Publications by authors named "Rui Fu"

166 Publications

Molecular tracking devices quantify antigen distribution and archiving in the murine lymph node.

Elife 2021 Apr 12;10. Epub 2021 Apr 12.

Medicine/Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, United States.

The detection of foreign antigens has relied on fluorescent conjugation or indirect read-outs such as antigen presentation. In our studies, we found that these widely used techniques had several technical limitations that have precluded a complete picture of antigen trafficking or retention across lymph node cell types. To address these limitations, we developed a 'molecular tracking device' to follow the distribution, acquisition, and retention of antigen in the lymph node. Utilizing an antigen conjugated to a nuclease-resistant DNA tag, acting as a combined antigen-adjuvant conjugate, and single-cell mRNA sequencing we quantified antigen abundance in lymph node. Variable antigen levels enabled the identification of caveolar endocytosis as a mechanism of antigen acquisition or retention in lymphatic endothelial cells. Thus, these molecular tracking devices enable new approaches to study dynamic tissue dissemination of antigen-adjuvant conjugates and identify new mechanisms of antigen acquisition and retention at cellular resolution .
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http://dx.doi.org/10.7554/eLife.62781DOI Listing
April 2021

Economic Consequences of Adult Living Kidney Donation: A Systematic Review.

Value Health 2021 Apr 18;24(4):592-601. Epub 2020 Nov 18.

Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.

Objectives: Current guidelines mandate organ donation to be financially neutral such that it neither rewards nor exploits donors. This systematic review was conducted to assess the magnitude and type of costs incurred by adult living kidney donors and to identify those at risk of financial hardship.

Methods: We searched English-language journal articles and working papers assessing direct and indirect costs incurred by donors on PubMed, MEDLINE, Scopus, the National Institute for Health Research Economic Evaluation Database, Research Papers in Economics, and EconLit in 2005 and thereafter. Estimates of total costs, types of costs, and characteristics of donors who incurred the financial burden were extracted.

Results: Sixteen studies were identified involving 6158 donors. Average donor-borne costs ranged from US$900 to US$19 900 (2019 values) over the period from predonation evaluation to the end of the first postoperative year. Less than half of donors sought financial assistance and 80% had financial loss. Out-of-pocket payments for travel and health services were the most reported items where lost income accounted for the largest proportion (23.2%-83.7%) of total costs. New indirect cost items were identified to be insurance difficulty, exercise impairment, and caregiver income loss. Donors from lower-income households and those who traveled long distances reported the greatest financial hardship.

Conclusions: Most kidney donors are undercompensated. Our findings highlight gaps in donor compensation for predonation evaluation, long-distance donations, and lifetime insurance protection. Additional studies outside of North America are needed to gain a global prospective on how to provide for financial neutrality for kidney donors.
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http://dx.doi.org/10.1016/j.jval.2020.10.005DOI Listing
April 2021

The novel HLA-DQB1*03:282N allele was identified in a Chinese individual.

HLA 2021 Apr 9. Epub 2021 Apr 9.

HLA typing laboratory, Blood Center of Zhejiang Province, Hangzhou, Zhejiang Province, China.

HLA-DQB1*03:282N differs from HLA-DQB1*03:03:02:01 by a single nucleotide deletion at position 258.
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http://dx.doi.org/10.1111/tan.14270DOI Listing
April 2021

The role of chest CT quantitative pulmonary inflammatory index in the evaluation of the course and treatment outcome of COVID-19 pneumonia.

Sci Rep 2021 04 8;11(1):7752. Epub 2021 Apr 8.

Department of Radiology, First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China.

To explore the clinical application value of chest CT quantitative pulmonary inflammation index (PII) in the evaluation of the course and treatment outcome of COVID-19 pneumonia. One hundred and eighteen patients with COVID-19 pneumonia diagnosed by RT-PCR were analyzed retrospectively. The correlation between chest CT PII, clinical symptoms and laboratory examinations during the entire hospitalization period was compared. The average age of the patients was 46.0 ± 15 (range: 1-74) years. Of the 118 patients, 62 are male (52.5%) and 56 are female (47.5%). Among them, 116 patients recovered and were discharged, 2 patients died, and the median length of hospital stay was 22 (range: 9-41) days. On admission, 76.3% of the patients presented with fever, and the laboratory studies showed a decrease in lymphocyte (LYM) count and an increase in lactate dehydrogenase (LDH) levels, C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR). Within the studies' chest CTs, the median number of involved lung lobes was 4 (range: 0-5) and the median number of involved lung segments was 9 (range 0-20). The left lower lobe and the right lower lobe were the most likely areas to be involved (89.0% and 83.9%), and 84.7% of the patients had inflammatory changes in both lungs. The main manifestations on chest CT were ground glass opacities (31.4%), ground glass opacities and consolidation (20.3%), ground glass opacities and reticular patterns (32.2%), mixed type (13.6%), and white lungs (1.7%); common accompanying signs included linear opacities (55.9%), air bronchograms (46.6%), thick small vessel shadows (36.4%), and pleural hypertrophy (13.6%). The chest CT at discharge showed complete absorption of lesions in 19 cases (16.1%), but not in the remaining 99 cases. Lesions remained in a median of 3 lung lobes (range: 0-5). Residual lesions remained in a median of 5 lung segments (range: 0-20). The residual lesions mainly presented as ground glass opacities (61.0%), and the main accompanying sign was linear opacities (59.3%). Based on chest CT, the median maximum PII of lungs was 30.0% (range: 0-97.5%), and the median PII after discharge in the patients excluding the two deaths was 12.5% (range: 0-53.0%). PII was significantly negatively correlated with the LYM count and significantly positively correlated with body temperature, LDH, CRP, and ESR. There was no significant correlation between the PII and the white blood cell count, but the grade of PII correlated well with the clinical classification. PII can be used to monitor the severity and the treatment outcome of COVID-19 pneumonia, provide help for clinical classification, assist in treatment plan adjustments and aid assessments for discharge.
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http://dx.doi.org/10.1038/s41598-021-87430-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032697PMC
April 2021

Inferring Causality from Observational Studies: The Role of Instrumental Variable Analysis.

