Publications by authors named "Jian-Bing Wang"

57 Publications

HDL-C, longitudinal change and risk of mortality in a Chinese cohort study.

Nutr Metab Cardiovasc Dis 2021 08 21;31(9):2669-2677. Epub 2021 Jun 21.

Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hangzhou, 310058, Zhejiang province, China; Department of Epidemiology and Biostatistics, National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang province, China. Electronic address:

Background And Aims: High-density lipoprotein cholesterol (HDL-C) concentration and variability are both important factors of cardiovascular disease (CVD) and mortality. We aimed to explore the associations of HDL-C and longitudinal change in HDL-C with risk of mortality.

Methods And Results: We recruited a total of 69,163 participants aged ≥40 years and had medical examination records of HDL-C during 2010-2014 from the Yinzhou District, Ningbo, China. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models. We observed a non-linear association of HDL-C with risks of non-accidental and CVD mortality. Compared with the moderate concentration group (1.4-1.6 mmol/L), HDL-C <1 mmol/L was associated with a higher risk of non-accidental mortality (HR: 1.13 (95% CI: 1.01-1.27)) and both HDL-C <1 mmol/L and ≥2 mmol/L were associated with a higher risk of CVD mortality (HRs: 1.23 (95% CI: 1.01-1.50) and 1.37 (95% CI: 1.03-1.82), respectively). Compared with the stable group ([-0.1, +0.1 mmol/L]), a large decrease ([-0.5, -0.3 mmol/L]) and very large decrease (<-0.5 mmol/L) in HDL-C were associated with a higher risk of non-accidental mortality (HRs: 1.40 (95% CI: 1.21-1.63) and 1.78 (95% CI: 1.44-2.20), respectively). Similar results were observed for CVD mortality and cancer mortality.

Conclusion: Extremely low or high HDL-C and a large decrease or very large decrease in HDL-C were associated with a higher risk of cause-specific mortality. Monitoring of HDL-C may have utility in identifying individuals at higher risk of mortality.
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http://dx.doi.org/10.1016/j.numecd.2021.06.004DOI Listing
August 2021

Family History and Risk of Upper Gastrointestinal Cancer in the Linxian General Population.

Front Oncol 2021 28;11:605106. Epub 2021 May 28.

Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States.

Objective: The objective of this study was to investigate family history (FH) of upper gastrointestinal (UGI) cancer and risk of esophageal squamous cell carcinoma (ESCC), gastric cardia carcinoma (GCC), and gastric non-cardia carcinoma (GNCC) in the Linxian General Population Nutrition Intervention Trial (NIT) cohort. Methods: This prospective analysis was conducted using the Linxian NIT cohort data. Subjects with FH of UGI cancer was treated as an exposed group while the remainders were considered as a comparison group. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between FH of UGI cancer and risk of UGI cancer incidence and mortality were estimated using Cox proportional hazards models.

Results: There were 5,680 newly diagnosed UGI cancer cases during the follow-up period, with a total of 4,573 UGI cancer deaths occurred, including 2,603 ESCC, 1,410 GCC, and 560 GNCC deaths. A positive FH of UGI cancer was associated with a significantly increased risk of ESCC and GCC (Incidence: HR = 1.45, 95%CI: 1.35-1.56; HR = 1.27, 95%CI: 1.15-1.40; Mortality: HR = 1.40, 95%CI: 1.30-1.52; HR = 1.27, 95%CI: 1.14-1.42) after adjusting for age at baseline, gender, smoking status, alcohol drinking, education level, and frequency of fresh fruit and vegetable consumption. Subjects with FH in both parents had the highest risk of ESCC and GCC incidence (HR = 1.65, 95%CI: 1.40-1.95; HR = 1.42, 95%CI: 1.12-1.81) and deaths (HR = 1.65, 95%CI: 1.38-1.97; HR = 1.42, 95%CI: 1.09-1.85). Spouse diagnosed with UGI cancer did not increase the risk of any UGI cancers of the subjects. In subgroup analysis, FH of UGI cancer was shown to significantly increase the risk of GCC in non-drinkers (Incidence: HR = 1.31, 95%CI: 1.17-1.47; Mortality: HR = 1.33, 95%CI: 1.17-1.50). No associations were observed for risk of GNCC. Sensitivity analysis by excluding subjects who were followed up less than three years did not materially alter our results.

Conclusion: Our data point to the role of the FH of UGI cancer to the risk of ESCC and GCC incidence and mortality. The influence of family history on the risk of UGI cancer varies from different types of family members.
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http://dx.doi.org/10.3389/fonc.2021.605106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193945PMC
May 2021

Low LDL-C levels are associated with risk of mortality in a Chinese cohort study.

Endocrine 2021 09 14;73(3):563-572. Epub 2021 May 14.

Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Zhejiang, 310058, Hangzhou, China.

Background And Aims: Although low-density lipoprotein cholesterol (LDL-C) has been considered as a risk factor of atherosclerotic cardiovascular disease, limited studies can be available to evaluate the association of LDL-C with risk of mortality in the general population. This study aimed to examine the association of LDL-C level with risk of mortality using a propensity-score weighting method in a Chinese population, based on the health examination data.

Methods: We performed a retrospective cohort study with 65,517 participants aged 40 years or older in Ningbo city, Zhejiang. LDL-C levels were categorized as five groups according to the Chinese dyslipidemia guidelines in adults. To minimize potential biases resulting from a complex array of covariates, we implemented a generalized boosted model to generate propensity-score weights on covariates. Then, we used Cox proportional hazard regression models with all-cause and cause-specific mortality as the dependent variables to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs).

Results: During the 439,186.5 person years of follow-up, 2403 deaths occurred. Compared with the median LDL-C group (100-130 mg/dL), subjects with extremely low LDL-C levels (group 1) had a higher risk of deaths from all-cause (HR = 2.53, 95% CI:1.80-3.53), CVD (HR = 1.84, 95% CI: 1.28-2.61), ischemic stroke (HR = 2.29, 95% CI:1.32-3.94), hemorrhagic stroke (HR = 3.49, 95% CI: 1.57-7.85), and cancer (HR = 2.12, 95% CI: 1.04-4.31) while the corresponding HRs in LDL-C group 2 were relatively lower than that in group 1.

Conclusions: Low LDL-C levels were associated with an increased risk of all-cause, CVD, ischemic stroke, hemorrhagic stroke, and cancer mortality in the Chinese population.
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http://dx.doi.org/10.1007/s12020-021-02746-6DOI Listing
September 2021

Effect of COVID-19 on hospital visits in Ningbo, China: an interrupted time-series analysis.

Int J Qual Health Care 2021 May;33(2)

Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, 866 Yuhangtang Road, Hangzhou, Zhejiang 310058, China.

