Adaptive Top-K Algorithm for Medical Conversational Diagnostic Model.

With advancements in computing technology and the rapid progress of data science, machine learning has been widely applied in various fields, showing great potential, especially in digital healthcare. In recent years, conversational diagnostic systems have been used to predict diseases through symptom checking. Early systems predicted the likelihood of a single disease by minimizing the number of questions asked. However, doctors typically perform differential diagnoses in real medical practice, considering multiple possible diseases to address diagnostic uncertainty. This requires systems to ask more critical questions to improve diagnostic accuracy. Nevertheless, such systems in acute medical situations need to process information quickly and accurately, but the complexity of differential diagnosis increases the system's computational cost. To improve the efficiency and accuracy of telemedicine diagnostic systems, this study developed an optimized algorithm for the Top-K algorithm. This algorithm dynamically adjusts the number of the most likely diseases and symptoms by real-time monitoring of case progress, optimizing the diagnostic process, enhancing accuracy (99.81%), and increasing the exclusion rate of severe pathologies. Additionally, the Top-K algorithm optimizes the diagnostic model through a policy network loss function, effectively reducing the number of symptoms and diseases processed and improving the system's response speed by 1.3-1.9 times compared to the state-of-the-art differential diagnosis systems.

Retinal ischemia-reperfusion injury and pretreatment with Lycium barbarum glycopeptide.

AIM: To investigate the antioxidant protective effect of Lycium barbarum glycopeptide (LbGP) pretreatment on retinal ischemia-reperfusion (I/R) injury (RIRI) in rats. METHODS: RIRI was induced in Sprague Dawley rats through anterior chamber perfusion, and pretreatment involved administering LbGP via gavage for 7d. After 24h of reperfusion, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatinine (CREA) levels, retinal structure, expression of Caspase-3 and Caspase-8, superoxide dismutase (SOD) activity, and malondialdehyde (MDA) in the retina were measured. RESULTS: The pretreatment with LbGP effectively protected the retina and retinal tissue from edema and inflammation in the ganglion cell layer (GCL) and nerve fiber layer (NFL) of rats subjected to RIRI, as shown by light microscopy and optical coherence tomography (OCT). Serum AST was higher in the model group than in the blank group (P=0.042), but no difference was found in ALT, AST, and CREA across the LbGP groups and model group. Caspase-3 expression was higher in the model group than in the blank group (P=0.006), but no difference was found among LbGP groups and the model group. Caspase-8 expression was higher in the model group than in the blank group (P=0.000), and lower in the 400 mg/kg LbGP group than in the model group (P=0.016). SOD activity was lower in the model group than in the blank group (P=0.001), and the decrease was slower in the 400 mg/kg LbGP group than in the model group (P=0.003). MDA content was higher in the model group than in the blank group (P=0.001), and lower in the 400 mg/kg LbGP group than in the model group (P=0.016). The pretreatment with LbGP did not result in any observed liver or renal toxicity in the model. CONCLUSION: LbGP pretreatment exhibits dose-dependent anti-inflammatory, and antioxidative effects by reducing Caspase-8 expression, preventing declines of SOD activity, and decreasing MDA content in the RIRI rat model.

Trajectories of body mass index and incident kidney stone disease: a prospective cohort study in Chinese young adults.

