[Association of BMI with acute exacerbation in mild to moderate chronic obstructive pulmonary disease patients in community: a prospective study].

Objective: BMI may play a protective role in reducing the mortality rate of patients with chronic obstructive pulmonary disease (COPD), but its effect on acute exacerbation of COPD remain unclear. Methods: Subjects were selected from the COPD patients registration system established in 2014 in Pudong new district, Shanghai. COPD patients from 8 communities were selected by cluster sampling and follow up was conducted prospectively for 18 months. Basic information and BMI were obtained from baseline survey, and acute exacerbations were collected during follow-up. The association between BMI and risk of acute exacerbation was evaluated by using multiple negative binomial regression. Results: Among 328 community COPD patients, 295 who completed the follow up were included in the analysis, in whom 96.3% (284/295) were mild COPD patients. During the follow-up, 11.1% (33/295) of the patients reported acute exacerbation. The results of multiple negative binomial regression suggested that, the risk for acute exacerbation decreased with the increase of BMI (IRR=0.85, 95%CI:0.73-0.98), overweight patients with BMI ≥25.0 kg/m2 (IRR=0.36, 95%CI:0.13-0.91) or moderate BMI (T2 vs. T1, IRR=0.31, 95%CI:0.11-0.77) had lower risk for acute exacerbation compared with the patients with normal or low BMI. BMI had a linear correlation with the risk of acute exacerbation. Conclusion: The risk for acute exacerbation in patients with mild or moderate COPD in communities decreased with the increase of BMI, and being overweight might be a protective factor for the acute exacerbation of COPD.

[Temporal trend of antibiotic use among primary school children in Shanghai, 2017-2020].

To investigate the temporal trend of antibiotic use among children in Shanghai from 2017 to 2020. The stratified cluster sampling method was used to establish a dynamic cohort of healthy children based on primary schools in Changning District, Shanghai. In the cohort, there were 282 children from 2017, 287 children from 2018, 294 from 2019 and 301 from 2020. A total of 700 children aged 7-11 years were included in the study. The basic information and antibiotic use of children were investigated by questionnaire every year, and their height and weight were measured at the same time. Chi-square test was used to analyze the difference of antibiotic use rate in each year and generalized estimation equation was used to analyze the temporal trend of antibiotic use. The results showed that the use rates of all antibiotics, cephalosporins, azithromycin and other antibiotics (including penicillin, lincomycin, quinolones, etc.) of children between 2017 and 2020 were 15.6%, 10.5%, 2.7%, and 2.4%, respectively. In 2017, 2018, 2019, and 2020, there were significant differences for the use rates of total antibiotics and other antibiotics in children (P=0.033, P=0.040), and there were no significant differences for the use rates of cephalosporins and azithromycin (P=0.274, P=0.455). After adjusting for children's basic characteristics, the generalized estimation equation showed that the annual use rate of all antibiotics, cephalosporins, and other antibiotics decreased over time.

[Incidence and risk factors of metabolic syndrome in rural community population on islands in Zhejiang province].

Objective: To estimate the incidence of metabolic syndrome and explore possible risk factors for metabolic syndrome in adults of rural communities in Yuhuan county, Zhejiang province, China. Methods: During June-December, 2018, a follow-up survey was conducted in participants without metabolic syndrome at baseline survey in 2012 to obtain the information collected in questionnaire survey, anthropometric data and laboratory data. The incidence of metabolic syndrome in the participants was estimated, and Logistic regression model was used to explore the risk factors, adjusted risk ratio (aRR) and 95%CI. Results: Among 3 162 participants, 522 new metabolic syndrome cases were identified. The 6-year cumulative incidence rate of metabolic syndrome was 16.5%, and the cumulative incidence rate was higher in women (20.6%) than that in men (12.3%, P<0.001). Those incidence rates were higher in those in jobless, smoking or drinking groups. Being women (aRR=1.96, 95%CI: 1.50-2.58) and family history of hypertension (aRR=1.31, 95%CI: 1.04-1.63) were independent risk factors for metabolic syndrome. Conclusion: The follow up indicated that the incidence of metabolic syndrome was relatively high in rural adults on islands in Zhejiang, and women or those with family history of hypertension were more likely to have metabolic syndrome.