Objective: Unprecedented rigorous public health measures were implemented during the coronavirus disease 2019 (COVID-19) epidemic, but it is still unclear how the intervention influenced hospital visits for different types of diseases. We aimed to evaluate the impact of the intervention on hospital visits in Yinzhou District, Ningbo, Zhejiang province, China.

Methods: We conducted an interrupted time-series analysis from 1 January 2017 to 6 September 2020 based on the Yinzhou Health Information System in Ningbo, Zhejiang province. The beginning of the intervention was on 23 January 2020, and thus, there were 160 weeks before the intervention and 32 weeks after the implementation of the intervention. Level changes between expected and observed hospital visits in the post-intervention period were estimated using quasi-Poisson regression models.

Results: Compared with the expected level, there was an estimated decrease of -22.60% (95% confidence interval (CI): -27.53%, -17.36%) in the observed total hospital visits following the intervention. Observed hospital visits for diseases of the respiratory system were found to be decreased dramatically (-62.25%; 95% CI: -65.62%, -58.60%). However, observed hospital visits for certain diseases were estimated to be increased, including diseases of the nervous system (+11.17%; 95% CI: +3.21%, +19.74%); diseases of pregnancy, childbirth and the puerperium (+27.01%; 95% CI: +17.89%, +36.85%); certain conditions originating in the perinatal period (+45.05%; 95% CI: +30.24%, +61.56%); and congenital malformation deformations and chromosomal abnormalities (+35.50%; 95% CI: +21.24%, +51.45%).

Conclusions: Our findings provided scientific evidence that cause-specific hospital visits evolve differently following the intervention during the COVID-19 epidemic.
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http://dx.doi.org/10.1093/intqhc/mzab078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135444PMC
May 2021

[Acupuncture combined with cranial electrotherapy stimulation on generalized anxiety disorder: a randomized controlled trial].

Zhongguo Zhen Jiu 2020 Nov;40(11):1187-90

Department of TCM, First Hospital of Hebei Medical University, Shijiazhuang 050000, China.

Objective: To observe the therapeutic effect of acupuncture combined with cranial electrotherapy stimulation (CES) on generalized anxiety disorder (GAD).

Methods: A total of 200 patients with GAD were randomized into an acupuncture+CES group, an acupuncture group, a CES group and a medication group, 50 cases in each one. In the medication group, patients were treated with tandospirone citrate tablet orally, 10 mg after breakfast, lunch and dinner respectively. In the CES group, CES was adopted by SCS brain electromedical instrument, 60 min each time, once a day. In the acupuncture group, acupuncture was applied to Baihui (GV 20), Sishencong (EX-HN 1), Yintang (GV 29), Shenting (GV 24), etc., 30 min each time, once a day. In the acupuncture+CES group, CES was adopted before acupuncture. Treatment of sixty days was required in the 4 groups. Before and after treatment, the scores of Hamilton anxiety scale (HAMA), World Health Organization's quality of life questionnaire-brief version (WHOQOL-BREF) and treatment emergent symptom scale (TESS) were observed, the clinical effect was evaluated, and the relapse of anxiety during follow-up of 1 year after treatment was recorded in the 4 groups.

Results: Compared before treatment, the scores of HAMA after treatment were decreased (<0.05), the scores of WHOQOL- BREF after treatment were increased in the 4 groups (<0.05), and the improvements of above scores in the acupuncture+CES group were greater than the other 3 groups (<0.05). The score of TESS after treatment and the relapse rate of 1-year follow-up in the medication group were higher than those in the other 3 groups (<0.05). The total effective rate in the acupuncture+CES group were superior to the other 3 groups (<0.05).

Conclusion: Acupuncture combined with CES can effectively relieve the symptoms in patients with GAD, improve the quality of life, reduce the occurrence of adverse reactions and the relapse rate, and its clinical effect is obviously superior to the western medication, the simple application of acupuncture or CES.
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http://dx.doi.org/10.13703/j.0255-2930.20190917-k0004DOI Listing
November 2020

Province-specific alcohol-attributable cancer deaths and years of potential life lost in China.

Drug Alcohol Depend 2021 01 23;218:108431. Epub 2020 Nov 23.

Department of Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang Province, People's Republic of China; Department of Epidemiology and Biostatistics, and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang Province, People's Republic of China.

Objective: Cancer is a major cause of death in China. As alcohol drinking, a risk factor of cancer, is common in China, we aimed to estimate the alcohol-attributable cancer deaths and years of potential life lost (YPLL) across all provinces in China.

Methods: We estimated the proportion of cancer deaths and YPLL attributable to alcohol consumption at the province level. Population attributable fraction (PAF) was calculated based on: 1) prevalence of alcohol consumption, obtained from the China National Nutrition and Health Survey 2002; 2) dose-response relative risks (RRs) of alcohol consumption and site-specific cancer, extracted from published meta-analyses; 3) cancer mortality data, originated from the National Program of Cancer Registry 2013.

Results: We estimated that 98,306 cancer deaths were attributable to alcohol consumption and accounted for 4.56 % of the total cancer deaths in China in 2013. Of these deaths, a total of 919,741.57 person-years premature loss of life was caused. Both overall PAF and average YPLL per 100,000 individuals were much higher in men than that in women (7.01 % vs. 0.33 % and 130.55 vs. 4.45, respectively). At the province level, overall PAF ranged from 2.14 % (95 % CI: 1.40 %-2.87 %) in Shanghai to 6.56 % (95 % CI: 4.06 %-9.05 %) in Anhui and the average YPLL per 100,000 individuals ranged from 10.97 in Tibet to 106.52 in Shandong.

Conclusions: Cancer burden attributable to alcohol consumption varied across provinces in China. Province-level approaches are warranted to decrease alcohol consumption and reduce the alcohol-related cancer burden.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108431DOI Listing
January 2021

Impact of Individual and Combined Lifestyle Factors on Mortality in China: A Cohort Study.

Am J Prev Med 2020 09 14;59(3):461-468. Epub 2020 May 14.

Department of Epidemiology and Biostatistics, Cancer Institute, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. Electronic address:

Introduction: Although numerous studies have suggested that lifestyle-related factors are associated with chronic diseases and preventable deaths, limited evidence is available for the Chinese population.

Methods: This study established a prospective cohort of >360,000 residents on the basis of the Yinzhou Health Information System in China during 2004-2017 and calculated the combined effects of lifestyle-related factors, including BMI, smoking, alcohol consumption, and physical activity, using a points system. A Cox regression model estimated the combined effects of lifestyle-related factors on total mortality, and a competing risk model estimated the combined effects on cancer and cardiovascular disease mortality. All data analyses were conducted in 2018‒2019.

