Nonhuman Primates Are Protected against Marburg Virus Disease by Vaccination with a Vesicular Stomatitis Virus Vector-Based Vaccine Prepared under Conditions to Allow Advancement to Human Clinical Trials.

Vaccines are needed to disrupt or prevent continued outbreaks of filoviruses in humans across Western and Central Africa, including outbreaks of Marburg virus (MARV). As part of a filovirus vaccine product development plan, it is important to investigate dose response early in preclinical development to identify the dose range that may be optimal for safety, immunogenicity, and efficacy, and perhaps demonstrate that using lower doses is feasible, which will improve product access. To determine the efficacious dose range for a manufacturing-ready live recombinant vesicular stomatitis virus vaccine vector (rVSV∆G-MARV-GP) encoding the MARV glycoprotein (GP), a dose-range study was conducted in cynomolgus macaques. Results showed that a single intramuscular injection with as little as 200 plaque-forming units (PFUs) was 100% efficacious against lethality and prevented development of viremia and clinical pathologies associated with MARV Angola infection. Across the vaccine doses tested, there was nearly a 2000-fold range of anti-MARV glycoprotein (GP) serum IgG titers with seroconversion detectable even at the lowest doses. Virus-neutralizing serum antibodies also were detected in animals vaccinated with the higher vaccine doses indicating that vaccination induced functional antibodies, but that the assay was a less sensitive indicator of seroconversion. Collectively, the data indicates that a relatively wide range of anti-GP serum IgG titers are observed in animals that are protected from disease implying that seroconversion is positively associated with efficacy, but that more extensive immunologic analyses on samples collected from our study as well as future preclinical studies will be valuable in identifying additional immune responses correlated with protection that can serve as markers to monitor in human trials needed to generate data that can support vaccine licensure in the future.

Preclinical immunogenicity and efficacy of a candidate COVID-19 vaccine based on a vesicular stomatitis virus-SARS-CoV-2 chimera.

BACKGROUND: To investigate a vaccine technology with potential to protect against coronavirus disease 2019 (COVID-19) and reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with a single vaccine dose, we developed a SARS-CoV-2 candidate vaccine using the live vesicular stomatitis virus (VSV) chimeric virus approach previously used to develop a licensed Ebola virus vaccine. METHODS: We generated a replication-competent chimeric VSV-SARS-CoV-2 vaccine candidate by replacing the VSV glycoprotein (G) gene with coding sequence for the SARS-CoV-2 Spike glycoprotein (S). Immunogenicity of the lead vaccine candidate (VSV∆G-SARS-CoV-2) was evaluated in cotton rats and golden Syrian hamsters, and protection from SARS-CoV-2 infection also was assessed in hamsters. FINDINGS: VSV∆G-SARS-CoV-2 delivered with a single intramuscular (IM) injection was immunogenic in cotton rats and hamsters and protected hamsters from weight loss following SARS-CoV-2 challenge. When mucosal vaccination was evaluated, cotton rats did not respond to the vaccine, whereas mucosal administration of VSV∆G-SARS-CoV-2 was found to be more immunogenic than IM injection in hamsters and induced immunity that significantly reduced SARS-CoV-2 challenge virus loads in both lung and nasal tissues. INTERPRETATION: VSV∆G-SARS-CoV-2 delivered by IM injection or mucosal administration was immunogenic in golden Syrian hamsters, and both vaccination methods effectively protected the lung from SARS-CoV-2 infection. Hamsters vaccinated by mucosal application of VSV∆G-SARS-CoV-2 also developed immunity that controlled SARS-CoV-2 replication in nasal tissue. FUNDING: The study was funded by Merck Sharp & Dohme, Corp., a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, and The International AIDS Vaccine Initiative, Inc. (IAVI), New York, USA. Parts of this research was supported by the Biomedical Advanced Research and Development Authority (BARDA) and the Defense Threat Reduction Agency (DTRA) of the US Department of Defense.

[A new model for disease control and prevention driven by big data in healthcare].

With the rapid development of Internet technology and the continuous advancement of medical informatization, big data in healthcare has gradually become an important resource to innovate health management and meet the growing health needs of people and the application of big data in healthcare has been one of the indispensable parts of national big data strategy in China. Based on the established healthcare big data platform and the application of big data technology, Yinzhou district has made innovative efforts to explore a new model driven by big data for the prevention and control of communicable and non-communicable diseases and the management of vaccination programs. It is expected that the "Internet plus healthcare" model will strengthen the disease prevention and control and public health management in local area, create a new business form and provide strong support for Healthy China 2030. This article introduces this new model driven by big data in Yinzhou and discusses the preliminary efficiency of this model in public health practice.

