Differences in antibiotic use between COPD and non-COPD residents based on the health information system.

OBJECTIVES: To compare the differences in antibiotic use between COPD and non-COPD residents, and to explore the effect of COPD on antibiotic use. METHODS: Participants aged 40 years old or over from the Songjiang Adult Cohort were included. Information on prescription and baseline survey was collected based on the health information system. A logit-negative binomial Hurdle model was used to explore correlations between COPD and percentage of antibiotic use and average rate of antibiotic prescribing of different types of antibiotic. Multinomial logistic regression was used to assess the association between COPD and antimicrobial combination therapy and routes of administration. RESULTS: A total of 34576 individuals were included and 1594 (4.6%) were COPD patients. During the 6 years' follow-up, the percentage of antibiotic use for COPD patients was 98.4%, which was 7.88 (95%CI: 5.24-11.85) times of that for non-COPD patients after adjusting for potential confounders. The prescribing rate was 3220 prescriptions (95%CI: 3063.6-3385.2) per 1000 person-years for COPD patients, which was 1.96 (95%CI: 1.87-2.06) times of that for non-COPD patients. Other beta-lactam antibacterials, Macrolides, lincosamides and streptogramins, and quinolone antibacterials were the most commonly used types of antibiotic. Except for aminoglycoside antibacterials, both percentage of antibiotic use and rate of antibiotic prescription were increased in COPD patients. COPD patients were more likely to be prescribed a maximum of two antibiotics (OR=1.34, 95%CI: 1.20-1.50); and were more likely to use antibiotics intravenously (OR=2.77, 95%CI: 2.47-3.11). CONCLUSION: COPD patients were more likely to have increased antibiotic use in a large-scale population-based adult cohort, suggesting COPD patients are a high-priority group for the management of antibiotic use in communities.

Impact of low-level exposure to antibiotics on bile acid homeostasis in adults: Implication for human safety thresholds.

Bile acid homeostasis is critical to human health. Low-level exposure to antibiotics has been suggested to potentially disrupt bile acid homeostasis by affecting gut microbiota, but relevant data are still lacking in humans, especially for the level below human safety threshold. We conducted a cross-sectional study in 4247 Chinese adults by measuring 34 parent antibiotics and their metabolites from six common categories (i.e., tetracyclines, qinolones, macrolides, sulfonamides, phenicols, and lincosamides) and ten representative bile acids in fasting morning urine using liquid chromatography coupled to mass spectrometry. Daily exposure dose of antibiotics was estimated from urinary concentrations of parent antibiotics and their metabolites. Urinary bile acids and their ratios were used to reflect bile acid homeostasis. The estimated daily exposure doses (EDED) of five antibiotic categories with a high detection frequency (i.e., tetracyclines, qinolones, macrolides, sulfonamides, and phenicols) were significantly associated with urinary concentrations of bile acids and decreased bile acid ratios in all adults and the subset of 3898 adults with a cumulative ratio of antibiotic EDED to human safety threshold of less than one. Compared to a negative detection of antibiotics, the lowest EDED quartiles of five antibiotic categories and four individual antibiotics with a high detection frequency (i.e., ciprofloxacin, ofloxacin, trimethoprim, and florfenicol) in the adults with a positive detection of antibiotics had a decrease of bile acid ratio between 6.6% and 76.6%. Except for macrolides (1.2×102 ng/kg/day), the medians of the lowest EDED quartile of antibiotic categories and individual antibiotics ranged from 0.32 ng/kg/day to 10 ng/kg/day, which were well below human safety thresholds. These results suggested that low-level antibiotic exposure could disrupt bile acid homeostasis in adults and existing human safety thresholds may be inadequate in safeguarding against the potential adverse health effects of low-level exposure to antibiotics.

Evaluation of phase-adjusted interventions for COVID-19 using an improved SEIR model.