Results: During 3,755,879 person-years of follow-up, 11,791 deaths were identified, including 4,983 from cancer and 3,143 from cardiovascular disease. Having a standard BMI, never smoking, never drinking, and engaging in physical activity more than 4 times per week had protective effects on total mortality. Overall, the risk of total and cause-specific mortality increased with the increment of risk score. Compared with subjects in the lowest quartile, the risk of total and cause-specific mortality peaked among individuals in the fourth quartile (total mortality: hazard ratio=1.87, 95% CI=1.77, 1.98; cancer mortality: hazard ratio=2.05, 95% CI=1.87, 2.25; cardiovascular disease mortality: hazard ratio=1.51, 95% CI=1.35, 1.68). Sensitivity analyses excluding individuals with follow-up <3 years did not materially change the results.

Conclusions: The combined effects of lifestyle-related factors, including BMI, smoking, alcohol drinking, and physical activity, are associated with total, cancer, and cardiovascular disease mortality among the Chinese population.
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http://dx.doi.org/10.1016/j.amepre.2020.01.029DOI Listing
September 2020

Short-term associations between ambient fine particulate matter pollution and hospital visits for chronic obstructive pulmonary disease in Yinzhou District, China.

Environ Sci Pollut Res Int 2020 Jun 11;27(17):21647-21653. Epub 2020 Apr 11.

Department of Epidemiology and Biostatistics, the Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China.

Ambient particulate matter is one of the main risk factors of chronic obstructive pulmonary disease (COPD) in developing countries. However, the studies were scant in China concerning the health effects of the fine particulate matter (PM; particulate matter ≤ 2.5 μm in diameter) on hospital visits for COPD. We applied a generalized additive model (GAM) to calculate relative risks (RRs) with 95% confidence intervals (CIs) for the associations between hospital visits for COPD and an interquartile range (24.50 μg/m) increment of ambient PM concentrations in Yinzhou District between 2016 and 2018. The ambient PM concentration was positively associated with hospital visits for COPD at a distributed lag of 0-7 days (RR = 1.073, 95% CI, 1.016, 1.133). In the stratified analysis, we found that the association between ambient PM and COPD was stronger during the warm season (April to September) than that during the cold season (October to March), but we did not observe statistically significant differences in age groups (< 60 years and ≥ 60 years) or gender groups (male and female) related to the effects of PM. The associations between ambient PM and COPD became partially attenuated after the adjustment for gaseous pollutants in subgroups. Our findings could provide evidence that regulations for controlling both PM and gaseous pollutants should be implemented to protect the overall population.
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http://dx.doi.org/10.1007/s11356-020-08448-2DOI Listing
June 2020

Regression-based normative data for social health scale for the elderly (short version) in eastern China.

Health Qual Life Outcomes 2020 Mar 4;18(1):54. Epub 2020 Mar 4.

Division of Epidemiology and Health Statistics, Department of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China.

Backgrounds: Social Health Scale for the Elderly short version (SHSE-S) is a psychometrically sound instrument that comprehensively assesses the social health status of older adults in China. The aim of the present study was to establish continuous normative data of SHSE-S.

Methods: We conducted a multicenter cross-sectional study among 31 communities in eastern China. Older adults aged 60 years and above were invited to participate in the study. Each participant was interviewed in-person to finish a structured questionnaire. The SHES-S score was calculated and standardized for each participant. We split the sample into generation and validation datasets and compared the distribution of SHSE-S score between two datasets. Multivariable linear regression was used to assess the SHSE-S score and demographic variables. Regression-based norms were built using a four-step process.

Results: A total of 6089 participants (51.2% females) aged 60 years old and above (mean age = 71.3, SD = 8.0) were enrolled as the normative sample. No significant difference was found between the distribution of SHSE-S standardized score in the generation (N = 2392) and validation (N = 3697) datasets. Multivariable linear regression showed that females, higher education levels were positive indicators while aging, living alone, divorced or never married, multimorbidity were negative factors. The regression-based norm which taking demographic factors into account was established and a user-friendly worksheet was also provided to facilitate the scoring and norming of the SHSE-S.

Conclusions: The population-based regression norm of SHSE-S can be a useful tool for assessing the social health status of the Chinese elderly population.
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http://dx.doi.org/10.1186/s12955-020-01306-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057499PMC
March 2020

Body mass index and risk of upper gastrointestinal cancer: A 30-year follow-up of the Linxian dysplasia nutrition intervention trial cohort.

Cancer Epidemiol 2020 04 9;65:101683. Epub 2020 Feb 9.

Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.

Background: Although a number of previous studies have noted the association between body mass index (BMI) and upper gastrointestinal (UGI) cancer risk, little evidence exists in the Chinese esophageal squamous dysplasia population. This prospective study investigated the association between BMI and UGI cancer risk in the Linxian Dysplasia Nutrition Intervention Trial (NIT) cohort.

Methods: A total of 3298 participants were included in the final analysis. Asian-specific BMI cut-offs were used to define BMI subgroups: underweight <18.5 kg/m, normal ≥18.5 to <24 kg/m and overweight or obese ≥24 kg/m. Hazard ratios (HRs) and 95 % confidence intervals (95 %CIs) were estimated using the Cox proportional hazard model.

Results: During over 30 years of follow-up we identified 654 incident esophageal squamous-cell carcinoma (ESCC) cases and 434 gastric cancer cases which included 88 gastric non-cardia carcinoma (GNCC) and 346 gastric cardia carcinoma (GCC) cases. Relative to normal weight, overweight or obesity were associated with a significantly reduced risk of ESCC (HR 0.69, 95 %CI 0.48-0.98) after multivariate adjustment, including age at baseline, gender, smoking, drinking, family history of cancer, education and consumption of fresh fruit. Subgroup analyses found that clear effects were evident in women and subjects with a family history of cancer. No association with gastric cancer was observed in any subjects or subgroups.

Conclusion: Overweight/obesity was associated with decreased risk of ESCC in this dysplasia population, particularly in women and persons who had a family history of cancer. Future studies are needed to confirm these findings.
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http://dx.doi.org/10.1016/j.canep.2020.101683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276490PMC
April 2020

Association between CPR-related genetic variants and risk of ischemic stroke: a nested case-control study.

Neurol Res 2019 Dec 4;41(12):1090-1096. Epub 2019 Oct 4.

Department of Epidemiology and Biostatistics, School of Public health, Zhejiang University , Hangzhou , China.

