The Levels and Associated Factors for Participation and Autonomy Among People with Parkinson´s Disease: A Cross-Sectional Study.

Background: Promoting participation and autonomy (PA) in society has been highlighted as an ultimate goal of rehabilitation for people with chronic diseases by the World Health Organization, but few studies have focused on PA in people with Parkinson's disease (PD). Therefore, this study aimed to determine the level of PA in PD patients and investigate the associated psychological and behavioural factors. Methods: PD patients were recruited from the Department of Neurology of the First Hospital Affiliated with Dalian Medical University using convenience sampling for this cross-sectional study. A questionnaire covering social-demographic and disease-related characteristics, Chinese version of Impact on Participation and Autonomy (IPA) Questionnaire, Connor-Davidson Resilience Scale (CD-RISC), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), Medical Coping Modes Questionnaire (MCMQ), Social Support Rating Scale (SSRS), Hoehn-Yahr Staging System and Unified Parkinson's Disease Rating Scale (UPDRS) were used for investigation. A multivariate stepwise linear regression analysis was used to determine the factors that influence IPA. Results: A total of 326 PD patients responded to all the questionnaires. The patients had a mean IPA score of 46.6 (SD 21.79). Multiple linear regression analyses revealed that UPDRS II (ß = 0.35, p < 0.001) had the strongest correlation with IPA, followed by tenacity, which was the second strongest factor (ß = -0.25, p < 0.001). Hoehn-Yahr stage (ß = 0.19, p < 0.001) and availability of social support (ß =-0.12, p =0.001) were also strong factors. Conclusion: The average level of PA among PD patients was at the lower middle-level. Among PD patients, physical function, psychological resilience and social support were the strongest factors associated with PA. These findings provide valuable insights into PD patients' PA and can help medical professionals identify the early risks of restricted PA among PD patients, implement interventions to promote PA and ultimately achieve rehabilitation.

Development and visualization of a risk prediction model for metabolic syndrome: a longitudinal cohort study based on health check-up data in China.

Aim: Our study aimed to construct a practical risk prediction model for metabolic syndrome (MetS) based on the longitudinal health check-up data, considering both the baseline level of physical examination indicators and their annual average cumulative exposure, and to provide some theoretical basis for the health management of Mets. Methods: The prediction model was constructed in male and female cohorts, separately. The shared set of predictive variables screened out from 49 important physical examination indicators by the univariate Cox model, Lasso-Cox model and the RSF algorithm collectively was further screened by Cox stepwise regression method. The screened predictors were used to construct prediction model by the Cox proportional hazards regression model and RSF model, respectively. Subsequently, the better method would be selected to develop final MetS predictive model according to comprehensive comparison and evaluation. Finally, the optimal model was validated internally and externally by the time-dependent ROC curve (tdROC) and concordance indexes (C-indexes). The constructed predictive model was converted to a web-based prediction calculator using the "shiny" package of the R4.2.1 software. Results: A total of 15 predictors were screened in the male cohort and 9 predictors in the female cohort. In both male and female cohorts, the prediction error curve of the RSF model was consistently lower than that of the Cox proportional hazards regression model, and the integrated Brier score (IBS) of the RSF model was smaller, therefore, the RSF model was used to develop the final prediction model. Internal validation of the RSF model showed that the area under the curve (AUC) of tdROC for 1 year, 3 years and 5 years in the male cohort were 0.979, 0.991, and 0.983, and AUCs in the female cohort were 0.959, 0.975, and 0.978, respectively, the C-indexes calculated by 500 bootstraps of the male and female cohort RSF models are above 0.7. The external validation also showed that the model has good predictive ability. Conclusion: The risk predictive model for MetS constructed by RSF in this study is more stable and reliable than Cox proportional hazards regression model, and the model based on multiple screening of routine physical examination indicators has performed well in both internal and external data, and has certain clinical application value.

Ficus carica polysaccharide extraction via ultrasound-assisted technique: Structure characterization, antioxidant, hypoglycemic and immunomodulatory activities.

