Management of esophageal cancer in patients with a right aortic arch or double aortic arch: a case series of 34 cases.

BACKGROUND: Few cases describing patients with a right aortic arch (RAA) or double aortic arch (DAA) and esophageal cancer (EC) have been reported. METHODS: We analyzed RAA and DAA cases treated with esophagectomy in our center's database and reported in English-language studies until April 1, 2023. Our study assessed the malformation characteristics and surgical details of EC patients with RAA and DAA. RESULTS: We extracted data of 24 EC patients with RAAs and 10 EC patients with DAAs. In both groups, the patients were more likely to be Japanese and male, to have squamous cell carcinoma and to have tumors located in the upper thoracic esophagus or middle thoracic esophagus. Left thoracotomy was commonly applied for RAA patients. For DAA patients, the proportions of left-sided and right-sided approaches were similar. Esophagectomy under video-assisted thoracoscopic surgery (VATS) in RAA or DAA patients had been performed on a routine basis in recent years. There were two anastomotic leakages in each group. Specifically, Kommerell diverticulum rupture occurred in 1 RAA patient; gastric tube dilation occurred in 1 DAA patient; and recurrent laryngeal nerve (RLN) injury occurred in 2 RAA patients. The postoperative course was uneventful for most patients in both cohorts. CONCLUSIONS: Esophageal carcinoma is rarely seen in patients with an RAA or DAA. To adequately dissect superior mediastinal LNs, an auxiliary incision (such as sternotomy), the left door open method or a preceding cervical procedure should be used appropriately. Esophagectomy, whether via thoracotomy or thoracoscopic surgery, can be performed safely for both RAA and DAA.

A clinical indicator-based prognostic model predicting treatment outcomes of pulmonary tuberculosis: a prospective cohort study.

OBJECTIVES: Identifying prognostic factors helps optimize the treatment regimen and promote favorable outcomes. We conducted a prospective cohort study on patients with pulmonary tuberculosis to construct a clinical indicator-based model and estimate its performance. METHODS: We performed a two-stage study by recruiting 346 pulmonary tuberculosis patients diagnosed between 2016 and 2018 in Dafeng city as the training cohort and 132 patients diagnosed between 2018 and 2019 in Nanjing city as the external validation population. We generated a risk score based on blood and biochemistry examination indicators by the least absolute shrinkage and selection operator (LASSO) Cox regression. Univariate and multivariate Cox regression models were used to assess the risk score, and the strength of association was expressed as the hazard ratio (HR) and 95% confidence interval (CI). We plotted the receiver operating characteristic (ROC) curve and calculated the area under the curve (AUC). Internal validation was conducted by 10-fold cross-validation. RESULTS: Ten significant indicators (PLT, PCV, LYMPH, MONO%, NEUT, NEUT%, TBTL, ALT, UA, and Cys-C) were selected to generate the risk score. Clinical indicator-based score (HR: 10.018, 95% CI: 4.904-20.468, P < 0.001), symptom-based score (HR: 1.356, 95% CI: 1.079-1.704, P = 0.009), pulmonary cavity (HR: 0.242, 95% CI: 0.087-0.674, P = 0.007), treatment history (HR: 2.810, 95% CI: 1.137-6.948, P = 0.025), and tobacco smoking (HR: 2.499, 95% CI: 1.097-5.691, P = 0.029) were significantly related to the treatment outcomes. The AUC was 0.766 (95% CI: 0.649-0.863) in the training cohort and 0.796 (95% CI: 0.630-0.928) in the validation dataset. CONCLUSION: In addition to the traditional predictive factors, the clinical indicator-based risk score determined in this study has a good prediction effect on the prognosis of tuberculosis.

Association of metabolically unhealthy non-obese and metabolically healthy obese individuals with arterial stiffness and 10-year cardiovascular disease risk: a cross-sectional study in Chinese adults.

