The Natural Progression of Parkinson's Disease in a Small Cohort with 15 Drug-naïve Patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The studies of the natural progression of Parkinson's disease (PD) in Chinese populations have been lacking. To address this issue and obtain a preliminary data, we conducted a PD progression assessment in 15 adults with de novo PD from a nutritional intervention trial (NIT) cohort in Lin County China.</p><p><b>METHODS</b>Using the Copiah County screening questionnaire and United Kingdom Parkinson's Disease Society Brain Bank diagnostic criteria, we surveyed the available NIT cohort members in 2000 and diagnosed 86 patients as PD. In 2010, we resurveyed all PD patients and confirmed definite PD diagnosis in 15 cases with the rest of them being dead (54); having probable (10) PD or vascular Parkinsonism (3); refusing to participate (2); or being away (2). In both surveys, we used Hoehn and Yahr (HY) scale and assessed the disease progression. Unified Parkinson's Disease Rating Scale (UPDRS) was added to the second survey.</p><p><b>RESULTS</b>In 2010, the average disease duration for 15 definite PD patients was 13.6 ± 7.3 years. Over a 10-year time span, 9 out of 15 patients remained at the same HY stage while the remaining 6 progressed. Rigidity (47% vs. 100%; P = 0.002) and postural instability (7% vs. 47%; P = 0.005) worsened significantly. The mean UPDRS motor scores in 2010 were 39.4 ± 23.7.</p><p><b>CONCLUSIONS</b>Overall worsening of motor function in PD seems to be the rule in this untreated cohort, and their rate of progression seemed to be slower than those reported in the western populations.</p>

Association between serum calcium levels and the risk of liver cirrhosis / 中华流行病学杂志

Objective To examine the association between serum calcium levels and the risk of liver cirrhosis.Methods A nested case-control study was performed based on the nutritional intervention trial of esophageal carcinoma in Linxian,Henan province.Serum samples of 281 liver cirrhosis cases and 562 controls were tested for calcium concentrations,surface antigen (HBsAg) and core antibody (anti-HBc) on Hepatitis virus B and antibody on Hepatitis virus C (anti-HCV),using automatic serum biochemical analysis system and enzyme-linked immunoassay.Data on baseline characteristics were collected via a questionnaire.Serum calcium value was divided into tertiles and logistic regression model was used to calculate odds ratios and 95％ confidence intervals.Results Individuals in the case group showed higher calcium levels (1.81 ± 0.84)mmol/L when compared to the controls (1.65 ± 0.79)mmol/L,with t =-2.640 and P=0.008.The calcium levels were associated with the risk of liver cirrhosis (x2=6.888,P=0.0319).Risks for the individuals in the highest tertile were doubled when compared to the lowest (adjusted OR=2.261,95％CI:1.497-3.416,P=0.002).A positive correlation was observed between serum calcium level and the risk of liver cirrhosis (x2=6.842,P=0.0089).Conclusion Results from our study revealed that the elevated serum calcium level might be an independent risk factor for liver cirrhosis.However,further investigations are anticipated to explore its potential mechanisms.

Screening for Parkinson syndrome in a Chinese rural population: re-examination of a historic questionnaire / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Standardized screening tools for Parkinson syndrome have not been developed for non-western populations. This study aimed to validate the Copiah County questionnaire (CCQ) as a screening instrument in a Chinese rural population.</p><p><b>METHODS</b>All participants of a previously reported prevalent study were interviewed using CCQ. The participants who answered yes to at least one item on CCQ were defined as positive. The Parkinson's disease (PD) diagnosis was established using United Kingdom Parkinson's disease Brain Bank Clinical diagnosis criteria (UKPDBBC) and served as a gold standard to determine the sensitivity, specificity, and positive and negative predictive values (PPV, NPV) for the questionnaire.</p><p><b>RESULTS</b>Among 16 130 participants, 2872 (17.8%) were screened positive for CCQ and 13 258 negative (82.2%). Among the 697 participants diagnosed as having Parkinson syndrome, 605 were positive for CCQ, and 92 were negative, leading to a sensitivity of 86.8%. Out of the 15 433 non-Parkinson syndrome participants, 13 166 were negative to CCQ, giving a specificity of 85.3%. Among the 2872 participants screened positive, 605 were diagnosed with Parkinson syndrome, and their PPV was 21.1%. For the 13 258 participants screened negative on CCQ, 92 were diagnosed with Parkinson syndrome and 13 166 did not have Parkinson syndrome, leading to a NPV of 99.3%.</p><p><b>CONCLUSIONS</b>CCQ appeared to have satisfactory statistical parameters to serve as a screening instrument for Parkinson syndrome in this rural Chinese population. Further studies may prove the utility of this short questionnaire in Parkinson syndrome screening among Chinese populations including those residing in rural areas.</p>