In this research, the ultrasound-assisted extraction (UAE) conditions of the water-soluble polysaccharide (FCPS) from Ficus carica fruits were optimized using the response surface methodology. The optimal FCPS yield was 7.97 % achieved by conducting ultrasound-assisted extraction four times at a solid-liquid ratio of 1:20 (g/mL) and an ultrasound temperature of 70 °C. Then, the structure, antioxidant properties, hypoglycemic effects, and immunomodulatory activities of FCPS were evaluated. FCPS was characterized as irregular, rough-surfaced, flaky materials consisting of pyran-type polysaccharides with α- and ß-glycosidic linkages, and composed of multiple monosaccharides and only one homogeneous concentrated polysaccharide component (FCPS1) with a molecular weight of 4.224 × 104 Da. The results suggested FCPS exhibited remarkable antioxidant activity in vitro, as evidenced by improved cell viability and reduced the reactive oxygen species (ROS) levels. Meanwhile, FCPS effectively improved liver-related insulin resistance by promoting glucose consumption in hepatocytes and activated the immune response through activation of murine bone marrow-derived dendritic cells (DCs) and upregulation of interleukin 6 (IL6) and interleukin 12 (IL-12) expression. The findings demonstrate the efficacy of the UAE technique in isolating FCPS with biological functionality and FCPS could potentially serve as a beneficial organic antioxidant source and functional food, carrying important implications for future studies.

Effects of Probiotics on Autism Spectrum Disorder in Children: A Systematic Review and Meta-Analysis of Clinical Trials.

Many studies have explored the efficacy of probiotics on autism spectrum disorder (ASD) in children, but there is no consensus on the curative effect. This systematic review and meta-analysis aimed to comprehensively investigate whether probiotics could improve behavioral symptoms in children with ASD. A systematic database search was conducted and a total of seven studies were included in the meta-analysis. We found a nonsignificant overall effect size of probiotics on behavioral symptoms in children with ASD (SMD = -0.24, 95% CI: -0.60 to 0.11, p = 0.18). However, a significant overall effect size was found in the subgroup of the probiotic blend (SMD = -0.42, 95% CI: -0.83 to -0.02, p = 0.04). Additionally, these studies provided limited evidence for the efficacy of probiotics due to their small sample sizes, a shorter intervention duration, different probiotics used, different scales used, and poor research quality. Thus, randomized, double-blind, and placebo-controlled studies following strict trial guidelines are needed to precisely demonstrate the therapeutic effects of probiotics on ASD in children.

Association of triglyceride-glucose index with incident hypertension among non-overweight healthy adults: A cohort study in China.

BACKGROUND AND AIMS: Overweight and obesity are well recognized as important and traditional risk factors for hypertension (HTN), but the prevalence of HTN tends to increase in non-overweight people. Triglyceride-glucose (TyG) index has been observed to be associated with HTN. However, whether such association still persists in non-overweight people remains unclear. The aim of our cohort study was to explore the link between TyG index and incident HTN in non-overweight Chinese population. METHODS AND RESULTS: As many as 4678 individuals without HTN at baseline were involved, who underwent at least two years of health check-ups in the eight-year study period and maintained non-overweight at follow-up. According to baseline TyG index quintiles, participants were classified into five groups. Compared with the 1st quantile, those in the 5th quantile of TyG index had a 1.73-fold (HR 95% CI 1.13-2.65) risk of incident HTN. The results remained consistent when analyses were restricted to participants without abnormal TG or FPG level at baseline (HR 1.62, 95% CI 1.17-2.26). Furthermore, the subgroup analyses were conducted, the risk of incident HTN was still significantly increased with increasing TyG index for subgroups of older participants (age≥ 40 years), males, females and higher BMI group (BMI≥ 21 kg/m2). CONCLUSIONS: The risk of incident HTN increased with increasing TyG index among Chinese non-overweight adults, so TyG index might be a reliable predictor of incident HTN among adults maintaining non-overweight.

Association of METS-IR with incident hypertension in non-overweight adults based on a cohort study in Northeastern China.