The present study aims to explore the potential changing trajectory patterns of body mass index (BMI) for Chinese young adults and identify the relationship of BMI trajectory patterns with kidney stone disease (KSD) incidence. Latent class growth analysis was used to identify distinct trajectories of BMI during young adulthood. Cox proportion hazard models were conducted to explore the association between the BMI trajectory group memberships and incident KSD. Subgroup and sensitivity analyses were undertaken to test the robustness of the findings. In total, 2,966 young adults who attended at least three annual check-ups from 2014 to 2021 without KSD at baseline were enrolled in the cohort analysis. Three district BMI trajectories were identified for young adults, labeled as low-stable in normal BMI (28.5%), medium-rising to high BMI (67.4%), and rapid-rising to high BMI (4.1%). Compared with the low-stable in normal BMI group, Hazard ratios (HRs) of the rapid-rising and medium-rising to high BMI groups were 3.19 (95% CI: 1.54-6.63) and 1.78 (95% CI: 1.08-2.92) after adjusting the covariates. The cumulative incidence curves likewise illustrated that young adults in the rapid-rising to high BMI group had the highest risk of developing KSD compared to the other two groups. The rapid BMI growth trajectories during young adulthood were identified to be independently associated with a higher risk of KSD. The findings supplied novel insights that monitoring the BMI changing pattern may be favorable to early intervention of KSD during young adulthood.

The diagnostic performance of T1 mapping in the assessment of breast lesions: A preliminary study.

PURPOSE: To assess T1 mapping performance in distinguishing between benign and malignant breast lesions and to explore its correlation with histopathologic features in breast cancer. METHODS: This study prospectively enrolled 103 participants with a total of 108 lesions, including 25 benign and 83 malignant lesions. T1 mapping, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) were performed. Two radiologists independently outlined the ROIs and analyzed T1 and apparent diffusion coefficient (ADC) values for each lesion, assessing interobserver reliability with the intraclass correlation coefficient (ICC). T1 and ADC values were compared between benign and malignant lesions, across different histopathological characteristics (histological grades, estrogen, progesterone and HER2 receptors expression, Ki67, N status). Receiver operating characteristic (ROC) analysis and Pearson correlation coefficient (ρ) were performed. RESULTS: T1 values showed statistically significant differences between benign and malignant groups (P < 0.001), with higher values in the malignant (1817.08 ms ± 126.64) compared to the benign group (1429.31 ms ± 167.66). In addition, T1 values significantly increased in the ER (-) group (P = 0.001). No significant differences were found in T1 values among HER2, Ki67, N status, and histological grades groups. Furthermore, T1 values exhibited a significant correlation (ρ) with ER (P < 0.01) and PR (P = 0.03). The AUC for T1 value in distinguishing benign from malignant lesions was 0.69 (95 % CI: 0.55 - 0.82, P = 0.005), and for evaluating ER status, it was 0.75 (95 % CI: 0.62 - 0.87, P = 0.002). CONCLUSIONS: T1 mapping holds the potential as an imaging biomarker to assist in the discrimination of benign and malignant breast lesions and assessing the ER expression status in breast cancer.

Demultiplexing of single-cell RNA-sequencing data using interindividual variation in gene expression.

Motivation: Pooled designs for single-cell RNA sequencing, where many cells from distinct samples are processed jointly, offer increased throughput and reduced batch variation. This study describes expression-aware demultiplexing (EAD), a computational method that employs differential co-expression patterns between individuals to demultiplex pooled samples without any extra experimental steps. Results: We use synthetic sample pools and show that the top interindividual differentially co-expressed genes provide a distinct cluster of cells per individual, significantly enriching the regulation of metabolism. Our application of EAD to samples of six isogenic inbred mice demonstrated that controlling genetic and environmental effects can solve interindividual variations related to metabolic pathways. We utilized 30 samples from both sepsis and healthy individuals in six batches to assess the performance of classification approaches. The results indicate that combining genetic and EAD results can enhance the accuracy of assignments (Min. 0.94, Mean 0.98, Max. 1). The results were enhanced by an average of 1.4% when EAD and barcoding techniques were combined (Min. 1.25%, Median 1.33%, Max. 1.74%). Furthermore, we demonstrate that interindividual differential co-expression analysis within the same cell type can be used to identify cells from the same donor in different activation states. By analysing single-nuclei transcriptome profiles from the brain, we demonstrate that our method can be applied to nonimmune cells. Availability and implementation: EAD workflow is available at https://isarnassiri.github.io/scDIV/ as an R package called scDIV (acronym for single-cell RNA-sequencing data demultiplexing using interindividual variations).

