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Radiation pneumonitis and pulmonary fibrosis are important dose-limiting side effects of radiotherapy that influence the prognosis and quality of life of patients with thoracic cancer. The disorder of the immune system plays a key role, especially macrophages. With the discovery of underlying molecular mechanisms, including the chemotaxis and polarization of macrophages, the infiltration of inflammatory cells, the release of inflammatory and pro-fibrotic factors, extracellular matrix deposition and the remodeling of lung structure, increasing strategies are under investigation to facilitate the prevention or treatment of lung injury via targeting macrophages. In this paper, the role of macrophages in the development of radiation pneumonitis, pulmonary fibrosis, and potential drug use strategies were reviewed.
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Objective To evaluate the effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes (T2DM) in China.Methods In this cluster randomized controlled trial,a total of 799 T2DM patients with most recent hemoglobin Alc (HbAlc) ≥ 7.5％ (or fasting plasma glucose level ≥ 10 mmol/L) were recruited from 8 communities in Minhang and Changning districts of Shanghai,and randomized into a health literacy intervention group,an exercise intervention group,a comprehensive intervention group and a control group.After baseline survey and examination,a one-year intervention and 3 times (at 3rd,6th,and 12th month) follow-up surveys were conducted.Results The follow-up rates for all the subjects were 99.4％,98.4％ and 95.2％,respectively,at 3rd,6th and 12th month.Patients in intervention groups were more likely to achieve a goal HbAlc level (HbA1c ＜ 7.0％) than those in control group,with the highest glycemic control rate (25.3％) observed in comprehensive intervention group at 3rd month and then in exercise intervention group (25.3％ and 34.6％) respectively,at 6th month and 12th month.The average levels of HbAlc in three intervention groups were lower at each follow-up time point than those at baseline survey.However,the decreases in HbA1c were obvious only at 6th month (P＜0.001),with ls-mean (95％CI) of-0.48％ (-0.71％,-0.25％),-0.33％ (-0.55％,-0.11％) and-0.70％ (-0.92％,-0.48％),respectively,in comprehensive,health literacy and exercise intervention groups,but it increased slightly by 0.03％ (-0.19％,0.25％) in control group.Compared with control group,the interventions were significantly associated with the decrease of HbA1c level,with the most improvement observed in comprehensive group (3 =-0.47,95％ CI:-0.73,-0.20) at 3rd month,and in exercise intervention group at 6th month (3=-0.73,95％CI:-0.98,-0.47) and at 12th month (β=-0.75,95％CI:-1.05,-0.45) of follow-up.Stratified analyses showed that patients with lower health literacy level could benefit from any intervention,while those with higher numeracy skill benefited more from exercise intervention.Conclusion Both health literacy and exercise-focused interventions may decrease HbA1c level in patients with T2DM,which would be helpful in reducing the risks of complications and deaths in diabetes patients.
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Objective To investigate the associations of obesity and physical activity with cognition in the elderly.Methods A cross-sectional survey was conducted from October 2009 to June 2010 among people aged ≥50 years selected through multistage random cluster sampling in Shanghai.The subjects' body weight,body height,waist circumference and hip circumference were measured to calculate body mass index (BMI) and waist-hip ratio (WHR),and the data on self-reported physical activity level were collected through questionnaire survey.A comprehensive battery of cognitive tests was conducted to assess subjects' cognitive functions,including verbal recall,forward digit span (FDS),backward digit span (BDS),and verbal fluency (VF).General linear model was used to examine the associations of BMI,WHR and physical activity with cognition.Results A total of 7 913 participants were included,with a median age of 60 years.Age,sex,education level,income level,BMI,WHR and physical activity level were significantly associated with cognitive scores in univariate analysis.After adjusted for age,sex,education level and income level,BMI was no longer significantly associated with cognitive scores in all cognitive functions (all P＞0.01).WHR was significantly associated with VF score (P＜0.01).Abdominally obese participants had lower VF score than non-abdominally obese participants (P＜0.01).Physical activity level was significantly associated with all cognitive functions (P＜0.01).Compared with participants with moderate physical activity level,participants with low physical activity level had lower scores in all cognitive functions (P＜0.01).Conclusion Abdominal obesity and low physical activity level were negatively associated with cognition level in the elderly,suggesting that waist circumference control and physical activity might help maintain cognition in the elderly.