BACKGROUND: Insulin resistance (IR) plays an important role in the progression of hypertension (HTN); therefore, early identification of IR is clinically important for preventing HTN. Our study aims to explore the relationship between the metabolic score for IR (METS-IR) and HTN in Chinese population who maintained non-overweight. METHODS: A total of 4678 adults who underwent annual health check-up in our institution from 2010 to 2017, did not have HTN at the first check-up and maintained non-overweight at follow-up were selected as subjects. The baseline METS-IR was calculated and the outcome was incident HTN. Cox proportional hazards regression models were used to evaluate hazards ratios of HTN for METS-IR. Additionally, sensitive analyses and stratification analyses were used to deeply verify the relationship of METS-IR with HTN. The dose-response association between METS-IR and HTN risk was investigated using restricted the cubic spline analysis fitted for the Cox proportional hazards model. RESULTS: Compared with the first quartiles of METS-IR, the risk of incident HTN was increased by 58% [hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.12-2.22] and 96% (HR 1.96, 95% CI 1.40-2.76) in the Q3 group and the Q4 group, respectively. The results remained consistent when analyses were restricted to people without abnormal high-density lipoprotein cholesterol, triglyceride or fasting plasma glucose level at baseline. A linear dose-response relationship between METS-IR and HTN risk was identified (HR 1.08, 95% CI 1.04-1.12). CONCLUSIONS: The risk of incident HTN was associated with elevated METS-IR levels in non-overweight individuals. METS-IR could help predict the risk of HTN in non-overweight individuals.

The Effect of Risk Accumulation on Childhood Stunting: A Matched Case-Control Study in China.

Background: Childhood stunting is still a public health issue in developing countries. However, the traditional risk factors in underdeveloped areas are not suitable for developed areas. Moreover, childhood stunting is influenced by several aspects, including genetic factors, perinatal conditions, maternal conditions, and feeding practices, but researchers have not yet clearly determined which aspect of risk accumulation exerts the strongest effect on stunting. A matched case-control study was performed to assess the effect of different aspects of risk accumulation on childhood stunting. Methods: In total, 173 non-stunted children aged under 7 years were matched in our study from June 2015 to August 2015. The children's heights and weights were measured, and a self-administered questionnaire was used to collect information from the children and their parents. The risk factors were assigned to the following five aspects: genetic factors, family socioeconomic status, perinatal conditions, maternal conditions, and feeding practices. The risk accumulation (cumulative risk score) in each aspect was defined as the total number of risk factors that occurred in a certain aspect. A conditional logistic regression model was used to assess the effect of risk accumulation in different aspects on stunting, and a decision-tree model was used to predict the children's stunting based on the cumulative risk scores. Results: Risk accumulation in perinatal conditions, genetic factors, maternal conditions, and feeding practices was significant in the conditional logistic regression model (P < 0.05). Perinatal conditions showed the strongest association with stunting in both the regression analysis and the decision-tree model. The risk of stunting increased by 1.199 times if the cumulative risk score for perinatal conditions increased by one, and the probability of stunting was 75.8% if the cumulative risk score for perinatal conditions was ≥1. Conclusion: Risk accumulation in perinatal conditions, genetic factors, maternal conditions, and feeding practices substantially increased the probability of stunting in childhood. Perinatal conditions were the main aspect associated with stunting. Prevention and intervention measures should be adopted to avoid risk accumulation in stunting.

The Relationship Between Parent-Adolescent Communication and Depressive Symptoms: The Roles of School Life Experience, Learning Difficulties and Confidence in the Future.

Purpose: Adolescent depression has become a public health issue in China. Family environment and school life play important roles in shaping adolescent mental health. Our study aimed to examine the effect of parent-adolescent communication, school-life experiences, learning difficulties, and confidence in the future on depressive symptoms. We also examined the mediating effects of school-life experiences, learning difficulties, and confidence in the future on the relationship between parent-adolescent communication and depressive symptoms. Methods: Data on depressive symptoms, parent-adolescent communication, and mediating variables were obtained from the China Education Panel Survey (CEPS), including baseline data (2013-2014) and follow-up data (2014-2015). Mixed-effect models were used to evaluate the effects of parent-adolescent communication, school-life experiences, learning difficulties, and confidence in the future on depressive symptoms, and path analyses were performed to determine the mediating roles of school-life experiences, learning difficulties, and confidence in the future on the relationship between parent-adolescent communication and adolescent depressive symptoms. Results: More father-adolescent communication, better school-life experiences, and higher confidence in the future were protective factors for depressive symptoms among all boys and girls, and learning difficulties were a risk factor for depressive symptoms among all boys and girls. School-life experiences, learning difficulties, and confidence in the future had statistically significant mediating effects on the relationship between parent-adolescent communication and depressive symptoms. Conclusion: More father-adolescent communication, higher confidence in the future, better school-life experiences, and fewer academic difficulties were associated with lower levels of depressive symptoms. Both mother-adolescent communication and father-adolescent communication affected depressive symptoms through their effects on school-life experience, learning difficulties, and confidence in the future. This finding highlighted the importance of parent-adolescent communication and its impact on depression.

