A machine learning-based data mining in medical examination data: a biological features-based biological age prediction model.

BACKGROUND: Biological age (BA) has been recognized as a more accurate indicator of aging than chronological age (CA). However, the current limitations include: insufficient attention to the incompleteness of medical data for constructing BA; Lack of machine learning-based BA (ML-BA) on the Chinese population; Neglect of the influence of model overfitting degree on the stability of the association results. METHODS AND RESULTS: Based on the medical examination data of the Chinese population (45-90 years), we first evaluated the most suitable missing interpolation method, then constructed 14 ML-BAs based on biomarkers, and finally explored the associations between ML-BAs and health statuses (healthy risk indicators and disease). We found that round-robin linear regression interpolation performed best, while AutoEncoder showed the highest interpolation stability. We further illustrated the potential overfitting problem in ML-BAs, which affected the stability of ML-Bas' associations with health statuses. We then proposed a composite ML-BA based on the Stacking method with a simple meta-model (STK-BA), which overcame the overfitting problem, and associated more strongly with CA (r = 0.66, P < 0.001), healthy risk indicators, disease counts, and six types of disease. CONCLUSION: We provided an improved aging measurement method for middle-aged and elderly groups in China, which can more stably capture aging characteristics other than CA, supporting the emerging application potential of machine learning in aging research.

Chinese expert consensus on prevention and intervention for the elderly with malnutrition (2022).

Malnutrition is a state of altered body composition and body cell mass due to inadequate intake or utilization of energy or nutrients, leading to physical and mental dysfunction and impaired clinical outcomes. As one of the most common geriatric syndromes, malnutrition in the elderly is a significant risk factor for poor clinical outcomes, causing a massive burden on medical resources and society. The risk factors for malnutrition in the elderly are diverse and include demographics, chronic diseases, and psychosocial factors. Presently, recommendations for the prevention and intervention of malnutrition in the elderly are not clear or consistent in China. This consensus is based on the latest global evidence and multiregional clinical experience in China, which aims to standardize the prevention and intervention of malnutrition in the elderly in China and improve the efficacy of clinical practice and the prognosis of elderly patients.

Response to dacomitinib in advanced non-small-cell lung cancer harboring the rare delE709_T710insD mutation: A case report.

BACKGROUND: Tyrosine kinase inhibitors (TKI) have been the standard first-line therapy for advanced non-small cell lung cancer (NSCLC) of epidermal growth factor receptor (EGFR) sensitive mutations. Uncommon EGFR mutations are increasingly reported with the development of next-generation sequencing. However, their sensitivity to TKIs is variable with limited clinical evidence. CASE SUMMARY: Here, we report a patient with the rare delE709_T710insD mutation, who showed the favorable efficacy of dacomitinib and achieved a partial response with a progression-free survival of 7.0 mo. CONCLUSION: To our knowledge, this is the first report displaying the clinical efficacy of dacomitinib for patients with delE709_T710insD, which may help to provide alternatives in non-classical variant NSCLC patients. Further studies are warranted to make the optimal choice of EGFR-TKI for rare mutations.

Pollution characteristics and mixture risk prediction of phenolic environmental estrogens in rivers of the Beijing-Tianjin-Hebei urban agglomeration, China.

Phenolic environmental estrogens (PEEs) are ubiquitous in most rivers worldwide and may cause potential endocrine-disrupting effects in aquatic organisms. Three typical PEEs (bisphenol A, BPA; 4-tert-octylphenol,4-t-OP; and nonylphenol, NP) were investigated in the rivers of the Beijing-Tianjin-Hebei urban agglomeration, which is the most urbanized and industrialized area in North China. The target PEEs were detected in 100% of river water samples, and the concentrations ranged from 23 to 255 ng L-1. The concentrations of NP in most river sections were higher than those of BPA and 4-t-OP. The spatiotemporal variations in PEEs indicated that both domestic and industrial wastewater were main sources of PEEs in river water. In addition, rainfall runoff might be an important source of PEEs in the receiving waters, especially in the wet season. The ecotoxicological risk assessment of individual PEE revealed a moderate to high risk for aquatic organisms at most sampling sites. The mixture risk prediction based on the concentration addition method indicated a potential cumulative risk of PEEs in the study area, highlighting the importance of mixture risk assessment in the aquatic environment.

Efficacy of platinum drugs in the treatment of elderly patients with advanced non-small cell lung cancer and their effects on prognosis and survival.