[Association between puberty with thyroid morphology and function in women].

Objective: To explore the effects of different puberty development stages on thyroid morphology and function in women. Methods: From October to November 2017, a multi-stage cluster sampling method was used to select one junior high school in Minhang district of Shanghai, Haimen city of Jiangsu province, Yuhuan city of Zhejiang province and Deqing county of Zhejiang province respectively. A total of 491 girls in the first grade in 4 schools were included in the study. The subjects were examined with thyroid B-ultrasound and physical examination, and their morning random urine samples and fasting blood samples were collected to detect urinary iodine and thyroid function indexes. Puberty Development Self-rating Scale (PDS) was used to evaluate the stages of puberty; multiple linear regression models and logistic regression models were used to investigate the effects of different puberty stages on thyroid morphology and function. Results: There were differences in thyroid status among women at different stages of puberty. Thyroid volume, the rate of nodules and the level of FT4 were lowest in prepubertal period, followed by pubertal period and postpubertal period (P<0.05). TT3 and FT3 levels were highest in prepubertal period, followed by pubertal period and postpubertal period (P<0.001), and there was an opposite trend on the abnormal rate. TSH and TT4 levels were not affected by the stage of puberty (P>0.05). Multiple linear regression analysis and multivariate logistic regression analysis showed consistent results. There was a negative correlation between puberty development and TT3 and FT3 levels. For each 1 point increase in PDS, TT3 and FT3 levels decreased by 0.067 nmol/L and 0.170 nmol/L in Model 1, respectively, and decreased by 0.065 nmol/L and 0.162 nmol/L in Model 2, respectively. Compared with the prepubertal period, the TT3 and FT3 levels were lower in postpubertal period (Model 1: OR=0.337, 95%CI: 0.173-0.658; OR=0.283, 95%CI: 0.144-0.557; Model 2: OR=0.306, 95%CI: 0.155-0.605; OR=0.263, 95%CI: 0.132-0.524). Conclusions: The process of puberty is related to the thyroid status in women. The better matured during the puberty, the larger volume the thyroid was, more likely the thyroid nodules appeared, and the levels of TT3 and FT3 was much lower.

[A cohort study on the association between dynamics of thyroid volume and the changes of physical growth as well as the comparison of different thyroid volume indexes in school-aged children].

Objectives: To investigate the association between the dynamics of thyroid volume and the changes of physical growth in school-aged children as well as to compare the applicability of different thyroid volume indexes, so as to explore more reliable methods for the assessment of thyroid volume. Methods: In October 2012, a multi-stage cluster sampling method was used to select a primary school in Minhang district of Shanghai, Haimen city of Jiangsu province and Yuhuan city of Zhejiang province, respectively. In these areas, a total number of 784 students aged 8-10 years were enrolled in the cohort. Demographic data was collected, while height and weight were measured, with BMI and body surface area (BSA) were calculated. Thyroid volume was examined by B-ultrasonography. Height volume index (HVI), weight and height volume index (WHVI), BMI volume index (BMIV) and BSA volume index (BSAV) were all applied to correct the thyroid volume. All students were followed up, one year later. Results: A total of 769 students with complete data on thyroid volume and physical growth were enrolled, including 378 boys (49.16%) and 391 girls (50.84%). Thyroid volume showed an increase with age, while growth of thyroid volume reduced with the increase of age (P<0.001). The thyroid volume showed a correlation with the changes of physical growth. The growth of height appeared as the dominant influencing factor for thyroid volume growth in those aged 8 and 10 years (P<0.05), while the growth of weight, BMI and BSA were all influencing factors for thyroid volume on students aged 9 years (P<0.05). Conclusions: Thyroid volume in school-aged children was a factor not only associated with age but also with physical growth which had not been considered in the currently used criteria. The inclusion of items as iodine intake, age, physical growth into the thyroid volume indexes seemed to be more reliable, in practice. For the assessment of goiter, HVI for students aged 8 and 10 years and BMIV for students aged 9 years might serve as better indicators.