Transition patterns of metabolism-weight phenotypes over time: A longitudinal study using the multistate Markov model in China.

Background: A change in weight or metabolic status is a dynamic process, yet most studies have focused on metabolically healthy obesity (MHO) and the transition between MHO and metabolically unhealthy obesity (MUO); therefore, they have not fully revealed the nature of all possible transitions among metabolism-weight phenotypes over the years. Methods: This was a longitudinal study based on a retrospective health check-up cohort. A total of 9,742 apparently healthy individuals aged 20-60 years at study entry were included and underwent at least two health check-ups. Six metabolism-weight phenotypes were cross-defined by body mass index (BMI) categories and metabolic status as follows: metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), MHO, metabolically unhealthy normal weight (MUNW), metabolically unhealthy overweight (MUOW), and MUO. A multistate Markov model was used to analyse all possible transitions among these phenotypes and assess the effects of demographic and blood indicators on the transitions. Results: The transition intensity from MUNW to MHNW was the highest (0.64), followed by the transition from MHO to MUO (0.56). The greatest sojourn time appeared in the MHNW state (3.84 years), followed by the MUO state (2.34 years), and the shortest sojourn time appeared in the MHO state (1.16 years). Transition intensities for metabolic improvement gradually decreased with BMI level as follows: 0.64 for MUNW to MHNW, 0.44 for MUOW to MHNW, and 0.27 for MUO to MHO; however, transition intensities for metabolic deterioration, including MHNW to MUNW, MHOW to MUOW, and MHO to MUO, were 0.15, 0.38, and 0.56, respectively. In the middle-aged male group, elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), and uric acid (UA) increased the risk of deterioration in weight and metabolic status and decreased the possibility of improvement. Conclusion: Maintaining a normal and stable BMI is important for metabolic health. More attention should be given to males and elderly people to prevent their progression to an unhealthy metabolic and/or weight status. MHO is the most unstable phenotype and is prone to convert to the MUO state, and individuals with abnormal ALT, AST and UA are at an increased risk of transitioning to an unhealthy weight and/or metabolic status; therefore, we should be alert to abnormal indicators and MHO. Intervention measures should be taken early to maintain healthy weight and metabolic status.

Transition Patterns of Weight Status and Their Predictive Lipid Markers Among Chinese Adults: A Longitudinal Cohort Study Using the Multistate Markov Model.

BACKGROUND: Obesity is well recognized as a risk factor for cardiometabolic diseases. The development of obesity is a dynamic process that can be described as a multistate process with an emphasis on transitions between weight states. However, it is still unclear what convenient biomarkers predict transitions between weight states. The aim of this study was to show the dynamic nature of weight status in adults stratified by age and sex and to explore blood markers of metabolic syndrome (MetS) that predict transitions between weight states. METHODS: This study involved 9795 individuals aged 18 to 56 at study entry who underwent at least two health check-ups in the eight-year period of study in the health check-up centre of our institution. Weight, height and biochemical indices were measured at each check-up. The participants were divided into four groups based on age and sex (young male, middle-aged male, young female and middle-aged female groups). A multistate Markov model containing 3 states (healthy weight, overweight and obesity) was adopted to study the longitudinal weight data. RESULTS: Young people were more likely to transit between weight states than middle-aged people, and middle-aged people were more resistant to recover from worse states. The mean sojourn time in obesity was greatest in the middle-aged male group (6.23 years), and the predicted rate of obesity beginning with healthy weight was greatest in the young male group (13.7%). In multivariate models, age group and triglyceride (TG) and high-density lipoprotein cholesterol (HDL) levels were significant for specific transitions in females, whereas age group and HDL levels were significant in males. In females, if HDL levels increased 1 mmol/L, the probability of progression from healthy weight to overweight decreased by 37.0% (HR= 0.63), and the probabilities of recovery (overweight to healthy weight and obesity to overweight) increased by 62.0% (HR= 1.62) and 1.23-fold (HR= 2.23), respectively. In males, if TG levels increased 1 mmol/L, the risk of progression from healthy weight to overweight increased by 24.0% (HR= 1.24). Each unit increase in HDL levels was associated with a 0.99-fold (HR= 1.99) increase in the chance of recovery from overweight to healthy weight and with a 0.37-fold (HR= 0.63) decrease in the risk of progression from healthy weight to overweight. CONCLUSION: The weight status of young people was less stable than that of middle-aged people. Males were more likely to become overweight and more resistant to recover from worse states than females. Young males with healthy weight were more likely to develop obesity than other healthy weight groups. Blood lipid levels, especially HDL, were predictors of weight transitions in adults. Prevention and intervention measures should be applied early.