Chloroplast biogenesis involves spatial coordination of nuclear and organellar gene expression in Chlamydomonas.

The localization of translation can direct the polypeptide product to the proper intracellular compartment. Our results reveal translation by cytosolic ribosomes on a domain of the chloroplast envelope in the unicellular green alga Chlamydomonas (Chlamydomonas reinhardtii). We show that this envelope domain of isolated chloroplasts retains translationally active ribosomes and mRNAs encoding chloroplast proteins. This domain is aligned with localized translation by chloroplast ribosomes in the translation zone, a chloroplast compartment where photosystem subunits encoded by the plastid genome are synthesized and assembled. Roles of localized translation in directing newly synthesized subunits of photosynthesis complexes to discrete regions within the chloroplast for their assembly are suggested by differences in localization on the chloroplast of mRNAs encoding either subunit of the light-harvesting complex II or the small subunit of Rubisco. Transcription of the chloroplast genome is spatially coordinated with translation, as revealed by our demonstration of a subpopulation of transcriptionally active chloroplast nucleoids at the translation zone. We propose that the expression of chloroplast proteins by the nuclear-cytosolic and organellar genetic systems is organized in spatially aligned subcompartments of the cytoplasm and chloroplast to facilitate the biogenesis of the photosynthetic complexes.

Polygenic risk-stratified screening for nasopharyngeal carcinoma in high-risk endemic areas of China: a cost-effectiveness study.

Background: Nasopharyngeal carcinoma (NPC) has an extremely high incidence rate in Southern China, resulting in a severe disease burden for the local population. Current EBV serologic screening is limited by false positives, and there is opportunity to integrate polygenic risk scores for personalized screening which may enhance cost-effectiveness and resource utilization. Methods: A Markov model was developed based on epidemiological and genetic data specific to endemic areas of China, and further compared polygenic risk-stratified screening [subjects with a 10-year absolute risk (AR) greater than a threshold risk underwent EBV serological screening] to age-based screening (EBV serological screening for all subjects). For each initial screening age (30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, and 65-69 years), a modeled cohort of 100,000 participants was screened until age 69, and then followed until age 79. Results: Among subjects aged 30 to 54 years, polygenic risk-stratified screening strategies were more cost-effective than age-based screening strategies, and almost comprised the cost-effectiveness efficiency frontier. For men, screening strategies with a 1-year frequency and a 10-year absolute risk (AR) threshold of 0.7% or higher were cost-effective, with an incremental cost-effectiveness ratio (ICER) below the willingness to pay (¥203,810, twice the local per capita GDP). Specifically, the strategies with a 10-year AR threshold of 0.7% or 0.8% are the most cost-effective strategies, with an ICER ranging from ¥159,752 to ¥201,738 compared to lower-cost non-dominated strategies on the cost-effectiveness frontiers. The optimal strategies have a higher probability (29.4-35.8%) of being cost-effective compared to other strategies on the frontier. Additionally, they reduce the need for nasopharyngoscopies by 5.1-27.7% compared to optimal age-based strategies. Likewise, for women aged 30-54 years, the optimal strategy with a 0.3% threshold showed similar results. Among subjects aged 55 to 69 years, age-based screening strategies were more cost-effective for men, while no screening may be preferred for women. Conclusion: Our economic evaluation found that the polygenic risk-stratified screening could improve the cost-effectiveness among individuals aged 30-54, providing valuable guidance for NPC prevention and control policies in endemic areas of China.

Bimetallic iron complex constructed clusters and single atoms neighboring structure to enhance oxygen reduction reaction performance.

