Inflammation-Immunity-Nutrition Score: A Novel Prognostic Score for Patients with Resectable Colorectal Cancer.

PURPOSE: This study was designed to investigate the prognostic value of the combination of high-sensitivity C-reactive protein, lymphocyte, and albumin in patients with resectable colorectal cancer. PATIENTS AND METHODS: Seven-hundred-and-nineteen patients who underwent colorectal cancer resection in Hubei Cancer Hospital were included. Inflammation-Immunity-Nutrition score (0-6) was constructed based on preoperative high-sensitivity C-reactive protein, lymphocyte, and albumin. Time-dependent receiver operating characteristic curve, decision curve, Kaplan-Meier survival curve, Cox regression, and C-index were conducted to detect the prognostic values of inflammation-immunity-nutrition score. The prognostic values of inflammation-immunity-nutrition score in different subgroups by sex, location of tumor, pathologic stage, and KRAS mutation were also explored. The prognostic performance of inflammation-immunity-nutrition score was further compared with that of other traditional prognostic indicators. RESULTS: The median follow-up time was 40 months. High inflammation-immunity-nutrition score (>2 scores) presented worse survival, with the adjusted hazard ratios (95% confidence intervals) of 3.106 (2.202-4.380) for overall survival and 2.105 (1.604-2.764) for disease-free survival. Besides, the associations of high inflammation-immunity-nutrition score with overall survival were even stronger in cases with wild type KRAS, with the adjusted hazard ratios (95% confidence intervals) of 4.018 (2.355-6.854). Considering the AUCs, C-indices, and hazard ratios estimates, inflammation-immunity-nutrition score presented better prognostic performance than high-sensitivity modified Glasgow prognostic score, high-sensitivity C-reactive protein to albumin ratio, prognostic nutrition index, carcinoembryonic antigen, and carbohydrate antigen 19-9 for overall survival. CONCLUSION: Inflammation-immunity-nutrition score might serve as a powerful prognostic score in patients with colorectal cancer for overall survival, particularly in patients with wild type KRAS.

Risk factors for low birth weight and preterm birth: A population-based case-control study in Wuhan, China.

Low birth weight (LBW) and preterm birth (PB) are associated with newborn mortality and diseases in adulthood. We explored factors related to LBW and PB by conducting a population-based case-control study from January 2011 to December 2013 in Wuhan, China. A total of 337 LBW newborn babies, 472 PB babies, and 708 babies with normal birth weights and born from term pregnancies were included in this study. Information of newborns and their parents was collected by trained investigators using questionnaires and referring to medical records. Univariate and logistic regression analyses with the stepwise selection method were used to determine the associations of related factors with LBW and PB. Results showed that maternal hypertension (OR=6.78, 95% CI: 2.27-20.29, P=0.001), maternal high-risk pregnancy (OR=1.53, 95% CI: 1.06-2.21, P=0.022), and maternal fruit intake ≥300 g per day during the first trimester (OR=1.70, 95% CI: 1.17-2.45, P=0.005) were associated with LBW. BMI ≥24 kg/m2 of mother prior to delivery (OR=0.48, 95% CI: 0.32-0.74, P=0.001) and gestation ≥37 weeks (OR=0.01, 95% CI: 0.00-0.02, P<0.034) were protective factors for LBW. Maternal hypertension (OR=3.36, 95% CI: 1.26-8.98, P=0.016), maternal high-risk pregnancy (OR=4.38, 95% CI: 3.26-5.88, P<0.001), maternal meal intake of only twice per day (OR=1.88, 95% CI: 1.10-3.20, P=0.021), and mother liking food with lots of aginomoto and salt (OR=1.60, 95% CI: 1.02-2.51, P=0.040) were risk factors for PB. BMI ≥24 kg/m2 of mother prior to delivery (OR=0.66, 95% CI: 0.47-0.93, P=0.018), distance of house from road ≥36 meters (OR=0.72, 95% CI: 0.53-0.97, P=0.028), and living in rural area (OR= 0.60, 95% CI: 0.37-0.99, P=0.047) were protective factors for PB. Our study demonstrated some risk factors and protective factors for LBW and PB, and provided valuable information for the prevention of the conditions among newborns.