SOCS3 Negatively Regulates Cardiac Hypertrophy via Targeting GRP78-Mediated ER Stress During Pressure Overload.

Pressure overload-induced hypertrophic remodeling is a critical pathological process leading to heart failure (HF). Suppressor of cytokine signaling-3 (SOCS3) has been demonstrated to protect against cardiac hypertrophy and dysfunction, but its mechanisms are largely unknown. Using primary cardiomyocytes and cardiac-specific SOCS3 knockout (SOCS3cko) or overexpression mice, we demonstrated that modulation of SOCS3 level influenced cardiomyocyte hypertrophy, apoptosis and cardiac dysfunction induced by hypertrophic stimuli. We found that glucose regulatory protein 78 (GRP78) was a direct target of SOCS3, and that overexpression of SOCS3 inhibited cardiomyocyte hypertrophy and apoptosis through promoting proteasomal degradation of GRP78, thereby inhibiting activation of endoplasmic reticulum (ER) stress and mitophagy in the heart. Thus, our results uncover SOCS3-GRP78-mediated ER stress as a novel mechanism in the transition from cardiac hypertrophy to HF induced by sustained pressure overload, and suggest that modulating this pathway may provide a new therapeutic approach for hypertrophic heart diseases.

Campus bullying victimization and its influencing factors among middle school students in Dalian / 中国学校卫生

Objective@#To describe bullying victimization of middle school students in Dalian and associated factors, so as to provide scientific basis for campus bullying prevention.@*Methods@#The stratified cluster sampling method was used to select 2 540 middle school students from urban and rural areas in Dalian, who were investigated with campus bullying victimization and related factors.@*Results@#The reported rate of campus bullying victimization among middle school students in Dalian was 25.11%. The rates of physical violence (5.99%, 3.66%) and verbal violence(24.93%, 15.87%) of male students were higher than that of female students( χ 2=6.56, 27.94, P <0.05). The rates of verbal violence (22.84%, 16.25%) and emotional neglect(16.84%, 13.18%) of junior high school students were higher than those of high school students( χ 2=14.21, 5.44, P < 0.05 ). The rates of physical violence(6.07%, 3.55%), verbal violence(24.58%, 16.05%) and emotional neglect(18.88%, 12.06 %) of rural students were higher than those of urban students( χ 2=7.72, 24.81, 19.64, P <0.05). Male students, junior high school students and rural students suffered more severe campus bullying than female students, high school students and urban students( Z =3.46, 3.75, 5.89, P <0.01). The structural equation model showed that academic performance (path coefficient -0.003) and father s education (path coefficient -0.004 ) have a direct negative effect on campus bullying behavior, while mother s education (indirect action coefficient -0.000 8), height(indirect action coefficient -0.000 3), father s education (indirect action coefficient -0.000 3) and weight (indirect action coefficient 0.000 2) indirect effects on campus bullying through academic performance.@*Conclusion@#The prevalence of campus bullying victimization among middle school students in Dalian is relatively high, which worths further attention to. Rural students, junior high school students and boys are more likely to suffer campus bullying. Improving academic performance might be beneficial for campus bullying prevention.

Sex-specific association of serum uric acid dynamics with the incidence of metabolic syndrome in a health check-up Chinese population: a prospective cohort study.