Electrocatalysts are useful in lowering the energy barrier in oxygen reduction reaction (ORR). In this study, a catalyst with neighboring Fe single-atom and cluster is created by adsorbing a bimetallic Fe complex onto N-doped carbon and then pyrolyzing it. The resulting catalyst has good performance and a half-wave potential of 0.89 V. When used in Zn-air batteries, the voltage drops by only 8.13 % after 145 h of cycling. Theoretical studies show that electrons transfer from neighboring clusters to single atoms and the catalyst has a lower d-band center. These reduce intermediate desorption energy, hence improving ORR performance. This work demonstrates the capacity to adjust the catalytic properties through the interaction of diverse metal structures, which helps to design more efficient catalysts.

Facilitative effect of awe on cooperation: The role of the small-self and self-other inclusion.

Awe has been theorized as a kind of self-transcendence emotion that has an important impact on individual social behavior. Based on the self-transcendence of awe, this study examined how awe can increase small-self and self-other inclusion to facilitate cooperation among individuals across three studies (N = 1162). First, the relationship between awe, cooperative propensity, and the mediating role of small-self and self-other inclusion in the relationship was examined using questionnaires on trait levels (Study 1). Second, awe emotions were induced from the state level through behavioral experiments to verify the facilitative effect on cooperative behavior in multiple rounds of public goods dilemma (Study 2). Third, by adding the induction of negative awe to discuss the impact of different valence of awe on cooperative behavior, the mediating role of small-self and self-other inclusion was supported (Study 3). Results show that awe has a facilitative effect on cooperation, which provides strong evidence for the positive social function of self-transcendent emotional awe.

Microbes translocation from oral cavity to nasopharyngeal carcinoma in patients.

The presence of oral microbes in extra-oral sites is linked to gastrointestinal cancers. However, their potential ectopically colonization in the nasopharynx and impact on local cancer development remains uncertain. Our study involving paired nasopharyngeal-oral microbial samples from nasopharyngeal carcinoma (NPC) patients and controls unveils an aberrant oral-to-nasopharyngeal microbial translocation associated with increased NPC risk (OR = 4.51, P = 0.012). Thirteen species are classified as oral-translocated and enriched in NPC patients. Among these, Fusobacterium nucleatum and Prevotella intermedia are validated through culturomics and clonal strain identification. Nasopharyngeal biopsy meta-transcriptomes confirm these microbes within tumors, influencing local microenvironment and cytokine response. These microbes correlate significantly with the Epstein-Barr virus (EBV) loads in the nasopharynx, exhibiting an increased dose-response relationship. Collectively, our study identifies oral microbes migrating to the nasopharynx, infiltrating tumors, impacting microenvironments and linking with EBV infection. These results enhance our understanding of abnormal microbial communication and their roles in carcinogenesis.

Nanoreceptors promote mutant p53 protein degradation by mimicking selective autophagy receptors.

In some cancers mutant p53 promotes the occurrence, development, metastasis and drug resistance of tumours, with targeted protein degradation seen as an effective therapeutic strategy. However, a lack of specific autophagy receptors limits this. Here, we propose the synthesis of biomimetic nanoreceptors (NRs) that mimic selective autophagy receptors. The NRs have both a component for targeting the desired protein, mutant-p53-binding peptide, and a component for enhancing degradation, cationic lipid. The peptide can bind to mutant p53 while the cationic lipid simultaneously targets autophagosomes and elevates the levels of autophagosome formation, increasing mutant p53 degradation. The NRs are demonstrated in vitro and in a patient-derived xenograft ovarian cancer model in vivo. The work highlights a possible direction for treating diseases by protein degradation.

A comprehensive predictive model for radiation-induced brain injury in risk stratification and personalized radiotherapy of nasopharyngeal carcinoma.