BACKGROUND: The relationship between metabolically healthy obese individuals (MHO) and cardiovascular disease (CVD) risk is disputed. This study investigated the association of metabolically unhealthy non-obese(MUNO) individuals and MHO with arterial stiffness and 10-year CVD risk. METHODS: A total of 13,435 participants were enrolled and further divided into the metabolically healthy non-obese (MHNO) phenotype (n = 4927), MUNO phenotype (n = 1971), MHO phenotype (n = 2537) and metabolically unhealthy obese (MUO) phenotype (n = 4000) according to body mass index (BMI) and metabolic status. We used brachial ankle pulse wave velocity (baPWV) to measure arterial stiffness and the Framingham risk score (FRS) to evaluate the 10-year CVD risk. RESULTS: The MUO and MUNO phenotypes had higher mean baPWV values than the MHO and MHNO phenotypes, regardless of age (1446.19 ± 233.65 vs. 1423.29 ± 240.72 vs. 1283.57 ± 213.77 vs. 1234.08 ± 215.99 cm/s, P < 0.001). Logistic regression analysis indicated that the MUNO and MUO phenotypes were independently correlated with elevated baPWV and 10-year CVD risk, while the MHO phenotype was independently associated with only the 10-year CVD risk. In metabolically healthy subjects, BMI showed a dose-dependent increase in the risk of elevated baPWV, with an adjusted OR of 1.007 (95% CI 1.004-1.010, P < 0.001). However, in metabolically unhealthy participants, the estimate for the relationship between elevated baPWV and BMI was nonsignificant. CONCLUSIONS: The MUNO phenotype exhibits increased arterial stiffness and 10-year CVD risk. However, BMI is positively and dose-dependently correlated with arterial stiffness only in metabolically healthy subjects. We speculate that metabolic status may be a strong confounder in the obesity-elevated baPWV association.

The Effects of the Built Environment on the Mental Health of Older Adults: A Case Study in Hangzhou, China.

Background and Objectives: This study examines the association between the built environment and mental health among older adults by exploring the potential pathways through the perceived built environment, social interaction, and environmental pollution. Research Design and Methods: Research data were collected from 1 405 older adults aged 60 years and older in 30 residential neighborhoods of Hangzhou, China, in 2022. The participants' evaluation of the perceived built environment, social interaction, and environmental pollution were assessed. Mental health was measured by the 12-item Short-Form Health Survey. The built environment was measured through an evaluation of density, diversity, design, destination accessibility, distance to transit, and the age-friendly environment. Structural equation models were established based on 300-m, 500-m, and 800-m buffers from the entrance of residential neighborhoods. The propensity score method was employed for sensitivity analysis. Results: With regard to older adult's mental health, there were significant direct effects of the accessibility of health services, shopping services, and bus stops. A robust mediating effect of perceived built environment was displayed on the relationship between land use mix and mental health of older adults. Social interaction exhibited robust mediating effects between the age-friendly environment, the number of bus stops, and mental health of older adults. Discussion and Implications: This study provides empirical experience for related research on the built environment and mental health as well as policy implications for urban planners focusing on community planning.

Molecular features, biological behaviors and clinical implications of m5C RNA methylation modification regulators in gastrointestinal cancers.

Epitranscriptome studies have shown that critical RNA modifications drive tumorigenicity; however, the role of 5-methylcytosine (m5C) RNA methylation remains poorly understood. We extracted 17 m5C regulators and clustered distinct m5C modification patterns by consensus clustering analysis. Gene set variation and single-sample gene set enrichment analysis were applied to quantify functional analysis and immune infiltration. The least absolute shrinkage and selection operator was employed to develop a prognostic risk score. Kaplan-Meier with log-rank test was used for survival analysis. Differential expression analysis was performed with the "limma" R package. Wilcoxon signed ranked test or Kruskal-Wallis test was used to compare groups. We observed that m5C RNA methylation was commonly upregulated in gastrointestinal cancer and related to prognosis. Clusters were identified for m5C patterns, with distinct immune infiltrations and functional pathways. The risk scores of m5C regulators were independent risk factors. Differentially expressed mRNAs (DEmRNAs) in m5C clusters were involved in cancer-related pathways. The methylation-based m5Cscore showed a significant effect on the prognosis. Patients with a lower m5Cscore exhibited more therapeutic efficiency on anti-CTLA4 therapy in liver cancer, while the combination of anti-CTLA4 therapy and pd1 was more efficient for patients with a lower m5Cscore in pancreatic cancer. We uncovered dysregulations of m5C-related regulators in gastrointestinal cancer and their associations with overall survival. Some immune cells were differently infiltrated in distinct m5C modification patterns, indicating their potential impacts on gastrointestinal cancer cell-immune. Moreover, an m5Cscore, derived from DEmRNAs in specific clusters, can serve as a classifier for immunotherapy.

circFAM120B functions as a tumor suppressor in esophageal squamous cell carcinoma via the miR-661/PPM1L axis and the PKR/p38 MAPK/EMT pathway.