Authors:
Rui Fu S Joseph Kim

Kidney Int 2021 Mar 31. Epub 2021 Mar 31.

Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; Division of Nephrology and the Ajmera Transplant Centre, Department of Medicine, Toronto General Hospital, University Health Network. Electronic address:

Inferring causality from observational studies can be challenging because of the perennial threat of biases from selection, measurement, and confounding. The gold standard study design in clinical research is the randomized controlled trial, since random allocation to treatment ensures that, on average, comparison groups are balanced with respect to both known and unknown prognostic factors. However, most clinically relevant exposure-outcome relationships are not amendable (logistically or ethically) to randomization. Thus, there has been an emergence of analytical approaches over the last several years to improve the validity of inferences made from observational studies. We present herein one such approach, instrumental variable (IV) analysis, a technique that has been used by economists for many years but has only recently seen increasing use in the health care literature. We provide a description of the method, the assumptions underlying it, and recent applications in nephrology outcomes research. A more detailed review of the underlying mathematics, properties of an IV, and suggested elements for reporting an IV analysis are provided in the Supplementary Appendix.
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http://dx.doi.org/10.1016/j.kint.2021.03.018DOI Listing
March 2021

Gene Expression Analysis Suggests Immunological Changes of Peripheral Blood Monocytes in the Progression of Patients With Coronary Artery Disease.

Front Genet 2021 11;12:641117. Epub 2021 Mar 11.

Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Objectives: To analyze the gene expression profile of peripheral blood monocytes in different stages of coronary artery disease (CAD) by transcriptome sequencing, and to explore potential genes and pathway involved in CAD pathogenesis.

Methods: According to the screening of coronary angiography and quality control of blood samples, eight intermediate coronary lesion patients were selected, then eight patients with acute myocardial infarction, and eight patients with normal coronary angiography were matched by age and gender. Transcriptomics sequencing was conducted for the peripheral blood monocytes of these 24 samples by using the Illumina HiSeq high-throughput platform. Then, differentially expressed genes (DEGs) were analyzed. Gene Ontology (GO) functional annotation, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway annotation, and protein-protein interaction (PPI) network were applied to annotate the potential functions of DEGs.

Results: Compared with the normal coronary angiography group, we identified a total of 169 DEGs in the intermediate coronary lesion group, which were significantly enriched in 59 GO terms and 17 KEGG pathways. Compared with the normal coronary angiography group, we found a total of 2,028 DEGs, which were significantly enriched in 311 GO terms and 20 KEGG pathways in the acute myocardial infarction group. The cross-comparison between normal versus intermediate coronary lesion group, and normal versus acute myocardial infarction group included 98 differential genes with 65 up regulated and 33 down regulated genes, which were significantly enriched in 46 GO terms and 10 KEGG pathways. During the progression of CAD, there was a significant up-regulated expression of CSF3, IL-1A, CCR7, and IL-18, and down-regulated expression of MAPK14. Besides GO items such as inflammatory response was significantly enriched, KEGG analysis showed the most remarkable enrichments in IL-17 signaling pathway and cytokine-cytokine receptor interactions.

Conclusions: Transcriptomics profiles vary in patients with different severity of CAD. CSF3, IL-1A, CCR7, IL-18, and MAPK14, as well as IL-17 signaling pathway and cytokine and cytokine receptor interaction signaling pathway related with inflammatory response might be the potential biomarker and targets for the treatment of coronary artery disease.
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http://dx.doi.org/10.3389/fgene.2021.641117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990797PMC
March 2021

A three-dimensional printing navigational template combined with mixed reality technique for localizing pulmonary nodules.

Interact Cardiovasc Thorac Surg 2020 Dec 1. Epub 2020 Dec 1.

Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

Objectives: Localizing non-palpable pulmonary nodules is challenging for thoracic surgeons. Here, we investigated the accuracy of three-dimensional (3D) printing technology combined with mixed reality (MR) for localizing ground glass opacity-dominant pulmonary nodules.

Methods: In this single-arm study, we prospectively enrolled patients with small pulmonary nodules (<2 cm) that required accurate localization. A 3D-printing physical navigational template was designed based on the reconstruction of computed tomography images, and a 3D model was generated through the MR glasses. We set the deviation distance as the primary end point for efficacy evaluation. Clinicopathological and surgical data were obtained for further analysis.

Results: Sixteen patients with 17 non-palpable pulmonary nodules were enrolled in this study. Sixteen nodules were localized successfully (16/17; 94.1%) using this novel approach with a median deviation of 9 mm. The mean time required for localization was 25 ± 5.2 min. For the nodules in the upper/middle and lower lobes, the median deviation was 6 mm (range, 0-12.0) and 16 mm (range, 15.0-20.0), respectively. The deviation difference between the groups was significant (Z = -2.957, P = 0.003). The pathological evaluation of resection margins was negative.

Conclusions: The 3D printing navigational template combined with MR can be a feasible approach for localizing pulmonary nodules.
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http://dx.doi.org/10.1093/icvts/ivaa300DOI Listing
December 2020

Acculturation and adjustment among rural migrant children in urban China: A longitudinal study.

Appl Psychol Health Well Being 2021 Mar 16. Epub 2021 Mar 16.

Department of Psychology, Shanghai Normal University, Shanghai, China.

