Association between metabolic syndrome and the risk of colorectal cancer: a prospective study in China.

OBJECTIVE: To evaluate the correlation between metabolic syndrome (MetS) and its components on the incidence of colorectal cancer (CRC) based on data from Jinchang Cohort. METHODS: This is a large prospective cohort study. Between 2011 and 2020, a total of 43 516 individuals from Jinchang Cohort were included for this study. Hazard ratios (HRs) with 95% confidence intervals (CIs) for CRC according to MetS were calculated with the Cox proportional hazard models. The restricted cubic spine models with four knots were conducted to fit the dose-response relationships. RESULTS: MetS was associated with increased risk of CRC (n = 141; HR: 1.64, 95% CI: 1.15-2.33) after adjusting for confounding factors (age, sex, education level, family history of CRC, smoking index and alcohol index). Participants with hyperglycemia had a significantly higher risk of developing incident CRC (HR: 1.70; 95% CI: 1.19-2.43). The positive association between MetS and CRC was observed in males (HR: 1.76; 95% CI: 1.17-2.63), but not in females (HR: 1.24; 95% CI: 0.59-2.64). Furthermore, linear dose-response relationship was found between fasting plasma glucose (FPG) and CRC risk in males ( Poverall < 0.05, Pnon-linear = 0.35). When stratified by smoke and drink, MetS was found to increase the incidence of CRC only in the smoke (HR: 2.07, 95% CI: 1.35-3.18) and drink (HR: 2.93, 95% CI: 1.51-5.69) groups. CONCLUSION: MetS was associated with a higher risk of CRC incidence. Hyperglycemia lended strong support to the role of MetS in new-onset CRC, especially in males. Other components of MetS were not found to be associated with increased risk of CRC.

Progression from different blood glucose states to cardiovascular diseases: a prospective study based on multi-state model.

AIMS: To quantify the trajectories from normoglycaemia to pre-diabetes, subsequently to type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), and cardiovascular death, and the effects of risk factors on the rates of transition. METHODS AND RESULTS: We used data from the Jinchang Cohort of 42 585 adults aged 20-88 free of coronary heart disease (CHD) and stroke at baseline. A multistate model was applied for analysing the progression of CVD and its relation to various risk factors. During a median follow-up of 7 years, 7498 participants developed pre-diabetes, 2307 developed T2DM, 2499 developed CVD, and 324 died from CVD. Among 15 postulated transitions, transition from comorbid CHD and stroke to cardiovascular death had the highest rate (157.21/1000 person-years), followed by transition from stroke alone to cardiovascular death (69.31/1000 person-years) and transition from pre-diabetes to normoglycaemia (46.51/1000 person-years). Pre-diabetes had a sojourn time of 6.77 years, and controlling weight, blood lipids, blood pressure, and uric acid within normal limits may promote reversion to normoglycaemia. Among transitions to CHD alone and stroke alone, transition from T2DM had the highest rate (12.21/1000 and 12.16/1000 person-years), followed by transition from pre-diabetes (6.81/1000 and 4.93/1000 person-years) and normoglycaemia (3.28/1000 and 2.39/1000 person-years). Age and hypertension were associated with an accelerated rate for most transitions. Overweight/obesity, smoking, dyslipidaemia, and hyperuricaemia played crucial but different roles in transitions. CONCLUSION: Pre-diabetes was the optimal intervention stage in the disease trajectory. The derived transition rates, sojourn time, and influence factors could provide scientific support for the primary prevention of both T2DM and CVD.

Former single-outcome studies on the relationship between glycaemia and cardiovascular disease (CVD) may ignore the complexity and multi-transformations across the multiple stages from normoglycaemia to CVD in real-world setting. We aimed to quantify the trajectories from normoglycaemia to pre-diabetes, subsequently to type 2 diabetes, CVD, and cardiovascular death. Pre-diabetes was the optimal intervention stage in the disease trajectory. Transitions from CVD to death had much higher rates than other transitions. Age and hypertension were associated with an accelerated rate for most transitions. Overweight/obesity, smoking, dyslipidaemia, and hyperuricaemia played crucial but different roles in transitions.

Fasting plasma glucose and alanine aminotransferase on the risk of hepatocellular carcinoma: A nested case-control study.