Extensive changes of circRNA expression underscore their essential contributions to multiple hallmarks of cancers; however, their functions and mechanisms of action in esophageal squamous cell carcinoma (ESCC) remain undetermined. Here, we adopted a three-stage approach by first screening for significantly differentially expressed circRNAs in ESCC and performing an external validation study, followed by the functional analyses. The properties of circRNAs were evaluated using Sanger sequencing, RNase R digestion, actinomycin D treatment, subcellular localization analysis, and fluorescence in situ hybridization. Target transcripts were predicted using online tools and verified by dual-luciferase, RNA immunoprecipitation, qRT-PCR, and western blot. Biotin-labeled RNA-protein pull-down, mass spectrometry, and RNA immunoprecipitation were employed to identify proteins interacting with circRNAs. Gain- and loss-of-function experiments were performed to uncover the roles of circRNAs, their target genes, and binding proteins in the proliferation, metastasis, and invasion. We observed that circFAM120B (hsa_circ_0001666) was frequently downregulated in cancer tissues and patient plasma, and its expression level was related to overall survival in ESCC patients. Overexpression of circFAM120B inhibited the proliferation, metastasis, and invasion of ESCC while silencing it enhanced malignant phenotypes. Mechanistically, circFAM120B was predominantly located in the cytoplasm, guarantying its sponging for miR-661 to restore the expression of PPM1L, a tumor suppressor. We observed that circFAM120B could reduce the stability of RNA-dependent protein kinase (PKR) by promoting its ubiquitination-dependent degradation and subsequently regulating the p38 MAPK signaling pathway, resulting in the repression of EMTs in ESCC cells. Our findings suggest that circFAM120B is a promising biomarker of ESCC, which acts as a tumor suppressor via the circFAM120B/miR-661/PPM1L axis and PKR/p38 MAPK/EMT pathway, supporting its significance as a candidate therapeutic target.

Risk factors for types of recurrent tuberculosis (reactivation versus reinfection): A global systematic review and meta-analysis.

BACKGROUND: The purpose of this meta-analysis (PROSPERO number: CRD42021243204) is to perform extensive and penetrating analyses on the risk factors associated with reactivation or reinfection. METHODS: We searched PubMed and Embase using search terms. Risk factors (including gender, length of time between first onset and recurrent diagnosis, extrapulmonary tuberculosis, sputum smear, pulmonary cavity, Beijing family strains, diabetes, HIV infection, history of imprisonment, and immigration) were analyzed. The pooled risk ratio (RR) and 95% confidence interval (CI) were calculated with STATA 15.1. Heterogeneity was evaluated by I2 and P values. RESULTS: The meta-analysis included 25 studies with a total of 1,477 recurrent patients. After subgroup analysis, sensitivity analysis, and testing for publication bias, it was concluded that time spanning less than two years (RR = 1.56, 95% CI: 1.33-1.85) was a risk factor for endogenous reactivation, whereas coinfection with HIV (RR = 0.72, 95% CI: 0.63-0.83), Beijing family genotype (RR = 0.46, 95% CI: 0.32-0.67), history of imprisonment (RR = 0.36, 95% CI: 0.16-0.81), and immigration (RR = 0.66, 95% CI: 0.53-0.82) were associated with exogenous reinfection. CONCLUSIONS: The recurrence interval is a risk factor for the endogenous reactivation of tuberculosis. Infection with Beijing family strains, coinfection with HIV, imprisonment, and immigration contribute to the risk of exogenous reinfection.

Effect of short-term ambient PM2.5 exposure on fasting blood glucose levels: A longitudinal study among 47,471 people in eastern China.

As a common health indicator in physical examinations, fasting blood glucose (FBG) level measurements are widely applied as a diagnostic method for diabetes mellitus. Uncertain conclusions remained regarding the relationship between PM2.5 exposure and FBG levels. We enrolled 47,471 subjects who participated in annual physical examinations between 2017 and 2019. We collected their general characteristics and FBG levels, and environmental factors simultaneously. We applied the generalized additive model to evaluate the impact of short-term outdoor PM2.5 exposure on FBG levels. Among the entire population, the single-pollutant models showed that a 10 µg/m3 increase in PM2.5 significantly contributed to 0.0030, 0.0233, and 0.0325 mmol/L increases in FBG at lag 0-7 days, lag 0-21 days, and lag 0-28 days, respectively. Accordingly, in multipollutant models, when PM2.5 increased by 10 µg/m3, there was an elevation of 0.0361, 0.0315, 0.0357, and 0.0387 mmol/L in FBG for 8-day, 15-day, 22-day, and 29-day moving averages, respectively. Similarly, we observed a significant positive association between them in the normal population. Moreover, the effects could be modified by age in both the entire and normal populations. Decreasing the ambient PM2.5 concentrations can alleviate the elevation of FBG, which may significantly impact the burden of diabetes mellitus.

[A comparative study of time series models in predicting COVID-19 cases].