This one-year longitudinal study examined relations between acculturation and adjustment in rural-to-urban migrant children in China. Participants included 335 migrant students (initial mean age = 12 years, 198 boys) in fourth to sixth grades in public schools in Shanghai, China. Data on acculturation were collected from children's self-reports, and data on social, school, and psychological adjustment were obtained from multiple sources, including peer evaluations, teacher ratings, self-reports, and school records. The results showed that accommodation to urban culture positively contributed to later social competence. Maintenance of rural culture positively contributed to later psychological well-being for migrant children who were low on accommodation to urban culture. In addition, social competence and academic performance positively contributed to later accommodation to urban culture and maintenance of rural culture. The results help understand the developmental processes involved in the acculturation and adjustment of migrant children in contemporary societies.
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http://dx.doi.org/10.1111/aphw.12264DOI Listing
March 2021

Timing and Origins of Local and Distant Metastases in Lung Cancer.

J Thorac Oncol 2021 Mar 13. Epub 2021 Mar 13.

Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China; Southern Medical University, Guangzhou, People's Republic of China. Electronic address:

Introduction: Metastasis is the primary cause of lung cancer-related death. Nevertheless, the underlying molecular mechanisms and evolutionary patterns of lung cancer metastases are still elusive.

Methods: We performed whole-exome sequencing for 40 primary tumors (PTs) and 61 metastases from 47 patients with lung cancer, of which 40 patients had paired PTs and metastases. The PT-metastasis genomic divergence, metastatic drivers, timing of metastatic dissemination, and evolutionary origins were analyzed using appropriate statistical tools and mathematical models.

Results: There were various degrees of genomic heterogeneity when comparing the paired primary and metastatic lesions or comparing metastases of different sites. Multiple metastasis-selected/enriched genetic alterations were found, such as MYC amplification, NKX2-1 amplification, RICTOR amplification, arm 20p gain, and arm 11p loss, and these results were were also featured in a meta-analysis cross-validated using an independent cohort from Memorial Sloan-Kettering Cancer Center database. To elucidate the metastatic seeding time, we applied a metastatic model and found 61.1% of the tumors were late dissemination, in which the metastatic seeding happened approximately 2.74 years before clinical detection. One exception was lymph node metastases whose dissemination time was relatively early. By analyzing the evolutionary origins, we reported that nonlymph node metastases were mainly seeded by the PT (87.5%) rather than the earlier colonized lymph node metastases.

Conclusions: Our results shed light on the molecular features that potentially drive lung cancer metastases. The distinct temporospatial pattern of disease progression revealed that lung cancer was susceptible to either late dissemination or indolent early lymph node metastases, leaving a potential time window to minimize metastases by early cancer detection.
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http://dx.doi.org/10.1016/j.jtho.2021.02.023DOI Listing
March 2021

Efficacy and safety of mycophenolate mofetil in the treatment for IgA nephropathy: a meta-analysis of randomized controlled trials.

Clin Exp Nephrol 2021 Mar 12. Epub 2021 Mar 12.

Department of Infectious Disease, Jiangxi Provincial Children's Hospital, 122 Yangming Road, Nanchang, 330006, Jiangxi, People's Republic of China.

Aim: IgA nephropathy is virtually known as the most common glomerulopathy to end-stage renal failure in the world. Mycophenolate mofetil is a selective immunosuppressant widely used in organ transplantation, yet its tolerance and effectiveness in IgAN is controversial.

Methods: This is a systematic review and random-effects meta-analysis, searching PubMed, Embase, Te Cochrane Library, Science Citation Index, Ovid evidence-based medicine, Chinese Biomedical Literature and Chinese Science and Technology Periodicals. Screen out randomized controlled trials on patients with biopsy-proven IgA nephropathy and analysis mycophenolate mofetil treatment regimens used for therapy of IgA nephropathy. Complete remission and partial remission, doubling of creatinine level, proteinuria, incidence of end-stage kidney disease, infection, Cushing syndrome, diabetes, hepatic dysfunction or gastrointestinal symptoms, neurologic or visual ambiguity, acne, and alopecia were observed.

Results: Nine relevant trials were conducted with 587 patients enrolled. In Mycophenolate mofetil or plus medium/low-dose steroid comparing full-dose steroid alone or placebo, there was no significant difference. The risk of Cushing syndrome and diabetes had been significantly lowered with Mycophenolate mofetil-treated patients, while the risk of infection had been increased.

Conclusions: Mycophenolate mofetil therapy did not differ in reducing proteinuria and Scr in patients with IgAN who had persistent proteinuria, while having fewer Cushing syndrome and diabetes risk and more infection risk. However, larger randomized studies are needed to reveal these results.
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http://dx.doi.org/10.1007/s10157-021-02028-5DOI Listing
March 2021

P2X4 receptor in the dorsal horn contributes to BDNF/TrkB and AMPA receptor activation in the pathogenesis of remifentanil-induced postoperative hyperalgesia in rats.

Neurosci Lett 2021 04 24;750:135773. Epub 2021 Feb 24.

Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China. Electronic address:

The mechanism underlying the high incidence of remifentanil-induced postoperative hyperalgesia is unclear. Also, no effective prevention method exists. Inflammatory pain-related studies showed that P2X4 purinergic receptors (P2X4Rs) in the dorsal horn of the spinal cord and dorsal root ganglia are essential for maintaining allodynia caused by inflammation. However, little is known about its role in opioid-induced hyperalgesia. This study aimed to determine the role of P2X4R and related signaling pathways in the remifentanil-induced postoperative hyperalgesia (RIH) model. The study simulated the remifentanil infusion and surgical incision during general anesthesia. The mRNA and protein expression level of P2X4R in rats with RIH model increased from 2 h to 48 h after the surgery. The administration of P2X4R inhibitors prevented the occurrence of RIH, resulting in a reduction in mechanical and thermal pain. Moreover, P2X4R was involved in RIH in male and female rats, indicating no sex-specific difference. P2X4R also increased the expression of AMPA receptor subunit GluA1 in a brain-derived neurotrophic factor (BDNF) / tyrosine receptor kinase B (TrkB) dependent manner. The results from whole-cell patch-clamp recording suggested that P2X4R also regulated AMPA receptor-mediated miniature excitatory postsynaptic currents and participated in the synaptic plasticity of spinal dorsal horn neurons. In summary, P2X4R was involved in AMPAR expression, electrophysiological function, and synaptic plasticity of spinal dorsal horn neurons through BDNF/TrkB signaling. This might be the mechanism underlying RIH, and hence inhibition of P2X4R might be a potential treatment strategy.
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http://dx.doi.org/10.1016/j.neulet.2021.135773DOI Listing
April 2021

Dialysis Initiation and All-Cause Mortality Among Incident Adult Patients With Advanced CKD: A Meta-analysis With Bias Analysis.

Kidney Med 2021 Jan-Feb;3(1):64-75.e1. Epub 2020 Dec 3.

Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Rationale & Objectives: Due to unmeasured confounding, observational studies have limitations when assessing whether dialysis initiation reduces mortality compared with conservative therapy among adults with advanced chronic kidney disease (CKD). We addressed this issue in this meta-analysis.

Study Design: Meta-analysis with bias analysis for unmeasured confounding.

Setting & Study Population: Adults with stage 4 or 5 CKD who had initiated dialysis or conservative treatment.

Selection Criteria For Studies: Prospective or retrospective cohort studies comparing survival of dialysis versus conservatively managed patients were searched on MEDLINE and Embase from January 2009 to March 20, 2019.

Data Extraction: HRs of all-cause mortality associated with dialysis initiation compared with conservative treatment.

Analytical Approach: We pooled HRs using a random-effects model. We estimated the percentage of effect sizes more protective than HRs of 0.80 and severity of unmeasured confounding that could reduce this percentage to only 10%. Subgroup analysis was performed for studies with only older patients (aged ≥ 65 years).

Results: 12 studies were included that involved 16,609 dialysis patients and 3,691 conservatively managed patients. A random-effects model suggested that dialysis initiation was associated with a mean mortality HR of 0.47 (95% CI, 0.34-0.64), in which 92% (95% CI, 50%-100%) of the true effects were more protective than HRs of 0.80. To reduce the percentage of HRs < 0.80 to 10%, unmeasured confounder(s) would need to be associated with both dialysis initiation and mortality by relative risks of 4.05 (95% CI, 2.39-4.15), which is equivalent to shifting each study's estimated HR by 2.31-fold (95% CI, 1.51-2.36). Restricting studies to include only older patients did not modify the results.

Limitations: Limited number of studies and evidence on the absence of publication bias.

Conclusions: Our findings suggest that dialysis initiation considerably reduces mortality among adults with advanced CKD. Future bias-adjusted meta-analyses need to assess outcomes beyond mortality.
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http://dx.doi.org/10.1016/j.xkme.2020.09.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873831PMC
December 2020

Single-cell RNA sequencing identifies macrophage transcriptional heterogeneities in granulomatous diseases.

Eur Respir J 2021 Feb 18. Epub 2021 Feb 18.

Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

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http://dx.doi.org/10.1183/13993003.03794-2020DOI Listing
February 2021

Dynamic RNA Regulation in the Brain Underlies Physiological Plasticity in a Hibernating Mammal.

Front Physiol 2020 18;11:624677. Epub 2021 Jan 18.

RNA Bioscience Initiative, University of Colorado School of Medicine, Aurora, CO, United States.

Hibernation is a physiological and behavioral phenotype that minimizes energy expenditure. Hibernators cycle between profound depression and rapid hyperactivation of multiple physiological processes, challenging our concept of mammalian homeostasis. How the hibernator orchestrates and survives these extremes while maintaining cell to organismal viability is unknown. Here, we enhance the genome integrity and annotation of a model hibernator, the 13-lined ground squirrel. Our new assembly brings this genome to near chromosome-level contiguity and adds thousands of previously unannotated genes. These new genomic resources were used to identify 6,505 hibernation-related, differentially-expressed and processed transcripts using RNA-seq data from three brain regions in animals whose physiological status was precisely defined using body temperature telemetry. A software tool, squirrelBox, was developed to foster further data analyses and visualization. SquirrelBox includes a comprehensive toolset for rapid visualization of gene level and cluster group dynamics, sequence scanning of -mer and domains, and interactive exploration of gene lists. Using these new tools and data, we deconvolute seasonal from temperature-dependent effects on the brain transcriptome during hibernation for the first time, highlighting the importance of carefully timed samples for studies of differential gene expression in hibernation. The identified genes include a regulatory network of RNA binding proteins that are dynamic in hibernation along with the composition of the RNA pool. In addition to passive effects of temperature, we provide evidence for regulated transcription and RNA turnover during hibernation. Significant alternative splicing, largely temperature dependent, also occurs during hibernation. These findings form a crucial first step and provide a roadmap for future work toward defining novel mechanisms of tissue protection and metabolic depression that may 1 day be applied toward improving human health.
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http://dx.doi.org/10.3389/fphys.2020.624677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848201PMC
January 2021

Polysaccharides extracted from balanophora polyandra Griff (BPP) ameliorate renal Fibrosis and EMT via inhibiting the Hedgehog pathway.

J Cell Mol Med 2021 Mar 28;25(6):2828-2840. Epub 2021 Jan 28.

College of Medical Science, China Three Gorges University, Yichang, China.

