification.

Characteristics and health risk assessment of volatile N-nitrosamines in the plasma of adults in Guangdong Province, China.

N-nitrosamines are strong carcinogens that are widely present in the environment. This study developed a method, and analyzed the concentrations of volatile N-nitrosamines (VNAs) in the plasma of adults in Guangdong Province, China. Finally, the health risks to adults in Guangdong Province, China, with dietary exposure to VNAs were assessed. Gas chromatography/mass spectrometry (GC/MS) in electron impact (EI) ionization source mode was used to quantitatively analyze VNAs, and to perform accurate mass determination. The lower limit of detection (LOD) of nine nitrosamines are ranged from 0.01 to 2.14 ng/mL. The recovery rate ranged from 83 % to 116 %, and the relative standard deviation (RSD) was < 10 %. The method developed is simple, rapid, and provides good reproducibility and high sensitivity. N-nitrosodimethylamine (NDMA), N-nitrosomethylethylamine (NMEA), N-nitrosodinbutylamine (NDBA), N-nitrosopiperidine (NPIP), N-nitrosopyrrolidine (NPYR), N-nitrosomorpholine (NMOR) and N-nitrosodiphenylamine (NDPhA) were detected in 92 adult plasma samples. NDMA and NMEA were detected in 56.5 % and 44.6 % of the samples, followed by NPIP (34.8 %). NDMA had the highest median concentration (43.7 ng/mL) in the total samples. There were gender-related differences found in the concentrations of NDBA and NDPhA. The exposure risk assessment results showed that the two highest daily dietary intakes of VNAs were N-nitrosodi-n-propylamine (NDPA) and NDMA, and aquatic products and pickled vegetables contributed the most total nitrosamine intake. The lifetime cancer risk of adults ranged from 2.88 × 10-10 to 7.46 × 10-5, and the risk associated with NDMA, NDPA, N-nitrosodiethylamine (NDEA), NMEA and NPIP are important and should attract more attention. This study aimed to explore the exposure levels of VNAs in the plasma of adults in Guangdong Province, China, and to assess the health risks of dietary intake of VNAs, which provides a basis of the effect of VNAs exposure on human health.

Comparison and risk factors analysis of multiple breast cancer screening methods in the evaluation of breast non-mass-like lesions.

OBJECTIVE: To compare multiple breast cancer screening methods for evaluating breast non-mass-like lesions (NMLs), and investigate new best screening method for breast non-mass-like lesions and the value of the lexicon of ACR BI-RADS in NML evaluation. METHODS: This retrospective study examined 253 patients aged 24-68 years who were diagnosed with breast NMLs and described the lexicon of ACR BI-RADS from April 2017 to December 2019. All lesions were evaluated by HHUS, MG, and ABUS to determine BI-RADS category, and underwent pathological examination within six months or at least 2 years of follow-up. The sensitivity, specificity, accuracy, positive predictive values (PPV), and negative predictive values (NPV) of MG, HHUS and ABUS in the prediction of malignancy were compared. Independent risk factors for malignancy were assessed using non-conditional logistic regression. RESULTS: HHUS, MG and ABUS findings significantly differed between benign and malignant breast NML, including internal echo, hyperechoic spot, peripheral blood flow, internal blood flow, catheter change, peripheral change, coronal features of ABUS, and structural distortion, asymmetry, and calcification in MG. ABUS is superior to MG and HHUS in sensitivity, specificity, PPV, NPV, as well as in evaluating the necessity of biopsy and accuracy in identifying malignancy. MG was superior to HHUS in specificity, PPV, and accuracy in evaluating the need for biopsy. CONCLUSIONS: ABUS was superior to HHUS and MG in evaluating the need for biopsy in breast NMLs. Compared to each other, HHUS and MG had their own relative advantages. Internal blood flow, calcification, and coronal plane feature was independent risk factors in NMLs Management, and different screening methods had their own advantages in NML management. The lexicon of ACR BI-RADS could be used not only in the evaluation of mass lesions, but also in the evaluation of NML.

Study on the levels of N-nitrosamine compounds and untargeted metabolomics in patients with colorectal cancer.