OBJECTIVE: Many studies have demonstrated that elevated serum uric acid (SUA) level is linked with metabolic syndrome (MetS). However, whether there is a sex difference in the association between SUA and MetS has not been determined. This study aimed to accurately explore the impact of SUA longitudinal changes on MetS by sex. DESIGN: A prospective cohort study. SETTING: The Health Check-up Centre of the Second Hospital affiliated with Dalian Medical University from 2010 to 2016. PARTICIPANTS: A health check-up cohort of 577 men and 1698 women aged 20-60 years who did not exhibit MetS or hyperuricaemia at baseline and underwent at least two physical examinations from 2010 to 2016. PRIMARY AND SECONDARY OUTCOME MEASURES: Weight, height, blood pressure and blood biochemistry parameters, including SUA, were measured. MetS was defined according to the Joint Interim Statement criteria. METHODS: Based on longitudinal data, a linear mixed-effects model was constructed to explore the characteristics of SUA dynamic changes in males and females, and joint modelling of longitudinal and survival data was done to analyse the association between SUA dynamic changes and MetS occurrence. RESULTS: The natural logarithm of SUA (LNSUA) in females exhibited a gradually increasing trend, and its annual growth rate in females who developed MetS was greater than that of the non-MetS females. The longitudinal growth of SUA in females was a risk factor for the onset of MetS, and the estimated HR was 13.2580 (95% CI 1.9106 to 91.9957) for each 1-unit rise in LNSUA longitudinally. An association between the longitudinal growth of LNSUA and MetS was not found in males. CONCLUSIONS: The longitudinal increase in SUA in females could increase the risk of MetS, even if the SUA changes within the normal range. The longitudinal increase in SUA in males was not a predictor for MetS.

Intensive multifactorial intervention improved renal impairment in short-duration type 2 diabetes: A randomized, controlled, 7-year follow-up trial.

AIMS: To investigate the effect of multifactorial intervention on the urinary albumin to creatinine ratio (UACR) and the estimated glomerular filtration rate (eGFR) in short-duration type 2 diabetes. METHODS: A total of 150 type 2 diabetes patients, with disease duration <1 year and with no evidence of atherosclerosis were randomized to either the intensive intervention group (IG, n = 75), or the conventional group (CG, n = 75) for 7 years. The predefined endpoint of microvascular complications was the progression of renal impairments (the development of albuminuria and the change of eGFR). RESULTS: The incidence of progression to albuminuria (UACR ≥30 mg/g) was 12% in IG and 28% in CG (HR 0.37, 95% CI: 0.19-0.70, P = .0025). eGFR was significantly lower in IG than that in CG in the year 2 (P = .043) and 3 (P = .032) follow-up. Sex, fasting plasma glucose (FPG), HbA1c, and systolic blood pressure (SBP) were independently associated with the UACR (ß = -5.112, P = .015; ß = 0.908, P = .045; ß = 2.087, P = .038; and ß = 2.787, P = .002, respectively); aging was independently associated with eGFR (ß = -0.447, P = .000). CONCLUSIONS: Intensive multifactorial intervention delayed the progression to albuminuria, and reduced eGFR rapidly in early stage of intervention in short-duration type 2 diabetes. FPG, HbA1c, and SBP were risk factors for UACR increase; aging was a risk factor for eGFR decline.

Transition Patterns of Weight Status and Their Associated Factors among Elementary School Children: A Longitudinal Cohort Study Using Multistate Markov Model.

Background: Childhood obesity is a recognized public health concern worldwide. It is essential to study the natural progression of obesity in the interest of prevention. This study aimed to describe the dynamic changes in weight status among elementary school children and identify the significant factors influencing the progression or regression of weight status. Methods: This study involved 928 elementary school children who were followed up annually during their elementary school years. Heights, weights, and vital capacity (VC) were measured each school year. A multistate Markov model containing three weight states was fit to longitudinal weight status data. Results: Children with healthy weight and obesity tended to stay in their preceding weight state. Children with overweight, in contrast, were more likely to move to the other two states. The mean sojourn time in obesity and in overweight states was 5.15 years (95% confidence interval [CI]: 4.22-6.3) and 2 years (95% CI: 1.76-2.28), respectively. Children in lower grades, those with a lower VC index, those with a higher initial BMI, those with a higher annual weight increment, and boys were at increased risk of progression to overweight or obesity, with a decreased probability of regression. Conclusions: Children with obesity were more resistant to recovery than those with overweight. Prevention and intervention measures should be adopted early when abnormal weight onset occurs. The multistate Markov model was an advanced tool to analyze dynamic changes in status and identify significant factors for progression and regression and helped to develop prevention and intervention targeting strategies.