: Serum C-reactive protein (CRP) has been reported to be associated with risk of ischemic vascular disease including ischemic stroke. Genome-wide association studies have revealed several gene variants related to CRP concentration. : We investigated genetic variants in CRP-related genes associated with ischemic stroke in a nested case-control study with 138 ischemic stroke cases and 276 controls. We sequenced the whole coding region of six CPR-related genes and selected eligible SNPs. Three genetic models (additive, dominant and recessive) were calculated by a multivariable conditional logistic regression to estimate the association between SNPs and risk of ischemic stroke. We also calculated gene-environment interactions by using a crossover analysis. : Three out of 10 eligible SNPs were shown to be associated with risk of ischemic stroke. rs1800947 in gene (additive model: OR = 2.08, 95% CI: 1.00-4.23) and rs1169288 in gene (additive model: OR = 1.45, 95% CI: 1.03-2.06) were associated with an increased risk of ischemic stroke. rs440446 in gene (additive model: OR = 0.63, 95%CI: 0.44-0.88) was associated with a decreased risk of ischemic stroke. Genetic risk scores models including SC-GRS and OR-GRS both showed a significant association with risk of ischemic stroke. These three SNPs interacted with smoking and red meat intake. : Our study showed genetic variants of CRP-related genes were associated with risk of ischemic stroke. Our findings could provide useful data for the etiology of ischemic stroke.
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http://dx.doi.org/10.1080/01616412.2019.1673286DOI Listing
December 2019

Association between visit-to-visit variability of HbA and cognitive decline: a pooled analysis of two prospective population-based cohorts.

Diabetologia 2020 01 4;63(1):85-94. Epub 2019 Sep 4.

Division of Epidemiology and Health Statistics, Department of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou,, Zhejiang, 310058, China.

Aims/hypothesis: The aim of this study was to investigate the association between visit-to-visit variability in HbA and cognitive function decline in the elderly population.

Methods: We performed a pooled analysis of two prospective population-based cohorts (the Health Retirement Study [HRS] and the English Longitudinal Study of Ageing [ELSA]). Cognitive function, including memory and executive function, were assessed at baseline and every 2 years, while HbA levels were assessed at baseline and every 4 years. Visit-to-visit variability (VVV) in HbA was calculated using the CV, SD and variation independent of the mean (VIM) during the follow-up period. Linear mixed models were used to evaluate the association between HbA variability and cognitive function decline with adjustment for demographics, mean HbA, education, smoking, alcohol consumption, BMI, baseline hypertension, baseline diabetes status and HDL-cholesterol.

Results: The study enrolled 6237 participants (58.23% women, mean age 63.38 ± 8.62 years) with at least three measurements of HbA. The median follow-up duration was 10.56 ± 1.86 years. In the overall sample, compared with the lowest quartile of HbA variability, participants in the highest quartile of HbA variability had a significantly worse memory decline rate (-0.094 SD/year, 95% CI -0.185, -0.003) and executive function decline rate (-0.083 SD/year, 95% CI -0.125, -0.041), irrespective of mean HbA values over time. Among individuals without diabetes, each 1-SD increment in HbA CV was associated with a significantly higher rate of memory z score decline (-0.029, 95% CI -0.052, -0.005) and executive function z score decline (-0.049, 95% CI -0.079, -0.018) in the fully adjusted model.

Conclusions/interpretation: We observed a significant association between long-term HbA variability and cognitive decline among the non-diabetic population in this study. The effect of maintaining steady glucose control on the rate of cognitive decline merits further investigation.
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http://dx.doi.org/10.1007/s00125-019-04986-8DOI Listing
January 2020

Intra-individual variability of total cholesterol is associated with cardiovascular disease mortality: A cohort study.

Nutr Metab Cardiovasc Dis 2019 11 12;29(11):1205-1213. Epub 2019 Jul 12.

Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China; Research Center for Air Pollution and Health, Zhejiang University, Hangzhou, China; Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. Electronic address:

Background And Aims: The relationship between serum total cholesterol (TC) and mortality remains inconsistent. Additionally, intra-individual variability of cholesterol has been of increasing interest as a new indicator for health outcomes. We aimed to examine the association between TC and its variability and risk of mortality.

Methods And Results: We performed a retrospective cohort study with 122,645 individuals aged over 40 years in Ningbo, China. The intra-individual variability was calculated using four metrics including standard deviation, coefficient variation, variation independent of mean and average successive variability. Hazard ratios and 95% confidence intervals were estimated for the associations of baseline and variability in TC with risk of mortality by Cox proportional hazards regression models. During 591,585.3 person-years of follow-up, 4563 deaths (including 1365 from cardiovascular disease, 788 from stroke and 1514 from cancer) occurred. A U-shaped association was observed for baseline TC level and risk of total, cardiovascular and cancer mortality, with lowest mortality at 5.46 mmol/L, 5.04 mmol/L and 5.51 mmol/L, respectively. As compared with subjects with TC variability in the lowest quartile, individuals in the highest quartile had 21% higher risk of all-cause mortality (HR = 1.21, 95% CI: 1.05 to 1.40), and 41% higher risk of CVD mortality (HR = 1.41, 95%CI: 1.10 to 1.81).

Conclusion: Both too low and too high baseline TC level were associated with higher risk of total, cardiovascular disease and cancer mortality. Variability of TC could be a risk factor of total and CVD mortality, independent of mean TC level. Future studies are needed to confirm these findings.
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http://dx.doi.org/10.1016/j.numecd.2019.07.007DOI Listing
November 2019

Clinical observation of C3-type patellar fractures treated by operation methods with or without a turned-over patella.

Injury 2019 Apr 18;50(4):966-972. Epub 2019 Mar 18.

Department of Orthopaedics, Wuxi the Ninth People's Hospital Affiliated to Suzhou University, 214062, China. Electronic address:

Objective: To evaluate the clinical efficacy of operation methods with or without a turned-over patella for treatment of C3-type patellar fractures.

Methods: A total of 68 patients with C3-type patellar fractures undergoing open reduction and internal fixation were retrospectively selected and treated with a turned-over patella surgery (turned-over patella group, n = 30) or conventional therapy without turning over the patella (conventional group, n = 38). The intraoperative and postoperative indicators of the two groups were assessed and comparatively analyzed.

Results: The bedridden time was significantly shorter in the turned-over patella group than in the conventional group (P = 0.002), while the range of motion (ROM) of knee joint was significantly higher in the turned-over patella group (P = 0.044). The Lysholm score was slightly higher in the turned-over patella group than in the conventional group, but the difference was not statistically significant (P = 0.055). No significant difference was observed between the two groups in terms of the operation time (P = 0.096), intraoperative blood loss (P = 0.543), time of weight bearing (P = 0.312), fracture healing time (P = 0.272), or complications (P = 1).

Conclusion: The turned-over patella operation method exhibited some superiority to conventional reduction-fixation approach for treatment of C3-type patellar fractures in terms of efficacy and safety by enlarging the ROM of the knee joint and promoting functional recovery.
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http://dx.doi.org/10.1016/j.injury.2019.03.028DOI Listing
April 2019

Association between tooth loss and upper gastrointestinal cancer: A 30-year follow-up of the Linxian Dysplasia Nutrition Intervention Trial Cohort.

Thorac Cancer 2019 04 18;10(4):966-974. Epub 2019 Mar 18.

Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.

Background: This prospective study investigated the association between tooth loss and upper gastrointestinal (UGI) cancer mortality in the Linxian Dysplasia Nutrition Intervention Trial Cohort.