PURPOSE: This study aimed to investigate the efficacy of platinum drugs in the treatment of elderly patients with advanced non-small cell lung cancer (NSCLC) and their effects on prognosis and survival. METHODS: A retrospective analysis was performed on the medical records of 128 elderly patients with stage IV NSCLC admitted to Yan'an Affiliated Hospital of Kunming Medical University from January 2015 to February 2016, who were distributed to a combination group (70 patients) and a control group (58 patients) according to chemotherapy. The efficacy was evaluated after 5 cycles of chemotherapy, and the expression levels of cytokeratin 19 fragment antigen (CYFRA21-1) and carcinoembryonic antigen (CEA) before and after chemotherapy were recorded. Patients in the two groups were followed up. RESULTS: Serum CYFRA21-1 and CEA expression levels in the combination group were lower than those in the control group after 3 and 5 cycles of chemotherapy (p<0.05). According to the Response Evaluation Criteria in Solid Tumors (RECIST), after 3 cycles of chemotherapy there were more patients with complete response (CR) and partial response (PR) in the combination group than those in the control group (p<0.05); after 5 cycles of chemotherapy, patients with CR in the combination group were more than those in the control group (p<0.05). According to CYFRA21-1 and CEA expression levels after 5 cycles of chemotherapy, the patients were separated to a high expression group with a median survival time of 19 weeks and a low expression group with a median survival time of 26 weeks, with a statistically significant difference between the two groups (c2=5.617, p=0.018). CONCLUSION: In conclusion, platinum drugs are effective in the treatment of elderly patients with advanced NSCLC, which prolong their survival and improve their quality of life, and therefore are worthy of clinical promotion.

Estrogens in municipal wastewater and receiving waters in the Beijing-Tianjin-Hebei region, China: Occurrence and risk assessment of mixtures.

The potentially high release of estrogens to surface waters due to high population density and local livestock production in the Beijing-Tianjin-Hebei region may pose adverse effects on reproductive systems of aquatic organisms. This study found that total measured concentrations of estrone (E1), 17ß-estradiol (E2), estriol (E3), 17α-ethinylestradiol (EE2) and diethylstilbestrol (DES) were 468 ± 27 ng/L in treated wastewater and 219 ± 23 ng/L in river waters in this region. E2, E3 and EE2 were the predominant estrogens in river waters. The restriction of DES for human use should have been enforced, however concentrations of DES were relatively high compared to other studies. Haihe and Yongdingxin Rivers delivered approximately 1.8 tonnes of estrogens to the Bohai Bay annually. Concentrations of individual estrogens were significantly higher in river waters in the dry season, however, mass loadings were significantly higher in the wet season. The average E2-equivalent concentrations reached 1.2 ± 0.2 and 0.64 ± 0.08 µg-E2/L following long-term and short-term exposure estimates, respectively, in river waters with an EE2 contribution of over 90 %. This could give rise to high risks to fish. Estrogens in river waters largely derived from human excretion. Field studies on estrogenic effects on fish reproductive systems are required locally considering high estrogen contamination levels.

Long noncoding RNA DANCR in various cancers: a meta-analysis and bioinformatics.

BACKGROUND: Differentiation antagonizing non-protein-coding RNA (DANCR) is a novel long noncoding RNA. Recent studies have shown that DANCR is aberrantly expressed in several types of cancer and is associated with poor outcomes. However, the clinical diagnostic significance of DANCR in tumors is not completely understood. METHODS: We searched the PubMed, Medline, Web of Science, EMBASE, Cochrane Library, and Ovid databases (up to December 30, 2018) for relevant literature. A total of 11 studies with 945 cancer patients were included in the present meta-analysis. We further validated the results using The Cancer Genome Atlas (TCGA) dataset. RESULTS: High expression of DANCR significantly predicted poor overall survival (low expression group vs high expression group; HR =0.56, 95% CI=[0.43, 0.72], =0.000); this was validated using TCGA. Moreover, DANCR expression was associated with advanced tumor node metastasis stage (I+II:III+IV; OR=0.22, 95% CI=[0.14, 0.35], P=0.001) and lymph node metastasis (no:yes; OR=0.21, 95% CI=[0.13, 0.35], P=0.001). CONCLUSION: Our results suggest that elevated DANCR is related to poor clinical outcomes and could serve as a potential prognostic biomarker of cancer.