A local COVID-19 outbreak with two community clusters occurred in a large industrial city, Shaoxing, China, in December 2021 after serial interventions were imposed. We aimed to understand the reason by analysing the characteristics of the outbreak and evaluating the effects of phase-adjusted interventions. Publicly available data from 7 December 2021 to 25 January 2022 were collected to analyse the epidemiological characteristics of this outbreak. The incubation period was estimated using Hamiltonian Monte Carlo method. A well-fitted extended susceptible-exposed-infectious-recovered model was used to simulate the impact of different interventions under various combination of scenarios. There were 387 SARS-CoV-2-infected cases identified, and 8.3% of them were initially diagnosed as asymptomatic cases. The estimated incubation period was 5.4 (95% CI 5.2-5.7) days for all patients. Strengthened measures of comprehensive quarantine based on tracing led to less infections and a shorter duration of epidemic. With a same period of incubation, comprehensive quarantine was more effective in containing the transmission than other interventions. Our findings reveal an important role of tracing and comprehensive quarantine in blocking community spread when a cluster occurred. Regions with tense resources can adopt home quarantine as a relatively affordable and low-impact intervention measure compared with centralized quarantine.

Do gut microbiome-targeted therapies improve liver function in cirrhotic patients? A systematic review and meta-analysis.

BACKGROUND AND AIM: Microbiome-targeted therapies (MTTs) are considered as promising interventions for cirrhosis, but the impact of gut microbiome modulation on liver function and disease severity has not been fully assessed. We comprehensively evaluated the efficacy of MTTs in patients with liver cirrhosis. METHODS: Data from randomized controlled trials were collected through MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrial.gov from inception to February 20, 2023. Clinical outcomes were pooled and expressed in terms of risk ratios or mean differences (MD). Additional subgroup and sensitivity analyses were performed to validate the robustness of findings. A trial sequential analysis was applied to calculate the required information size and evaluate the credibility of the meta-analysis results. RESULTS: Twenty-one studies with a total of 1699 cirrhotic patients were included for meta-analysis. MTTs were associated with a significant reduction in aspartate aminotransferase (MD, -3.62; 95% CI, -6.59 to -0.65), the risk of hepatic encephalopathy (risk ratio = 0.56, 95% CI: 0.46 to 0.68), model for end-stage liver disease score (MD, -0.90; 95% CI, -1.17 to -0.11), ammonia (MD, -11.86; 95% CI, -16.39 to -7.33), and endotoxin (MD, -0.14; 95% CI, -0.23 to -0.04). The trial sequential analysis yielded reliable results of these outcomes. No effects were observed on the changes of other hepatic function indicators. CONCLUSION: MTTs appeared to be associated with a slowed deterioration in liver cirrhosis, which could provide reference for clinicians in treatment of cirrhotic patients based on their conditions.

[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.

[Association between tea drinking and the risk of type 2 diabetes mellitus among rural adults in Deqing County:a prospective cohort study].

OBJECTIVE: To explore the associations between tea drinking and the incident risk of type 2 diabetes mellitus(T2 DM). METHODS: A dynamic prospective cohort study among a total of 27 841 diabetes-free permanent adult residents randomly selected from 2, 6 and 7 rural communities between 2006-2008, 2011-2012 and 2013-2014, respectively. Questionnaire survey, physical examination, and laboratory test were carried out among the participants. In 2018, we conducted a follow-up through the electronic health records of residents. Cox regression model were applied to explore the association between tea drinking and the incident risk of T2 DM and estimate the hazard ratio(HR), and its 95%CI. RESULTS: Among the 27 841 rural community residents in Deqing County, there were 10 726(38.53%) were tea drinkers, 8215 of which were green tea drinkers, accounting for 76.59%. Totally 883 new T2 DM incidents were identified until December 31, 2018, and the incidence density was 4.43 per 1000 person years(PYs). The incidence density was 4.07/1000 PYs in those with tea drinking habits and 4.71/1000 PYs in those without tea drinking habits, among which the incidence density was 3.79/1000 PYs in those with green tea drinking habits. After controlling for sex, age, education, farming, smoking, alcohol consumption, dietary preference, body mass index, hypertension, impaired fasting glucose, family history of diabetes, the risk of T2 DM among rural residents with tea drinking habits in Deqing County was 0.79 times higher than that among residents without tea drinking habits(HR=0.79, 95%CI 0.65-0.96), and the risk of T2 DM among residents with green tea drinking habits was 0.72 times higher than that among residents without tea drinking habits(HR=0.72, 95%CI 0.58-0.89). However, no significant associations were found between other kinds of tea and the risk of T2 DM, nor the amount of green tea to drink. CONCLUSION: Drinking green tea may reduce the risk of T2 DM among adult population in rural China.