BACKGROUND AND PURPOSE: Radiation-induced brain injury (RBI) is a severe radiotoxicity for nasopharyngeal carcinoma (NPC) patients, greatly affecting their long-term life quality and survival. We aim to establish a comprehensive predictive model including clinical factors and newly developed genetic variants to improve the precision of RBI risk stratification. MATERIALS AND METHODS: By performing a large registry-based retrospective study with magnetic resonance imaging follow-up on RBI development, we conducted a genome-wide association study and developed a polygenic risk score (PRS) for RBI in 1189 NPC patients who underwent intensity-modulated radiotherapy. We proposed a tolerance dose scheme for temporal lobe radiation based on the risk predicted by PRS. Additionally, we established a nomogram by combining PRS and clinical factors for RBI risk prediction. RESULTS: The 38-SNP PRS could effectively identify high-risk individuals of RBI (P = 1.42 × 10-34). Based on genetic risk calculation, the recommended tolerance doses of temporal lobes should be 57.6 Gy for individuals in the top 10 % PRS subgroup and 68.1 Gy for individuals in the bottom 50 % PRS. Notably, individuals with high genetic risk (PRS > P50) and receiving high radiation dose in the temporal lobes (D0.5CC > 65 Gy) had an approximate 50-fold risk over individuals with low PRS and receiving low radiation dose (HR = 50.09, 95 %CI = 24.27-103.35), showing an additive joint effect (Pinteraction < 0.001). By combining PRS with clinical factors including age, tumor stage, and radiation dose of temporal lobes, the predictive accuracy was significantly improved with C-index increased from 0.78 to 0.85 (P = 1.63 × 10-2). CONCLUSIONS: The PRS, together with clinical factors, could improve RBI risk stratification and implies personalized radiotherapy.

Machine learning regression algorithms to predict short-term efficacy after anti-VEGF treatment in diabetic macular edema based on real-world data.

The objective of this retrospective study was to predict short-term efficacy of anti-vascular endothelial growth factor (VEGF) treatment in diabetic macular edema (DME) using machine learning regression models. Real-world data from 279 DME patients who received anti-VEGF treatment at Ineye Hospital of Chengdu University of TCM between April 2017 and November 2022 were analyzed. Eight machine learning regression models were established to predict four clinical efficacy indicators. The accuracy of the models was evaluated using mean absolute error (MAE), mean square error (MSE) and coefficient of determination score (R2). Multilayer perceptron had the highest R2 and lowest MAE among all models. Regression tree and lasso regression had similar R2, with lasso having lower MAE and MSE. Ridge regression, linear regression, support vector machines and polynomial regression had lower R2 and higher MAE. Support vector machine had the lowest MSE, while polynomial regression had the highest MSE. Stochastic gradient descent had the lowest R2 and high MAE and MSE. The results indicate that machine learning regression algorithms are valuable and effective in predicting short-term efficacy in DME patients through anti-VEGF treatment, and the lasso regression is the most effective ML algorithm for developing predictive regression models.

The interaction and mediation effects between the host genetic factors and Epstein-Barr virus VCA-IgA in the risk of nasopharyngeal carcinoma.

Previous studies have demonstrated strong associations between host genetic factors and Epstein-Barr virus (EBV) VCA-IgA with the risk of nasopharyngeal carcinoma (NPC). However, the specific interplay between host genetics and EBV VCA-IgA on NPC risk is not well understood. In this two-stage case-control study (N = 4804), we utilized interaction and mediation analysis to investigate the interplay between host genetics (genome-wide association study-derived polygenic risk score [PRS]) and EBV VCA-IgA antibody level in the NPC risk. We employed a four-way decomposition analysis to assess the extent to which the genetic effect on NPC risk is mediated by or interacts with EBV VCA-IgA. We consistently found a significant interaction between the PRS and EBV VCA-IgA on NPC risk (discovery population: synergy index [SI] = 2.39, 95% confidence interval [CI] = 1.85-3.10; replication population: SI = 3.10, 95% CI = 2.17-4.44; all pinteraction < 0.001). Moreover, the genetic variants included in the PRS demonstrated similar interactions with EBV VCA-IgA antibody. We also observed an obvious dose-response relationship between the PRS and EBV VCA-IgA antibody on NPC risk (all ptrend < 0.001). Furthermore, our decomposition analysis revealed that a substantial proportion (approximately 90%) of the genetic effects on NPC risk could be attributed to host genetic-EBV interaction, while the risk effects mediated by EBV VCA-IgA antibody were weak and statistically insignificant. Our study provides compelling evidence for an interaction between host genetics and EBV VCA-IgA antibody in the development of NPC. These findings emphasize the importance of implementing measures to control EBV infection as a crucial strategy for effectively preventing NPC, particularly in individuals at high genetic risk.