[Relationship between platelet/lymphocyte ratio and cognitive impairment in diabetic patients treated with maintenance hemodialysis].

Objective: To explore the relationship between platelet/lymphocyte ratio (PLR) and cognitive impairment (CI) in diabetic patients treated with maintenance hemodialysis (MHD). Methods: The data of age, gender, underlying diseases, medication history, mini-mental state examination (MMSE) and biochemical indexes of diabetic MHD patients who were treated in 18 hemodialysis center in Guizhou Province between May and August 2019 were collected. According to whether they had CI or not, the patients were divided into CI group and control group, and the clinical characteristics between the two groups were compared. In addition, the patients were divided into four groups according to the quartile of PLR (PLR Q1, Q2, Q3 and Q4 group). Multivariate logistic regression models were used to analyze the relationship between PLR level and CI in diabetic MHD patients. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of PLR in detecting CI in diabetic MHD patients. Results: Totally, 586 diabetic MHD patients (389 males) were included, with a mean age of (63±11) years. Multivariate logistic regression analysis showed that PLR was associated with the risk of CI in diabetic MHD patients, and the risk of CI in PLR Q4 group was 3.022 times of that of PLR Q1 Group (95%CI: 1.866-4.895, P<0.001). After adjusting for gender, age, dialysis age and education level, the risk of CI in PLR Q4 group was 2.529 times of that in PLR Q1 Group (95%CI: 1.536-4.164, P<0.001). After further adjusting for hemoglobin, albumin, creatinine, leukocyte and blood glucose, the risk of CI in PLR Q4 group was 2.281 times of that in PLR Q1 group (95%CI: 1.203-4.326, P=0.012). ROC curve analysis showed that the optimal threshold for PLR to predict CI in diabetic MHD patients was 155.3, with a sensitivity of 57.2% and a specificity of 60.8%, and the area under the curve was 0.608 (95%CI: 0.561-0.644, P<0.001). Conclusion: PLR is associated with CI in diabetic MHD patients.

[Epidemiological characteristics of COVID-19 monitoring cases in Yinzhou district based on health big data platform].

Objective: To understand the epidemiological characteristics of COVID-19 monitoring cases in Yinzhou district based on health big data platform to provide evidence for the construction of COVID-19 monitoring system. Methods: Data on Yinzhou COVID-19 daily surveillance were collected. Information on patients' population classification, epidemiological history, COVID-19 nucleic acid detection rate, positive detection rate and confirmed cases monitoring detection rate were analyzed. Results: Among the 1 595 COVID-19 monitoring cases, 79.94% were community population and 20.06% were key population. The verification rate of monitoring cases was 100.00%. The total percentage of epidemiological history related to Wuhan city or Hubei province was 6.27% in total, and was 2.12% in community population and 22.81% in key population (P<0.001). The total COVID-19 nucleic acid detection rate was 18.24% (291/1 595), and 53.00% in those with epidemiological history and 15.92% in those without (P<0.001).The total positive detection rate was 1.72% (5/291) and the confirmed cases monitoring detection rate was 0.31% (5/1 595). The time interval from the first visit to the first nucleic acid detection of the confirmed monitoring cases and other confirmed cases was statistically insignificant (P>0.05). Conclusions: The monitoring system of COVID-19 based on the health big data platform was working well but the confirmed cases monitoring detection rate need to be improved.

[Application of healthcare big data in active case finding of COVID-19 in Yinzhou district of Ningbo].

During the prevention and control of the COVID-19 epidemic, identifying and controlling the source of infection has become one of the most important prevention and control measures to curb the epidemic in the absence of vaccines and specific therapeutic drugs. While actively taking traditional and comprehensive "early detection" measures, Yinzhou district implemented inter-departmental data sharing through the joint prevention and control mechanism. Relying on a healthcare big data platform that integrates the data from medical, disease control and non-health sectors, Yinzhou district innovatively explored the big data-driven COVID-19 case finding pattern with online suspected case screening and offline verification and disposal. Such effort has laid a solid foundation and gathered experience to conduct the dynamic and continuous surveillance and early warning for infectious disease outbreaks more effectively and efficiently in the future. This article introduces the exploration of this pattern in Yinzhou district and discusses the role of big data-driven disease surveillance in the prevention and control of infectious diseases.

Characterization of Pingliang xiaoheidou (ZDD 11047), a soybean variety with resistance to soybean cyst nematode Heterodera glycines.