Renal interstitial fibrosis (RIF) is a crucial pathological change leading to chronic kidney disease (CKD). Currently, no effective medicines have been available for treating it. In our research, we examined the effects of polysaccharides extracted from Balanophora polyandra Griff (BPPs) on kidney fibrosis and epithelial to mesenchymal transition (EMT) in vivo and in vitro, aiming to explore the underlying mechanisms. By using the mice with unilateral urethral obstruction (UUO) as experimental subjects, we examined the medicinal values of BPPs on alleviating RIF. The effects of BPPs were evaluated by examining the histological staining and relative mRNA and protein expression levels of the related genes. The possible underlying mechanisms were further explored with human normal renal proximal tubular epithelia (HK-2 cells) as in vitro model. In UUO mice, BPP treatment could significantly alleviate interstitial fibrosis through reducing the components (Collagens I, III and IV) of extracellular matrix (ECM), and reducing the activation of fibroblasts producing these components, as revealed by inhibiting the hallmarks (fibronectin and α-SMA) of fibroblast activation. Furthermore, BPP administration increased the expression levels of matrix metalloproteinases (MMPs) and declined those of tissue inhibitors of metalloproteinases (TIMPs). BPPs markedly ameliorated EMT in both the kidneys of UUO mice and TGF-β1 treated HK-2 cells. Moreover, BPP treatment decreased the expression levels of several transcriptional factors involved in regulating E-cadherin expression, including snail, twist and ZEB1. Additionally, the Hedgehog pathway was found to be closely correlated with renal fibrosis and EMT. Altogether, our results clearly demonstrated that BPP treatment effectively inhibited the Hedgehog pathway both in renal tissues of UUO mice and TGF-β1-treated HK-2 cells. Thus, BPPs ameliorated RIF and EMT in vivo and in vitro via suppressing Hedgehog signalling pathway.
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http://dx.doi.org/10.1111/jcmm.16313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957266PMC
March 2021

Precise resection of multiple pulmonary nodules using a three-dimensional reconstruction model: A case report.

Thorac Cancer 2021 03 27;12(6):970-973. Epub 2021 Jan 27.

Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China.

A 48-year-old woman presented to our department and chest computed tomography (CT) revealed five pulmonary nodules, two of which were in the left upper lobe of the lung and three in the superior segment of the left lower lobe., All the lesions were resected for comprehensive histological assessment in order to distinguish synchronous multiple primary lung cancers (SMPLCs) from intrapulmonary metastases. The nodules were all successfully removed by minimally invasive surgery under the guidance of three dimensional (3D) reconstruction, in order to preserve as much lung function for the patient as possible. Postoperative histopathological examination demonstrated the presence of SMPLC. The patient was discharged from hospital on postoperative day 4 without any complications.
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http://dx.doi.org/10.1111/1759-7714.13861DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952800PMC
March 2021

Identification of the novel HLA-C*03:04:79 allele in a Chinese bone marrow donor.

HLA 2021 Apr 2;97(4):371-373. Epub 2021 Feb 2.

HLA Typing Laboratory, Blood Center of Zhejiang Province, Hangzhou, China.

HLA-C*03:04:79 differs from HLA-C*03:04:01:01 by a single nucleotide substitution at position 834 G>A.
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http://dx.doi.org/10.1111/tan.14186DOI Listing
April 2021

Unpaid Caregiving and Labor Force Participation among Chinese Middle-Aged Adults.

Int J Environ Res Public Health 2021 01 13;18(2). Epub 2021 Jan 13.

Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, ON M5T3M6, Canada.

Unpaid family caregivers must consider the economic trade-off between caregiving and paid employment. Prior literature has suggested that labor force participation (LFP) declines with caregiving intensity, but no study has evaluated this relationship by accounting for the presence of both kinks and discontinuities. Here we used respondents of the China Health and Retirement Longitudinal Study baseline survey who were nonfarming, of working age (aged 45-60) and had a young grandchild and/or a parent/parent-in-law. For women and men separately, a caregiving threshold-adjusted probit model was used to assess the association between LFP and weekly unpaid caregiving hours. Instrumental variables were used to rule out the endogeneity of caregiving hours. Of the 3718 respondents in the analysis, LFP for men was significantly and inversely associated with caregiving that involved neither discontinuities nor kinks. For women, a kink was identified at the caregiving threshold of eight hrs/w such that before eight hours, each caregiving hour was associated with an increase of 0.0257 in the marginal probability of LFP, but each hour thereafter was associated with a reduction of 0.0014 in the marginal probability of LFP. These results have implications for interventions that simultaneously advance policies of health, social care and labor force.
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http://dx.doi.org/10.3390/ijerph18020641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828581PMC
January 2021

A novel tissue-engineered bone graft composed of silicon-substituted calcium phosphate, autogenous fine particulate bone powder and BMSCs promotes posterolateral spinal fusion in rabbits.

J Orthop Translat 2021 Jan 14;26:151-161. Epub 2020 Sep 14.

Department of Orthopedic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.

Background: Autogenous bone graft is the gold standard bone grafting substrate available in spinal fusion because of its osteoconductive, osteogenic, and osteoinductive properties. However, several shortcomings including bleeding, infection, chronic pain, and nerve injury are known to be associated with the procedure. Bone tissue engineering has emerged as an alternative therapeutic strategy for bone grafts. New materials have been developed and tested that can substitute for the autogenous bone grafts used in the spinal fusion. The purpose of this study is to evaluate the role of a novel tissue-engineered bone graft with silicon-substituted calcium phosphate (Si-CaP), autogenous fine particulate bone powder (AFPBP), and bone marrow mesenchymal stem cells (BMSCs) using a rabbit posterolateral lumbar fusion model based on bone tissue engineering principles. The application of this graft can represent a novel choice for autogenous bone to reduce the amount of autogenous bone and promote spinal fusion.