Spatial and seasonal variations of antibiotics in river waters in the Haihe River Catchment in China and ecotoxicological risk assessment.

Concentrations of widely used antibiotics were predicted to be the highest in the Haihe River Catchment across China previously, potentially resulting in high ecotoxicological risks in this region. As a result of growing usage and regulation of antibiotic use in animals, the pattern of use may have altered temporally for different antibiotics. It is important to monitor the occurrence of antibiotics within different categories for understanding their mass loading to the catchment and the potential ecotoxicological risks involved. This study investigated the seasonal occurrence and spatial variation of 15 antibiotics in the Haihe River Catchment during 2016-2017. The investigated compounds included veterinary antibiotics, human-use antibiotics, and those intended for both human and animal use. Measurements reported from previous studies were compared with the results of this study and indicated that the use of veterinary antibiotics is probably increasing around the catchment. The ∑antibiotics concentration (i.e. the summed concentration of the 15 target antibiotics) ranged from 414 to 1951 ng/L, with an average of 821 ng/L. Discharges from wastewater treatment plants were the main sources of these compounds. The mass loading of antibiotics to the river waters was higher during wet seasons than during dry seasons. The mass fluxes of the antibiotics continuously increased towards the lower reaches of the rivers. The total annual input of the antibiotics from the Haihe River and Yongdingxin River into the Bohai Bay was 5008 kg/yr. Ofloxacin, trimethoprim, leucomycin, anhydro erythromycin and florfenicol were the predominant antibiotics, whilst amoxicillin, anhydro erythromycin, ofloxacin, norfloxacin and enrofloxacin may pose high ecotoxicological risks to the investigated aquatic ecosystem. Several antibiotics selected in this study were reported for the first time in this catchment. This study provides important information for chemical management and indicates that further monitoring is needed on the more harmful and veterinary antibiotics in the catchment.

Using magnetic susceptibility to evaluate pollution status of the sediment for a typical reservoir in northwestern China.

Intensive anthropogenic activities may add to pollution risks to lakes and rivers, which can be revealed by the magnetic characteristics of sediments. The present study aims to assess the pollution status of the sediment of a typical reservoir in northwestern China by application of magnetic susceptibility. The values of magnetic susceptibility exhibited significant positive correlations with trace metals (Co, Cu, Mn, Ni, and V) and natural radionuclides (232Th and 40K). Multivariate statistical analysis indicated common sources and similar deposition characteristics of magnetic particles and trace metals. It was conformed that magnetic susceptibility could be used as an indicator to identify industrial sources of trace metals, but was not suitable to indicate the traffic or natural sources. Linear regression equations between the low-frequency magnetic susceptibility and the integrated pollution index as well as annual effective dose rate indicated a potential for using magnetic susceptibility in semi-quantitative assessment of trace metal pollution and radiological hazard in sediments. A three-step procedure is proposed for the use of magnetic susceptibility in pollution monitoring, which provides a fast and effective method for estimating the pollution extent and tracing the major sources of trace metals in the sediment of lakes and rivers.

Pectolinarigenin inhibits non­small cell lung cancer progression by regulating the PTEN/PI3K/AKT signaling pathway.

Lung cancer is the principal cause of cancer­-associated mortality. Pectolinarigenin (Pec) reportedly has effective antitumor activity against certain cancer types. Phosphatase and tensin homolog (PTEN) is a well­known tumor suppressor and serves a vital role in cancer progression. However, the effect of Pec on non­small cell lung cancer (NSCLC) cell proliferation and metastasis, and the underlying mechanism, has not yet been elucidated. In the present study, it was demonstrated that Pec inhibited the proliferation of A549 and Calu­3 cells in dose­ and time­dependent manners. The apoptosis rate significantly increased with increasing doses of Pec. Apoptosis­associated protein expression was additionally altered by Pec exposure. Pec was able to suppress the metastasis of NSCLC cells; it upregulated the mRNA and protein expression levels of E­cadherin, and downregulated the mRNA and protein expression levels of vimentin. Additionally, Pec was able to activate PTEN and subsequently downregulate the PI3K/protein kinase B (AKT) signaling pathway. In summary, Pec was able to inhibit cell proliferation, promote apoptosis and suppress metastasis in NSCLC cells through the PTEN/PI3K/AKT signaling pathway, indicating that Pec is a potential agent for NSCLC therapy.

The occurrence of home and personal care products in the Haihe River catchment and estimation of human exposure.