The longitudinal increments of serum alanine aminotransferase increased the incidence risk of metabolic syndrome: A large cohort population in China.

BACKGROUND: Although alanine aminotransferase (ALT) is well known to be associated with metabolic syndrome (MetS), prospective data on longitudinal increments in ALT activities and incident cases of MetS are limited. We analyzed the impact of longitudinal increments of ALT on MetS based on a health check-up population in China. METHODS: A total of 4491 subjects free of MetS who completed at least two annual health examinations during March 2010 to April 2016 were enrolled in this cohort study. The MetS was defined according to the Joint Interim Statement criteria 2009. The RRs of incident MetS were estimated by using the Cox model and the Joint model in R software. RESULTS: The cumulative incidence of MetS was 18.55% during the 7 years of follow-up. In the Cox model, the estimated RR of developing MetS was 1.751 (95% CI =1.532-2.000) for 1 unit augmented in LNALT-0 level. In the Joint model, the estimated RR of developing MetS was 3.626 (95% CI = 2.721-4.831) for 1 unit augmented in LNALT activity longitudinally. CONCLUSIONS: The longitudinal increment of individuals' ALT activity over time increased the incidence risk of MetS and the effects generated by longitudinal increments of ALT on MetS was higher than that generated by baseline ALT.

Calcium-Polystyrene Sulfonate Decreases Inter-Dialytic Hyperkalemia in Patients Undergoing Maintenance Hemodialysis: A Prospective, Randomized, Crossover Study.

Hyperkalemia is a life-threatening emergency in maintenance hemodialysis (MHD) patients. This clinical trial investigated the efficacy and safety of calcium-polystyrene sulfonate (Ca-PS) in MHD patients with interdialytic hyperkalemia. A total of 58 hemodialysis patients with hyperkalemia (≥5.5 mol/L) were selected and administered either a 3-week Ca-PS (3 × 5 g/day) or a blank control following the model of a prospective, randomized, crossover clinical trial with a 1-week washout period. All patients were followed up for another 3 weeks for safety evaluations. The primary outcome was the magnitude of the change in serum potassium levels. The secondary outcomes were electrocardiography (ECG) changes and treatment safety (volume overload, electrolyte imbalance). Compared with the control group, Ca-PS treatment significantly reduced serum potassium levels (P <0.01). More patients in the Ca-PS group had lower serum potassium levels than the safety level of <5.5 mmol/L (32% for control vs. 61% for Ca-PS, P <0.01). Peaked T-wave occurred less frequently in patients in the Ca-PS group (13.8% for Ca-PS vs. 31.03% for control, P <0.01). In addition, Ca-PS reduced serum phosphorus levels with no effects on serum levels of calcium and sodium, fluid volume, blood pressure, or interdialytic weight gain. Ca-PS treatment decreases serum levels of potassium and phosphorus in MHD patients with interdialytic hyperkalemia. Ca-PS does not induce volume overload or disrupt electrolyte balance.

Longitudinal associations of high-density lipoprotein cholesterol or low-density lipoprotein cholesterol with metabolic syndrome in the Chinese population: a prospective cohort study.

OBJECTIVE: Currently, most studies only reveal the relationship between baseline high-density lipoprotein cholesterol (HDL-c) or low-density lipoprotein cholesterol (LDL-c) levels and metabolic syndrome (MetS). The relationship between dynamic changes in HDL-c or LDL-c and MetS remains unclear. We aimed to gain a deeper understanding of the relationship between the dynamic changes in HDL-c or LDL-c and MetS. DESIGN: A prospective study. SETTING: The Medical Centre of the Second Hospital affiliated with Dalian Medical University from 2010 to 2016. PARTICIPANTS: A total of 4542 individuals who were initially MetS-free and completed at least two follow-up examinations as part of the longitudinal population were included. METHODS: The Joint Interim Statement criteria 2009 were used to define MetS. We used the Joint model to estimate the relative risks (RRs) of incident MetS. RESULTS: The cumulative incidence of MetS was 17.81% and was 14.86% in men and 5.36% in women during the 7 years of follow-up. In the Joint models, the RRs of the longitudinal decrease in HDL-c and the longitudinal increase in LDL-c for the development of MetS were 18.8781-fold (95% CI 12.5156 to 28.4900) and 1.3929-fold (95% CI 1.2283 to 1.5795), respectively. CONCLUSIONS: The results highlight that the dynamic longitudinal decrement of HDL-c or the increment of LDL-c is associated with an elevated risk of MetS.