Objective: To compare the performances of different time series models in predicting COVID-19 in different countries. Methods: We collected the daily confirmed case numbers of COVID-19 in the USA, India, and Brazil from April 1 to September 30, 2020, and then constructed an autoregressive integrated moving average (ARIMA) model and a recurrent neural network (RNN) model, respectively. We applied the mean absolute percentage error (MAPE) and root mean square error (RMSE) to compare the performances of the two models in predicting the case numbers from September 21 to September 30, 2020. Results: For the ARIMA models applied in the USA, India, and Brazil, the MAPEs were 13.18%, 9.18%, and 17.30%, respectively, and the RMSEs were 6 542.32, 8 069.50, and 3 954.59, respectively. For the RNN models applied in the USA, India, and Brazil, the MAPEs were 15.27%, 7.23% and 26.02%, respectively, and the RMSEs were 6 877.71, 6 457.07, and 5 950.88, respectively. Conclusions: The performance of the prediction models varied with country. The ARIMA model had a better prediction performance for COVID-19 in the USA and Brazil, while the RNN model was more suitable in India.

Meteorological factors contribute to the risk of pulmonary tuberculosis: A multicenter study in eastern China.

BACKGROUND: Most studies on associations between meteorological factors and tuberculosis (TB) were conducted in a single city, used different lag times, or merely explored the qualitative associations between meteorological factors and TB. Thus, we performed a multicenter study to quantitatively evaluate the effects of meteorological factors on the risk of pulmonary tuberculosis (PTB). METHODS: We collected data on newly diagnosed PTB cases in 13 study sites in Jiangsu Province between January 1, 2014, and December 31, 2019. Data on meteorological factors, air pollutants, and socioeconomic factors at these sites during the same period were also collected. We applied the generalized additive mixed model to estimate the associations between meteorological factors and PTB. RESULTS: There were 20,472 newly diagnosed PTB cases reported in the 13 study sites between 2014 and 2019. The median (interquartile range) weekly average temperature, weekly average wind speed, and weekly average relative humidity of these sites were 17.3 °C (8.0-24.1), 2.2 m/s (1.8-2.7), and 75.1% (67.1-82.0), respectively. In the single-meteorological-factor models, for a unit increase in weekly average temperature, weekly average wind speed, and weekly average relative humidity, the risk of PTB decreased by 0.9% [lag 0-13 weeks, 95% confidence interval (CI): -1.5, -0.4], increased by 56.2% (lag 0-16 weeks, 95% CI: 32.6, 84.0) when average wind speed was <3 m/s, and decreased by 28.1% (lag 0-14 weeks, 95% CI: -39.2, -14.9) when average relative humidity was ≥72%, respectively. Moreover, the associations remained significant in the multi-meteorological-factor models. CONCLUSIONS: Average temperature and average relative humidity (≥72%) are negatively associated with the risk of PTB. In contrast, average wind speed (<3 m/s) is positively related to the risk of PTB, suggesting that an environment with low temperature, relatively high wind speed, and low relative humidity is conducive to the transmission of PTB.

A Prospective Cohort Study on the Prevalent and Recurrent Tuberculosis Isolates Using the MIRU-VNTR Typing.

The study aims to describe the clustering characteristics of Mycobacterium tuberculosis (M.tb) strains circulating in eastern China and determine the ratio of relapse and reinfection in recurrent patients. We recruited sputum smear-positive pulmonary tuberculosis cases from five cities of Jiangsu Province, China, during August 2013 and December 2015. Patients were followed for the treatment outcomes and recurrence based on a cohort design. M.tb strains were isolated and genotyped using the 12-locus MIRU-VNTR. The Beijing family was identified by the extended Region of Difference (RD) analysis. The Hunter-Gaston Discriminatory Index (HGDI) was used to judge the resolution ability of MIRU-VNTR. The odds ratio (OR) together with 95% confidence interval (CI) were used to estimate the strength of association. We performed a cluster analysis on 2098 M.tb isolates and classified them into 545 genotypes and five categories (I, 0.19%; II, 0.43%; III, 3.34%; IV, 77.46%; V, 18.59%). After adjusting for potential confounders, the Beijing family genotype (OR = 118.63, 95% CI: 79.61-176.79, P = 0.001) was significantly related to the dominant strain infections. Patients infected with non-dominant strains had a higher risk of the pulmonary cavity (OR = 1.39, 95% CI: 1.01-1.91, P = 0.046). Among 37 paired recurrent cases, 22 (59.46%) were determined as endogenous reactivation, and 15 (40.54%) were exogenous reinfection. The type of M.tb strains prevalent in Jiangsu Province is relatively single. Beijing family strains infection is dominant in local tuberculosis cases. Endogenous reactivation appears to be a major cause of recurrent tuberculosis in Eastern China. This finding emphasizes the importance of case follow-up and monitoring after the completion of antituberculosis treatment.