Methods: Subjects were categorized into three groups according to age at baseline. No missing teeth and less or greater than median tooth loss in each group was defined as none, moderate, and severe, respectively. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated using the Cox proportional hazard model.

Results: Through 30 September 2015, 541 esophageal squamous cell carcinoma (ESCC), 284 gastric cardia carcinoma (GCC), and 77 gastric non-cardia carcinoma (GNCC) deaths occurred. In the six-year follow-up, severe tooth loss was associated with an increased risk of GCC mortality (HR 1.55, 95% CI 1.06-2.18). In the 15-year follow-up, moderate tooth loss increased the ESCC mortality risk by 58% (HR 1.58, 95% CI 1.06-2.35), while severe loss increased the GCC mortality risk by 30% (HR 1.30, 95% CI 1.03-1.64). In the 30-year follow-up, moderate tooth loss increased the risk of ESCC mortality (HR 1.34, 95% CI 1.01-1.76). In subjects aged < 55 at baseline and men, moderate tooth loss had 53% and 52% higher risks of ESCC mortality (HR 1.53, 95% CI 1.06-2.05; HRmen 1.52, 95% CI 1.01-2.28). No significant association was observed for GNCC in any subjects or subgroups.

Conclusion: Moderate tooth loss increased the risk of ESCC mortality, particularly in younger subjects and men. Severe tooth loss increased the risk of GCC mortality. Future studies are needed to confirm these findings.
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http://dx.doi.org/10.1111/1759-7714.13037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6449253PMC
April 2019

Association of Visit-to-Visit Variability of Blood Pressure with Cardiovascular Disease among Type 2 Diabetes Mellitus Patients: A Cohort Study.

Diabetes Metab J 2019 06 6;43(3):350-367. Epub 2019 Mar 6.

Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, Hangzhou, China.

Background: Increasing evidence has shown that visit-to-visit variability (VVV) of blood pressure (BP) is associated with an increased risk of cardiovascular disease (CVD). The objective of this study was to evaluate the impact of VVV of systolic blood pressure (SBP) and diastolic blood pressure (DBP) on the risk of CVD among patients with type 2 diabetes mellitus (T2DM) in China.

Methods: We conducted a retrospective cohort study of 10,163 T2DM patients who were not previously diagnosed with CVD from January 2008 to December 2012 in Ningbo, China. The VVV of BP was calculated using five metrics, including standard deviation (SD), coefficient of variation (CV), variation independent of mean, average real variability, and successive variability (SV) of measurements, obtained over a 24-month measurement period. Hazard ratios and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression models for the associations of variability in BP with risk of CVD.

Results: A total of 894 CVD events were observed during a median follow-up of 49.5 months. The hazard ratio in the highest quintile of SD of SBP was 1.24 (95% CI, 1.01 to 1.52) compared with patients in the lowest quintile. The association between higher VVV of DBP and risk of CVD was not consistent across different metrics and sensitivity analyses.

Conclusion: Higher VVV of SBP was associated with an increased risk of CVD, irrespective of the mean SBP level. Future studies are needed to confirm these findings.
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http://dx.doi.org/10.4093/dmj.2018.0108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581546PMC
June 2019

Prognostic value of visit-to-visit systolic blood pressure variability related to diabetic kidney disease among patients with type 2 diabetes.

J Hypertens 2019 07;37(7):1411-1418

Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Hangzhou.

Background: This study aimed to evaluate the impact of visit-to-visit variability (VVV) of blood pressure on the risk of diabetic nephropathy and whether it provides additional predictive information among patients with type 2 diabetes mellitus (T2DM) in China.

Methods: We included 12 630 T2DM patients during January 2008-December 2012 using a retrospective cohort design. VVV of SBP was assessed as standard deviation, coefficient of variation and variation independent of mean of the blood pressure readings during the measurement period. Hazard ratios and 95% confidence intervals were estimated for the associations of variability in SBP with risk of diabetes nephropathy by using Cox proportional hazards regression models. Risk prediction ability was assessed using C statistic, integrated discrimination improvement (IDI) and net reclassification index (NRI).

Results: We found a dose-response relationship across quartiles of VVV SBP (P trend < 0.001). Hazard ratio in the highest quartile of SD SBP (≥9.2 mmHg) was 1.49 (1.16-1.93) as compared with the lowest quartile (<4.8 mmHg) after adjusted for mean SBP values, max SBP values and other covariates. Addition of SD SBP significantly improved risk prediction for diabetic kidney disease (DKD) [C statistic (from 0.664 to 0.673), IDI (0.0011, 95% CI: 0.0003-0.0104) and NRI (0.053, 95% CI: 0.0017-0.113)]. Results remained similar across different subgroups, sensitivity analyses or using coefficient of variation and variance independent of mean.

Conclusion: VVV of SBP is a significant risk factor of DKD among T2DM patients on top of mean and max BP values, which provides additional significant predictive information.
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http://dx.doi.org/10.1097/HJH.0000000000002038DOI Listing
July 2019

Air pollution exposures and blood pressure variation in type-2 diabetes mellitus patients: A retrospective cohort study in China.

Ecotoxicol Environ Saf 2019 Apr 31;171:206-210. Epub 2018 Dec 31.

Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, NO. 866 Yuhangtang Road, Xihu District, Hangzhou, Zhejiang 310058, China; Center for Disease Control and Prevention of Yinzhou District, Ningbo, Zhejiang 315100, China; Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China. Electronic address:

Air pollution exposure has been associated with hypertension, but limited studies have examined the associations in diabetic patients. We aimed to examine the associations of exposure to air pollution with blood pressure in diabetic patients. We identified patients who were previously diagnosed as type-2 diabetes mellitus from hospital records from January 2013 to May 2017. We used generalized linear models to estimate adverse effects of air pollution on systolic/diastolic blood pressure in diabetic patients. A total of 40,125 patients were enrolled in this study. An IQR increase in PM, PM, NO, SO, and O exposure was associated with an increased risk of higher systolic blood pressure level (β = 0.628 for PM, β = 0.758 for PM, β = 0.766 for NO, β = 0.516 for SO, β = 0.482 for O, all P value < 0.05). Significant associations were observed for some air pollutants and SBP among patients with fasting blood glucose (FBG) ≥ 7.0 mmol/L, normal weight, and younger age. Little evidence was available for the associations between particulate matter (PM) or O exposure and diastolic blood pressure in present study. In our study, diabetic patients were at increased risk of higher blood pressure when exposed to higher residential PM, NO and SO. Individuals with lower BMI, younger age, and FBG ≥ 7.0 mmol/L were more susceptible to the adverse effects of ambient air pollution.
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http://dx.doi.org/10.1016/j.ecoenv.2018.12.069DOI Listing
April 2019

Acute effect of fine and coarse particular matter on cardiovascular visits in Ningbo, China.

