Objective:To evaluate the efficacy and toxicity of single-agent bendamustine in patients with indolent B-cell non-Hodgkin's lymphoma (NHL) refractory to rituximab. Methods:Between April 2010 and April 2013, 100 patients with rituximab-refrac-tory indolent B-cell NHL from 8 institutions were enrolled. Bendamustine was administered at 120 mg/m2 on days 1 and 2 every 21 days for 6-8 cycles. The primary endpoint was the overall response rate (ORR). The secondary endpoints included disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and safety. Results:One hundred patients with a median age of 56 (rang-ing from 28 to 74) years were recruited in this clinical study. The total number of chemotherapy was 447 cycles, and the median number was 4 cycles. Ninety-three patients could be evaluated for efficacy. Fifteen patients (16.1%) had complete remission (CR), 52 (55.9%) had partial remission (PR), 22 (23.7%) had stable disease (SD), and 4 (4.3%) had progression disease (PD). The ORR and DCR were 72%and 95.7%, respectively. After a median follow-up of 26.6 months (ranging from 2 to 48.4 months), 59 patients (63.4%) had PD.The median PFS was 8.53 (95%CI:6.518-10.542) months, and PFS rate for 1 year was (40.6±5.3)%. Forty-eight patients (48%) had 3/4 grade adverse events, including leucopenia (26%), neutropenia (24%), and anemia (11%). Conclusion:Single-agent bendamustine produced a high rate of objective responses in patients with rituximab-refractory indolent B-cell NHL and could be one of the new op-tions for second-line treatment of these patients. The most common adverse event is hematologic toxicity.

Biological age (BA) can be used to measure the aging process of individuals and make up for the deficiency that chronological age cannot explain the discrepancy of health status among individuals at same chronological age. In recent years, multiple measurements of BA based on clinical or phenotypic, molecular biological, or compound indicators have emerged. In the paper, we summarize some common measurements of BA and compare their validities.

Objective:To explore the associations between perceived built environment attributes and adults’ leisure-time physical activity in four cities of China.Methods:Multistage cluster random sampling method was used to select adults aged 25 to 64 in Hangzhou, Suzhou, Chengdu, and Qingdao. Data were collected from June 2017 to July 2018. The perception of the urban built environment was assessed by the neighborhood environment walkability scale-abbreviated (NEWS-A), and the physical activity was assessed by the International Physical Activity Questionnaire. Generalized linear mixed models were used to explore the relationship between the perceived built environment and leisure-time physical activities.Results:A total of 3 789 participants were included in the analysis. After adjusting for potential confounders, better access to public services ( OR=1.34, 95% CI: 1.02-1.75) and higher aesthetic quality ( OR=1.37, 95% CI: 1.09-1.73) were positively associated with the possibility of engaging in leisure-time physical activity in the past week. Similarly, these two attributes were positively associated with leisure-time walking. Higher scores on the perception of street connectivity were positively associated with leisure-time walking [ exp( β)=1.09, 95% CI: 1.00-1.19]. Higher residential density [ exp( β)=1.000 4, 95% CI:1.000 0-1.000 8], better access to physical activity destinations[ exp( β)=1.09, 95% CI: 1.00-1.19], and better aesthetics [ exp( β)=1.11, 95% CI:1.00-1.22] were associated with higher leisure-time physical activity. Similarly, these three attributes were positively associated with the possibility of meeting the WHO recommendations. Conclusion:Changing some urban built environment attributes may increase leisure-time physical activity.

Objective:To evaluate the transitions of frailty status and related factors influencing its worsening in middle-aged and elderly adults.Methods:Data was obtained from the Beijing MJ Health Screening Center. A total of 13 689 participants who attended health checkups at least twice during 2008-2019 and had more than three years' intervals during these two health checkups were included in the study. The frailty index comprising 28 variables was used to measure frailty status. Frailty was defined as frailty index ≥0.25, and prefrailty was defined as frailty index >0.10 and <0.25. Logistic regression analysis was performed to investigate the association of socio-demographic factors and lifestyle characteristics with the worsening of frailty status, stratified by frailty status at the first health checkup.Results:The mean age at the first and last health checkups were (42.3±9.2) and (47.9±9.3) years, respectively. The mean interval during these two health checkups was (5.7±1.9) years. At the first health checkup, the prevalence of frailty and prefrailty were 2.5% and 50.3%, respectively. While at the last health checkup, the prevalence of frailty and prefrailty rose to 3.9% and 55.4%. Of all participants, 67.3% remained in the same frailty state, 21.2% worsening, and 12.5% improving. In robust participants at the first health checkup, older age, female, low education level, smoking cessation, daily smoking, being general obesity measured by BMI or central obesity measured by WHR showed an increased the risk of worsening frailty status. However, in prefrail participants at the first health checkup, older age, female, general, or central obesity presented as risk factors for worsening frailty status.Conclusion:Modifiable factors such as low education level, smoking, and obesity may increase the risk of worsening frailty status.