Risk Factors for Low Birth Weight and Preterm Birth: A Population-based Case-control Study in Wuhan, China / 华中科技大学学报（医学）（英德文版）

Low birth weight (LBW) and preterm birth (PB) are associated with newborn mortality and diseases in adulthood.We explored factors related to LBW and PB by conducting a population-based case-control study from January 2011 to December 2013 in Wuhan,China.A total of 337 LBW newborn babies,472 PB babies,and 708 babies with normal birth weights and born from term pregnancies were included in this study.Information of newborns and their parents was collected by trained investigators using questionnaires and referring to medical records.Univariate and logistic regression analyses with the stepwise selection method were used to determine the associations of related factors with LBW and PB.Results showed that maternal hypertension (OR=6.78,95％ CI:2.27-20.29,P=0.001),maternal high-risk pregnancy (OR=1.53,95％ CI:1.06-2.21,P=0.022),and maternal fruit intake ≥300 g per day during the first trimester (OR=1.70,95％ CI:1.17-2.45,P=0.005) were associated with LBW.BMI ≥24 kg/m2 of mother prior to delivery (OR=0.48,95％ CI:0.32-0.74,P=0.001) and gestation ≥37 weeks (OR=0.01,95％ CI:0.00-0.02,P＜0.034) were protective factors for LBW.Maternal hypertension (OR=3.36,95％ CI:1.26-8.98,P=0.016),maternal high-risk pregnancy (OR=4.38,95％ CI:3.26-5.88,P＜0.001),maternal meal intake of only twice per day (OR=1.88,95％ CI:1.10-3.20,P=0.021),and mother liking food with lots of aginomoto and salt (OR=1.60,95％ CI:1.02-2.51,P=0.040) were risk factors for PB.BMI ≥24 kg/m2 of mother prior to delivery (OR=0.66,95％ CI:0.47-0.93,P=0.018),distance of house from road ≥36 meters (OR=0.72,95％ CI:0.53-0.97,P=0.028),and living in rural area (OR=0.60,95％ CI:0.37-0.99,P=0.047) were protective factors for PB.Our study demonstrated some risk factors and protective factors for LBW and PB,and provided valuable information for the prevention of the conditions among newborns.

Boosting cancer survival in Nigeria: self-management strategies.

Cancer is a menace fast gaining momentum in Nigeria and other developing countries. It is an expensive disease requiring a major financial and human resources for prevention, diagnosis and treatment. With no national policy on cancer control in the country, incidence (111.7/100,000 population) and mortality (86.6/100,000) rates in Nigeria are spiraling beyond control. This literature search study was primarily aimed at providing recommendations on cost-effective strategies for development interventions to promote self-management for cancer survivors in Nigeria with a goal to improve quality of life and overall survival.

[Study on the risk factors of tuberculosis in four cities and provinces in China].

OBJECTIVE: To investigate the influencing factors on tuberculosis (TB) in four provinces in the eastern and central parts of China. METHODS: From Nov. 2009 to Feb. 2011, three population-based field surveys were conducted among the resident population in several townships/streets in Guangdong, Hunan and Jiangsu provinces and Shanghai municipality to collect TB-related information. 474 sputum smear positive TB patients and 1896 controls were randomly selected from the population under study and each case was matched by province, age and sex using a frequency matching method. Single-variable and multiple non-conditional logistic regression modeling were applied for data analysis, and odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were estimated. RESULTS: Data from Single-variable analysis showed that TB history, history of exposure to TB, DM history, immigrant population and per-capita living space were risk factors for TB, and high level of education was protective factors. RESULTS: from multiple logistic regression showed that the risk factors of TB would include the following items: history of having had TB (OR = 52.356, 95%CI: 18.956 - 144.607), living space over 50 m(2)per-capita (OR = 8.742, 95%CI: 1.107 - 69.064), history of exposure to TB (OR = 6.083, 95%CI: 2.336 - 15.839) and being immigrants (OR = 3.306, 95%CI: 1.907 - 5.734), while having had high degree of education as the protective factor of TB (OR = 0.284, 95%CI: 0.110 - 0.733). CONCLUSION: Control programs targeting those ever having TB patients and contacts to TB patients as well as immigrants should be strengthened.

[Depression and associated factors among migrant women of reproductive age in some areas of Wuhan].