Methods: BMSCs from New Zealand white rabbits were isolated and cultured in vitro. Then, BMSCs were marked by the cell tracker chloromethyl-benzamidodialkylcarbocyanine (CM-Dil). A total of 96 New Zealand White rabbits were randomly divided into four groups: (a) AFPBP, (b) Si-CaP, (c) Si-CaP/AFPBP, (d) Si-CaP/AFPBP/BMSCs.The rabbits underwent bilateral posterolateral spine arthrodesis of the L5-L6 intertransverse processes using different grafts. Spinal fusion and bone formation were evaluated at 4, 8, and 12 weeks after surgery by manual palpation, radiology, micro-computed tomography (micro-CT), histology, and scanning electronic microscopy (SEM).

Results: The rate of fusion by manual palpation was higher in the Si-CaP/AFPBP/BMSCs group than the other groups at 8 weeks. The fusion rates in the Si-CaP/AFPBP/BMSCs and the AFPBP groups both reached 100%, which was higher than the Si-CaP/AFPBP group (62.5%) (P ​> ​0.05) and Si-CaP group (37.5%) (P ​< ​0.05) at 12 weeks. New bone formation was observed in all groups after implantation by radiology and micro-CT. The radiographic and CT scores increased in all groups from 4 to 12 weeks, indicating a time-dependent osteogenetic process. The Si-CaP/AFPBP/BMSCs group showed a larger amount of newly formed bone than the Si-CaP/AFPBP and Si-CaP groups at 12 weeks. Bone formation in the Si-CaP/AFPBP/BMSCs group was similar to the AFPBP group. Histology showed that new bone formation continued and increased along with the degradation and absorption of Si-CaP and AFPBP from 4 to 12 weeks in the Si-CaP, Si-CaP/AFPBP, and Si-CaP/AFPBP/BMSCs groups. At 4 weeks, a higher proportion of bone was detected in the AFPBP group (23.49%) compared with the Si-CaP/AFPBP/BMSCs group (14.66%, P ​< ​0.05). In the Si-CaP/AFPBP/BMSCs group at 8 weeks, the area percentage of new bone formation was 28.56%, which was less than the AFPBP group (33.21%, P ​< ​0.05). No difference in bone volume was observed between the Si-CaP/AFPBP/BMSCs group (44.39%) and AFPBP group (45.06%) at 12 weeks (P ​> ​0.05). At 12 weeks, new trabecular were visible in the Si-CaP/AFPBP/BMSCs group by SEM. CM-Dil-positive cells were observed at all stages. Compared with histological images, BMSCs participate in various stages of osteogenesis by transforming into osteoblasts, chondrocytes, and osteocytes.

Conclusion: This study demonstrated for the first time that Si-CaP/AFPBP/BMSCs is a novel tissue-engineered bone graft with excellent bioactivity, biocompatibility, and biodegradability. The graft could reduce the amount of autogenous bone and promote spinal fusion in a rabbit posterolateral lumbar fusion model, representing a novel alternative to autogenous bone.

The Translational Potential Of This Article: The translational potential of this article lies in that this graft will be a novel spinal fusion graft with great potential for clinical applications.
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http://dx.doi.org/10.1016/j.jot.2020.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773983PMC
January 2021

Real-world vaping experiences and smoking cessation among cigarette smoking adults.

Addict Behav 2021 May 31;116:106814. Epub 2020 Dec 31.

Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Electronic address:

Introduction: E-cigarettes may have the potential to be an effective cessation aid for some cigarette smokers. However, the extent to which smokers' experiences using e-cigarettes (vaping) to quit smoking impact their cessation outcomes is unclear. In this cross-sectional survey study, we develop a multidimensional measure of vaping experiences in adults who quit smoking by vaping and test its association with perceived success in smoking cessation.

Methods: In 2019, recruitment invitations were emailed to adult past-year smokers who had accessed cessation services across Ontario, Canada. Respondents who tried vaping to quit smoking in the past year completed a detailed online survey. Factor analysis was performed on ratings of 45 vaping experiences items to identify dimensions of vaping experiences. Factor scores were entered into logistic regressions to test if vaping experiences dimensions had differential impact on perceived success in smoking cessation.

Results: Of the 889 participants, 56.0% were female, 81.1% were Caucasian, and the mean age was 37.7 ± 11.9 years. Twenty percent (19.6%) reported having successfully quit smoking by vaping in the past year. Among the six vaping experiences factors, better experiences in five factors-Relationships, Flexibility of Vaping, Side Effects, Vaping Devices, and Sensory Functions-were each independently and positively associated with improved odds of successful quitting. Notably, Relationships [OR = 2.01, 95% CI: 1.61-2.64] and Side Effects [OR = 1.95; 95% CI 1.54-2.29] were the strongest correlates of perceived success in smoking cessation.

Conclusions: These findings indicate an opportunity to increase cessation rates by improving the experiences of smokers who vape to quit smoking.
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http://dx.doi.org/10.1016/j.addbeh.2020.106814DOI Listing
May 2021

Identification of the novel HLA-DRB1*04:305 allele in a Chinese leukemia patient.

HLA 2020 Dec 14. Epub 2020 Dec 14.

HLA Typing Laboratory, Blood Center of Zhejiang Province, Hangzhou, China.

HLA-DRB1*04:305 differs from HLA-DRB1*04:05:01:01 by two nucleotide substitutions. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/tan.14169DOI Listing
December 2020

Sleep quality and risk of coronary heart disease - a prospective cohort study from the English longitudinal study of ageing.

Aging (Albany NY) 2020 11 16;12(24):25005-25019. Epub 2020 Nov 16.

Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Background: The association between sleep quality and risk of coronary heart disease (CHD) remains unclear in the elderly.