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Objective To evaluate the effect of health literacy and exercise-focused interventions on glycemic control in patients with type 2 diabetes (T2DM) in China.Methods In this cluster randomized controlled trial,a total of 799 T2DM patients with most recent hemoglobin Alc (HbAlc) ≥ 7.5％ (or fasting plasma glucose level ≥ 10 mmol/L) were recruited from 8 communities in Minhang and Changning districts of Shanghai,and randomized into a health literacy intervention group,an exercise intervention group,a comprehensive intervention group and a control group.After baseline survey and examination,a one-year intervention and 3 times (at 3rd,6th,and 12th month) follow-up surveys were conducted.Results The follow-up rates for all the subjects were 99.4％,98.4％ and 95.2％,respectively,at 3rd,6th and 12th month.Patients in intervention groups were more likely to achieve a goal HbAlc level (HbA1c ＜ 7.0％) than those in control group,with the highest glycemic control rate (25.3％) observed in comprehensive intervention group at 3rd month and then in exercise intervention group (25.3％ and 34.6％) respectively,at 6th month and 12th month.The average levels of HbAlc in three intervention groups were lower at each follow-up time point than those at baseline survey.However,the decreases in HbA1c were obvious only at 6th month (P＜0.001),with ls-mean (95％CI) of-0.48％ (-0.71％,-0.25％),-0.33％ (-0.55％,-0.11％) and-0.70％ (-0.92％,-0.48％),respectively,in comprehensive,health literacy and exercise intervention groups,but it increased slightly by 0.03％ (-0.19％,0.25％) in control group.Compared with control group,the interventions were significantly associated with the decrease of HbA1c level,with the most improvement observed in comprehensive group (3 =-0.47,95％ CI:-0.73,-0.20) at 3rd month,and in exercise intervention group at 6th month (3=-0.73,95％CI:-0.98,-0.47) and at 12th month (β=-0.75,95％CI:-1.05,-0.45) of follow-up.Stratified analyses showed that patients with lower health literacy level could benefit from any intervention,while those with higher numeracy skill benefited more from exercise intervention.Conclusion Both health literacy and exercise-focused interventions may decrease HbA1c level in patients with T2DM,which would be helpful in reducing the risks of complications and deaths in diabetes patients.
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Objective To investigate the associations of obesity and physical activity with cognition in the elderly.Methods A cross-sectional survey was conducted from October 2009 to June 2010 among people aged ≥50 years selected through multistage random cluster sampling in Shanghai.The subjects' body weight,body height,waist circumference and hip circumference were measured to calculate body mass index (BMI) and waist-hip ratio (WHR),and the data on self-reported physical activity level were collected through questionnaire survey.A comprehensive battery of cognitive tests was conducted to assess subjects' cognitive functions,including verbal recall,forward digit span (FDS),backward digit span (BDS),and verbal fluency (VF).General linear model was used to examine the associations of BMI,WHR and physical activity with cognition.Results A total of 7 913 participants were included,with a median age of 60 years.Age,sex,education level,income level,BMI,WHR and physical activity level were significantly associated with cognitive scores in univariate analysis.After adjusted for age,sex,education level and income level,BMI was no longer significantly associated with cognitive scores in all cognitive functions (all P＞0.01).WHR was significantly associated with VF score (P＜0.01).Abdominally obese participants had lower VF score than non-abdominally obese participants (P＜0.01).Physical activity level was significantly associated with all cognitive functions (P＜0.01).Compared with participants with moderate physical activity level,participants with low physical activity level had lower scores in all cognitive functions (P＜0.01).Conclusion Abdominal obesity and low physical activity level were negatively associated with cognition level in the elderly,suggesting that waist circumference control and physical activity might help maintain cognition in the elderly.