A sub-catchment of the Haihe River basin goes through the Beijing-Tianjin region with a population of 26 million, therefore, the use and release of home and personal care product ingredients (HPCPs) to the river catchment could be potentially substantial. Many HPCPs have been shown to be toxic to human and animals. So, it is essential to know the exposure level of HPCPs in the river basin. The average concentrations of five preservatives, three disinfectants and an antioxidant were found to be 398, 352 and 77.7 ng L-1, respectively, in the dry season. The chemical concentrations in the effluents of wastewater treatment plants (WWTPs) and untreated wastewater discharge were respectively ca. 1.3-2.2 and 1.6-7.5 times higher than those in river water. The mass flux of ∑HPCPs has been estimated to be 8.7 g/h at the outfall of the Shahe Reservoir and 181 g/h and 214 g/h at the estuary of the Haihe River and Yongdingxin River to Bohai Bay, respectively. The attenuation of ∑HPCPs was over 79% along the Wenyu River. By using the backward method, the estimated average loadings to WWTPs ranged from 0.51 to 2.0 mg/day/cap for the various individual compounds. They were 1-3 orders of magnitude higher than the estimation from the forward calculation for parabens. This indicates the possible underestimation of chemical usage and human exposure levels by the current published studies or the probably additional industrial release to the target catchment. Such a study provides useful information for the development of chemical management approaches and indicates that further research is needed to improve the estimation of HPCPs usage and emissions to aquatic environment.

Lead in roadway dusts from different functional areas in a typical valley city, NW China: contamination and exposure risk.

Lead contamination and exposure risk assessment in roadway dusts from four different functional areas in a typical valley city in northwest China (Xi'an) were conducted in this study. A total of 130 roadway dust samples from park area (PA), traffic area (TA), educational area (EA), and residential area (RA) were collected and Pb concentrations in the samples were determined by using XRF (X-ray fluorescence). Geo-accumulation index (I geo) and enrichment factor (EF) were applied to assess Pb contamination level and the hazard indexes (HI) of Pb were calculated to evaluate the exposure risks to children and adults. The results showed that roadway dusts from all four functional areas had elevated Pb concentrations and pollution characteristics of Pb were discrepant in different functional areas. The mean concentration of Pb in roadway dusts from PA, TA, EA, and RA was 147.4, 74.8, 119.6, and 161.0 mg kg-1, respectively. The I geo and EF of Pb were mostly 1-3 and 2-20, which indicated moderate to high Pb contamination in roadway dusts. High contamination level of Pb in RA and EA should receive priority for prevention and control. Exposure risk assessment of Pb from roadway dusts was mainly in the acceptable range, but the potential risk of Pb exposure to children should be continuously concerned.

A comprehensive analysis of heavy metals in urban road dust of Xi'an, China: Contamination, source apportionment and spatial distribution.

A detailed investigation was conducted to study heavy metal contamination in road dust from four regions of Xi'an, Northwest China. The concentrations of eight heavy metals Co, Cr, Cu, Mn, Ni, Pb, Zn and V were determined by X-Ray Fluorescence. The mean concentrations of these elements were: 30.9mgkg-1 Co, 145.0mgkg-1 Cr, 54.7mgkg-1 Cu, 510.5mgkg-1 Mn, 30.8mgkg-1 Ni, 124.5mgkg-1 Pb, 69.6mgkg-1 V and 268.6mgkg-1 Zn. There was significant enrichment of Pb, Zn, Co, Cu and Cr based on geo-accumulation index value. Multivariate statistical analysis showed that levels of Cu, Pb, Zn, Co and Cr were controlled by anthropogenic activities, while levels of Mn, Ni and V were associated with natural sources. Principle component analysis and multiple linear regression were applied to determine the source apportionment. The results showed that traffic was the main source with a percent contribution of 53.4%. Natural sources contributed 26.5%, and other anthropogenic pollution sources contributed 20.1%. Clear heavy metal pollution hotspots were identified by GIS mapping. The location of point pollution sources and prevailing wind direction were found to be important factors in the spatial distribution of heavy metals.

Postreperfusion hyperkalemia in liver transplantation using donation after cardiac death grafts with pathological changes.