Plasma samples were collected from 34 patients with advanced CRC and 92 healthy persons (control group), and the levels of 9 VNAs were measured using GC-MS. Untargeted metabolomics analysis was performed using LC-MS/MS. Partial least squares discriminant analysis (PLS-DA) and hierarchical cluster analysis were used to determine differential metabolites between the 2 groups. Receiver operating characteristic (ROC) curve analysis and Kyoto Encyclopedia of Genes and Genomes pathway analysis were performed on the differential metabolites. It turned out that the detection rates of N-nitrosodimethylamine (NDMA) and N-nitrosopyrrolidine (NPYR) in patients with CRC were higher than in the control group (P < 0.05). N-nitrosomethylethylamine (NMEA) and N-nitrosodiphenylamine (NDPhA) were not detected in CRC patients. NDMA, N-nitrosodibutylamine (NDBA), N-nitrosopiperidine (NPIP), and NPYR were detected in male and female patients with CRC. There was no difference in VNAs exposure between the sexes of CRC patients. In the positive and negative ion mode, a total of 132 differential metabolites and 6 differential metabolic pathways were detected. Adenosine 5'-monophosphate, hypoxanthine, 11,12-epoxy-(5Z,8Z,11Z)-icosatrienoic acid, 16(R)-HETE, acetylcarnitine, and lysophosphatidic acid (LPA 20:5, LPA 20:4) were candidate biomarkers with higher predictive value. Hypoxanthine and xanthine metabolic pathways were associated with changes in VNAs in CRC patients. In summary, the effects of changes of VNAs in the plasma of CRC patients (especially NDMA and NPYR) on the progression of CRC should attract attention. Abnormalities of adenine and guanine and downstream hypoxanthine-xanthine metabolic pathways were closely related to changes of VNAs and metabolomics in CRC patients.

CEUS helps to rerate small breast tumors of BI-RADS category 3 and category 4.

PURPOSE: The primary aim of this study was to explore if classification, whether using the BI-RADS categories based on CEUS or conventional ultrasound, was conducive to the identification of benign and malignant category 3 or 4 small breast lesions. MATERIAL AND METHODS: We evaluated 30 malignant and 77 benign small breast lesions using CEUS. The range of enhancement, type of enhancement strength, intensity of enhancement, and enhancement patterns were independent factors included to assess the BI-RADS categories. RESULTS: Of the nonenhanced breast lesions, 97.8% (44/45) were malignant, while, of the hyperplasic nodules, 96.8% (30/31) showed no enhancement in our study. Category changes of the lesions were made according to the features determined using CEUS. The results showed that these features could improve diagnostic sensitivity (from 70.0 to 80.0, 80.0, 90.0, and 90.0%), reduce the negative likelihood ratio (from 0.33 to 0.22, 0.25, 0.11, and 0.12), and improve the NPV (from 88.8 to 92.2, 91.2, 96.2, and 95.5%). However, this was not conducive to improve diagnostic specificity or the PPV. CONCLUSION: The vast majority of nonenhanced small breast lesions were malignant and most of the hyperplasic nodules showed no contrast enhancement. As a reference, CEUS was helpful in identifying BI-RADS category 3 or 4 small breast lesions.

[Value of contrast-enhanced sonography in early diagnosis of breast cancer].