Environ Sci Pollut Res Int 2018 Nov 29;25(33):33548-33555. Epub 2018 Sep 29.

Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, C217 Academic Building, 866 Yuhangtang Road, Xihu District, Hangzhou, 310058, Zhejiang, China.

Although a growing number of epidemiological studies have been conducted on size-specific health effects of particulate matter in China, results remain inconsistent. In this study, we investigated acute effect of fine and coarse particular matter on cardiovascular hospital visits in Ningbo, China. We used generalized additive models to examine short-term effects of PM and PM on cardiovascular hospital visits by adjustment for temporal, seasonal, and meteorological effects. Subgroup analyses were conducted by age, sex, and season. We also examined the stability of their effects in multi-pollutant models. We found that PM were associated with cardiovascular hospital visits (RR = 1.006; 95% CI 1.000, 1.011) and results remained similar after adjustment for PM (RR = 1.005; 95% CI 0.998, 1.013). There was a borderline association between PM and cardiovascular hospital visits (RR = 1.007; 95% CI 0.997, 1.016), which disappeared after controlling for PM (RR = 1.000; 95% CI 0.988, 1.013). The associations appeared to be stronger in the cold season and among the elderly (≥ 75 years). The findings of this study suggested significant adverse effects of PM, but no independent effects of PM on cardiovascular hospital visits. Additional studies are needed to confirm these findings.
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http://dx.doi.org/10.1007/s11356-018-3286-2DOI Listing
November 2018

Association between ambient air pollutants and preterm birth in Ningbo, China: a time-series study.

BMC Pediatr 2018 09 20;18(1):305. Epub 2018 Sep 20.

Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, 310058, China.

Background: Exposure to air pollutants has been related to preterm birth, but little evidence can be available for PM, O and CO in China. This study aimed to investigate the short-term effect of exposure to air pollutants on risk preterm birth during 2014-2016 in Ningbo, China.

Methods: We conducted a time-series study to evaluate the associations between daily preterm birth and major air pollutants (including PM, PM, SO, NO, O and CO) in Ningbo during 2014-2016. A General Additive Model extend Poisson regression was used to evaluate the relationship between preterm birth and air pollution with adjustment for time-trend, meteorological factors and day of the week (DOW). We also conducted a subgroup analysis by season and age.

Results: In this study, a total of 37,389 birth occurred between 2014 and 2016 from the Electronic Medical Records System of Ningbo Women and Children's Hospital, of which 5428 were verified as preterm birth. The single pollutant model suggested that lag effect of PM, PM, NO reached a peak at day 3 before delivery and day 6 for SO, and no relationships were observed for O and preterm birth. Excess risks (95% confidence intervals) for an increase of IQR of air pollutant concentrations were 4.84 (95% CI: 1.77, 8.00) for PM, 3.56 (95% CI: 0.07, 7.17) for PM, 3.65 (95% CI: 0.86, 6.51) for SO, 6.49 (95% CI: 1.86, 11.34) for NO, - 0.90 (95% CI: -4.76, 3.11) for O, and 3.36 (95% CI: 0.50, 6.30) for CO. Sensitivity analyses by exclusion of maternal age < 18 or > 35 years did not materially alter our results.

Conclusions: This study indicates that short-term exposure to air pollutants (including PM, PM, SO, NO) are positively associated with risk of preterm birth in Ningbo, China.
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http://dx.doi.org/10.1186/s12887-018-1282-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147039PMC
September 2018

Baseline and longitudinal change in blood pressure and mortality in a Chinese cohort.

J Epidemiol Community Health 2018 12 4;72(12):1083-1090. Epub 2018 Aug 4.

Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China.

Background: A J-curve association has been demonstrated for blood pressure (BP) and all-cause mortality, but data on longitudinal change of BP and mortality in Chinese population are limited.

Methods: We performed a retrospective cohort study to examine the association between BP (at baseline and longitudinal change) and risk of mortality in Yinzhou District, Ningbo, China, based on the Yinzhou Health Information System. At baseline, a total of 181 352 subjects aged over 18 years with at least one BP examination record were recruited through the Yinzhou Health Information System. The final analysis was restricted to 168 061 participants after exclusion of outliers of BP.

Results: A U-shaped association was observed for BP at baseline and risk of total and cardiovascular mortality. When compared with normotensive participants, patients with hypotension (HRs=1.51, 95% CI 1.21 to 1.88) and stage 3 hypertension (1.28, 95% CI 1.09 to 1.50) had an increased risk of all-cause mortality. Relative to stable BP of normotension, having a rise in BP from normotension to hypertension or from prehypertension to hypertension both conferred an increased risk of total and cardiovascular mortality (total: 1.39 (95% 1.10 to 1.75) and 1.40 (95% 1.15 to 1.69); cardiovascular: 2.22 (95% CI 1.35 to 3.65) and 1.89 (95% CI 1.20 to 2.96), respectively).

Conclusions: Our findings emphasise that hypotension and stage 3 hypertension were associated with an increased risk of all-cause mortality. Longitudinal change from normotensive or prehypertensive levels to 140/90 mm Hg or higher could increase the risk of total and cardiovascular mortality.
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http://dx.doi.org/10.1136/jech-2018-211050DOI Listing
December 2018

Association of 25-Hydroxyvitamin D with Liver Cancer Incidence and Chronic Liver Disease Mortality in Finnish Male Smokers of the ATBC Study.

Cancer Epidemiol Biomarkers Prev 2018 09 2;27(9):1075-1082. Epub 2018 May 2.

Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.

Although circulating 25-hydroxyvitamin D [25(OH)D] concentrations were linked to liver cancer and chronic liver disease (CLD) in laboratory studies, few epidemiologic studies have addressed the associations. Within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, we measured 25(OH)D in baseline serum of 202 incident liver cancer cases and 225 CLD deaths that occurred during nearly 25 years of follow-up, and 427 controls. ORs and 95% confidence intervals (CIs) were estimated using unconditional logistic regression. We examined predetermined clinically defined cut-points, and season-specific and season-standardized quartiles. Low serum 25(OH)D concentrations were associated with higher risk of liver cancer (<25 nmol/L vs. ≥50 nmol/L: 1.98; 95% CI, 1.22-3.20; across categories = 0.003) and CLD mortality (1.93; 95% CI, 1.23-3.03; = 0.006) in models adjusted for age and date of blood draw. After additional adjustment for body mass index, diabetes, smoking, and other potential confounders, the association remained statistically significant for liver cancer (1.91; 95% CI, 1.16-3.15; = 0.008), but was somewhat attenuated for CLD mortality (1.67; 95% CI, 1.02-2.75; = 0.05). Associations were similar for analyses using season-specific and season-standardized quartiles, and after excluding participants with diabetes, or hepatitis B or C. Our results suggest a possible preventive role for vitamin D against liver cancer and CLD, although the importance of the liver for vitamin D metabolism and the lack of information about underlying liver disease makes reverse causality a concern. Future studies are needed to evaluate associations of vitamin D with liver cancer and liver disease in other populations, particularly those with a different constellation of risk factors. .
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http://dx.doi.org/10.1158/1055-9965.EPI-17-0877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6148352PMC
September 2018

Longitudinal change in blood pressure is associated with cardiovascular disease mortality in a Chinese cohort.