Association between echinococcosis-specific health literacy and behavioural intention to prevent echinococcosis among herdsmen on the Tibet Plateau in China: a cross-sectional study.

BACKGROUND: Echinococcosis is considered a neglected zoonotic disease and has been a major worldwide public health problem. Although it is known that health literacy is closely related to health behaviours and health outcomes, few studies have paid attention to echinococcosis related health literacy. This study aims to examine the association between echinococcosis-specific health literacy (ES-HL) and behavioural intention to prevent echinococcosis (BIPE) among herdsmen on the Tibet Plateauin in China. METHODS: A cross-sectional study of 401 Tibetan herdsmen was conducted in Gande county of Qinghai Province, China. Participants were recruited from August to September 2018 and from February to March 2019. A self-developed questionnaire was used to measure demographic information, ES-HL and BIPE. Hierarchical regression analysis was done to identify the factors associated with BIPE. RESULTS: In the hierarchical regression analysis, we entered age, sex, education level, marital state and family monthly income per capita into model 1 which explained a significant amount of variance in BIPE (Adjusted R2 change = 0.029, P = 0.006). Sex (ß = - 0.125, P = 0.013) and family monthly income per capita (ß = - 0.133, P = 0.009) were found to be associated with BIPE. Subsequently, the three factors of ES-HL were added to Model 1 to create Model 2. In Model 2, the two factors of ES-HL, perceived echinococcosis information support (ß = 0.229, P < 0.001) and echinococcosis-specific self-management ability (ß = 0.252, P < 0.001), were significantly associated with BIPE, while the information acquisition and evaluation ability factor (ß =0.093, P = 0.089) was not found to be associated with BIPE. The model improved significantly when ES-HL was included (Model 2) explaining the 25.8% of variance of BIPE (Adjust R2 change =0.229, P < 0.001). CONCLUSIONS: ES-HL is an important predictor of whether individuals take preventive actions against echinococcosis. An ES-HL promotion action project should be developed targeting specific populations to enhance the prevention of echinococcosis.

Associations between serum amino acids and incident type 2 diabetes in Chinese rural adults.

BACKGROUND AND AIMS: Some amino acids (AAs) may be associated with type 2 diabetes (T2DM). This study aimed to determine the associations of individual AAs with the development of T2DM in rural Chinese adults. METHODS AND RESULTS: A cohort study of 1199 individuals aged 18 years or older was conducted from 2006 to 2008 in a rural community of Deqing, China, a repeated survey was done in 2015 and data linkage with the electronic health records system was performed each year for identifying new T2DM cases. A high-performance liquid chromatography approach was used to measure the baseline serum concentrations of 15 AAs. Cox proportional hazards models were used to examine the associations between AAs and the risk of incident T2DM. A total of 98 new T2DM cases were identified during the follow-up of 12 years on average. Among 15 AAs, proline was associated with an increased risk of incident T2DM after adjusted for age, sex, body mass index, fasting plasma glucose, family history of T2DM, smoking status, alcohol use, and history of hypertension, the adjusted hazard ratio for 1-standard deviation increment was 1.20 (95% confidence interval: 1.00, 1.43). The association tended to be more marked in subjects younger than 60 years and overweight/obese subjects. Among participants without hypertension, proline and phenylalanine were associated with an increased risk of incident T2DM, while aspartic acid was associated with a decreased risk. CONCLUSION: Serum proline was associated with the risk of incident T2DM in rural Chinese adults and might be a potential predictor.