OBJECTIVE: To understand factors as social support, situation of depression and related risk factors among migrant women of reproductive age in some areas of Wuhan. METHODS: Cluster sampling method and face-to-face interview with structured questionnaire were used to investigate 316 migrant women in Wuhan. RESULTS: The overall prevalence rate of depression was 32.3%. RESULTS: from binary logistic regression analysis showed that factors as: under pressure (OR = 4.010, 95%CI: 1.672 - 9.617), having had negative life events (OR = 2.050, 95%CI: 1.170 - 3.591) or tight relations with neighbors (OR = 2.537, 95%CI: 1.053 - 6.113), not quite satisfied (OR = 4.247, 95%CI: 1.521 - 11.855) or satisfied (OR = 2.411, 95%CI: 1.111 - 5.233), on his/her own health status etc., might serve as the possible risk factors for depression. In scores related to social support, and the utilization of such support, there were statistically significant differences seen between the groups with depression and the one without. CONCLUSION: The prevalence of depression among migrant women of reproductive age appeared to be high in some areas on Wuhan. Factors as: under pressure, having had negative life events, tight relations with neighbors, status on satisfaction of one's own health situation as well as related social support, seemed to be the main risk factors for depression in this population.

Electromagnetic field exposure and male breast cancer risk: a meta-analysis of 18 studies.

BACKGROUND: The possibility that electromagnetic fields (EMF) exposure may increase male breast cancer risk has been discussed for a long time. However, arguments have been presented that studies limited by poor quality could have led to statistically significant results by chance or bias. Moreover, data fo the last 10 years have not been systematically summarized. METHODS AND RESULTS: To confirm any possible association, a meta-analysis was performed by a systematic search strategy. Totals of 7 case-control and 11 cohort studies was identified and pooled ORs with 95% CIs were used as the principal outcome measures. Data from these studies were extracted with a standard meta-analysis procedure and grouped in relation to study design, cut-off point, exposure assessment method, adjustment and exposure model. A statistical significant increased risk of male breast cancer with EMF exposure was defined (pooled ORs = 1.32, 95% CI = 1.14 -1.52, P < 0.001), and subgroup analyses also showed similar results. CONCLUSIONS: This meta-analysis suggests that EMF exposure may be associated with the increase risk of male breast cancer despite the arguments raised.

Sleep duration and cancer risk: a systematic review and meta-analysis of prospective studies.

To assess the risk of cancers associated with sleep duration using a meta-analysis of published cohort studies, we performed a comprehensive search using PubMed, Embase and Web of Science through October 2013. We combined hazard ratios (HRs) from individual studies using meta-analysis approaches. A random effect dose-response analysis was used to evaluate the relationship between sleep duration and cancer risk. Subgroup analyses and sensitivity analyses were also performed. Publication bias was evaluated using Funnel plots and Begg's test. A total of 13 cohorts from 12 studies were included in this meta-analysis, which included 723,337 participants with 15,156 reported cancer outcomes during a follow-up period ranging from 7.5 to 22 years. The pooled adjusted HRs were 1.06 (95% CI: 0.92, 1.23; P for heterogeneity=0.003) for short sleep duration, 0.91 (95% CI: 0.78, 1.07; P for heterogeneity <0.0001) for long sleep duration. In subgroup analyses stratified by cancer type, long duration of sleep showed an inverse relation with hormone-related cancer (HR=0.79; 95% CI: 0.65, 0.97; P for heterogeneity=0.009) and a greater risk of colorectal cancer (HR=1.29; 95% CI: 1.09, 1.52; P for heterogeneity=0.346). Further meta-analysis on dose-response relationships showed that the relative risks of cancer were 1.00 (95% CI: 0.99, 1.01; P for linear trend=0.9151) for one hour of sleep increment per day, and 1.00 (95% CI: 0.98, 1.01; P for linear trend=0.7749) for one hour of sleep increment per night. No significant dose-response relationship between sleep duration and cancer was found on non-linearity testing (P=0.5053). Our meta-analysis suggests a positive association between long sleep duration and colorectal cancer, and an inverse association with incidence of hormone related cancers like those in the breast. Studies with larger sample size, longer follow-up times, more cancer types and detailed measure of sleep duration are warranted to confirm these results.

[The application of integrated surveillance system for symptoms in surveillance of influenza among children].