[Study on the situation of drug use in patients with chronic obstructive pulmonary diseases in the Chinese communities of large cities].

Objectives: To understand the medication being used among patients with chronic obstructive pulmonary diseases (COPD) in Chinese communities of large cities. Methods: A cross-sectional survey was carried out in Beijing, Shanghai, Chengdu and Guangzhou with the total number as 678 COPD cases who were continuously recruited. Subjects were face-to-face interviewed using a structured questionnaire and with medical records checked at the same time. All data were double entered into a database under EpiData 3.1, and analyzed by SAS 9.2. Results: One quarter of all the subjects did not receive any clinical treatment. The top three drugs for COPD were expectorant (50.74%), phosphodiesterase inhibitors (49.56%), and leukotriene (49.12%). Totally, there were 36 different types combination of drugs used for COPD and the proportions of drugs being used as one, two, and three or more at the same time were 29.5%(200 cases), 39.7%(269 cases) and 30.8%(209 cases) respectively. In addition 36.6% (248 cases) of them used oxygen. There were statistical correlations between drug-use patterns and the severity of COPD. Conclusion: The patterns of medication varied over COPD cases in communities from Chinese large cities and appeared differently under the recommendations in the clinical guidelines set for COPD. Guidance and surveillance programs on drugs use for COPD should be improved on patients with COPD in the Chinese communities.

[Association between IKZF3 gene polymorphisms and systemic lupus erythematosus in Han ethnic group in southern China: a case-control study].

OBJECTIVE: To understand the association between IKZF3 gene polymorphism and the risk of systemic lupus erythematosus(SLE)in Han ethnic group in southern China. METHODS: A case-control study was conducted among 213 SLE patients and 234 healthy controls. Venous blood samples were collected from them to measure single nucleotide polymorphism(SNP)in IKZF3 by using the method of restriction fragment length polymorphism(PCR-RFLP). Multivariate logistic analysis and generalized multifactor dimensionality reduction(GMDR)method were used under multiple genetic models(additive, dominant, recessive), to analyze the association between IKZF3 and SLE susceptibility or different clinical features and gene-gene interactions. In addition, bioinformatics analysis was also conducted. RESULTS: As for rs114509391, CA genotype might decrease the risk of SLE compared with AA genotype(OR=0.14, 95%CI: 0.03-0.56, P=0.006)and significant association was also observed under dominant model(OR=0.26, 95%CI: 0.09-0.81, P=0.02). Stratified analysis indicated that rs9635726 and rs9909593 were related to SLE onset. The study of clinical features showed that rs907091 was associated with both renal disorder(additive: OR=0.59, 95%CI: 0.35-0.98, P=0.043)and anti-SSB(dominant: OR=0.41, 95%CI: 0.18-0.96, P=0.040). rs9635726 GG and GA genotype might decrease the risk of anti-SSB compared with AA genotype(OR=0.37, 95%CI:0.16-0.88, P=0.025). In addition, bioinformatics analysis indicated that all the studied SNPs were functional. CONCLUSION: IKZF3 rs114509391, rs9635726 and rs9909593 polymorphisms might be related to SLE susceptibility in Han ethnic group in southern China and rs9909593, rs907091 might be associated with renal disorder and anti-SSB.

[A meta-analysis of microRNA-149, microRNA-499 gene polymorphism and susceptibility to hepatocellular carcinoma].