Association of body fat percentage with kidney stone Disease: a cross-sectional and longitudinal study among bus drivers.

BACKGROUND: The association between body fat percentage (BFP) and kidney stone disease (KSD) among bus drivers has not been explored in the existing literature. Thus, this study was conducted to explore the influence of BFP on the risk of KSD as well as KSD development for bus drivers to fill the research gap. METHODS: A cross-sectional and longitudinal cohort study was designed. In total, 3433 bus drivers were included in the cross-sectional analyses, and 1864 bus drivers without KSD at baseline and with regular follow-up were included in the longitudinal cohort study. RESULTS: During a median follow-up of 2.9 years, KSD occurred in 15.0% of bus drivers. Multivariate logistic analysis found that each 5% higher BFP was not only significantly related with higher odds of KSD (odds ratio [OR] = 1.48), but also associated with higher odds of developing KSD (OR = 1.27). The risk of prevalent KSD in obesity group based on BFP was 2.47 times of the normal group; and the corresponding risk of developing KSD was 1.61 times. For obesity bus drives with age < 40, the corresponding risk increased to 4.54 times. CONCLUSION: Bus drivers were reported to have a high prevalence of KSD as well as development of KSD. As a significant predictive factor for KSD, BFP can be used to monitor and prevent bus drivers from kidney stone formation. Bus drivers in obesity group based on BFP, especially with age < 40 years should become priority subjects for targeted prevention.

Wheat WRKY transcription factor TaWRKY24 confers drought and salt tolerance in transgenic plants.

Drought and salt stress are major environmental conditions that severely limit plant growth and productivity. WRKY transcription factors play a vital role in the responses against biotic or abiotic stress. In this study, TaWRKY24, a gene of the IIe WRKY family identified in wheat, was cloned and characterized. TaWRKY24 was mainly expressed in wheat leaf and stem and induced by treatment with PEG6000, salt, H2O2, ABA, MeJA, and ethrel. TaWRKY24 transient expression in onion epidermal cells suggested its nuclear localization and its transcriptional activation capability characteristics. Overexpression of TaWRKY24 in tobacco improved the seed germination rate and root growth of seedlings in transgenic lines when subjected to higher mannitol and NaCl concentrations. Further research showed that transgenic lines had higher proline and soluble sugars and lower levels of reactive oxygen species (ROS) and malondialdehyde (MDA). Moreover, compared to normal and negative control plants, TaWRKY24 silenced wheat seedlings had reduced growth under salt and drought stress. This study shows that wheat TaWRKY24 is crucial to plant stress, providing an excellent candidate gene for wheat resistance breeding.

A wheat WRKY transcription factor TaWRKY17 enhances tolerance to salt stress in transgenic Arabidopsis and wheat plant.