BACKGROUND: The risk of hepatocellular carcinoma (HCC) is associated with a variety of factors. However, the possible association between the abnormal metabolism of fasting plasma glucose (FPG) and alanine aminotransferase (ALT) and the risk of HCC has not been widely studied. We examined this relationship based on a prospective cohort study. METHODS: 162 first-attack HCC cases during three follow-up periods (2014-2020) were selected as the case group. A control group of 648 participants was obtained by 1:4 matching of age (± 2 years) and sex with noncancer participants in the same period. Conditional logistic regression models, restricted cubic spline models, additive interaction models, and generalized additive models were used to explore the effects of FPG and ALT on the risk of HCC. RESULTS: After correction for confounding factors, we found that abnormal FPG and elevated ALT increased the risk of HCC, respectively. Compared with the normal FPG group, the risk of HCC was significantly increased in the impaired fasting glucose (IFG) (OR = 1.91, 95 %CI: 1.04, 3.50) and diabetes groups (OR = 2.12, 95 %CI: 1.24, 3.63). Compared with the lowest quartile of ALT, subjects in the fourth quartile had an 84 % increased risk of HCC (OR = 1.84, 95 %CI: 1.05-3.21). Moreover, there was an interaction between FPG and ALT on the risk of HCC, and 74 % of the HCC risk could be attributed to their synergistic effect (AP = 0.74, 95 %CI: 0.56-0.92). CONCLUSION: Abnormal FPG and elevated ALT are independent risk factors for HCC, and they have a synergistic effect on the risk of HCC. Therefore, serum FPG and ALT levels should be monitored to prevent the development of HCC.

Mediating effect of metabolic diseases on the relationship between hyperuricemia and coronary heart disease.

BACKGROUND AND AIMS: Studies have shown that elevated serum uric acid (SUA) may increase the risk of coronary heart disease (CHD). However, it is still disputable how mediate effects between metabolic diseases and hyperuricemia affect the incidence of CHD. This study aimed to explore whether metabolic diseases may mediate the connection from hyperuricemia at baseline to the elevated incidence risk of CHD during follow-ups. METHODS AND RESULTS: Based on the Jinchang cohort, 48 001 subjects were followed for 9 years between June 2011 and December 2019. Multivariate-adjusted Cox regression models were applied to estimate hazard ratios (HRs) of CHD with 95% confidence intervals (CIs). Significantly increased risks of CHD were observed in hyperuricemia (HR:1.46, 95%CI:1.28, 1.67) when compared with normouricemia population. The mediating effect model further demonstrated that metabolic diseases could mediate the association between hyperuricemia and CHD pathogenesis, partially for the combined metabolic diseases with mediation effects of 45.12%, 25.24% for hypertension, 28.58% for overweight or obese status, 29.05% for hypertriglyceridemia, 6.70% for hypercholesterolemia, 3.52% for low high density lipoprotein cholesterol (HDL-C), and 6.51% for high low density lipoprotein cholesterol (LDL-C), respectively. CONCLUSIONS: Hyperuricemia significantly increased the risk of incident CHD, and this association was partly mediated by metabolic diseases.

Cohort Profile Update: the China Metal-Exposed workers Cohort Study (Jinchang Cohort).

The Jinchang Cohort was an ongoing 20-year ambispective cohort with unique metal exposures to an occupational population. From January 2014 to December 2019, the Jinchang Cohort has completed three phases of follow-up. The baseline cohort was completed from June 2011 to December 2013, and a total of 48 001 people were included. Three phases of follow-ups included 46 713, 41 888, and 40 530 participants, respectively. The death data were collected from 2001 to 2020. The epidemiological, physical examination, physiological, and biochemical data of the cohort were collected at baseline and during follow-up. Biological specimens were collected on the baseline to establish a biological specimen bank. The concentrations of metals in urine and serum were detected by inductively coupled plasma mass spectrometry (ICP-MS). The new areas of research aim to study the all-cases mortality, the burden of diseases, heavy metals and diseases, and the course of the chain from disease to high-risk outcomes using a combination of macro and micro means, which provided a scientific basis to explore the pathogenesis of multi-etiology and multi-disease and to evaluate the effects of the intervention measures in the population.

High-Performance Computational Recognition of Communication Signals Based on Bispectral Quadratic Feature Model.