OBJECTIVE: To investigate the relationship between microRNA-149 (rs2292832), microRNA-499 (rs2292832) polymorphism and hepatocellular carcinoma susceptibility by meta-analysis. METHODS: We used"hepatocellular carcinoma/HCC","miRNA-149/miR-149/microRNA-149", and"miRNA-499/miR-499/microRNA-499"as key words to search papers in databases including China National Knowledge Internet (CNKI), Chinese BioMedical Literature (CBM), Vip Citation Databases (VIP), Wanfang, PubMed and Web of Science databases, and collected the case-control studies on the association of rs2292832 or rs3746444 and the susceptibility to hepatocellular carcinoma from updated to May 31st 2015. Data were extracted by two independent reviewers and pooled OR with 95% CI was calculated. A bioinformatics analysis was further conducted. RESULTS: A total of 13 research papers were collected, and 5 studies for rs2292832 and 12 studies for rs3746444. 1 096 cases and 1 701 controls were included for rs2292832 and 3 117 cases and 4 126 controls were included for rs3746444. Meta-analysis failed to detect associations between rs2292832, rs3746444 and susceptibility to hepatocellular carcinoma under each genetic model tested and alleles of OR(95% CI) were 0.99(0.78-1.28) and 1.11(0.88-1.40). However, subgroup analysis showed that rs3746444 C allele seem to be associated with an increased hepatocellular carcinoma risk in both researches which had more than 400 samples and which used more accurate genotyping methods, and OR(95%CI) were 1.32(1.02-1.70) and 1.34(1.09-1.66), respectively. Furthermore, bioinformatics analysis also showed that the expression of both SNPs were down-regulated in HepG2 cells and indicated possible functional effects on gene transcription. Cochran's Q test indicated that there was the heterogeneity among the studies included. CONCLUSIONS: No significant association was found between rs2292832, rs3746444 and susceptibility to hepatocellular carcinoma, but subgroup study indicated C allele might be associated with increased hepatocellular carcinoma risk for rs3746444. Bioinformatics analysis indicated that the two SNPs might have possible influence on gene transcription.

Association of the interleukin-6 polymorphisms with systemic lupus erythematosus: a meta-analysis.

BACKGROUND: Interleukin (IL)-6, an important proinflammatory cytokine, plays a potential pathological role in systemic lupus erythematosus (SLE). Studies on the relationship of IL-6 gene polymorphisms with SLE are inconclusive. The aim of this study was to estimate the relationship more precisely. METHODS: The databases of PubMed and Web of Science updated to 30 August 2014 were retrieved. Meta-analysis was conducted using allelic contrast, dominant, recessive and homozygote contrast models. Fifteen studies were included in this study and ethnicity-specific meta-analysis was performed on European, Iranian and Asian populations. RESULTS: Analysis for the IL-6-174 G/C polymorphism under all models except the homozygote contrast model indicated an association in the overall population (allelic contrast model: odds ratio (OR) 1.428, 95% confidence interval (CI) 1.124-1.812, dominant model: OR 1.382, 95% CI 1.037-1.842, recessive model: OR 1.610, 95% CI 1.158-2.240, homozygote contrast model: OR 1.759, 95% CI 0.989-3.127), as well as in European individuals under all four genetic models (allelic contrast model: OR 1.557, 95% CI 1.155-2.098, dominant model: OR 1.699, 95% CI 1.203-2.400, recessive model: OR 1.506, 95% CI 1.176-1.930, homozygote contrast model: OR 2.118, 95% CI 1.103-4.065). Analysis for the IL-6-572 G/C polymorphism indicated significant association in overall ethnicities under the recessive model (OR 1.491, 95% CI 1.104-2.014), but not under other models or in Asian individuals. In addition, significant association between the IL-6-174 G/C polymorphism and discoid skin lesions and antinuclear antibodies (ANAs) were found under the allelic contrast model and recessive model, respectively (discoid skin lesions: OR 2.271, 95% CI 1.053-4.895; ANAs: OR 2.244, 95% CI 1.141-4.416). CONCLUSION: This meta-analysis provides evidence of the association between the IL-6 polymorphism and the risk of SLE, hinting that the IL-6-174 G/C and IL-6-572 G/C polymorphisms may play a role in SLE susceptibility.

Association between serum 25-hydroxyvitamin D levels measured 24 hours after delivery and postpartum depression.