KEY MESSAGE: A novel QTL (qSCN-PL10) for SCN resistance and related candidate genes were identified in the soybean variety Pingliang xiaoheidou, and plant basal immunity seems to contribute to the SCN resistance. Soybean cyst nematode (SCN, Heterodera glycines Ichinohe) is one of the most devastating soybean pests worldwide. The development of host plant resistance represents an effective strategy to control SCN. However, owing to the lack of diversity of resistance genes in soybean varieties, further investigation is necessary to identify new SCN resistance genes. By analyzing the resistance phenotypes of soybean variety Pingliang xiaoheidou (Pingliang, ZDD 11047), we found that it exhibited the different resistance phenotypes from PI 88788 and Peking varieties. Because Pingliang variety contains the Rhg1-a (low copy) haplotype and lacks the resistant Rhg4 haplotype, novel quantitative trait locus might account for their SCN resistance. After sequencing parental lines (Magellan and Pingliang) and 200 F2:3 progenies, a high-density genetic map was constructed using the specific length amplified fragment sequencing method and qSCN-PL10 was identified as a novel locus for SCN resistance. Candidate genes were predicted by RNA sequencing (RNA-seq) in the qSCN-PL10 locus region. The RNA-seq analysis performed also indicated that plant basal immunity plays an important role in the resistance of Pingliang to SCN. These results lay a foundation for the use of marker-assisted breeding to enhance the resistance to SCN.

[Clinicopathological analysis of 187 cases of external nose skin tumors].

Objective:To explore the pathological types, distribution and characteristics of external nose skin tumors, in order to improve the diagnosis and treatment of such diseases, and provide reference for the clinical diagnosis and treatment of external nose skin tumors. Method: The gender, age of onset, lesion location, lesion size, pathological type, course of disease and related risk factors of all 187 cases with external nose skin tumors in our hospital from January 2008 to December 2017 were analyzed retrospectively. Result:The sex ratio of patients with external nasal skin benign tumors was 1.10：1.00, and that of patients with external nasal skin malignant tumors was 0.97：1.00. There was no significant difference in the composition of benign and malignant patients(χ²=0.169,P=0.681). The peak age of skin tumors of the external nose is over 60 years old, accounting for 71.1%(133/187). There was a significant difference in the ratio of benign to malignant tumors among different age groups(χ²=31.378,P<0.001). The ratio of malignant tumors increased with age(χ²trend=28.741, P<0.001). The most common benign external nasal skin tumors were alar nasi(28 cases, 22.2%), nasal root(25 cases,19.8%), dorsal nasal(23 cases, 18.3%), tip nasi(22 cases, 17.5%) and paranasal(18 cases,14.3%). Malignant external nasal skin tumors were alar nasi(18 cases,28.5%), dorsal nasal(15 cases,24.6%) and tip nasi(11 cases,18.0%). Epidermal cellderived basal cell carcinoma was the most common malignant tumor(44 cases,72.1%), followed by squamous cell carcinoma(11 cases,18.0%). Conclusion: External nasal skin malignancies have the characteristics of the elderly at the peak age of onset, skin basal cell carcinoma is the most common, for the incidence of basal cell carcinoma constitutes the largest, so that early detection, early diagnosis, early treatment.

RNA-Seq analysis of nodule development at five different developmental stages of soybean (Glycine max) inoculated with Bradyrhizobium japonicum strain 113-2.

Nodule development directly affects nitrogen fixation efficiency during soybean growth. Although abundant genome-based information related to nodule development has been released and some studies have reported the molecular mechanisms that regulate nodule development, information on the way nodule genes operate in nodule development at different developmental stages of soybean is limited. In this report, notably different nodulation phenotypes in soybean roots inoculated with Bradyrhizobium japonicum strain 113-2 at five developmental stages (branching stage, flowering stage, fruiting stage, pod stage and harvest stage) were shown, and the expression of nodule genes at these five stages was assessed quantitatively using RNA-Seq. Ten comparisons were made between these developmental periods, and their differentially expressed genes were analysed. Some important genes were identified, primarily encoding symbiotic nitrogen fixation-related proteins, cysteine proteases, cystatins and cysteine-rich proteins, as well as proteins involving plant-pathogen interactions. There were no significant shifts in the distribution of most GO functional annotation terms and KEGG pathway enrichment terms between these five development stages. A cystatin Glyma18g12240 was firstly identified from our RNA-seq, and was likely to promote nodulation and delay nodule senescence. This study provides molecular material for further investigations into the mechanisms of nitrogen fixation at different soybean developmental stages.

