BACKGROUND: Severe liver disease (SLD), including cirrhosis and liver cancer, constitutes a major disease burden in China. We aimed to examine the association of genetic and healthy lifestyle factors with the incidence and prognosis of SLD. METHODS: The study population included 504,009 participants from the prospective China Kadoorie Biobank aged 30-79 years. The individuals were from 10 diverse areas in China without a history of cancer or liver disease at baseline. Cox regression was used to estimate adjusted hazard ratios (HRs) for incident SLD and death after SLD diagnosis associated with healthy lifestyle factors (smoking, alcohol, physical activity, and central adiposity). Additionally, the contribution of genetic risk for hepatitis B virus (HBV, assessed by genetic variants in major histocompatibility complex, class II, DP/DQ [ HLA - DP / DQ ] genes) was also estimated. RESULTS: Compared with those with 0-1 healthy lifestyle factor, participants with 2, 3, and 4 factors had 12% (HR 0.88 [95% confidence interval [CI] 0.85, 0.92]), 26% (HR 0.74 [95%CI: 0.69, 0.79]), and 44% (HR 0.56 [95%CI: 0.48, 0.65]) lower risks of SLD, respectively. Inverse associations were observed among participants with both low and high genetic risks (HR per 1-point increase 0.83 [95%CI: 0.74, 0.94] and 0.91 [95%CI: 0.82, 1.02], respectively; Pinteraction = 0.51), although with a non-significant trend among those with a high genetic risk. Inverse associations were also observed between healthy lifestyle factors and liver biomarkers regardless of the genetic risk. Despite the limited power, healthy lifestyle factors were associated with a lower risk of death after incident SLD among participants with a low genetic risk (HR 0.59 [95%CI: 0.37, 0.96]). CONCLUSIONS Lifestyle modification may be beneficial in terms of lowering the risk of SLD regardless of the genetic risk. Moreover, it is also important for improving the prognosis of SLD in individuals with a low genetic risk. Future studies are warranted to examine the impact of healthy lifestyles on SLD prognosis, particularly among individuals with a high genetic risk.
Humans ; Prospective Studies ; Incidence ; East Asian People ; Healthy Lifestyle ; Risk Factors ; Liver Neoplasms ; Prognosis ; China/epidemiology*

BACKGROUND: Several studies have reported that polygenic risk scores (PRSs) can enhance risk prediction of coronary artery disease (CAD) in European populations. However, research on this topic is far from sufficient in non-European countries, including China. We aimed to evaluate the potential of PRS for predicting CAD for primary prevention in the Chinese population. METHODS: Participants with genome-wide genotypic data from the China Kadoorie Biobank were divided into training ( n = 28,490) and testing sets ( n = 72,150). Ten previously developed PRSs were evaluated, and new ones were developed using clumping and thresholding or LDpred method. The PRS showing the strongest association with CAD in the training set was selected to further evaluate its effects on improving the traditional CAD risk-prediction model in the testing set. Genetic risk was computed by summing the product of the weights and allele dosages across genome-wide single-nucleotide polymorphisms. Prediction of the 10-year first CAD events was assessed using hazard ratios (HRs) and measures of model discrimination, calibration, and net reclassification improvement (NRI). Hard CAD (nonfatal I21-I23 and fatal I20-I25) and soft CAD (all fatal or nonfatal I20-I25) were analyzed separately. RESULTS: In the testing set, 1214 hard and 7201 soft CAD cases were documented during a mean follow-up of 11.2 years. The HR per standard deviation of the optimal PRS was 1.26 (95% CI:1.19-1.33) for hard CAD. Based on a traditional CAD risk prediction model containing only non-laboratory-based information, the addition of PRS for hard CAD increased Harrell's C index by 0.001 (-0.001 to 0.003) in women and 0.003 (0.001 to 0.005) in men. Among the different high-risk thresholds ranging from 1% to 10%, the highest categorical NRI was 3.2% (95% CI: 0.4-6.0%) at a high-risk threshold of 10.0% in women. The association of the PRS with soft CAD was much weaker than with hard CAD, leading to minimal or no improvement in the soft CAD model. CONCLUSIONS In this Chinese population sample, the current PRSs minimally changed risk discrimination and offered little improvement in risk stratification for soft CAD. Therefore, this may not be suitable for promoting genetic screening in the general Chinese population to improve CAD risk prediction.
Male ; Humans ; Female ; Coronary Artery Disease/genetics* ; Biological Specimen Banks ; East Asian People ; Risk Assessment/methods* ; Genetic Predisposition to Disease/genetics* ; Risk Factors ; Genome-Wide Association Study