OBJECTIVE: To assess the possible relationship between serum levels of 25[OH]D (25-hydroxyvitamin D) collected 24 hours after delivery and postpartum depression in a Chinese cohort sample. DESIGN: Cohort study. SETTING: One city hospital in Beijing, China. POPULATION: Women delivering a full-term, singleton, live-born infant at one city hospital in Beijing between August 2013 and November 2013. METHODS: Women were enrolled immediately postpartum. A blood sample was obtained 24-48 hours after childbirth to test serum levels of 25[OH]D. Participation consisted of a visit to an obstetric unit 3 months after delivery. MAIN OUTCOME MEASURE: At 3 months' postpartum, women were screened for depression using the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome measure was a prespecified EPDS score of ≥12. RESULTS: During the study period, 323 women were admitted. In all, 248 agreed to enrol and 213 completed 3 months' follow-up (21 were lost to follow-up and 14 withdrew). Of the 213 women who were included, 26 (12.2%) were considered to meet criteria for postpartum depression. Serum 25[OH]D levels in women with no postpartum depression were significantly higher than those in women with postpartum depression (P < 0.0001). Based on the receiver operating characteristic curve, the optimal cutoff value for serum 25[OH]D level as an indicator for screening for postpartum depression was estimated to be 10.2 ng/ml, with an area under the curve of 0.801 (95%CI 0.704-0.896). In multivariate analysis, there was an increased risk of postpartum depression associated with 25[OH]D levels ≤10.2 ng/ml (OR 7.17, 95%CI 3.81-12.94; P < 0.0001) after adjusting for possible confounders. CONCLUSION: Our study demonstrated that lower serum 25[OH]D levels were associated with postpartum depression. This association was independent of other possible variables.

Laparoscopic high anterior resection with natural orifice specimen extraction (NOSE) for early rectal cancer.

Laparoscopic surgery for colorectal cancer requires an abdominal incision to extract the resected specimen. We describe a technique for laparoscopic resection of an early-stage upper rectal cancer in a 51-year-old man followed by transanal specimen delivery, hence avoiding the need for making any additional abdominal incisions for retrieval of the specimen. Pneumoperitoneum was created, followed by medial-tolateral mobilization of the sigmoid colon, and take down of the splenic flexure and division of the inferior mesenteric vessels laparoscopically. The upper rectum distal to the tumour and proximal colon was transected with a laparoscopic stapler. The specimen was retrieved transanally via an opening in the rectal stump. The proximal colon was then delivered transanally and the anvil of the circular stapler inserted before returning it to the pelvic cavity. The rectal stump was transected again just below the opening to close off the stump, and the colorectal anastomosis was then completed intracorporeally. The patient, a 51-year-old male (BMI 18.6 kg/m(2)) with a 2.5-cm, early-stage posterior rectal cancer 12 cm from the anal verge, underwent the above-described procedure. Postoperative recovery was uneventful. He resumed normal daily activities 1 week after surgery. Histology confirmed a T1N0 upper rectal cancer. In the effort to minimize surgical trauma and postoperative pain, natural orifice specimen extraction techniques have been attempted. This procedure may be applicable to benign tumours and early colorectal cancer, and serves as an intermediate step between laparoscopic and natural orifice surgery.

Statistical change detection with moments under time-varying illumination.

In this paper, an illumination-independent statistical change detection method is proposed. The proposed method consists of two parts. First, based on our defined circular shift moments, structural changes can be distinguished from those due to time-varying illumination in the noise-free case. Moreover, the amount of computation is less than that of the shading model method. Second, in the light of the characteristics of the defined moments, a statistical decision rule is also proposed to cope with the effects of noise. The change detection problem can be treated as one of hypothesis testing. Critical values can be chosen according to the desired level of significance. Experimental results indicate that the proposed method detects changes accurately in the time-varying illumination case.

Determination of propranolol and 4-hydroxypropranolol in human plasma by high-performance liquid chromatography.

A high-performance liquid chromatographic method was developed to determine the levels of propranolol and its major metabolite, 4-hydroxypropranolol, in human plasma. The limits of determination are 10 ng ml-1 of propranolol and 5 ng ml-1 of 4-hydroxypropranolol using a 0.5-ml plasma sample. The stability of plasma samples stored at -30 degrees C for up to 2 months was also tested. No stabilising antioxidants were added to the samples.