BACKGROUND: With the increasing use of donation after cardiac death (DCD), especially of the graft liver with steatosis or other pathological changes, the frequency of postreperfusion hyperkalemia in liver transplantation has increased significantly. The present study aimed to determine the factors associated with developing postreperfusion hyperkalemia in liver transplantation from DCD. METHODS: One hundred thirty-one consecutive adult patients who underwent orthotopic liver transplantation from DCD were retrospectively studied. Based on serum potassium within 5 minutes after reperfusion, recipients were divided into two groups: hyperkalemia and normokalemia. According to preoperative biopsy results, the DCD graft livers were classified into five categories. Univariate analysis was performed using Chi-square test to identify variables that were significantly different between two groups. Multivariate logistic regression was used to confirm the risk factors of developing hyperkalemia and postreperfusion syndrome. Correlation analysis was used to identify the relationship between the serum concentration of potassium within 5 minutes after reperfusion and the difference in mean arterial pressure values before and within 5 minutes after reperfusion. RESULTS: Twenty-two of 131 liver recipients had hyperkalemia episodes within 5 minutes after reperfusion. The rate of hyperkalemia was significantly higher in recipients of macrosteatotic DCD graft liver (78.6%, P<0.001) than that in recipients of non-macrosteatotic DCD graft liver. The odds ratio of developing postreperfusion hyperkalemia in recipients of macrosteatotic DCD graft liver was 51.3 (P<0.001). Macrosteatosis in the DCD graft liver was an independent risk factor of developing hyperkalemia within 5 minutes after reperfusion. The highest rate of postreperfusion syndrome also occurred in the recipients with macrosteatotic DCD graft liver (71.4%, P<0.001). A strong relationship existed between the serum potassium within 5 minutes after reperfusion and the difference in mean arterial pressure values before and within 5 minutes after reperfusion in macrosteatotic DCD graft liver recipients. CONCLUSION: Macrosteatosis in the DCD graft liver was an independent risk factor of developing hyperkalemia and postreperfusion syndrome in the recipients.

Analysis of heavy metals in the re-suspended road dusts from different functional areas in Xi'an, China.

A study on heavy metal pollution was undertaken in the re-suspended road dusts from different functional areas in Xi'an City of China to investigate the impacts of human activities and land uses on urban environment. The concentrations of Co, Cr, Cu, Mn, Ni, Pb, V, and Zn were determined using X-ray fluorescence spectrometry, and their accumulations were analyzed using enrichment factor. Correlation analysis, principal component analysis, and cluster analysis, combined with the concentration property and enrichment factor, were used to identify the possible sources of heavy metals investigated. The investigated re-suspended road dusts had Co, Cr, Cu, Pb, and Zn concentrations higher than background levels. Samples from different functional areas had diverse heavy metal concentration levels. Co, Cr, Cu, Pb, and Zn presented moderate/significant enrichment in the samples. The source analyses indicated that Mn, Ni, V, Pb, and Zn had the mixed sources of nature and traffic, Cr and Cu mainly originated from traffic source, while Co was primarily derived from construction source. Traffic and construction activities had a significant impact on urban environment. This preliminary research provides a valuable basis for urban environment protection and management.

Natural radioactivity in reservoir sediment near an industrial park of northwest China.

The activity concentration of natural radionuclides in the sediment of a reservoir near an industrial park of northwest China was determined using gamma ray spectrometry. The activity concentrations of (226)Ra, (232)Th and (40)K in the investigated samples range from 30.2 to 37.5, 56.5 to 79.8 and 785.6 to 940.3 Bq kg(-1) with an average of 33.2, 71.8 and 866.2 Bq kg(-1), respectively, which are higher than the corresponding activity concentrations in the control sample. Radium equivalent activity, external hazard index, internal hazard index, indoor air absorbed dose rate and annual effective dose rate were calculated to assess the radiation hazards associated with the use of this sediment in the construction of dwellings. It was concluded that the radiation levels in the reservoir sediment do not give rise to radiological health concerns and the sediment can be safely used in the construction of buildings.

Contamination and human health risk of lead in soils around lead/zinc smelting areas in China.