In response to the problems in the signal identification of radiation sources during the communication process, the bispectral quadratic feature model is applied to the identification algorithm for communication signals. According to the signal eigenvalues obtained from the bispectrum of the diagonal slices in the radiation source signals, the eigenvalues of the bispectrum diagonal slices can be extended from the frequency domain to the complex plane through the chirp-z operation in this paper, and the relevant data are obtained based on the bispectrum quadratic feature model of the signals by using the separation rules corresponding to the extended Babbitt distance. The bispectral quadratic feature model method is used to establish a sparse observation model, and the communication signal processing problem can be transformed into an estimation problem of signal motion parameters through the construction of a parametric database. At the same time, the high-resolution distance of communication signals is tested, and the communication signals are estimated by using the variational inference method. Finally, practical cases are analyzed, and the results indicate that the algorithm proposed in this paper can be used to identify different types of communication signals in accordance with simulated and measured data in the processing of communication signals in various environments, which has the certain anti-interference capacity to noise, can improve the identification rate of communication signals, and has verified the effectiveness and practicality of the algorithm proposed in this paper.

Elevated serum bilirubin may significantly reduce coronary heart disease risk in females: A prospective cohort study.

BACKGROUND AND AIMS: There is still inconsistent evidence over the protective effect of total bilirubin on the development of coronary heart disease (CHD). Therefore, we aimed to investigate the association between bilirubin in population subtypes and the risks of CHD between different gender and menstruation subgroups. METHODS AND RESULTS: In this prospective cohort study, 29,750 participants free of CHD with an average age of 47 ± 14 years were recruited at baseline; of these, 720 CHD first-attack cases were collected after 7-years of follow up. The covariate-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) of CHD with 95% confidence intervals (CIs). The serum bilirubin concentration was quarterly stratified based on the distribution of healthy population without CHD onset. The HRs of incident CHD decreased with elevated bilirubin in females (ρ trend<0.05), but not males. In postmenopausal females, compared with the lowest quartile of total bilirubin, the adjusted HRs for the third and fourth quartiles were 0.64 (95% CI: 0.45, 0.93) and 0.59 (95% CI: 0.42, 0.86), the adjusted HRs in the third and fourth quartiles of direct bilirubin were 0.56 (0.39, 0.82) and 0.56 (0.38, 0.81), and for indirect bilirubin, corresponding HR in the highest quartile was 0.56 (0.38, 0.83). CONCLUSION: Elevated serum bilirubin was inversely associated with adjusted HRs of CHD in females, especially postmenopausal females. The relationship between elevated direct bilirubin and reduced HRs of CHD may be closer than indirect bilirubin in postmenopausal females.

Mental health and its associated factors in college students during COVID-19 confinement in campus / 中国学校卫生

Objective@#To investigate mental health and its associated factors in college students during COVID-19 confinement in campus, and to provide a scientific basis for mental health education.@*Methods@#A general questionnaire, the Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder- 7 (GAD-7) were administered. A total of 1 816 college students under COVID-19 confinement in campus in Lanzhou City were surveyed from October 18 to November 18, 2021. Data were analyzed by using the ordinal Logistic regression method.@*Results@#The overall incidence of depressive emotions was 38.76%, and the incidences of mild, moderate to severe depression emotions were 31.33% and 7.43%, respectively. About 16.36% of students showed anxiety, with mild, moderate to severe anxiety being 13.33% and 3.03%, respectively. Multivariate analysis showed that poverty( OR =1.29), daily schedule (basically normal OR =0.33, normal OR =0.18), adaptability of online learning (moderate adaptation OR =0.45, high level of adaptation OR =0.25), concerns about the infection of oneself and family members (some concerns OR =1.73, considerable concerns OR =2.09),male( OR =0.78), and the isolation mode( OR =1.70). The music listening (sometimes OR =0.44, often OR =0.41), daily schedule (basically normal OR =0.36, normal OR =0.19), adaptability of online learning (moderate adaptation OR =0.42, high level of adaptation OR =0.28), and concerns about the infection of oneself and family members (some concerns OR =1.87, considerable concerns OR =3.27) were primary factors associated with high level of anxiety among college students( P <0.05).@*Conclusion@#The incidence of depression and anxiety among college students increased following COVID-19 confinement and centralized isolation for medical observation in campus. Universities and relevant departments should take timely and precise measures for psychological counseling.

Optimal colonoscopy surveillance interval period for the adenoma patients who had an adequate polypectomy at baseline colonoscopy.