Relative prediction error and protection from attentional blink in human associative learning.

The relationship between predictive learning and attentional processing was investigated in two experiments. During a learning procedure participants viewed rapid serial visual presentation (RSVP) of stimuli in the context of a choice-reaction-time (CRT) task. Salient stimuli in the RSVP streams were either predictive or non-predictive for the outcome of the CRT task. Following this procedure we measured attentional blink (AB) to the predictive and non-predictive stimuli. In Experiment 1, despite the use of a large sample and checks demonstrating the validity of the learning procedure and the AB measure, we did not observe reduced AB for predictive stimuli. In contrast, in Experiment 2, where the predictive stimuli occurred alongside salient non-predictive comparison stimuli, we did find less AB for predictive than for non-predictive stimuli. Our results support an attentional model of learning in which relative prediction error is used to increase learning rates for good predictors and reduce learning rates for poor predictors and provide confirmation of the AB learning effect.

Genome-wide transcriptional analysis of two soybean genotypes under dehydration and rehydration conditions.

BACKGROUND: Soybean is an important crop that provides valuable proteins and oils for human use. Because soybean growth and development is extremely sensitive to water deficit, quality and crop yields are severely impacted by drought stress. In the face of limited water resources, drought-responsive genes are therefore of interest. Identification and analysis of dehydration- and rehydration-inducible differentially expressed genes (DEGs) would not only aid elucidation of molecular mechanisms of stress response, but also enable improvement of crop stress tolerance via gene transfer. Using Digital Gene Expression Tag profiling (DGE), a new technique based on Illumina sequencing, we analyzed expression profiles between two soybean genotypes to identify drought-responsive genes. RESULTS: Two soybean genotypes - drought-tolerant Jindou21 and drought-sensitive Zhongdou33 - were subjected to dehydration and rehydration conditions. For analysis of DEGs under dehydration conditions, 20 cDNA libraries were generated from roots and leaves at two different time points under well-watered and dehydration conditions. We also generated eight libraries for analysis under rehydration conditions. Sequencing of the 28 libraries produced 25,000-33,000 unambiguous tags, which were mapped to reference sequences for annotation of expressed genes. Many genes exhibited significant expression differences among the libraries. DEGs in the drought-tolerant genotype were identified by comparison of DEGs among treatments and genotypes. In Jindou21, 518 and 614 genes were differentially expressed under dehydration in leaves and roots, respectively, with 24 identified both in leaves and roots. The main functional categories enriched in these DEGs were metabolic process, response to stresses, plant hormone signal transduction, protein processing, and plant-pathogen interaction pathway; the associated genes primarily encoded transcription factors, protein kinases, and other regulatory proteins. The seven most significantly expressed (|log2 ratio| ≥ 8) genes - Glyma15g03920, Glyma05g02470, Glyma15g15010, Glyma05g09070, Glyma06g35630, Glyma08g12590, and Glyma11g16000 - are more likely to determine drought stress tolerance. The expression patterns of eight randomly-selected genes were confirmed by quantitative RT-PCR; the results of QRT-PCR analysis agreed with transcriptional profile data for 96 out of 128 (75%) data points. CONCLUSIONS: Many soybean genes were differentially expressed between drought-tolerant and drought-sensitive genotypes. Based on GO functional annotation and pathway enrichment analysis, some of these genes encoded transcription factors, protein kinases, and other regulatory proteins. The seven most significant DEGs are candidates for improving soybean drought tolerance. These findings will be helpful for analysis and elucidation of molecular mechanisms of drought tolerance; they also provide a basis for cultivating new varieties of drought-tolerant soybean.

Identification of genes associated with nitrogen-use efficiency by genome-wide transcriptional analysis of two soybean genotypes.