Prevalences of metabolic syndrome and its sex-specific association with socioeconomic status in rural China: a cross-sectional study.

BACKGROUND: Few studies have reported the prevalence of metabolic syndrome (MS) and examined relationships between socioeconomic status and MS in rural China. This study aimed to evaluate the prevalence of MS and MS components as well as their associations with socioeconomic status among rural Chinese adults. METHODS: A cross-sectional study of 26,836 participants aged 20 years and older was conducted from June to December 2012 in Yuhuan City, Zhejiang Province, China, which is located on Yuhuan Island. A multivariable logistic regression model was used to identify risk factors for MS and their possible interactions. RESULTS: Among 26,836 subjects with an average age of 53.4 ± 14.0 years, 59% were female. The overall prevalence of MS was 20.5%, and there was a significant sex difference in the prevalence (15.1% for males vs. 24.2% for females, P < 0.001). Compared with males, females also showed a significantly higher proportion of most MS components. A significantly higher prevalence of MS was found among subjects who were elderly, had a lower income level, had a lower level of education, or were unemployed. Multiple significant interactions were observed between the prevalence of MS and sex, age or socioeconomic status (P < 0.001). The risk of MS increased significantly with age in females but not in males. Additionally, a lower income level and a lower level of education were significantly related to an increased risk only in females, and unemployed males had a higher risk of MS than unemployed females. CONCLUSIONS: The prevalence of MS and its components was relatively high in a rural island Chinese population with rapid urbanization, and sex-specific associations between socioeconomic factors and MS were found. Targeted preventive interventions should be developed and implemented to prevent and control MS among those with low socioeconomic status, especially females.

Inequalities in changing mortality and life expectancy in Jiading District, Shanghai, 2002-2018.

BACKGROUND: Improvements of population health in China have been unevenly distributed among different sexes and regions. Mortality Registration System provides an opportunity for timely assessments of mortality trend and inequalities. METHODS: Causes of death were reclassified following the method of Global Burden of Disease Study (GBD). Age-standardized mortality rate (ASMR) and ring-map of the rate by town were used to describe inequalities in changing mortality. Life expectancy (LE) and cause-deleted LE were calculated on the basis of life table technique. RESULTS: The burden of death from 2002 to 2018 was dominated by cardiovascular diseases (CVD), neoplasms, chronic respiratory diseases and injuries in Jiading district, accounting for almost 80% of total deaths. The overall ASMR dropped from 407.6/100000 to 227.1/100000, and LE increased from 77.86 years to 82.31 years. Women lived about 3.0-3.5 years longer than men. Besides, a cluster of lower LE was found for CVD in the southeast corner and one cluster for neoplasms in the southern corner of the district. The largest individual contributor to increment in LE was neoplasms, ranged from 2.41 to 3.63 years for males, and from 1.60 to 2.36 years for females. CONCLUSIONS: Improvement in health was mainly attributed to the decline of deaths caused by CVD and neoplasms, but was distributed with sex and town. This study served as a reflection of health inequality, is conducive to formulate localized health policies and measures.

Impact of maternal HIV-HBV coinfection on pregnancy outcomes in an underdeveloped rural area of southwest China.