BACKGROUND: Evidence on the relations of the American Heart Association's ideal cardiovascular health (ICH) with mortality in Asians is sparse, and the interaction between behavioral and medical metrics remained unclear. We aimed to fill the gaps. METHODS: A total of 198,164 participants without cancer and cardiovascular disease (CVD) were included from the China Kadoorie Biobank study (2004-2018), Dongfeng-Tongji cohort (2008-2018), and Kailuan study (2006-2019). Four behaviors (i.e., smoking, physical activity, diet, body mass index) and three medical factors (i.e., blood pressure, blood glucose, and blood lipid) were classified into poor, intermediate, and ideal levels (0, 1, and 2 points), which constituted 8-point behavioral, 6-point medical, and 14-point ICH scores. Results of Cox regression from three cohorts were pooled using random-effects models of meta-analysis. RESULTS: During about 2 million person-years, 20,176 deaths were recorded. After controlling for demographic characteristics and alcohol drinking, hazard ratios (95% confidence intervals) comparing ICH scores of 10-14 vs. 0-6 were 0.52 (0.41-0.67), 0.44 (0.37-0.53), 0.54 (0.45-0.66), and 0.86 (0.64-1.14) for all-cause, CVD, respiratory, and cancer mortality. A higher behavioral or medical score was independently associated with lower all-cause and CVD mortality among the total population and populations with different levels of behavioral or medical health equally, and no interaction was observed. CONCLUSIONS ICH was associated with lower all-cause, CVD, and respiratory mortality among Chinese adults. Both behavioral and medical health should be improved to prevent premature deaths.
Adult ; Humans ; Cardiovascular Diseases/prevention & control* ; East Asian People ; Prospective Studies ; Risk Factors ; Smoking

Objective:Take Xi′an Jiaotong University as an example, to analyze the funding status of the National Natural Science Foundation of the Comprehensive University in the field of medicine-Engineering integration, with a view to revealing the general picture of interdiscipline of medicine and engineering research of Xi′an Jiaotong University, and gaining a glimpse of the development of the interdiscipline of medicine and engineering research in universities.Methods:Descriptive statistics were used to analyze the basic situation of the National Natural Science Foundation of China approved in the field of medicine-Engineering integration.Results:A total number of 692 projects were funded in the field of medicine-Engineering integration, with a total funding of 420 million yuan. Funding types are mainly general projects, followed by Youth Science Foundation projects. The number of key and major projects is small, but it is of great significance to the growth of the funding amount. The Department of Medical Science and the Department of Engineering Science are the departments with the largest total number of funding projects and funding amounts. In terms of funding disciplines, the core disciplines of imaging medicine and biomedical engineering, mechanical design and manufacturing, mechanics, biomaterials, imaging and tissue engineering, optics and optoelectronics, and oncology have been formed.Conclusions:The research shows that the interdiscipline of medicine and engineering research of Xi′an Jiaotong University has continued to grow, attracting scholars in science, engineering, medicine, management and other fields to participate, forming an advantageous discipline group. For the development of the integration of medicine and engineering in domestic universities, it is recommended to strengthen the top-level design, increase support for young people, and pay attention to the advanced layout of key and major projects.

Background:It remains unclear about the association of muscle mass, strength, and quality with death in the general Chinese population of diverse economical and geographical backgrounds. The present study aimed to comprehensively examine such associations across different regions in China.Methods:Based on the China Kadoorie Biobank study, the present study included 23,290 participants who were aged 38 to 88 years and had no prevalent cardiovascular diseases or cancer. Muscle mass and grip strength were measured using calibrated instruments. Arm muscle quality was defined as the ratio of grip strength to arm muscle mass. Low muscle mass, grip strength, and arm muscle quality were defined as the sex-specific lowest quintiles of muscle mass index, grip strength, and arm muscle quality, respectively. Cox proportional hazards models yielded hazard ratios (HRs) and 95% confidence intervals (CIs) for risks of all-cause mortality in relation to muscle mass, strength, and quality.Results:During a median follow-up of 3.98 years, 739 participants died. The HR (95% CI) of all-cause mortality risk was 1.28 (1.08-1.51) for low appendicular muscle mass index, 1.38 (1.16-1.62) for low total muscle mass index, 1.68 (1.41-2.00) for low grip strength, and 1.41 (1.20-1.66) for low arm muscle quality in models adjusted for sociodemographic characteristics, lifestyle factors, and medical histories.Conclusion:Low muscle mass, grip strength, and arm muscle quality are all associated with short-term increased risks of mortality, indicating the importance of maintaining normal muscle mass, strength, and quality for general Chinese adults.