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Objective To investigate the levels of literacy and numeracy in type 2 diabetes patients with poor glycemic status in communities of Shanghai,China,and to evaluate their associations with blood glucose level.Methods A total of 800 type 2 diabetes patients with recent HbA1c≥7.5％ or fasting plasma glucose level ≥10 mmol/L were recruited from 8 communities in Minhang district and Changning district of Shanghai,China,and were interviewed using a structured questionnaire during February 2015 and March 2016.Literacy and numeracy levels of all patients were evaluated using the validated Health Literacy Management Scale (HeLMS) and the 5-item version Diabetes Numeracy Test (DNT-5),respectively.Results The patients included in this study were observed to have higher levels of health literacy,with a median score of HeLMS being 116 [interquartile range (IQR),108-120] and a median correct rate of DNT-5 of 80％ (IQR,60％-100％).Age,educational level and occupation were significantly related with health literacy levels and numeracy.Sex and income were closely related with health literacy levels.HeLMS score was not significantly associated with HbA1c level (P =0.383),while the lower correct rate of DNT-5 was linked with a higher level of HbA1c.The median HbA1c level was 8.3％ (IQR 7.7％-9.4％) in the patients with the lowest tertile of DNT-5 correct rate,significantly higher than 8.2％ (IQR:7.5％-9.2％) in the medium and 8.0％ (IQR:7.5 ％-8.8 ％) in the highest tertile group (P =0.009).Conclusions Diabetes patients with poor glycemic status in communities of Shanghai have high levels of health literacy,which was significantly related with age,sex,educational level,occupation and income.Ability in numeracy may be a more important influence factor than health literacy for glycemic status of diabetes patients.
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Objective To determine the most cost-effective modality for breast cancer screening in women living in Shanghai.Methods A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district,Shanghai,during 2008 to 2012.Parameters of the model were derived from literatures.General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years.Incremental cost-effectiveness ratio (ICER) was used to determine the most cost-effective modality.Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness.Results The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one.The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year (QALY) saved,which were within the threshold of 2-3 times of local per capita Gross Domestic Product.Results from sensitivity analysis showed that,due to higher incidence rate of breast cancer in Shanghai,the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China.Conclusion Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai,and thus be widely promoted in this population elsewhere.
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Objective To determine the most cost-effective modality for breast cancer screening in women living in Shanghai.Methods A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district,Shanghai,during 2008 to 2012.Parameters of the model were derived from literatures.General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years.Incremental cost-effectiveness ratio (ICER) was used to determine the most cost-effective modality.Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness.Results The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one.The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year (QALY) saved,which were within the threshold of 2-3 times of local per capita Gross Domestic Product.Results from sensitivity analysis showed that,due to higher incidence rate of breast cancer in Shanghai,the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China.Conclusion Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai,and thus be widely promoted in this population elsewhere.
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Background In previous study,peripheral retinal nerve fiber layer (RNFL) thickness is considered to be the earliest structural changes which can be detected.3D-OCT can measure the thickness of macular ganglion cell complex (mGCC),which makes the detection of primary glaucoma possible in the early stage.Objective This study was to measure the thickness of mGCC and disc-peripheral RNFL in early stage of primary glaucomous eyes by 3D-OCT and assess the anatomic basis of glaucoma-induced optical nerve damage.Methods 3D-OCT images from 10 patients with advanced stage primary glaucoma in one lateral eye and early stage glaucoma in fellow eye from December 2010 to December 2012 were prospectively analyzed in China-Japan Friendship Hospital.The patients were diagnosed based on the recommended standard of National glaucoma group (1987 version) and received routine eye examination.3D-OCT scanning was performed using 3D-macular mode,3D-macular Wide mode and 3D-disc mode with TOPCON 3D-OCT 2000 system,and the images at macular 6 mm×6 mm area were analyzed.The posterior pole area was divided into 5 concentric rings from fovea toward periphery and equally subdivided into 100 small checks,with the area of 0.6 mm×0.6 mm for each.The probable values in each check were calculated as the ratio of each figure and corresponding normal value.The probable values were expressed as red color (P＜ 1％),yellow color (P＜5％) and gray color (P≥ 5％).Then the disc-periphery RNFL thickness and disc cup were evaluated.Results No evident abnormality was found in the thicknesses of photoreceptors layer and bipolar cell layer in both advanced glaucomous eyes and the early stage of glaucomous eyes in the 10 patients.Serious damage of visual field was seen in the advanced glaucomous eyes and presented with red color in the parapapillary RNFL area,mGCC area and macular RNFL area,showing an evidently attenuation of the thicknesses of parapapillary RNFL,mGCC and RNFL.However,the visual field was close normal in the early stage glaucomous eyes,and mGCC and macular RNFL showed yellow color,while green or yellow color was exhibited in the parapapillary RNFL area,indicating mGCC and macular RNFL thickness was reduced,but parapapillar RNFL thickness was near normal.Conclusions The change of mGCC thickness is earlier than that of peripheral RNFL at optic disc in primary glaucomaous eyes,which may imply that the disappear of macular ganglion cell body is earlier than that of the axon.