WRKY transcription factors are essential to plant growth, development, resistance, and the regulation of metabolic pathways. In this study, we characterized TaWRKY17, a WRKY transcription factor from wheat, which was differentially expressed in various wheat organs and was up-regulated by salt, drought, hydrogen peroxide (H2O2) and abscisic acid (ABA) treatment. To analyze TaWRKY17 function under salt stress, we obtained stable T3 generation transgenic Arabidopsis and wheat TaWRKY17 overexpression plants. TaWRKY17 overexpression in Arabidopsis and wheat caused a significant plant salt-stress tolerance enhancement. Under salt stress, superoxide dismutase (SOD), peroxidase (POD), and catalase (CAT) enzyme activities were elevated in transgenic Arabidopsis and wheat plants compared with the wild type (WT), whereas H2O2 and malondialdehyde (MDA) accumulation was reduced in the transgenic lines. Moreover, ABA/reactive oxygen species (ROS)-related, and stress-response genes were regulated in the transgenic wheat plants, increasing tolerance to salt stress. The transgenic wheat plants were highly sensitive to ABA during seed germination and early seedling growth. In addition, TaWRKY17 virus-induced gene silencing (VIGS) decreased salt tolerance. These results showed that TaWRKY17 enhances salt tolerance by regulating ABA/ROS-related, and stress-response genes and increasing anti-oxidative stress capabilities. Therefore, this gene could be a target for the genetic modification of wheat.

Genome-wide identification of ETHYLENE INSENSITIVE 2 in Triticeae species reveals that TaEIN2-4D.1 regulates cadmium tolerance in Triticum aestivum.

ETHYLENE INSENSITIVE 2 (EIN2), as the core component of the ethylene signaling pathway, can widely regulate plant growth, development, and stress responses. However, the comprehensive study and function of EIN2 in wheat Cadmium (Cd) stress remain largely unexplored. Here, we identified 33 EIN2 genes and designated as TaEIN2-2B to TaEIN2-Un.3 in Triticum aestivum. The analysis of cis-regulatory elements in promoter regions and RNA-Seq showed that TaEIN2s were functionally related to plant growth and development, as well as the response to biotic and abiotic stress. qRT-PCR analysis of TaEIN2s indicated their sensitivity to Cd stress. Compared with WT plants, TaEIN2-4D.1-RNAi transgenic wheat lines showed enhanced shoot and root elongation, dry weight and chlorophyll accumulation, together with a reduced accumulation of Cd in wheat grain. In addition, TaEIN2-4D.1-RNAi transgenic wheat lines showed enhanced Reactive Oxygen Species (ROS) scavenging capacity compared with WT plants. In conclusion, our research indicates that TaEIN2 plays a key role in response to cadmium stress in wheat, which provides valuable information for crop improvement.

A 5-Year Follow-Up Study to Explore Factors Associated with Rapid Kidney Function Decline Among Bus Drivers.

Background: Owing to the stressful occupational characteristics, bus drivers have been reported to have a higher risk of renal dysfunction. However, the related factors associated with rapid kidney function decline among bus drivers have not been explored in the existing literature. Therefore, our research aimed to investigate factors related with rapid kidney function decline, and to explore the correlation of baseline SUA (serum uric acid), longitudinal changes in SUA, and rapid eGFR (estimated glomerular filtration rate) decline for bus drivers. Methods: This was a five-year cohort study in Shenzhen, China, between 2017 and 2021. We included 832 bus drivers with normal kidney function at baseline. Study subjects were stratified into four quartiles of change in eGFR, and rapid eGFR decline was regarded as the highest (4th) quartile of ΔeGFR (eGFR in 2017-eGFR in 2021). Univariable and multivariable logistic regressions were conducted to explore factors affecting rapid eGFR decline. Results: The incidence of hyperuricemia among bus drivers was 37.7% in 2017 and 40.5% in 2021. The overall subjects had a median 5-year decrease in eGFR of 6.72 mL/min/1.73 m2, and individuals with increased SUA from normal to hyperuricemia group had the greatest decline of eGFR. Multivariate analysis showed bus drivers' age (Odds radio: OR, 1.04), elevated baseline eGFR (OR, 1.08), and SUA increase (OR, 1.38) were significantly associated with rapid eGFR changes. Conclusion: The high prevalence of hyperuricemia among bus drivers should warrant more attention from health professionals. Subjects' age, elevated baseline eGFR, and SUA increase were risk factors for rapid eGFR decline over 5-year. The findings can provide significant evidence for timely prevention and intervention to decrease the incidence of rapid renal function decline among bus drivers.