OBJECTIVE: To explore the integrated application of sales of child-specific over-the-counter (OTC) cold related medications in retail pharmacies and healthcare visits of children for influenza-like illness (ILI) in surveillance and early warning of influenza among children. METHODS: An integrated surveillance system (ISS) was implemented since 2012 in Qianjiang County, a rural area in Hubei Province of China. The daily information from August 1, 2012 to February 28, 2013 of health care visits of children for ILI reported by 80 health facilities and sales of 14 child-specific over-the-counter (OTC) cold related medications reported by 11 pharmacies were extracted from ISS database. Cumulative sums (CUSUM) model was conducted to analyze the degree of fitting and the early warning signal generated; the correlationship was then analyzed further. RESULTS: In 212 days, 983 visits of children for ILI and 12 819 sales by person of child-specific OTC were reported. Conducting CUSUM model, the fitting degree was in the acceptable range, 31 warning signals were generated from ILI data series with 3 peak periods and 14 from OTC data series with 2 peak periods. A similar time trend of two data series was observed with a correlation(r = 0.497, P < 0.05), but without any spatial clustering. And the optimal correlation(r = 0.505, P < 0.05) appeared at a time offset of 4 days preceded by OTC sales. CONCLUSION: The availability of integrated surveillance system for symptoms could be applied for surveillance of influenza among children; while it could explore the possibility of real epidemic in the very early stage.

[Role of alcohol-metabolizing enzymes gene polymorphisms and environmental exposure on colorectal cancer: a case-only study].

OBJECTIVE: This study was designed to explore the interactions of alcohol dehydrogenase 1B (ADH1B) rs1229984, aldehyde dehydrogenase 2 (ALDH2)(rs671) and cytochrome P4502E1(CYP2E1)rs1329149 with environmental factors and the interactions between genetic factors in the susceptibility of colorectal cancer (CRC). Roles of genetic factors in the development of colorectal cancer were also studied. METHODS: With a case-only study design, 472 colorectal cancer cases were enrolled between 2007 and 2009 in this study. Data on demographic characteristics, histories of environmental exposure and clinico-pathological parameters were obtained from all the participants through written questionnaires. Genotypes were determined by Sequenom MassARRAY system. Unconditional logistic regression analysis was employed to explore the gene-environment interactions and gene-gene interactions. χ(2) test and unconditional logistic regression were used to evaluate the roles of polymorphisms on the risk of metastasis to CRC. RESULTS: Overweighted individuals that carrying at least one of the ADH1B rs1229984 G alleles presented significant increase on the risk to colorectal cancer(OR = 1.720, 95%CI:1.038-2.848,ORadj = 1.785, 95%CI:1.061-3.002). Modest interaction was seen between smoking and ADH1B(rs1229984) only before the adjustment of data, by sex, age and drinking status(OR = 0.597, 95% CI:0.387-0.921, ORadj = 0.922, 95%CI:0.509-1.669). Correlations between polymorphisms and the Dukes stage were not found. CONCLUSION: Overweight presented significant interaction with G allele of ADH1B rs1229984 in the susceptibility of CRC. None of the rs1229984, rs671 and rs1329149 exhibited significant influence on the development of CRC.

[Construction of surveillance and early-warning-index-system on tuberculosis in China].

OBJECTIVE: To establish the surveillance and warning index system corresponding with the epidemic characteristics of tuberculosis, in China. METHODS: Literature review and expert meeting were conducted to formulate the preliminary index system frame. Delphi method was used for screening the index and determining the weight of each index. RESULTS: Two-round Delphi consultations were performed. The activity coefficients were 87.0%, 90.0% respectively, with means of authority coefficient as 0.850±0.055 and 0.917±0.017, respectively. Mean scores of the index were 7.063±1.435, 8.156±0.611 respectively, with the means of coefficient of variation as 0.352±0.161 and 0.170±0.057 respectively. The harmony coefficients were 0.322 (χ2=499.472, P<0.05) and 0.393 (χ2=241.126, P<0.05) respectively. After the two-round consultation, the tuberculosis monitoring and warning index system was developed, including 4 first-class indicators, 9 second-class indicators and 48 third-class indicators. CONCLUSION: An index system was established for tuberculosis monitoring and early warning that could provide evidence for tuberculosis prevention and control as well as for the forecasting and warning model of the disease.

[Application of log-linear model in the case-parent triad study].