Objective:To explore the predictive value of Red Blood Cell Distribution Width (RDW) in predicting the prognosis of patients with Extracorporeal Membrane Oxygenation (ECMO).Methods:The clinical data of patients undergoing ECMO admitted to Intensive Care Unit of Sichuan Provincial People’s Hospital from January 2015 to January 2020 were retrospectively analyzed. Patients were divided into the survival group and death group according to the prognosis during ICU hospitalization. The patients' basic data , acute physiology and chronic health score system Ⅱ (APACHE Ⅱ), RDW and activated partial thromboplastin time (APTT) at 72 hours after treatment with ECMO were compared between the two groups. Univariate and Logistic regression multivariate analyses were used to analyze the prognostic factors of patients with ECMO, predictive models and death warning scores were established. The receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficacy of RDW and death warning scores for the prognosis of patients with ECMO.Results:A total of 71 patients with ECMO who met the inclusion criteria were included, including 38 patients in the death group and 33 patients in the survival group. The age, APACHE-Ⅱscore, 72 h RDW and 72 h APTT in the death group were higher than those in the survival group. Respectively, the hospitalization time of ICU in the death group was significantly lower than that in the survival group ( P< 0.05). Logistic regression analysis showed that APACHE-Ⅱscore ( OR=1.117, P=0.047)、72 h RDW( OR=1.102, P=0.029) and 72 h APTT ( OR=1.049, P=0.029) were independent risk factors for death in patients with ECMO. ROC curve analysis showed that the area under ROC curve (AUC) of the APACHE-Ⅱ, score 、72 h RDW and 72 h APTT were 0.691, 0.691 and 0.632( P<0.05), Respectively, the combined AUC was 0.764, the sensitivity was 0.526, and the specificity was 0.909. The death warning score of patients with ECMO was established according to the Predictive model , which is less than 2 points with low risk of death and more than 2 points with high risk of death. The area under the ROC curve of death warning score is 0.8, the sensitivity is 0.607 and the specificity is 0.923. Conclusions:The RDW at 72 hours after treatment with ECMO has a good value in predicting the prognosis of patients with ECMO. Besides, a greater predictive value for the prognosis of patients with ECMO by combining 72 hours RDW, 72 hours APTT with APACHE-Ⅱscore than that of any separate indicator.

Objective    To explore the clinical pattern of intrapulmonary lymph node metastasis and the significance of No.13 and No.14 lymph nodes biopsy in patients with non-small cell lung cancer (NSCLC). Methods    The clinical data of 234 patients with primary peripheral NSCLC who underwent systemic dissection of intrathoracic lymph nodes and intrapulmonary lymph nodes in the First Affiliated Hospital of Chongqing Medical University between 2013 and 2015 were retrospectively analyzed. There were 159 males and 75 females, aged 36-89 (61.35±8.57) years. Statistical analysis was performed accordingly on hilar (No.10), interlobar (No.11), lobar (No.12) and segmental (No.13 and 14) sites of the samples of N1 lymph nodes after surgery. Results    A total of 3 019 lymph nodes of No.10-14 were dissected in 234 patients (12.9 per patient). The 263 lymph nodes were positive with a rate of 8.71% (263/3 019) and lymph node metastasisa occured in 99 patients with a rate of 42.31% (99/234), among whom there were 40 patients of N1 metastasis, 48 of N1+N2 metastasis and 11 of N2 skipping metastasis. Routine pathological examination demonstrated No.13 and No.14 lymph nodes metastasis in 16 patients with a rate of 6.84% (16/234). In 886 dissected lymph nodes of No.13 and No.14, 86 lymph nodes showed metastasis with a rate of 9.71% (86/886). Of the patients with swelling hilar and mediastinal lymph nodes reported by preoperative CT scan, only 56.32% of them were confirmed with lymph node metastasis by postoperative histopathology; while 34.01% of the patients with normal size lymph nodes had lymph node metastasis. Conclusion    In the surgical treatment of NSCLC, it is necessary to detect the metastasis of No. 13 and 14 lymph nodes and non-tumor parabronchial lymph nodes, which is helpful to obtain accurate postoperative TNM staging and is of great significance for guiding postoperative treatment. Preoperative CT is not a reliable method to judge lymph node metastasis, particularly for intrapulmonary lymph node metastasis.