OBJECTIVES: Our objective was to determine the impact of maternal HIV-hepatitis B virus (HBV) coinfection on pregnancy outcomes. METHODS: The current study was conducted in a county of Yi Autonomous Prefecture in southwest China. Data were abstracted from hospitalisation records, including maternal and infant information. The seroprevalences of HIV and HBV infections and HIV-HBV coinfection were determined and the impact of maternal HIV-HBV coinfection on adverse pregnancy outcomes was assessed using logistic regression analysis. A treatment effects linear regression model was also applied to examine the effect of HBV, HIV or coinfection to quantify the absolute difference in birth weight from a reference of HBV-HIV negative participants. RESULTS: A total of 13 198 pregnant women were included in our study, and among them, 99.1% were Yi people and 90.8% lived in rural area. The seroprevalences of HIV and HBV infections and HIV-HBV coinfection were 3.6% (95% CI: 3.2% to 3.9%), 3.2% (95% CI: 2.9% to 3.5%) and 0.2% (95% CI: 0.1% to 0.2%) among the pregnant women, respectively. Maternal HIV-HBV coinfection was a risk factor for low birth weight (adjusted OR (aOR)=5.52, 95% CI: 1.97 to 15.40). Compared with the HIV mono-infection group, the risk of low birth weight was significantly higher in the HIV-HBV coinfection group (aOR=3.62, 95% CI: 1.24 to 10.56). Maternal HIV infection was associated with an increased risk of low birth weight (aOR=1.90, 95% CI: 1.38 to 2.60) and preterm delivery (aOR=2.84, 95% CI: 1.81 to 4.47). Perinatal death was more common when mothers were infected with HBV (aOR=2.85, 95% CI: 1.54 to 5.26). CONCLUSIONS: The prevalence of HIV infection was high among pregnant women of the Yi region. Both HIV and HBV infections might have adverse effects on pregnancy outcomes. Maternal HIV-HBV coinfection might be a risk factor for low birth weight in the Yi region, which needs to be confirmed.

Influence of coarse particulate matter on chickenpox in Jiading District, Shanghai, 2009-2018: A distributed lag non-linear time series analysis.

Although the link between ambient air pollution and some infectious diseases has been studied, few studies have explored so far, the relationship between chickenpox and particulate matter. Daily chickenpox counts in Jiading District, Shanghai, were collected from 2009 to 2018. Time series analysis was conducted to describe the trends of the daily number of chickenpox cases and the concentration of particulate matter 10 µm or less (PM10). The distributed lag non-linear model (DLNM) was developed to assess the lag and non-linear relationship between the number of chickenpox cases and PM10 concentration adjusting for meteorological factors and other pollutants. Spatiotemporal scanning was used to detect the clustering of chickenpox cases. There was a concomitant relationship between the number of chickenpox cases and PM10 concentration, especially in the period of high PM10 concentration. DLNM results showed a nonlinear relationship between the number of chickenpox cases and PM10 concentration with the maximum effect of PM10 being lagged for 13-14 days, which was consistent with the average incubation period of chickenpox. PM10 was significantly associated with the daily number of chickenpox cases when above 300 µg/m3. The risk of chickenpox increased with increasing PM10 concentration and the association was strongest at the lag of 14 day (RR = 1.13, 95% CI: 1.04-1.23) for PM10 concentration of 500 µg/m3 versus 50 µg/m3. The study provides evidence that high PM10 concentration increases the risk of chickenpox spreading.

Prevalence and associated factors of Treponema pallidum infection in a rural area of southwestern China.

BACKGROUND: Epidemiological data on Treponema pallidum infection are scarce from the southwestern region of China. The purpose of this study was to determine the distribution and determinants of T. pallidum infection in the region. METHODS: A community-based cross-sectional study of 2608 participants aged ≥14 years was conducted in a rural area of southwestern China in 2014-15. A pretested questionnaire was used to collect sociodemographic characteristics and other factors associated with T. pallidum infection. The diagnoses of T. pallidum, human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) infections were determined by commercial test kits. Logistic regression analysis was used to determine the correlates for T. pallidum infection, and adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS: The prevalence of T. pallidum infection was 1.2% (95% CI 0.8 to 1.7%). Risk factors varied by gender. In the male group, T. pallidum infection was significantly associated with ever injection drug use (aOR = 9.42, 95% CI 2.47 to 35.87) and HCV infection (aOR = 13.28, 95% CI 3.20 to 51.70). In the female group, correlates for T. pallidum infection included spouse having syphilis (aOR = 126.66, 95% CI 7.58 to 2122.94), ever having blood transfusion (aOR = 10.51, 95% CI 1.58 to 41.21) and HBV infection (aOR = 4.19, 95% CI 1.35 to 10.93). CONCLUSIONS: The prevalence of T. pallidum infection was high in the rural area of southwestern China. Correlates for T. pallidum infection varied with sex specific. Intervention should be developed for the prevention and control of T. pallidum infection.