We were introducing a log-linear model for case-parent triad study. Data from a previous study of the association between MTHFR C677T and cleft lip with or without cleft palate (CL/P) was analyzed, in order to investigate the maternal effect, fetal effect and their interaction, using a series of log-linear models. Our results showed that mothers who were carrying two copies of MTHFR C677T variant alleles appeared to have reduced the risk of CL/P in offspring, comparing to those with homozygous of wild-type allele. With S2=0.43 (95%CI: 0.19-0.95). No significant association was found for fetal genotype and maternal-fetal interaction with CL/P. Log-linear model method seemed to be useful in the estimation of maternal effect, fetal effect and maternal-fetal interaction, in the case-parent triad study design. This approach showed specific benefit in studies that related to genetic effects on complex diseases such as pregnancy complications and diseases originated from fetus.

[The influence of T lymphocyte activation on HIV-1 susceptibility of Han Chinese].

OBJECTIVE: To explore the influence of T lymphocyte activation on HIV-1 susceptibility of Han Chinese. METHODS: In 2008, 37 HIV-1 highly exposed persistently seronegative individuals (ESNs) and 101 healthy controls were screened from Shenzhen. Flow cytometer was used to assay the expression difference of HIV-1 infection related co-receptor, the difference between the two groups were analyzed by Mann-Whitney U statistics methods. RESULTS: T cell HLA-DR(+) CD4 T cells and HLA-DR(+) expression of ESNs (12.64 (5.94 - 21.90), 21.12 (10.74 - 30.21)) were all significantly lower than that of healthy controls (22.52 (7.91 - 58.60), 32.28 (14.72 - 67.82)) (P values all < 0.05). T cell CD45RA-RO(+), CCR5(+)CD4 expression of ESNs (58.68 (49.06 - 72.44), 21.93 (15.84 - 25.89)) were all significantly higher than that of healthy controls (53.17 (42.63 - 63.21), 16.14 (11.94 - 21.98)) (P values all < 0.05). T cell CXCR4(+)CD4 T cells expression of ESNs (93.67 (92.17 - 94.96)) was significantly lower than that of healthy controls (95.16 (92.99 - 96.77)) (P values all < 0.05). Healthy controls and ESNs could be divided into low expression group and high expression group according to HLA-DR(+)CD8 T cells bimodal distribution. A total of 89.2% (33/37) ESNs fell into HLA-DR + CD8 low expression group, and 58.4% (59/101) of the healthy controls located in low expression group (P < 0.05). CONCLUSION: To Han Chinese, the low activation status of T lymphocyte has significant correlation with HIV-1 low susceptibility.

Establishing a web-based integrated surveillance system for early detection of infectious disease epidemic in rural China: a field experimental study.

BACKGROUND: A crucial goal of infectious disease surveillance is the early detection of epidemics, which is essential for disease control. In China, the current surveillance system is based on confirmed case reports. In rural China, it is not practical for health units to perform laboratory tests to confirm disease and people are more likely to get 'old' and emerging infectious diseases due to poor living conditions and closer contacts with wild animals and poultry. Syndromic surveillance, which collects non-specific syndromes before diagnosis, has great advantages in promoting the early detection of epidemics and reducing the necessities of disease confirmation. It will be especially effective for surveillance in resource poor settings. METHODS/DESIGN: This is a field experimental study. The experimental tool is an innovative electronic surveillance system, combining syndromic surveillance with the existing case report surveillance in four selected counties in China. In the added syndromic surveillance, three types of data are collected including patients' major symptoms from health clinics, pharmaceutical sales from pharmacies and absenteeism information from primary school. In order to evaluate the early warning capability of the new added syndromic surveillance, the timelines and validity of the alert signals will be analyzed in comparison with the traditional case reporting system. The acceptability, feasibility and economic evaluation of the whole integrated surveillance system will be conducted in a before and after study design. DISCUSSIONS: Although syndromic surveillance system has mostly been established in developed areas, there are opportunities and advantages of developing it in rural China. The project will contribute to knowledge, experience and evidence on the establishment of an integrated surveillance system, which aims to provide early warning of disease epidemics in developing countries.

Interactions between genetic variants in the adiponectin, adiponectin receptor 1 and environmental factors on the risk of colorectal cancer.