Clinical and Pathologic Features of Multifocal and Multicentric Breast Cancer in Chinese Women: A Retrospective Cohort Study / 한국유방암학회지

PURPOSE: This study aims to analyze the clinical-pathological characteristics of multifocal and multicentric breast cancer (MMBC) in Chinese women. METHODS: Sixty-seven cases with MMBC were randomly collected and reviewed at seven hospitals in representative districts of China during 1999 to 2008. RESULTS: The incidence of MMBC in breast cancer in China was 1.75%. Compared to those with unifocal breast cancer, women with MMBC were more likely to have larger tumor size, lymph node metastasis (59.70% vs. 45.62%) and stage III to IV (46.26% vs. 21.10%). The peak age at onset of MMBC was 40 to 49 years old and has been gradually increasing during 1999 to 2008. Most of the MMBC women were treated with surgery and adjuvant therapy. CONCLUSION: In China, the incidence of MMBC in breast cancer is significantly lower than that in Western countries. Compared to unifocal breast cancer, MMBC is biologically more aggressive. Most MMBC women underwent mastectomy, instead of breast conservation surgery.

Prospective study on the relation between serum vitamin D levels and liver cirrhosis risk / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To explore the relation between serum vitamin D (25(OH)D) concentrations and liver cirrhosis.</p><p><b>METHODS</b>A nested case control study was designed based on the Nutrition Intervention Trial (NIT) cohort, from which non-degraded serum samples and complete baseline and follow-up data were available for 282 individuals diagnosed with liver cirrhosis and 564 healthy controls. The serum samples were tested by enzyme-linked immunosorbent assay to detect and quantify 25(OH)D, as well as hepatitis B virus surface antigen and core antibody and hepatitis C virus antibody. The study participants were divided into four groups according to quartile range of 25(OH)D concentration and logistic regression modeling was used to evaluate the relation with liver cirrhosis risk by estimating odds ratios (ORs) and 95% confidence intervals (CIs).</p><p><b>RESULTS</b>The liver cirrhosis group had a significantly lower concentration of 25(OH)D than the control group (median and quartile range in nmol/L, cases: 15.3 and 13.8; controls: 20.2 and 16.6; t = 5.169, P = 0.002). When the first interval was set as the reference level, the ORs(95% CIs) of the second, third, and fourth intervals were: 0.495(0.333 - 0.736), 0.452(0.303 - 0.675), and 0.349(0.231- 0.527). After adjusting the analysis for the presence of pathogenic-related confounding factors, the ORs(95% CIs) of the second, third, and fourth intervals were: 0.499(0.328 - 0.759), 0.427(0.278 - 0.654), and 0.344(0.222-0.532). The 25(OH)D level was inversely correlated with risk of liver cirrhosis (Chi2 = 25.200, P < 0.001).</p><p><b>CONCLUSION</b>Risk of liver cirrhosis increases as 25(OH)D serum concentration decreases. Vitamin D might function as a protective factor against development of cirrhosis.</p>