The role of surveillance colonoscopy has long been established: it reduces both the incidence and the mortality of colorectal cancer. We aimed to assess the optimal colonoscopy surveillance interval period for the adenoma patients who underwent an adequate polypectomy at baseline colonoscopy to avoid overuse or underuse of colonoscopy. A retrospective study was carried out on the baseline adenoma patients who had had at least two completed colonoscopy examinations during the years 2000-2013 in the Digestive Endoscopy Center of the First Affiliated Hospital of Kunming Medical University. All the patients had a complete polypectomy of adenomas at baseline. Data on the patients' demographics and colorectal findings were extracted from a specially designed colonoscopy database. The end point was the finding of adenoma during the subsequent surveillance colonoscopy; an analysis was carried out to identify recurrence factors and the optimal colonoscopy surveillance interval period. A total of 765 (463 men, 302 women, average age 56.51±11.95) eligible patients were included in the study. Three hundred and twelve patients had adenoma and 453 had no adenoma after surveillance colonoscopies (the frequency of repeat colonoscopy is 1-10, average 1.73±1.24). The diameter of adenomas found on the follow-up colonoscopy was 0.2-3.0 cm (average 0.54±0.30 cm). The number of adenomas was 1-11 (2.21±1.53) and the surveillance adenoma interval period was 0.5-13 years (2.64±2.36 years). A total of 576 patients had baseline nonadvanced adenomas. Male sex, age older than 50 years, and more than two different intestine segment adenomas were the risk factors for recurrence. The optimal colonoscopy surveillance interval period is 2.85 years (95% confidence interval: 2.53-3.17) according to the recurrence rate of 5% adenomas. One hundred and eighty-nine patients had baseline advanced adenomas. Male sex, diameter of adenomas less than 1.0 cm, and adenomas in the right colon or the whole colon were the risk factors for recurrence. The optimal colonoscopy surveillance interval period is 2.06 years (95% confidence interval: 1.71-2.45) according to the recurrence rate of 5% adenomas. The optimal colonoscopy surveillance interval period is 3 years or so for the adenoma patients who had an adequate polypectomy at baseline colonoscopy. Male sex, age older than 50 years, less than 1.0 cm adenomas diameter and the right colon, or multisegment intestine adenomas were the risk factors for recurrence. This has significance for guiding the follow-up colonoscopy interval time of the patients with intestine adenomas.

Risk factors for colorectal neoplasms based on colonoscopy and pathological diagnoses of Chinese citizens: a multicenter, case-control study.

PURPOSE: Since observational data in the urban residents are required to better assess the risk factors of colorectal neoplasm occurrence and the effectiveness of colonoscopy screening and surveillance, we conducted a case-control study at multicenters in China to identify patient characteristics and neoplasm features of colorectal adenoma (CRA) and colorectal carcinoma (CRC). METHODS: A total of 4089 patients who had undergone a colonoscopy from 19 hospitals were enrolled, of which 1106 had CRA and 466 had CRC. They were compared with controls. The analysis provides features and risk factors of colorectal neoplasm using multivariate logistic regression. RESULTS: Increasing age, a family history of colorectal cancer or previous cases of colorectal adenoma or hypertension disease, gastrointestinal surgery, regular intake of pickled food (adjusted odds ratio [aOR] 1.42, 95 % confidence interval [CI], 1.048-1.924), consumption of alcohol, and a positive result of fecal occult blood testing (FOBT; aOR 2.509, 95 % CI 1.485-4.237) were associated with an increased risk of CRA. In the CRC group, increasing age, regular intake of pickled foods, and a positive FOBT result were risk factors. In addition, a positive abdominal computed tomography (CT) before a colonoscopy and physical signs of emaciation were also significantly associated with an increasing risk of colorectal carcinoma. Regular intake of vegetables decreased the risk of both CRA and CRC. CONCLUSIONS: Age, pickled foods, and a positive FOBT are risk factors for colorectal neoplasm. Vegetable intake was associated with a decreased risk of CRA and CRC.

Modeling urban growth by the use of a multiobjective optimization approach: environmental and economic issues for the Yangtze watershed, China.