Results: At eight-year follow up, a total of 411 (4.29%) participants developed CHD. Compared with good quality group, the multivariable hazard ratio [HR] (95% confidence interval [CI]) for CHD was 1.393 (1.005, 1.931) for intermediate quality group and 1.913 (1.206, 3.035) for poor quality group. Consistent results were observed in participants with normal sleep duration.

Conclusions: Poor sleep quality may be a novel modifiable risk factor for CHD in the elderly independent of conventional cardiovascular risk factors, even when sleep duration was normal.

Methods: The current study included 9570 CHD-free participants in the English Longitudinal Study of Ageing (ELSA) from wave 4 (2008 to 2009). Incident CHD included new onset angina or myocardial infarction. Sleep quality was measured by a four-item questionnaire. Score ranged from 1 (best) to 4 (poorest). Participants were divided into three groups: good quality (1 ≤ score <2), intermediate quality (2 ≤ score <3) and poor quality (3 ≤ score ≤4). Cox regression model was used to calculate HR for CHD risk according to sleep quality, adjusted for conventional CHD risk factors and sleep duration.
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http://dx.doi.org/10.18632/aging.103866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803507PMC
November 2020

Gfi1 and Zc3h12c orchestrate a negative feedback loop that inhibits NF-kB activation during inflammation in macrophages.

Mol Immunol 2020 12 3;128:219-226. Epub 2020 Nov 3.

Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Henan Province, 453003, China; Henan Key Laboratory of Immunology and Targeted Therapy, School of Laboratory Medicine, Xinxiang Medical University, Henan Province, 453003, China. Electronic address:

NF-κB activation is essential in mediating the induction of pro-inflammatory cytokines and also plays a key role in regulating the inflammatory response through intricate mechanisms. In this study, loss of Gfi1 was found to be associated with transcriptomic profiles related to NF-κB activation, including an increase in pro-inflammatory cytokines. Genetically inactivating the IKK/NF-κB signaling pathway in macrophages showed that Gfi1 deficiency led to pro-inflammatory cytokine production requiring NF-κB activation. More importantly, we revealed that one of the under-researched mechanisms, involving Gfi1 and Zc3h12c exerted negative regulation on NF-κB activation. Both Gfi1 and Zc3h12c were found to inhibit NF-κB activation, and double knockout exhibited additive roles of Gfi1 and Zc3h12c in preventing proinflammatory cytokine production. The loss of Gfi1 upregulated Zc3h12c which in turn inhibited NF-κB activation. Therefore, this study delineates the function of Zc3h12c in enhancing the negative regulation of Gfi1 through NF-κB activation during inflammation in macrophages.
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http://dx.doi.org/10.1016/j.molimm.2020.10.023DOI Listing
December 2020

Association of Hospital-Level Differences in Care With Outcomes Among Patients With Acute ST-Segment Elevation Myocardial Infarction in China.

JAMA Netw Open 2020 10 1;3(10):e2021677. Epub 2020 Oct 1.

Thrombolysis in Myocardial Infarction Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Importance: The incidence of acute myocardial infarction has increased over the past decades in China, and management challenges include an unbalanced economy, disparate resources, and variable access to medical care across the nation.

Objective: To examine the variations in care and outcomes of patients with ST-segment elevation myocardial infarction among 3 levels of hospitals in the typical Chinese public hospital model.

Design, Setting, And Participants: This cross-sectional study used data from the China Acute Myocardial Infarction Registry to compare the differences in care and outcomes among patients at 108 hospitals from 31 provinces and municipalities throughout mainland China. Participants included patients with ST-segment elevation myocardial infarction directly admitted to hospitals between January 2013 and September 2014. Data analyses were performed from June 2015 to June 2019.

Exposures: Care in province-level, prefecture-level, or county-level hospitals in China.

Main Outcomes And Measures: The primary outcome was in-hospital mortality. Secondary outcomes included presentation, treatments, and major complications.

Results: A total of 12 695 patients (9593 men [75.6%]; median [interquartile range] age, 63 [54-72] years) were included; 3985 were at province-level hospitals, 6731 were at prefecture-level hospitals, and 1979 were at county-level hospitals. Compared with patients admitted to province-level hospitals, those admitted to prefecture-level and county-level hospitals were older (median [interquartile range] age, 61 [52-70] years vs 63 [54-72] years and 65 [57-75] years) and more likely to be women (815 women [20.5%] vs 1620 women [24.1%] and 667 women [33.7%]). Patients in prefecture-level and county-level hospitals were less likely to use ambulances compared with patients at province-level hospitals (11.6% [95% CI, 10.8%-12.4%] and 12.0% [95% CI, 10.6%-13.5%] vs 19.4% [95% CI, 18.1%-20.7%]; P < .001) and were less likely to experience early presentation, with onset-to-arrival times less than 12 hours for 75.3% (95% CI, 73.9%-76.6%) of patients at province-level hospitals, 70.8% (95% CI, 69.7%-71.9%) of patients at prefecture-level hospitals, and 69.8% (95% CI, 67.7%-71.8%) of patients at county-level hospitals (P < .001). The rates of reperfusion therapy were significantly lower in low-level hospitals (54.3% [95% CI, 53.1%-55.5%] for prefecture-level hospitals and 45.8% [95% CI, 43.6%-48.1%] for county-level hospitals) compared with province-level hospitals (69.4% [95% CI, 67.9%-70.8%]; P < .001). There was a progressively higher rate of in-hospital mortality at the 3 levels of hospitals: 3.1% (95% CI, 2.6%-3.7%) for province-level hospitals, 5.3% (95% CI, 4.8%-5.9%) for prefecture-level hospitals, and 10.2% (95% CI, 8.9%-11.7%) for county-level hospitals (P for trend < .001). After adjustment for patient characteristics, presentation, hospital facility, and treatments, the odds of death remained higher in prefecture-level (odds ratio, 1.39 [95% CI, 1.06-1.84]) and county-level (odds ratio, 1.43 [95% CI, 0.97-2.11]) hospitals compared with province-level hospitals (P for trend = .04).