Heart 2018 11 24;104(21):1764-1771. Epub 2018 Apr 24.

Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.

Background: A number of studies have demonstrated a J-shaped curve between blood pressure (BP) and all-cause mortality, but few studies have used longitudinal change in BP to study mortality in the Chinese population.

Methods: We performed a 30-year follow-up study to examine the association between BP (at baseline and longitudinal change) and risk of mortality in the Linxian General Population Trial Cohort. At baseline, a total of 29 584 healthy adults were enrolled in the Linxian General Population Trial in 1985 and followed through to the end of 2014. The final analysis was restricted to 29 439 participants (55% women) after exclusion of outliers. We also examined the potential effects of BP trajectory patterns during the period of 1985-1999 on sequent risk of mortality. Adjusted Cox proportional hazards models were used to estimate HRs and 95% CIs.

Results: Compared with participants with normal BP, patients with prehypertension, stage 1, stage 2 or stage 3 hypertension had an increased risk of all-cause mortality, with HRs of 1.09 (95% CI 1.05 to 1.14), 1.34 (95% CI 1.28 to 1.40), 1.69 (95% CI 1.60 to 1.79) and 2.14 (95% CI 2.01 to 2.28), respectively. Relative to stable BP of normotension, having a rise in BP from normotension to hypertension or from prehypertension to hypertension both conferred an increased risk of total and cardiovascular disease and stroke mortality (total: HRs 1.22 (95% CI 1.12 to 1.34) and 1.36 (95% CI 1.23 to 1.51); cardiovascular disease: HRs 1.42 (95% CI 1.17 to 1.73) and 1.55 (95% CI 1.24 to 1.93); stroke: HRs 2.29 (95% CI 1.88 to 2.80) and 2.61 (95% CI 2.11 to 3.24), respectively).

Conclusions: These findings emphasise that development of incident hypertension in middle age could increase the risk of total, cardiovascular disease and stroke mortality, and suggest that current BP targets could be revised.

Trial Registration Number: NCT00342654;Post-results.
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http://dx.doi.org/10.1136/heartjnl-2017-312850DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6185795PMC
November 2018

Association between short-term exposure to ambient air pollution and daily mortality: a time-series study in Eastern China.

Environ Sci Pollut Res Int 2018 Jun 29;25(16):16135-16143. Epub 2018 Mar 29.

Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, NO. 866 Yuhangtang Road, Xihu District, Hangzhou, 310058, Zhejiang, China.

Few studies were conducted to evaluate health effects of acute exposure to PM and daily mortality in Asian countries due to lack of large-scale PM monitoring data. We conducted a time-series study to examine the associations of short-term exposure to four common air pollutants (PM, PM, NO, and SO) and daily mortality in Ningbo, Zhejiang, China. We used generalized addictive model (GAM) to estimate relative risks (RRs) and 95% confidence intervals (CIs) for the association of these four air pollutants with daily mortality. The study included 9365 people in the 2-year study period from 2014 to 2015. SO were significantly associated with risk of NAD, RD, and CD mortality with RRs of 1.034 (95% CI 1.004, 1.064), 1.067 (95% CI 1.010, 1.127), and 1.049 (95% CI 1.001, 1.098), respectively.PM and PM were significantly associated with risk of death from NAD mortality in warm season. Similar associations were observed for PM (RR = 1.056, 95% CI 1.004, 1.111) and risk of CD mortality. The study provides further evidence that short-term exposure to PM, PM, NO, and SO are associated with increased risk of daily mortality.
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http://dx.doi.org/10.1007/s11356-018-1759-yDOI Listing
June 2018

Effects of air pollution on hospital visits for pneumonia in children: a two-year analysis from China.

Environ Sci Pollut Res Int 2018 Apr 29;25(10):10049-10057. Epub 2018 Jan 29.

Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, No. 866 Yuhangtang Road, Xihu District, Hangzhou, Zhejiang, 310058, China.

Although the effect of air pollution on respiratory health has been identified, few studies can be available to evaluate the association of air pollution with hospital visits for children's pneumonia in China. To explore whether high concentrations of air pollutants (including PM, PM, NO, and SO) are related to hospital visits for pneumonia in children, we conducted a population-based time-series study in Ningbo, China, from January 1st, 2014 to November 1st, 2015. We used a generalized additive Poisson regression model to calculate risk ratios and 95% confidence intervals for the associations of air pollutants and hospital visits for pneumonia in children and found that these four pollutants were associated with the increased hospital visits for pneumonia in children (1.3% for PM2.5, 1.0% for PM10, 2.9% for NO, 5.0% for SO per 10-μg/m increase in PM2.5, PM10, NO, and SO, respectively). Stronger associations were observed in the cold seasons and among children under 5 years.
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http://dx.doi.org/10.1007/s11356-018-1192-2DOI Listing
April 2018

Attributable causes of colorectal cancer in China.

BMC Cancer 2018 01 5;18(1):38. Epub 2018 Jan 5.

Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, 866 Yuhangtang Road, Hangzhou, 310058, China.

Background: Colorectal cancer is the 4th common cancer in China. Most colorectal cancers are due to modifiable lifestyle factors, but few studies have provided a systematic evidence-based assessment of the burden of colorectal cancer incidence and mortality attributable to the known risk factors in China.

Methods: We estimated the population attributable faction (PAF) for each selected risk factor in China, based on the prevalence of exposure around 2000 and relative risks from cohort studies and meta-analyses.

Results: Among 245,000 new cases and 139,000 deaths of colorectal cancer in China in 2012, we found that 115,578 incident cases and 63,102 deaths of colorectal cancer were attributable to smoking, alcohol drinking, overweight and obesity, physical inactivity and dietary factors. Low vegetable intake was the main risk factor for colorectal cancer with a PAF of 17.9%. Physical inactivity was responsible for 8.9% of colorectal cancer incidence and mortality. The remaining factors, including high red and processed meat intake, low fruit intake, alcohol drinking, overweight/obesity and smoking, accounted for 8.6%, 6.4%, 5.4%, 5.3% and 4.9% of colorectal cancer, respectively. Overall, 45.5% of colorectal cancer incidence and mortality were attributable to the joint effects of these seven risk factors.