Urban growth is an unavoidable process caused by economic development and population growth. Traditional urban growth models represent the future urban growth pattern by repeating the historical urban growth regulations, which can lead to a lot of environmental problems. The Yangtze watershed is the largest and the most prosperous economic area in China, and it has been suffering from rapid urban growth from the 1970s. With the built-up area increasing from 23,238 to 31,054 km(2) during the period from 1980 to 2005, the watershed has suffered from serious nonpoint source (NPS) pollution problems, which have been mainly caused by the rapid urban growth. To protect the environment and at the same time maintain the economic development, a multiobjective optimization (MOP) is proposed to tradeoff the multiple objectives during the urban growth process of the Yangtze watershed. In particular, the four objectives of minimization of NPS pollution, maximization of GDP value, minimization of the spatial incompatibility between the land uses, and minimization of the cost of land-use change are considered by the MOP approach. Conventionally, a genetic algorithm (GA) is employed to search the Pareto solution set. In our MOP approach, a two-dimensional GA, rather than the traditional one-dimensional GA, is employed to assist with the search for the spatial optimization solution, where the land-use cells in the two-dimensional space act as genes in the GA. Furthermore, to confirm the superiority of the MOP approach over the traditional prediction approaches, a widely used urban growth prediction model, cellular automata (CA), is also carried out to allow a comparison with the Pareto solution of MOP. The results indicate that the MOP approach can make a tradeoff between the multiple objectives and can achieve an optimal urban growth pattern for Yangtze watershed, while the CA prediction model just represents the historical urban growth pattern as the future growth pattern. Moreover, according to the spatial clustering index, the urban growth pattern predicted through MOP is more reasonable. In summary, the proposed model provides a set of Pareto urban growth solutions, which compromise environmental and economic issues for the Yangtze watershed.

Heterotopic gastric mucosa in the upper and middle esophagus: 126 cases of gastroscope and clinical characteristics.

BACKGROUND/AIMS: In this retrospective study, we aimed to investigate the prevalence of heterotopic gastric mucosa (HGM) in the upper and middle esophagus, to identify its macroscopic characteristics and evaluate clinical features. METHODOLOGY: One hundred and twenty-six patients (82 males, 44 females; mean age 43.08 ± 12.84 years, range 15-81) with HGM in the upper and middle esophagus diagnosed by gastroscopy and biopsies were admitted to this retrospective study. Disease histories of all patients were carefully inquired, especially the associated complaints including discomfort of throat, heartburn or dysphagia, etc. RESULTS: The prevalence was 0.21%. Patch size ranged between 5-20mm, mean diameter was 7.5 ± 3.7mm; 80 cases appeared as a single patch; 96.83% had the patch in the upper esophagus. Male gender was predominant (male:female ratio, 1.86), but age was not significant. The mean distance from the incisors to the patch was 18.83 ± 2.23cm and 17.20 ± 2.48cm in the male and the female respectively, with a significant difference (t=3.749, p<0.001). In 39 of 126 patients (26 male, 13 female), the esophageal and laryngopharyngeal symptoms were remarkable. Twelve were associated with other diseases of the esophagus. There were no correlations to esophageal symptom, gender, age, location, quantity or diameter. Among the 126 cases, 29 patients were associated with other esophageal diseases. CONCLUSIONS: HGM patches in the esophagus should not be overlooked during endoscopy because they may lead to esophageal symptoms and even important complications in relation to their acid secretions.

[Study on metronidazole resistance to Helicobacter pylori from three populations with different ethnics in Yunnan].

OBJECTIVE: To evaluate the prevalence of Helicobacter pylori (H.pylori) resistance to metronidazole among three populations in Yunnan. METHODS: Susceptibilities to metronidazole among 109 H. pylori strains (33 H. pylori strains from Han, 31 H. pylori strains from Bai and 45 H. pylori strains from Naxi ethnic populations) were tested by Epsilometer test (E-test). RESULTS: In 109 H. pylori strains, the overall metronidazole resistance rate was 67.89%. There were no significant difference in the metronidazole resistant rates of H. pylori among Han, Bai, Naxi populations Yunnan in terms of the distribution on age and upper gastroduodenal diseases. In the facet of gender, metronidazole resistant rate of H. pylori was significantly lower in Han males than in females (chi2=5.304, P=0.027), but not seen in the Bai or Naxi peoples. CONCLUSION: Metronidazole resistance rate of H. pyloriin Yunnan was high, but no significant difference was found among Han, Bai, Naxi peoples in the province.