Factors associated with uptake of Haemophilus influenzae type b vaccination in Shanghai, China.

BACKGROUND: Haemophilus influenzae type b (Hib) vaccine is effective in reducing the burden of Hib related diseases, but little is known about factors influencing the uptake of Hib vaccine. This study aimed to assess the uptake of Hib vaccination and its associated factors in Shanghai City, China. METHODS: We used data from a retrospective cohort of 183,246 children born in 2012-2016 obtained from the Shanghai Immunization Program Information System, which provided information on the uptake of Hib vaccination. We conducted a cross-sectional study of 451 children to collect information on demographic and other factors that might be associated with Hib vaccination. RESULTS: In the retrospective cohort study, the proportions of Hib dose-1 coverage, vaccination completion and timeliness were 67.7, 52.2 and 29.4%, respectively. These measures were better among local children and increased with birth year, while there were regional differences. Hib vaccine uptake was significantly associated with maternal occupation (non-health vs health workers, OR = 2.33, 95% CI: 1.32-4.13, P = 0.004) and caregivers' awareness of Hib (yes vs no, OR = 1.75, 95% CI: 1.12-2.74, P = 0.013). CONCLUSIONS: We found low levels of coverage of dose-1 Hib vaccine, timeliness and completion, suggesting inadequate protection against Hib disease for children in Shanghai. Non-local children and those of health workers should be targeted for interventions. The inclusion of Hib vaccine into the national immunization program could help improve the uptake of Hib vaccines.

UCP2 and UCP3 variants and gene-environment interaction associated with prediabetes and T2DM in a rural population: a case control study in China.

BACKGROUND: There are disparities for the association between uncoupling proteins (UCP) and type 2 diabetes (T2DM). The study was to examine the associations of genetic variants of UCP2 and UCP3 with prediabetes and T2DM in a rural Chinese population. METHODS: A population-based case-control study of 397 adults with T2DM, 394 with prediabetes and 409 with normal glucose tolerance (NGT) was carried out in 2014 in a rural community in eastern China. Three groups were identified through a community survey and the prediabetes and NGT groups were frequently matched by age and gender with the T2DM group and they were not relatives of T2DM subjects. With r2 ≥ 0.8 and minor allele frequency (MAF) ≥0.05 for tag single nucleotide polymorphisms (SNPs) with potential function, three (rs660339, rs45560234 and rs643064) and six (rs7930460, rs15763, rs647126, rs1800849, rs3781907 and rs1685356) SNPs were selected respectively for UCP2 and UCP3 and genotyped in real time using the MassARRAY system (Sequenom; USA). The haplotypes, gene-environmental interaction and association between genetic variants of UCP2 and UCP3 and prediabetes or T2DM were explored. RESULTS: There were no significant differences in age and sex among three study groups. After the adjustment for possible covariates, the A allele of rs1800849 in UCP3 was significantly associated with prediabetes (aORAA vs GG = 1.68, 95% CI: 1.02-2.78), and the association was also significant under the recessive model (aOR AA vs GA + GG = 1.64, 95% CI: 1.02-2.66). Also, rs15763 was found to be marginally significantly associated with T2DM under dominant model (ORGA + AA vs GG = 0.73, 95% CI: 0.52-1.03, P = 0.072). No haplotype was significantly associated with prediabetes or T2DM. Multiplicative interactions for rs660339-overweight on T2DM were observed. In addition, the AA genotype of rs660339 was associated with an increased risk of T2DM in overweight subjects (OR = 1.48, 95%CI: 0.87-2.52) but with a decreased risk in those with normal weight (OR = 0.54, 95%CI: 0.28-1.05). CONCLUSIONS: Rs1800849 in UCP3 was significantly associated with prediabetes. Overweight might modify the effects of rs660339 of UCP2 on T2DM.