Objective:To describe the prevalence of multimorbidity and its secular trend, and to explore the common patterns of multimorbidity in Chinese adults.Methods:A total of 25 033 participants who attended the second resurvey of China Kadoorie Biobank (CKB) were included in the study. We used data collected both at baseline (2004-2008) and at resurvey (2013-2014). A total of 13 chronic conditions were included, defined by self-reported, physical examination, and blood sample testing. Multimorbidity was defined as co-existence of two or more chronic conditions. Patterns of multimorbidity were explored using hierarchical cluster analysis.Results:The mean age of participants was (51.5±10.1) years at baseline and (59.5±10.2) years at second resurvey. The prevalence of multimorbidity increased from 33.5% to 58.1% over (8.0±0.8) years of follow-up. The average number of chronic conditions per person increased from 1.15 to 1.82 and all participants increased 0.42 conditions per 5 years on average. Participants who were older, less educated or lived in urban areas had a higher prevalence of multimorbidity and a higher increase in the number of chronic conditions. The increase in the number of chronic conditions was also higher among smokers and heavy alcohol drinkers. The most common multimorbidity pattern in the present population consisted of obesity, hypertension, diabetes, stroke, and heart disease.Conclusions:The prevalence of multimorbidity in Chinese adults is increasing rapidly due to ageing population. Populations of different sociodemographic background and lifestyle habits may have different prevalence of multimorbidity and changes in rates over time.

Objective:To compare the consistency of frailty status measured by Fried phenotype and frailty index composed of different numbers of deficits, and their prospective associations with risk of mortality.Methods:Data of 23 615 participants from the second resurvey of the China Kadoore Biobank (CKB) was used. Fried phenotype was constructed using five phenotypes, and frailty indexes (FI) were constructed using 28 and 40 deficits, respectively. We calculated the Weighted Kappa coefficient to compare the consistency of three measures in the classification of frailty status. Cox regression was performed to analyze the association of frailty status with risk of mortality.Results:The frailty prevalence calculated by Fried phenotype, FI-28, and FI-40 were 5.4%, 7.9%, and 4.0%, respectively. The Kappa coefficients of Fried phenotype with FI-28 and FI-40 were 0.357 and 0.408, respectively. The Kappa coefficients of FI-28 and FI-40 was 0.712. During an average of (3.9±0.5) years of follow-up, 755 participants died. When Fried phenotype was used, compared with the robust participants, the prefrail and frail participants had increased risk of mortality, the multivariable-adjusted HRs were 1.60 (95% CI: 1.32-1.94) and 2.90 (95% CI: 2.25-3.73), respectively. When FI-28 was used, the corresponding HRs were 1.71 (95% CI: 1.39-2.11) and 2.52 (95% CI:1.95-3.27) for prefrail and frail participants, and when FI-40 was used, the corresponding HRs were 1.98 (95% CI:1.60-2.44) and 3.71 (95% CI: 2.80-4.91). The association of frailty status with mortality differed in different age groups, with the association stronger in younger adults than in older adults. Conclusion:Fried phenotype and frailty index constituted with different numbers of deficits showed good consistency; which can be used to well predict the risk of mortality.

BACKGROUND: Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population. We aimed to identify multimorbidity patterns and examined the associations of multimorbidity patterns and the number of chronic diseases with the risk of mortality among Chinese middle-aged and older adults. METHODS: We used data from the China Kadoorie Biobank and included 512,723 participants aged 30 to 79 years. Multimorbidity was defined as the presence of two or more of the 15 chronic diseases collected by self-report or physical examination at baseline. Multimorbidity patterns were identified using hierarchical cluster analysis. Cox regression was used to estimate the associations of multimorbidity patterns and the number of chronic diseases with all-cause and cause-specific mortality. RESULTS: Overall, 15.8% of participants had multimorbidity. The prevalence of multimorbidity increased with age and was higher in urban than rural participants. Four multimorbidity patterns were identified, including cardiometabolic multimorbidity (diabetes, coronary heart disease, stroke, and hypertension), respiratory multimorbidity (tuberculosis, asthma, and chronic obstructive pulmonary disease), gastrointestinal and hepatorenal multimorbidity (gallstone disease, chronic kidney disease, cirrhosis, peptic ulcer, and cancer), and mental and arthritis multimorbidity (neurasthenia, psychiatric disorder, and rheumatoid arthritis). During a median of 10.8 years of follow-up, 49,371 deaths occurred. Compared with participants without multimorbidity, cardiometabolic multimorbidity (hazard ratios [HR] = 2.20, 95% confidence intervals [CI]: 2.14 - 2.26) and respiratory multimorbidity (HR = 2.13, 95% CI:1.97 - 2.31) demonstrated relatively higher risks of mortality, followed by gastrointestinal and hepatorenal multimorbidity (HR = 1.33, 95% CI:1.22 - 1.46). The mortality risk increased by 36% (HR = 1.36, 95% CI: 1.35 - 1.37) with every additional disease. CONCLUSION Cardiometabolic multimorbidity and respiratory multimorbidity posed the highest threat on mortality risk and deserved particular attention in Chinese adults.
Aged ; Arthritis, Rheumatoid ; Asians ; China/epidemiology* ; Humans ; Hypertension ; Middle Aged ; Multimorbidity