BACKGROUND: Soybean is a valuable crop that provides protein and oil. Soybean requires a large amount of nitrogen (N) to accumulate high levels of N in the seed. The yield and protein content of soybean seeds are directly affected by the N-use efficiency (NUE) of the plant, and improvements in NUE will improve yields and quality of soybean products. Genetic engineering is one of the approaches to improve NUE, but at present, it is hampered by the lack of information on genes associated with NUE. Solexa sequencing is a new method for estimating gene expression in the transcription level. Here, the expression profiles were analyzed between two soybean varieties in N-limited conditions to identify genes related to NUE. RESULTS: Two soybean genotypes were grown under N-limited conditions; a low-N-tolerant variety (No.116) and a low-N-sensitive variety (No.84-70). The shoots and roots of soybeans were used for sequencing. Eight libraries were generated for analysis: 2 genotypes × 2 tissues (roots and shoots) × 2 time periods [short-term (0.5 to 12 h) and long-term (3 to 12 d) responses] and compared the transcriptomes by high-throughput tag-sequencing analysis. 5,739,999, 5,846,807, 5,731,901, 5,970,775, 5,476,878, 5,900,343, 5,930,716, and 5,862,642 clean tags were obtained for the eight libraries: L1, 116-shoot short-term; L2 84-70-shoot short-term; L3 116-shoot long-term; L4 84-70-shoot long-term; L5 116-root short-term; L6 84-70-root short-term; L7 116-root long-term;L8 84-70-root long-term; these corresponded to 224,154, 162,415, 191,994, 181,792, 204,639, 206,998, 233,839 and 257,077 distinct tags, respectively. The clean tags were mapped to the reference sequences for annotation of expressed genes. Many genes showed substantial differences in expression among the libraries. In total, 3,231 genes involved in twenty-two metabolic and signal transduction pathways were up- or down-regulated. Twenty-four genes were randomly selected and confirmed their expression patterns by quantitative RT-PCR; Twenty-one of the twenty-four genes showed expression patterns consistent with the Digital Gene Expression (DGE) data. CONCLUSIONS: A number of soybean genes were differentially expressed between the low-N-tolerant and low-N-sensitive varieties under N-limited conditions. Some of these genes may be candidates for improving NUE. These findings will help to provide a detailed understanding of NUE mechanisms, and also provide a basis for breeding soybean varieties that are tolerant to low-N conditions.

Heterotopic pregnancy after in vitro fertilization-embryo transfer.

OBJECTIVE: A ruptured cornual pregnancy is a rare and challenging problem. We present two cases of cornual pregnancies after in vitro fertilization and embryo transfer (IVF-ET) treated by cornual resection, with an excellent perinatal outcome for the intrauterine pregnancy in both cases. A literature review of cornual pregnancy after IVF-ET is also included. CASE REPORTS: Two women had undergone IVF-ET because of tubal problems. Emergent laparotomy was performed because of internal bleeding at 12 weeks of gestation in one case and 17 weeks in the other, and in both cases, ruptured cornual pregnancies were found. Cornual resection and primary repair were performed. The women were discharged on the 6th and 7th postoperative day, respectively, and they underwent an elective cesarean delivery at 37 weeks of pregnancy. They were delivered of healthy babies, one weighing 2700 g and the other 2310 g. CONCLUSION: These cases illustrate that good perinatal outcomes can be achieved by surgical intervention in heterotopic pregnancies, even in the event of a ruptured cornu.

Welcome address by Chairman, Hospital Authority of Hong Kong: opening ceremony of the International Hospital Federation Congress--May 2001.

One of the significant features of Hong Kong is its public healthcare system, which provides universal, easily accessible and heavily subsidized medical care for all. The governing policy has been to ensure that no one is denied adequate medical care because of insufficient means through the provision of a comprehensive range of healthcare services funded from the public purse at extremely low fees to users. Over the past decade, the public hospital sector has been able to provide efficient and quality health services comparable to those of the industrialised nations. However, the reality today is that the public hospitals are facing many challenges that must be overcome and ways must be sought to mitigate the growing strains on the healthcare system and rebalance the healthcare economics. The recently published Consultation Document on Healthcare Reform, by Dr E K Yeoh, Secretary for Health & Welfare, proposes the introduction of a comprehensive range of short-term and long-term initiatives to revitalize and transform the healthcare system into a community-focused, patient-centred and knowledge-based integrated healthcare service with improved interface between the public and private sectors.

Endoscopic management of injured bowel using the automatic stapler.

Bowel injury is a rare but potentially fatal complication of laparoscopy if it is unrecognized at the time of the procedure. Once a bowel injury is identified, it must be repaired by either laparoscopy or laparotomy. The Endo GIA 30 stapler is effective for achieving large-vessel hemostasis and facilitating laparoscopic procedures, and is reported safe for laparoscopic hysterectomy. It was used successfully in two women to repair extensive bowel injuries.

Vaginoscopy using hysteroscope for diagnosis of vaginal bleeding during childhood: case report.