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<p><b>OBJECTIVE</b>To analyze the association between thyroid volume and physical growth of school-age children, and to compare volume indexes of individual thyroids for reference of selection of assessment indicators.</p><p><b>METHODS</b>All the students of the 12 classes of grades 3-5 at a primary school in Minhang district, Shanghai were rounded up with a multi-stage cluster sampling, for physical examinations to measure their height, weight, Body mass index (BMI) and body surface area (BSA), followed by B-ultrasonography to measure their thyroid volume. Data of the measurements were calculated to learn their height corrected volume index (HVI), weight and height corrected volume index (WHVI), BMI corrected volume (BMIV), and BSA corrected volume (BSAV) individually. Their urine and salt samples were collected to measure iodine concentration in urine and salt. Individual indexes were studied for their association with the growth and development indexes of children.</p><p><b>RESULTS</b>Thyroid volume data were collected for 485 students, including 258 boys (53.2%) and 227 girls (46.8%). Their height, weight, BMI and BSA were found to be positively correlated with their age (P < 0.05). For children of the same age group, their thyroid volume was also positively correlated with their physical development indexes. Of all the thyroid indexes, the difference between BSAV physical development factors had no statistical association (with partial-correlation coefficients for age, gender, height, and weight being 0.07, 0.05, 0.01 and 0.02 respectively), and their thyroid volume, HVI, BMI and weight were correlated to age, height and weight.</p><p><b>CONCLUSION</b>Thyroid volume was associated with age and weight. It was inappropriate to diagnose goiter with criteria of age, gender and thyroid volume. BSAV was recommended for its non-association with age, gender and weight and its stability.</p>
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Child , Female , Humans , Male , Body Mass Index , Body Surface Area , Body Weight , China , Goiter , Diagnosis , Iodides , Iodine , Organ Size , Sodium Chloride, Dietary , Thyroid GlandABSTRACT
Objective To evaluate the association between birth weight and subsequent risk of type 2 diabetes (T2DM) across two generations in Chinese females.Methods A cross-sectional survey was conducted among 10 324 blood-related females in Shanghai from November 2012 to January 2013.A structured questionnaire was used to collect data about demographic information,birth weight,lifestyle factors and diagnosis of T2DM.Path analysis was performed to estimate the matemal effect of birth weight and diabetes status on their offspring,and mediation analysis was conducted to test whether birth weight mediates the association between maternal and daughters' diabetes status.Results A positive association was observed between maternal and daughters' birth weight.One kg increase in maternal birth weight was associated with an average of 0.335 (95％CI:0.307-0.363) kg elevated birth weight in female offspring.Maternal diabetes status was also related with an average of 0.066 (95％ CI:0.025-0.107) kg increase in birth weight and tripled risk of subsequent T2DM (OR=3.173,95％CI:1.946-5.174) in female offspring.In all subjects aged ≥20 years,no significant relationship was observed between birth weight and risk of T2DM subsequently after adjusting for age.Offspring' s birth weight,as a mediator of maternal and daughters' diabetes status,explained 2.8％ of their association.Conclusion Maternal birth weight and diabetes status may influence their female offspring' s birth weight and subsequent risk of T2DM.