Conclusions: Tobacco smoking, alcohol drinking, overweight or obesity, physical inactivity, low vegetable intake, low fruit intake, and high red and processed meat intake were responsible for nearly 46% of colorectal cancer incidence and mortality in China in 2012. Our findings could provide a basis for developing guidelines of colorectal cancer prevention and control in China.
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http://dx.doi.org/10.1186/s12885-017-3968-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756355PMC
January 2018

Association between oral leukoplakia and risk of upper gastrointestinal cancer death: A follow-up study of the Linxian General Population Trial.

Thorac Cancer 2017 11 20;8(6):642-648. Epub 2017 Sep 20.

Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.

Background: This study was conducted to explore the association between oral leukoplakia (OL) and the risk of upper gastrointestinal cancer death in the Linxian General Population Trial Cohort.

Methods: A prospective cohort study of the Linxian General Population Trial Cohort was performed. Participants with OL were treated as an exposed group, and the remainder was selected as a control group. All subjects were followed monthly by village health workers and reviewed quarterly by the Linxian Cancer Registry. Hazard ratios (HRs) and 95% confidence interval (CIs) were evaluated using proportional hazard and proportional subdistribution hazard models, respectively.

Results: Over a median of 27 years of observation, 29 476 subjects were followed-up. A total of 17 473 deaths occurred, including 2345 esophageal squamous cell carcinoma (ESCC), 1139 gastric cardia carcinoma, and 506 gastric non-cardia carcinoma deaths. Significant increased ESCC mortality was observed in subjects with OL (exposed 9.66% vs. unexposed 7.39%; P < 0.0001). Furthermore, subjects with OL had a 22% higher risk of death from ESCC (HR 1.22, 95% CI 1.10-1.34; P = 0.0001) after adjusted covariates. In subjects aged ≤52 at the baseline, OL was significantly associated with an elevated risk of ESCC mortality (HR 1.32, 95% CI 1.13-1.54; P = 0.0005). No significant associations were observed for gastric cardia carcinoma and non-cardia carcinoma mortality.

Conclusions: OL may increase the risk of ESCC mortality, especially in the younger population. These associations should be investigated in further studies.
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http://dx.doi.org/10.1111/1759-7714.12501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707438PMC
November 2017

Air pollution and hospital visits for acute upper and lower respiratory infections among children in Ningbo, China: A time-series analysis.

Environ Sci Pollut Res Int 2017 Aug 26;24(23):18860-18869. Epub 2017 Jun 26.

Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, C217 Academic Building, 866 Yuhangtang Road, Xihu District, Hangzhou, Zhejiang, 310058, China.

Acute upper and lower respiratory infections are main causes of mortality and morbidity in children. Air pollution has been recognized as an important contributor to development and exacerbation of respiratory infections. However, few studies are available in China. In this study, we investigated the short-term effect of air pollution on hospital visits for acute upper and lower respiratory infections among children under 15 years in Ningbo, China. Poisson generalized models were used to estimate the associations between air pollution and hospital visits for acute upper and lower respiratory infections adjusted for temporal, seasonal, and meteorological effects. We found that four pollutants (PM, PM, NO, and SO) were significantly associated with hospital visits for acute upper and lower respiratory infections. The effect estimates for acute upper respiratory infections tended to be higher (PM ER = 3.46, 95% CI 2.18, 4.76; PM ER = 2.81, 95% CI 1.93, 3.69; NO ER = 11.27, 95% CI 8.70, 13.89; SO ER = 15.17, 95% CI 11.29, 19.19). Significant associations for gaseous pollutants (NO and SO) were observed after adjustment for particular matter. Stronger associations were observed among older children and in the cold period. Our study suggested that short-term exposure to outdoor air pollution was associated with hospital visits for acute upper and lower respiratory infections in Ningbo.
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http://dx.doi.org/10.1007/s11356-017-9279-8DOI Listing
August 2017

Body mass index and risk of gastric cancer: A 30-year follow-up study in the Linxian general population trial cohort.

Cancer Sci 2017 Aug 30;108(8):1667-1672. Epub 2017 Jun 30.

Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.

Although a number of previous studies have noted either positive or no association for body mass index (BMI) and gastric cancer risk, little evidence exists in the Chinese population. We prospectively examined the associations of BMI with risk of gastric cancer in the Linxian General Population Trial cohort, with 29 584 healthy adults enrolled in 1985 and followed through to the end of 2014. Body weight and height were measured during physical examination at baseline and BMI was calculated as weight in kilograms divided by height in meters squared. Body mass index from 138 subjects was missing, and a total of 29 446 participants were included in the final analysis. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals. During 30 years of follow-up, we confirmed 1716 newly diagnosed gastric cardia adenocarcinoma (GCA) cases and 626 new gastric non-cardia adenocarcinoma (GNCA) cases. Overall, compared to the lowest quartile (BMI <20.32 kg/m ), subjects in the fourth quartile (BMI ≥23.31 kg/m ) subjects had lower risk of developing GNCA (hazard ratio, 0.65; 95% confidence interval, 0.51-0.83). Age- and sex-specific analyses showed that this protective effect was only observed in men and older (52 + years) persons. No associations were observed for BMI with GCA incidence. Higher BMI was associated with decreased risk of GNCA in this population, particularly in men and older persons. Future studies are needed to confirm these findings. The trial is registered with ClinicalTrials.gov: NCT00342654.
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http://dx.doi.org/10.1111/cas.13292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543512PMC
August 2017

[Mucoadhesive buccal films of tramadol for effective pain management].

Rev Bras Anestesiol 2017 May - Jun;67(3):231-237. Epub 2016 Nov 26.

Zhejiang University, University Hospital, Department of Orthopedics, Hangzhou, China. Electronic address:

Background And Objectives: Tramadol hydrochloride is a centrally-acting synthetic opioid analgesic binding to specific opioid receptors. It is used in the management of chronic pain and is recommended as first line drug in the treatment of postoperative or orthopedic injury induced acute pain. The present work is designed to prepare and evaluate mucoadhesive buccal film of tramadol hydrochloride as a novel form of prolonged analgesia for patients with orthopedic injuries.

Methods: Buccal films of tramadol hydrochloride were prepared by solvent casting method. The prepared films were evaluated for the various evaluation parameters like thickness, surface pH, weight uniformity, content uniformity, folding endurance, swelling index, in vitro drug release study, in vitro test for mucoadhesion and in vivo studies (primary mucosal irritancy test and analgesic activity).

Results: All the formulations exhibited good results for physicochemical characterizations. In in vitro drug release study the films exhibited controlled release more than 12hours. The formulation BFT2 (containing chitosan and PVP K-90) showed no irritant effect on buccal mucosa and elicit the significant in vivo analgesic activity with 57.14% analgesia against that of standard (61.04%). It was concluded that the mucoadhesive films of tramadol hydrochloride can be effectively used to alleviate the severe pain of orthopedic injuries with prompt onset and prolonged action.
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http://dx.doi.org/10.1016/j.bjan.2016.10.006DOI Listing
April 2019
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