BACKGROUND: Metabolic syndrome traits play an important role in the development of colorectal cancer. Adipokines, key metabolic syndrome cellular mediators, when abnormal, may induce carcinogenesis. METHODOLOGY/PRINCIPAL FINDINGS: To investigate whether polymorphisms of important adipokines, adiponectin (ADIPOQ) and its receptors, either alone or in combination with environmental factors, are implicated in colorectal cancer, a two-stage case-control study was conducted. In the first stage, we evaluated 24 tag single nucleotide polymorphisms (tag SNPs) across ADIPOQ ligand and two ADIPOQ receptors (ADIPOR1 and ADIPOR2) among 470 cases and 458 controls. One SNP with promising association was then analyzed in stage 2 among 314 cases and 355 controls. In our study, ADIPOQ rs1063538 was consistently associated with increased colorectal cancer risk, with an odds ratio (OR) of 1.94 (95%CI: 1.48-2.54) for CC genotype compared with TT genotype. In two-factor gene-environment interaction analyses, rs1063538 presented significant interactions with smoking status, family history of cancer and alcohol use, with ORs of 4.52 (95%CI: 2.78-7.34), 3.18 (95%CI: 1.73-5.82) and 1.97 (95%CI: 1.27-3.04) for smokers, individuals with family history of cancer or drinkers with CC genotype compared with non-smokers, individuals without family history of cancer or non-drinkers with TT genotype, respectively. Multifactor gene-environment interactions analysis revealed significant interactions between ADIPOQ rs1063538, ADIPOR1 rs1539355, smoking status and BMI. Individuals carrying one, two and at least three risk factors presented 1.18-fold (95%CI:0.89-fold to 1.58-fold), 1.87-fold (95%CI: 1.38-fold to 2.54-fold) and 4.39-fold (95%CI: 2.75-fold to 7.01-fold) increased colorectal cancer risk compared with those who without risk factor, respectively (P(trend) <0.0001). CONCLUSIONS/SIGNIFICANCE: Our results suggest that variants in ADIPOQ may contribute to increased colorectal cancer risk in Chinese and this contribution may be modified by environmental factors, such as smoking status, family history of cancer and BMI.

Predicting the incidence risk of ischemic stroke in a hospital population of southern China: a classification tree analysis.

OBJECTIVE: To determine the major risk factors and their interactions of ischemic stroke (IS) and to develop a classification tree model to predict the incidence risk of IS for a Chinese population. METHODS: Exhaustive Chi-squared Automatic Interaction Detection (Exhaustive CHAID) algorithm of classification tree method was applied to build a prediction model for the incidence risk of IS under the design of 1:1 matched case-control study. The statistics of misclassification risk was used to evaluate the fitness of the model. RESULTS: In the prediction model, six variables of physical exercise, history of hypertension, tea drinking, HDL-c level, smoking status and educational level were in turn selected as the predictors of IS incidence risk. In the subgroup of lacking of physical exercise, individuals who had history of hypertension would have a significantly higher IS risk (92%) than that of the ones who had no history of hypertension (64%). The misclassification risk estimate of the prediction model was 0.21 with the standard error of 0.02, indicating that 79% of the cases could be classified correctly based on current prediction model. CONCLUSIONS: Lacking of physical exercise and history of hypertension are identified to be the prominent predicting variables of IS risk for a hospital population of southern China. Although CHAID analysis could provide detailed information and insight about interactions among risk factors of IS, we still need to validate our model and improve the vascular risk prediction for Chinese subjects in further studies.

Ventilator-associated pneumonia in intensive care units in Hubei Province, China: a multicentre prospective cohort survey.

A multicentre prospective cohort study was performed in 17 intensive care units (ICUs) in tertiary care hospitals in Hubei Province, China. Ventilator-associated pneumonia (VAP) was defined according to modified criteria from the published literature. Among 4155 ventilated patients, the crude incidence and incidence rate of VAP were 20.9% and 28.9 cases per 1000 ventilator-days. Multivariate analysis using logistic regression revealed risk factors including male sex [risk ratio (RR): 1.5; P<0.001], coma (RR: 2.1; P<0.001), chronic obstructive pulmonary disease (RR: 1.4; P<0.001), infections at other sites (RR: 1.6; P=0.001), serious disease predating the onset of VAP (RR: 1.6; P<0.001) and interventions including antacid treatment (RR: 1.4; P<0.001), antimicrobial treatment (RR: 5.1; P<0.001), bronchoscopy (RR: 1.5; P=0.041) and tracheostomy (RR: 1.4; P=0.014). The most frequently isolated causative pathogens were Pseudomonas aeruginosa and Acinetobacter baumannii. Of all Staphylococcus aureus isolates, 45.7% were meticillin resistant. Rates, risk factors and causal pathogens of VAP in ICUs in Hubei differ from those reported from developed countries. These data show the need for more effective infection control interventions in Hubei, China.