BACKGROUND AND PURPOSE: Both genetic factors and smoking are associated with ischemic stroke (IS) risk. However, little is known about the potential interaction of these factors. We aimed to assess whether smoking and a positive family history interact to increase the risk of IS. METHODS: The nationwide prospective study recruited 210,000 men and 300,000 women in 2004 to 2008 at ages 30 to 79 years. During 9.7 years of follow-up, we documented 16,923 and 20,656 incident IS cases in men and women without major chronic diseases at baseline, respectively. Multivariable Cox regression models were used to examine associations between family history and IS. Likelihood ratio tests were used to test the smoking-family history interactions on IS. RESULTS: About 67.8% (n=135,168) of men ever smoked regularly compared with 2.7% (n=7,775) of women. Among men, a significant interaction between family history and smoking on IS was observed (P for interaction=0.03), with more pronounced association between family history and IS among ever-regular smokers (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.16 to 1.27) than among never-smokers (HR, 1.11; 95% CI, 1.01 to 1.23). The association between family history and IS among ex-smokers after more than 10 years of cessation (HR, 1.01; 95% CI, 0.85 to 1.20) appeared similar to that among never-smokers. Among women, a similar but not significant interaction between family history and smoking on IS was observed. Ever-regular smokers who had a family history of stroke had the highest risk of IS. CONCLUSIONS: Among Chinese men, the association of family history with IS was accentuated by smoking, and such accentuation tended to be lowered by cessation.
Asian Continental Ancestry Group ; Chronic Disease ; Cohort Studies ; Family Health ; Female ; Follow-Up Studies ; Gene-Environment Interaction ; Humans ; Male ; Prospective Studies ; Smoke ; Smoking ; Stroke ; Tobacco

BACKGROUND AND PURPOSE: Self-rated health (SRH) is a consistent and strong predictor of all-cause and cardiovascular mortality in various populations. However, the associations between SRH measures and risk of first-ever or recurrent stroke were rarely explored. We thus aim to prospectively investigate the associations between SRH measures and risk of total and subtypes of stroke in Chinese population. METHODS: A total of 494,113 participants from the China Kadoorie Biobank without prior heart diseases or cancer (486,541 without stroke and 7,572 with stroke) were followed from baseline (2004 to 2008) until December 31, 2013. General and age-comparative SRH were obtained from baseline questionnaires. First-ever stroke or recurrent events were ascertained through linkage to disease registry system and health insurance data. RESULTS: We identified 27,662 first-ever stroke and 2,909 recurrent events during an average of 7.0 years of follow-up. Compared with excellent general SRH, the hazard ratios (HRs) and 95% confidence intervals (CIs) for first-ever stroke associated with good, fair, and poor general SRH were 1.04 (1.00 to 1.08), 1.19 (1.15 to 1.23), and 1.49 (1.42 to 1.56) in the multivariate model, respectively. Compared with better age-comparative SRH, the HRs (95% CIs) of same and worse age-comparative SRH were 1.13 (1.10 to 1.17) and 1.51 (1.45 to 1.58), respectively. The relations of SRH measures with ischemic stroke, hemorrhagic stroke, and recurrent stroke were similar to that with total first-ever stroke. However, the magnitude of associations was much stronger for fatal stroke than for non-fatal stroke. CONCLUSIONS: This large-scale prospective cohort suggests that self-perceived health status is associated with incident stroke, regardless of stroke subtype.
Adult* ; Asian Continental Ancestry Group* ; China* ; Cohort Studies ; Follow-Up Studies ; Heart Diseases ; Humans ; Insurance, Health ; Mortality ; Prospective Studies ; Stroke*

BACKGROUND AND PURPOSE: Large cohort studies on relationship between family history of stroke (FHS) and stroke risk are lacking in Asians. We aimed to systematically evaluate the association of FHS with stroke risk in a cohort study of 0.5 million Chinese adults. METHODS: Information about FHS was self-reported. The median follow-up time was 7.16 years and the end-point of follow-up was incident stroke, which was entered directly into the China Kadoorie Biobank system. Multivariate analyses were performed with Cox proportional hazards model, and interaction analyses were carried using likelihood-ratio tests. RESULTS: Compared with participants without FHS, the hazard ratio (HR) (95% confidence interval, CI) of stroke for participants with FHS was 1.50 (1.46-1.55). The HRs increased with the number of first degree relatives with stroke (HRs=1.41, 1.98 and 2.47 for 1, 2 and ≥3 relatives, respectively, P(trend) <0.001). The HRs were 1.57 (95% CI: 1.50-1.66) and 1.49 (95% CI: 1.45-1.54) for sibling history and parental history, respectively. Similar associations with offspring stroke risk were observed between paternal history (HR=1.48, 95% CI: 1.43-1.54) and maternal history (HR=1.49, 95% CI: 1.43-1.55). Moreover, significant interactions were detected between FHS and health-risk behaviors (tobacco smoking and alcohol drinking). CONCLUSIONS: FHS is an independent risk factor for stroke in Chinese. The more first degree relatives are affected by stroke, the higher are individuals’ risk of suffering from stroke. The management of the health-risk behaviors for reducing stroke should be highlighted, especially for the individuals with FHS.
Adult ; Asian Continental Ancestry Group ; China* ; Cohort Studies* ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Parents ; Proportional Hazards Models ; Risk Factors ; Siblings ; Smoke ; Smoking ; Stroke*