10-year changes and development of surgical treatment for breast cancer in China / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the changes and development of surgical treatment for breast cancer from 1999 to 2008 in China, and compare the differences between the surgical methods used in high-resource and low-resource areas.</p><p><b>METHODS</b>Clinicopathological data of surgical treatment for female primary breast cancer was collected via medical chart review at hospitals in seven geographic areas in China. Chi-square test and chisqure test for linear trends were used to analyze the changes and development of the surgical methods used for breast cancer in the 10 years.</p><p><b>RESULTS</b>A total of 4211 primary breast cancer patients were selected from the 10-year database, including 4078 women (97.5%) treated by surgical operation. Among 3271 women (80.21%) treated with modified radical mastectomy, the surgical rate was rising from 68.89% in 1999 to 80.17% in 2008, ascending by 11.28% (χ(2) = 31.143, P < 0.001). In high-resource areas, the surgical rate of modified radical mastectomy was rising from 45.64% in 1999 to 76.13% in 2008, ascending by 30.49% (χ(2) = 89.393, P < 0.001), while in low-resource areas it kept a steady rate at 80% in the ten years (χ(2) = 2.113,P = 0.146). Among 231 women (5.66%) treated with breast-conserving surgery, the surgical rate was rising from 1.29% in 1999 to 11.57% in 2008, ascending by 10.28% (χ(2) = 102.835, P < 0.001). In high-resource areas, the surgical rate of breast-conserving surgery was rising from 2.68% in 1999 to 16.87% in 2008, ascending by 14.19% (χ(2) = 69.544, P < 0.001), while in low-resource areas it was rising from 0.42% in 1999 to 6.22% in 2008, ascending by 5.80% (χ(2) = 30.003, P < 0.001). Among 469 women (11.50%) treated with Halsted radical mastectomy, the surgical rate was declining from 28.28% in 1999 to 4.96% in 2008, descending by 23.32% (χ(2) = 206.202, P < 0.001). In high-resource areas, the surgical rate of Halsted radical mastectomy was declining from 50.34% in 1999 to 3.29% in 2008, descending by 47.05% (χ(2) = 274.830, P < 0.001), while in low-resource areas it was declining from 14.58% in 1999 to 6.64% in 2008, descending by 7.94% (χ(2) = 8.166, P = 0.004). Among 3786 women treated with breast mastectomy (including modified radical mastectomy and Halsted radical mastectomy), the surgical rate was declining from 98.46% in 1999 to 86.36% in 2008, descending by 12.10% (χ(2) = 95.744, P < 0.001). In high-resource areas, the surgical rate of breast mastectomy was declining from 96.64% in 1999 to 80.66% in 2008, descending by 15.98% (χ(2) = 53.446, P < 0.001), while in low-resource areas it was declining from 99.58% in 1999 to 92.12% in 2008, descending by 7.46% (χ(2) = 36.758,P < 0.001).</p><p><b>CONCLUSIONS</b>The main primary surgical treatment for breast cancer is modified radical mastectomy during the period 1999 - 2008. Halsted radical mastectomy is gradually replaced by modified radical mastectomy and breast-conserving surgery. The rate of changes for breast-conserving surgery and mastectomy is higher in high-resource areas than that in low-resource areas. Breast-conserving surgery will become the main treatment for early-stage breast cancer.</p>

Prospective study of the association between fasting glucose concentrations and liver cirrhosis risk / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the association between concentration levels of fasting serum glucose and liver cirrhosis.</p><p><b>METHODS</b>A nested case-control study was carried out based on the sample cohort from the Nutrition Intervention Trials previously conducted in one country in Henan province. Using an automatic biochemical analysis system and enzyme-linked immunoassay, baseline serum samples from 310 liver cirrhosis patients and 620 healthy controls were tested for fasting glucose concentration, hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), and hepatitis C virus antibody (anti-HCV). Baseline demographic information was collected by questionnaire. The serum glucose values were divided into quintiles and applied to a logistic regression model to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs).</p><p><b>RESULTS</b>The mean fasting blood glucose level was significantly higher in cases (4.5+/-1.8 mmol/L) than in controls (4.2+/-2.1 mmol/L) (t=-2.414, P=0.016). The individuals in the highest quintile had a significantly higher risk of disease than those in the lowest quintile [OR=1.672 (1.080, 2.588)]. Moreover, increase in glucose level was accompanied by increased risk, and the relation showed statistically significant linearity (P=0.002). The statistical significance of risk remained after adjustment for potential confounders, including sex, age, HBsAg, anti-HBc, and residence running water status [OR=1.96 (1.216, 3.157), P=0.001].</p><p><b>CONCLUSION</b>Elevated serum fasting glucose concentration was an independent risk factor of cirrhosis.</p>

A prospective study on the relationship between nutrition intervention and incidence of malignant tumors in Lin County, China / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the tendency in the incidence of malignant tumors in nutrition-intervened population of Lin County.</p><p><b>METHODS</b>Subjects who had been enrolled in the General Population Trial, Lin County Nutrition Intervention Trial were followed up and the data of malignant tumors were collected with collaboration of National Cancer Institute/National Institute of Health. Incidences of malignant tumors during and after nutrition intervention were calculated and compared.</p><p><b>RESULTS</b>Esophageal cancer, cardiac cancer, and stomach cancer were constantly the three leading cancers, accounting for 84.06% and 83.74% of the malignant tumors in men and women, respectively. The incidences of lung cancer and liver cancer in men showed increasing tendencies, while similar tendencies were found in those of stomach cancer, colorectal cancer, and liver cancer in women. With the prolonging of the follow-up, the incidences of upper digestive tract cancers declined (except stomach cancer in women).</p><p><b>CONCLUSIONS</b>The upper digestive tract cancers remain the leading malignant tumors, although their incidences may decline with longer-term follow-up. Prevention and control of tumors in Lin County should still be focused on the esophageal cancer, cardiac cancer, and stomach cancer, as well as lung cancer and liver cancer.</p>