Atherosclerosis associated with dynamic inflammation changes after multifactorial intervention in short-duration type 2 diabetes: A randomized, controlled, 10-year follow-up trial.

PURPOSE: To analyze the impact of dynamic changes in inflammation on atherosclerosis in short-duration type 2 diabetes after multifactorial intervention. METHODS: In this randomized controlled study, a total of 150 type 2 diabetes patients who had a mean age of 49.8±7.3years, 51% male, with disease duration <1year and without evidence of atherosclerosis were randomized into an intensive intervention group (IG), in which patients received multiple risk factors intervention by the special project team and tried to reach the pre-determined intervention goals, and a conventional group (CG), in which patients received standard diabetes care by the clinic doctor. All patients recieved intervention study for 7 years, then underwent a 3-year observational follow-up study. The primary endpoints were occurrence of subclinical atherosclerosis, defined as the intima-media thickness of the common carotid artery (CC-IMT)≥1.0mm or formation of atherosclerosis plaques, and the occurrence of cardiovascular events. RESULTS: 68 patients in IG and 65 patients in CG completed the 10-year study. The cumulative incidence of subclinical atherosclerosis was 30.7% vs 57.3% (IG vs CG, HR 0.36, 95% CI 0.22-0.60, P<0.0001) and that of cardiovascular events was 12.0% vs 22.7% (IG vs CG, HR 0.46, 95% CI 0.21-0.98, P=0.0516). High sensitivity C-reactive protein (hs-CRP) reduction from baseline to the 10-year follow-up was -1.54mg/L (IG) and -0.67mg/L (CG) with difference (IG minus CG) of -0.87mg/L(95% CI -0.72 to -1.02, P=0.008) and the natural logarithm of serum amyloid A (SAA) reduction was -4.04 (IG) and -1.44 (CG) with difference (IG minus CG) of -2.60 (95% CI -2.30 to -2.90, P=0.002). The decrease in general score of inflammatory markers (combination of hs-CRP and SAA) was independently associated with subclinical atherosclerosis (OR=0.65, P=0.045) and cardiovascular events (OR=0.60, P=0.042). CONCLUSIONS: Dynamic changes in inflammation act as an important factor that affects the occurrence of atherosclerosis in type 2 diabetes patients. Multifactorial intensive intervention can reduce systemic low-grade inflammation and delay the occurrence of atherosclerosis in short-duration type 2 diabetes.

Efficacy and safety of FOLFIRI and biotherapy versus FOLFIRI alone for metastatic colorectal cancer patients: A meta-analysis.

BACKGROUND: Previous randomized controlled trials (RCTs) and meta-analyses have demonstrated the useless of FOLFIRI alone for previously treated patients with metastatic colorectal cancer (mCRC). The role of FOLFIRI regimen combined with biological therapy is unknown. The purpose of this meta-analysis is to evaluate the efficacy and safety of combining biological therapy with chemotherapy in previously treated patients with mCRC. METHODS: MEDLINE, EMBASE, Web of Science, Cochrane library, and ClinicalTrials.gov were searched. Eligible studies were RCTs that evaluated the efficacy and safety of the FOLFIRI regimen with or without biological therapy for previously treated patients with mCRC. The hazard ratio (HR) or risk ratio (RR) with 95% confidence interval was estimated. The Chi-squared and I-squared tests were used to assess the statistical heterogeneity. RESULTS: The literature search identified 7 RCTs that met the inclusion criteria for the meta-analysis, and 3680 patients with mCRC were included. The meta-analysis showed that combined therapy was associated with a significant improved progression-free survival (PFS) (HR = 0.78, 95% CI = 0.72-0.85, P < .001), overall survival (OS) (HR = 0.84, 95% CI = 0.77-0.92, P < .001), and overall response rate (ORR) (RR = 1.70, 95% CI = 1.25-2.31, P = .001). Sensitivity analysis suggested that combined therapy versus FOLFIRI alone might increase the risk of Grade 3/4 AEs. CONCLUSION: The addition of biological therapy to the FOLFIRI regimen improved the PFS, OS, and ORR compared with FOLFIRI alone for previously treated patients with mCRC. Long-term survival outcomes are warranted.