OBJECTIVE: To assess the clinical value of contrast-enhanced ultrasonography (CEUS) in early diagnosis of breast cancer. METHODS: CEUS was performed in 107 cases of ultrasound BI-RADS(®) category 3 or category 4 small breast tumors (diameter no greater than 10 mm) before surgery. The range, type and patter of enhancement of the tumor and the surrounding tissues were observed, and the time-intensity curve (TIC) was analyzed for TIC curve type, basic and peak intensity, enhancement intensity, rising slope, and enhancement intensity. The results were analyzed comparatively between benign and malignant tumors. RESULTS: The peak intensity, enhancement intensity index and peak time in CEUS were statistically significant between benign and malignant breast tumor (t=-2.310, -2.592, -2.127, P=0.021, 0.010, 0.033), and the intensity difference and rising slope also differed significantly (t=-3.422, -3.388, P=0.001, 0.001). TIC curve type, enhancement pattern, enhancement types and enhancement range were statistically significantly between benign and malignant breast tumor (P<0.001). CONCLUSION: Benign and malignant BI-RADS(®) category 3 or 4 small breast tumors differ in the peak intensity, enhancement intensity index and peak time in CEUS. More nodular hyperplasia showed no enhancement in CEUS, and 97.8% of the lesions without enhancement are benign. In enhanced breast nodules, malignant breast lesions show more quick wash-in and wash-out type and quick wash-in and slow wash-out type, and the latter is more common; benign lesions often show a slow wash-in and slow wash-out type. In CEUS, the range of enhancement in malignant nodules is wider than that in two-dimensional ultrasound.

[Features of preoperative contrast-enhanced ultrasound of breast cancer: relationship with the syndrome classification in traditional Chinese medicine].

OBJECTIVE: To analyze the relationship between the features of preoperative contrast-enhanced ultrasound and the differentiation of symptoms and signs for syndrome classification by traditional Chinese medicine (TCM). METHODS: Eighty-two patients with malignant breast tumor were examined with contrast-enhanced ultrasound before the operation. The tumor diameter was greater than 2.0 cm in 48 cases and below 2.0 cm in 34 cases. According to the curative effect standard of TCM disorder, differentiation of symptoms and signs for classification of syndrome were performed, and the ultrasonic manifestations of different syndrome types were compared. RESULTS: In patients with maximum tumor diameter < or = 2 cm, Chong and Ren disorder type and liver Qi stagnation type were prevalent. In those with tumor diameter of <2 cm, Zeyi liver Qi stagnation type and virtual drug junction were more common. The mass peak intensity, slope of increase, enhancement intensity index and time-intensity curve of ultrasound differed significant between different syndrome types (P<0.05). CONCLUSION: The preoperative ultrasound features of breast cancer are associated with the syndrome types in TCM.

[Contrast-enhanced ultrasound findings of breast cancer].

OBJECTIVE: To study the manifestation of breast cancers of different sizes in contrast-enhanced sonography. METHODS: Eighty-four patients with breast cancers were examined by contrast-enhanced ultrasound. Among them, the tumor diameter was beyond 2.0 cm in 50 cases, and no greater than 2.0 cm in the rest cases. The time-intensity curve (TIC) on the enhanced images was analyzed quantitatively, and the relations between the type of TIC and the enhancement patterns of the tumors were analyzed. RESULTS: The enhancement patterns of the breast cancers showed significant difference between patients with tumor diameter beyond 2.0 cm and those with smaller tumors (P<0.01), but the other parameters were comparable between the two groups (P>0.05). CONCLUSION: The enhancement patterns of breast cancers differ between tumors with sizes over 2.0 cm and smaller tumors, and differential analysis is suggested in the diagnosis of breast cancer using contrast-enhanced ultrasound.

[Expressions of tumor necrosis factor receptor I and II in human gastric carcinoma].

OBJECTIVE: To study the clinical significance of expressions of tumor necrosis factor receptor I and II(TNFR I and II) and their relationship with clinical pathology in human gastric carcinoma. METHODS: SABC immunohistochemical method was used to examine the expressions of TNFR I and II in 51 cases of gastric carcinoma, 41 adjacent mucosal and 15 normal gastric mucosa tissues. RESULTS: The positivity rates of TNFR I and II expressions in human gastric carcinoma were significantly higher than those in the adjacent mucosal and normal mucosal tissues, and their expressions were significantly higher in the surrounding mucosa than in the normal tissues. In gastric carcinoma tissues, no correlations of TNFR I and II expressions with serous membrane invasion or lymph node metastasis were found, but the differentiation grade was positively correlated with TNFR expressions (r=-0.3111, P=0.035; r=-0.5952, P=0.000, respectively). CONCLUSION: TNFR I and II expressions are valuable indicators for determining the malignancy and predicting the differentiation grade of gastric carcinoma.