Vaginal bleeding is an uncommon and alarming symptom for children, and serious underlying causes should be excluded. Though vaginal bleeding during childhood was mostly associated with precocious puberty, the physician should keep in mind that local vaginal lesions such infectious vaginitis, vaginal trauma, and vaginal foreign bodies frequently present vaginal bleeding. A 10-year-old girl who denied any traumatic injuries or sexual abuse presented with profuse vaginal bleeding. She had normal development milestones and had no signs of thelarche or adrenarche. Her hymen was intact and the basal measurements of sex hormones including tyrotropic hormone and thyroxine were all within reference ranges. Finally, a laceration of the vaginal wall was found by vaginoscopy using a hysteroscope under general anesthesia and treated using gauze packing. We must emphasize the importance of vaginoscopy and examination under anesthesia in a child with vaginal bleeding to exclude local vaginal lesions. In addition, vaginoscopy using a hysteroscope makes the examination efficient and cost effective.

[A quantitative study on the relationship between the specific binding of glucocorticoid receptor and glucocorticoid biopotency in rat thymocytes].

The inhibitory effect of dexamethasone (Dex) on the incorporation of [3H] Urd and specific binding of [3H] Dex with glucocorticoid receptor (GR) were measured in order to quantitatively study the relationship between these two indices in rat thymocytes. The results showed that there existed a close correlation between the two indices in the range of 10(-9)-10(-5) mol/L Dex. When thymocytes were treated with RU486 in the concentration range of 10(-10)-10(-6) mol/L, both [3H] Dex specific binding and inhibitory effect of Dex were blocked with different fractions. The specific binding was linearly related to Dex biopotency. When extrapolated 100% of specific binding corresponded to 100% of biopotency while 20% of specific binding corresponded approximately to 0% of biopotency. It is likely that GR exhibited an occupancy threshold of about 20% total receptors, with only few spare ones in rat thymocytes.

Dentition, oral hygiene, and risk of oral cancer: a case-control study in Beijing, People's Republic of China.

A case-control study of oral cancer was conducted in Beijing, People's Republic of China. The study was hospital-based and controls were hospital in-patients matched to the cases by age and gender. A total of 404 case/control pairs were interviewed. This paper provides data regarding oral conditions as risk factors for oral cancer, with every patient having an intact mouth examined (pre-operation among cases) using a standard examination completed by trained oral physicians. After adjustment for tobacco smoking and alcohol consumption, poor dentition--as reflected by missing teeth--emerged as a strong risk factor for oral cancer: the odds ratio (OR) for those who had lost 15-32 teeth compared to those who had lost none was 5.3 for men and 7.3 for women and the trend was significant (P less than 0.01) in both genders. Those who reported that they did not brush their teeth also had an elevated risk (OR = 6.9 for men, 2.5 for women). Compared to those who had no oral mucosal lesions on examination (OR = 1.0), persons with leukoplakia and lichen planus also showed an elevated risk of oral cancer among men and women. Denture wearing per se did not increase oral cancer risk (OR = 1.0 for men, 1.3 for women) although wearing metal dentures augmented risk (OR = 5.5 for men). These findings indicate that oral hygiene and several oral conditions are risk factors for oral cancer, independently of the known risks associated with smoking and drinking.

Tobacco smoking, alcohol consumption, and risk of oral cancer: a case-control study in Beijing, People's Republic of China.

A case-control study of oral cancer was conducted in Beijing, People's Republic of China (PRC). The study was hospital-based and controls were hospital in-patients matched for age and gender with the cases. The response rates for cases and controls were 100 percent and 404 case/control pairs were interviewed. Tobacco smoking and alcohol consumption emerged as independent risk factors for oral cancer. For tobacco smoking, the association was considerably stronger for smokers of pipes than for smokers of cigarettes. For all kinds of tobacco, expressed as cigarette equivalents, the odds ratio (OR) for total pack-years smoked, among males, rose from 1.0 in never-smokers to 3.7 (95 percent confidence interval, 1.8-7.4) in the highest quintile of exposure. Similar results were found for females. The association with tobacco consumption was strong for squamous cell carcinoma but there was no trend in risk associated with tobacco for adenocarcinomas and other histologic types. So few women reported consuming alcohol that this variable could be examined only in males. Risk in the highest category of total lifetime intake of alcohol relative to that in lifetime abstainers was 2.3 (1.1-4.8) with a significant trend in risk with increasing dose (P less than 0.002). The combined effects of tobacco and alcohol appear to be approximately multiplicative in males. The attributable risk of oral cancer for tobacco among tobacco smokers was estimated as 34 percent (45 percent among males and 21 percent among females); for alcohol consumption in males the estimate was 23 percent.