Changes in gut microbiota and plasma inflammatory factors across the stages of colorectal tumorigenesis: a case-control study.

BACKGROUND: Colorectal cancer (CRC) is a common malignant gastrointestinal tumor. In China, CRC is the 5th most commonly diagnosed cancer. The vast majority of CRC cases are sporadic and evolve with the adenoma-carcinoma sequence. There is mounting evidence indicating that gut microbiota and inflammation play important roles in the development of CRC although study results are not entirely consistent. In the current study, we investigated the changes in the CRC-associated bacteria and plasma inflammatory factors and their relationships based on data from a case-control study of Han Chinese. We included 130 initially diagnosed CRC patients, 88 advanced colorectal adenoma patients (A-CRA), 62 patients with benign intestinal polyps and 130 controls. RESULTS: Fecal microbiota composition was obtained using 16S ribosomal DNA (16S rDNA) sequencing. PCOA analysis showed structural differences in microbiota among the four study groups (P = 0.001, Unweighted Unifrac). Twenty-four CRC-associated bacteria were selected by a two-step statistical method and significant correlations were observed within these microbes. CRC-associated bacteria were found to change with the degree of malignancy. Plasma C-reactive protein (CRP) and soluble tumor necrosis factor II (sTNFR-II) displayed significant differences among the four study groups and increased with adenoma-carcinoma sequence. The correlations of CRP and sTNFR-II with several CRC-associated microbes were also explored. CONCLUSIONS: CRC-associated species and plasma inflammatory factors tended to change along the adenoma-carcinoma sequence. Several CRC-associated bacteria were correlated with CRP and sTNFR-II. It is likely that gut microbiome and inflammation gradually form a microenvironment that is associated with CRC development.

Exposure of Adults to Antibiotics in a Shanghai Suburban Area and Health Risk Assessment: A Biomonitoring-Based Study.

An extensive exposure to antibiotics has been demonstrated in children and pregnant women by biomonitoring, but data from general adults remain limited. In the current study, we studied 822 adults aged 21-75 years in Shanghai in 2017 and analyzed 18 common antibiotics (five veterinary antibiotics (VAs), four human antibiotics (HAs), and nine human/veterinary antibiotics (H/VAs)) in spot urine by liquid chromatography coupled to high-resolution mass spectrometry. All 18 antibiotics were detected in urine with an overall detection frequency of 45.9% and the detection frequency for each ranged from 0.1% to 15.2%. HAs, VAs, H/VAs, and VAs+H/VAs were detected in 4.4%, 11.6%, 38.0, and 44.5% of urine samples, respectively. Adults with the sum of estimated daily exposure dose of all the antibiotics below 1.55 µg/kg/day accounted for 89.1% of adults tested positive. A hazard index value beyond one was seen in 7.2% of adults based on microbiological effect. Ciprofloxacin was the biggest contributor to HI and its hazard quotient value more than one was seen in 5.6% of adults. These findings indicated an extensive exposure to low-dose multiple antibiotics in adults in Shanghai and some adults were at health risk related to the disturbance of gut microbiota.

Poor sleep quality and influencing factors among rural adults in Deqing, China.