Pb/Zn smelting, an important economic activity in China, has led to heavy environmental pollution. This research reviewed studies on soil Pb contamination at Pb/Zn smelting sites in China published during the period of 2000 to 2015 to clarify the total levels, spatial changes, and health risks for Pb contamination in soils at local and national scales. The results show that Pb contents in surface soils at 58 Pb/Zn smelting sites in China ranged from 7 to 312,452 mg kg(-1) with an arithmetic average, geometric average, and median of 1982, 404, and 428 mg kg(-1), respectively (n = 1011). Surface soil Pb content at these smelting sites decreased from an average of 2466 to 659 mg kg(-1), then to 463 mg kg(-1) as the distance from the smelters increased from <1000 to 1000∼2000 m, and then to >2000 m. With respect to variation with depth, the average soil Pb content at these sites gradually decreased from 986 mg kg(-1) at 0- to 20-cm depth to 144 mg kg(-1) at 80- to 100-cm depth. Approximately 78 % of the soil samples (n = 1011) at the 58 Pb/Zn smelting sites were classified as having high Pb pollution levels. Approximately 34.2 and 7.7 % of the soil samples (n = 1011) at the 58 Pb/Zn smelting sites might pose adverse health effects and high chronic risks to children, respectively. The Pb/Zn smelting sites in the southwest and southeast provinces of China, as well as Liaoning province, were most contaminated and thus should receive priority for remediation.

Effects of icotinib on advanced non-small cell lung cancer with different EGFR phenotypes.

Icotinib is the first oral epidermal growth factor receptor (EGFR) tyrosine kinase receptor inhibitor, which has been proven to exert significant inhibitory effects on non-small cell lung cancer in vitro. Clinical evidence has showed that the efficacy of Icotinib on retreating advanced non-small cell lung cancer is comparable to Gefitinib. However, different phenotypes of EGFR can affect the therapeutic outcomes of EGFR tyrosine kinase receptor inhibitor. Therefore, our study focused on efficacy and safety of Icotinib in patients with advanced non-small cell lung cancer of different EGPR phenotypes. Clinical data of patients with advanced non-small cell lung cancer who received Icotinib treatment from August, 2011 to May, 2013 were retrospectively analyzed. Kaplan-Meier analysis was used for survival analysis and comparison. 18 wild-type EGFR and 51 mutant type were found in a total of 69 patients. Objective response rate of patients with mutant type EGFR was 54.9 % and disease control rate was 86.3 %. Objective response rate of wild-type patients was 11.1 % (P = 0.0013 vs mutant type), disease control rate was 50.0 % (P = 0.0017). Median progression-free survival (PFS) of mutant type and wild-type patients were 9.7 and 2.6 months, respectively (P < 0.001). Median PFS of exon 19 mutated mutant patients was 11.3 months, mean PFS of exon 21 L858R mutated mutant patients was 8.7 months (P = 0.3145). Median overall survival (OS) of EGFR mutated patients had not reached. OS time of 13 wild-type patients was 12.9 months (P < 0.001). The common adverse reactions of Icotinib included rash, diarrhea, itching skin with occurrence rates of 24.6 % (17/69), 13.0 % (9/69), and 11.6 % (8/69), respectively. Most adverse reactions were grade I-II. Icotinib has great efficacy in EGFR mutated patients, making it an optimal regimen to treat EGFR mutated patients. Furthermore, most of adverse reactions associated with Icotinib treatment were tolerable.

Endothelial progenitor cells are associated with plasma homocysteine in coronary artery disease.

OBJECTIVE: Little is known about the association between plasma homocysteine (Hcy) and endothelial progenitor cells (EPCs) in coronary artery disease (CAD). METHODS: Blood mononuclear cells were isolated from CAD (n = 30) patients and non-CAD controls (n = 30). Flow cytometric analysis and an in vitro culture system was used to evaluate the number and function of the EPC. Plasma homocysteine (Hcy) concentration was measured by an automated fluorescence polarization immunoassay. RESULTS: Hcy level was higher in CAD than in non-CAD (13.69 +/- 4.48 vs 9.34 + 2.31 pmol/L, P < 0.01). The number of circulating EPCs from CAD was decreased compared with non-CAD (58.7 +/- 10.6 vs. 94.3 +/- 15.1 cells/ml, P < 0.01). This decrease of EPCs in CAD was also detected (33.5 +/- 6.9 vs. 55.9 +/- 9.7 EPCs/x200 field; P < 0.01) in an in vitro culture system. The numbers of circulating and differentiated EPCs were both inversely correlated with Hcy. EPCs from CAD were significantly impaired in their migratory capacity and ability to adhere to fibronectin. CONCLUSIONS: We observed the correlation between Hcy level and EPC number, and also found an increased Hcy level in CAD patients. It will be interesting to reveal the underlying mechanisms contributing to the correlation and examine the possible causal relationship between Hcy levels and CAD.