BACKGROUND: Poor sleep quality is prevalent and is associated with cognitive decline, impaired health, and reduced quality of life. There is a lack of studies about sleep quality and its potential risk factors among rural adults aged 45 years or above under rapid urbanization in China. METHODS: In a cross-sectional survey conducted in Deqing County, China in 2015, we included 1584 adults 45+ years of age. Sleep quality was measured by using the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). Poor sleep quality was defined by a CPSQI global score > 5. Other data collected included sociodemographic and lifestyle factors as well as physical health. Logistic regression model was applied to assess factors influencing sleep quality by calculating crude odds ratio (cOR), adjusted OR (aOR), and their 95% confident intervals (CI). RESULTS: Of 1584 subjects, more than half were female with an average age of 58.9 ± 8.1 years. Their night sleep duration was 7.7 ± 1.2 h, sleep latency was 31.9 ± 32.0 min, and 17% of them could not fall asleep within half hour, averagely. The mean score of CPSQI was 4.4 ± 2.7. The prevalence of poor sleep quality was 27.7% (95% CI = 25.4-29.7%) overall, and there existed a significant sex difference-30.6% (95% CI = 27.7-33.7%) for women and 24.0% (95% CI = 20.9-27.2%) for men. Five domains of the CPSQI except for sleep efficiency and use of sleeping medication also showed a sex difference (p < 0.05). Logistic regression analysis indicated that unmarried status (aOR = 1.51, 95% CI = 1.03-2.22), lower monthly individual income (aOR = 2.09, 95% CI = 1.49-2.94), and chronic diseases (aOR = 1.95, 95% CI = 1.51-2.51) were significantly related to poor sleep quality. CONCLUSIONS: Sleep problems were prevalent among the rural Chinese adults aged 45+ years. People who were unmarried or had low personal income or any chronic diseases were more likely to have poor sleep quality.

Urinary Antibiotics of Pregnant Women in Eastern China and Cumulative Health Risk Assessment.

Exposure to antibiotics during pregnancy can pose a systematic effect on human health. A few biomonitoring studies have demonstrated an extensive exposure of children to antibiotics, but there is still a lack of data for pregnant women. To assess the exposure of pregnant women to antibiotics and potential health risk, we investigated 536 pregnant women aged 16-42 years from two geographically different study sites in Eastern China in 2015. We measured 21 antibiotics of five categories (seven fluoroquinolones, three phenicols, four tetracyclines, three macrolides, and four sulfonamides) in urine using the isotope dilution ultraperformance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry. The hazard index (HI) was calculated on the basis of estimated daily exposure dose and acceptable daily intakes. A total of 16 antibiotics were found in urine, with detection frequencies between 0.2 and 16.0%. Antibiotics were overall detected in 41.6% of urine, and two or more antibiotics were detected in 13.1% of urine. Ciprofloxacin, ofloxacin, and trimethoprim were most frequently detected in urine, with detection frequencies between 10 and 20%. The majority of the antibiotics tested had an estimated daily exposure dose less than 1 µg/kg/day, and 4.3% of pregnant women had a HI value of more than 1. These findings indicated that pregnant women were frequently exposed to antibiotics and some individuals were in the potential risk of adverse microbiological effects induced by antibiotics.

[Related factors for early-onset type 2 diabetes mellitus of rural adults in Yuhuan County of Zhejiang Province in 2012].

OBJECTIVE: To explore related factors for early-onset type 2 diabetes mellitus( EOD) in rural Chinese adults. METHODS: Totally, 1695 newly diagnosed cases of type 2 diabetes mellitus( T2DM) were recruited from baseline survey of Yuhuan Rural Adults Cohort for Diabetes during June to December 2012 in Yuhuan County, Zhejiang Province, China, and divided into EOD or late-onset type 2 diabetes mellitus( LOD) with their diagnosis age at ≤ 40 or > 40 years, respectively. Diagnosis age was compared among different characteristics. Logistic regression was used to analyze related factors in EOD. RESULTS: Among 1695 new T2 DM cases, near half( 47. 3%) were men and 85( 5. 0%) were grouped into EOD. Their mean age at diagnosis of T2 DM was( 60. 39 ±12. 49) years overall. Men or those with more than 9 education years, family average personal income ≥2000 Yuan per month, less occupational physical activities, smoking, drinking, overweight and family history of T2 DM had lower average age at diagnosis than women or those without them, while those with regular physical exercise had higher that than those without that. After the adjustment for other covariates, multiple logistic regression showed that more than 9 education years( OR = 6. 62, 95% CI 3. 87-11. 32), family average personal income ≥2000 Yuan per month( OR = 6. 60, 95% CI 3. 32-13. 12), and regular physical exercise( OR = 0. 37, 95% CI 0. 17-0. 80) were independently correlated to EOD. CONCLUSION: Education level, income, and regular exercise are significantly correlated to EOD in rural Chinese adults.