Conclusions And Relevance: These findings suggest that there are significant variations in care and outcomes of patients among the 3 levels of hospitals in China. More efforts should be made to address the identified gaps, particularly in the prefecture-level and county-level hospitals. This work can inform national quality improvements efforts in China and in other developing countries.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.21677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584928PMC
October 2020

Linking executive functions to distracted driving, does it differ between young and mature drivers?

PLoS One 2020 24;15(9):e0239596. Epub 2020 Sep 24.

School of Automobile, Chang'an University, Xi'an, China.

Distracted driving is a leading cause of traffic accidents. Certain executive functions significantly affect the willingness of distracted driving; however, little research has compared the effects of executive functions on distracted driving behaviors in different aged populations. This study explores and compares the behavioral and cognitive processes underlying distracted driving behaviors in young and mature drivers. A total of 138 participants aged 18-65 years old completed a self-report questionnaire for measuring executive function index and distracted driving behaviors. Independent sample t-tests were conducted for executive functions (motivational drive, organization, strategic planning, impulse control, and empathy) and driving variables to examine any differences between young and mature groups. Partial correlation coefficients and z-score of these comparisons were calculated to compare the differences between age groups. Furthermore, multiple hierarchical regression models were constructed to determine the relative contributions of age, gender, and executive functions on distracted driving behaviors. Results demonstrated the following: (1) Mature drivers performed better for impulse control, the executive function index as well as the measure of distracted driving behavior than young drivers; (2) the relationships between executive functions and distracted driving behaviors did not significantly differ between young and mature drivers; (3) for both young and mature drivers, motivational drive and impulse control were found to significantly improve the prediction of distracted driving behavior in regression models. The findings emphasize that similar behavioral and cognitive processes are involved in distracted driving behavior of young and mature drivers, and can promote a single strategy for driver education and accident prevention interventions for both age groups.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239596PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7514019PMC
November 2020

Research on the Comfort of Vehicle Passengers Considering the Vehicle Motion State and Passenger Physiological Characteristics: Improving the Passenger Comfort of Autonomous Vehicles.

Int J Environ Res Public Health 2020 09 18;17(18). Epub 2020 Sep 18.

School of Automobile, Chang'an University, Xi'an 710064, China.

Comfort is a significant factor that affects passengers' choice of autonomous vehicles. The comfort of an autonomous vehicle is largely determined by its control algorithm. Therefore, if the comfort of passengers can be predicted based on factors that affect comfort and the control algorithm can be adjusted, it can be beneficial to improve the comfort of autonomous vehicles. In view of this, in the present study, a human-driven experiment was carried out to simulate the typical driving state of a future autonomous vehicle. In the experiment, vehicle motion parameters and the comfort evaluation results of passengers with different physiological characteristics were collected. A single-factor analysis method and binary logistic regression analysis model were used to determine the factors that affect the evaluation results of passenger comfort. A passenger comfort prediction model was established based on the bidirectional long short-term memory network model. The results demonstrate that the accuracy of the passenger comfort prediction model reached 84%, which can provide a theoretical basis for the adjustment of the control algorithm and path trajectory of autonomous vehicles.
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http://dx.doi.org/10.3390/ijerph17186821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559987PMC
September 2020

Sleep quality and risk of cancer: findings from the English longitudinal study of aging.

Sleep 2021 Mar;44(3)

Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Study Objective: To prospectively examine the association between sleep quality and incident cancer risk in the elderly.

Methods: A total of 10,036 participants aged ≥50 years free of cancer at baseline from the English Longitudinal Study of Ageing at wave 4 (2008) were included, and followed up until 2016. The primary endpoint was new onset physician-diagnosed cancer. Sleep quality was assessed by four questions regarding the frequency of sleep problems and overall subjective feeling of sleep quality in the last month, with higher score denoting poorer sleep quality. The multivariable Cox regression model was used to calculate hazard ratio (HR) with 95% confidence interval (CI) for incident cancer risk according to sleep quality.

Results: At 8-year follow-up, a total of 745 (7.4%) participants developed cancer. Compared with good sleep quality at baseline, HR (95% CI) for incident cancer risk was 1.328 (1.061, 1.662) for intermediate quality, 1.586 (1.149, 2.189) for poor quality. Similarly, compared with maintaining good sleep quality in the first 4 years, HR (95% CI) for incident cancer risk was 1.615 (1.208, 2.160) for maintaining intermediate quality and 1.608 (1.043, 2.480) for maintaining poor quality. The exclusion of participants with family history of cancer or abnormal sleep duration yielded consistent results.

Conclusions: Poor sleep quality is positively associated with the long-term risk of developing cancer in an elderly cohort. Both medical staffs and the general public should pay more attention to improving sleep hygiene.
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http://dx.doi.org/10.1093/sleep/zsaa192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7953221PMC
March 2021

A Practical Risk Score to Predict 24-Month Post-Discharge Mortality Risk in Patients With Non-ST-Segment Elevation Myocardial Infarction.

Circ J 2020 Oct 17;84(11):1974-1980. Epub 2020 Sep 17.

Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College.

Background: Risk stratification of patients with non-ST-segment elevation myocardial infarction (NSTEMI) is important in terms of treatment strategy selection. Current efforts have focused on short-term risk prediction after discharge, but we aimed to establish a risk score to predict the 24-month mortality risk in survivors of NSTEMI.Methods and Results:A total of 5,509 patients diagnosed with NSTEMI between January 2013 and September 2014 were included. Primary endpoint was all-cause death at 24 months. A multivariable Cox regression model was used to establish a practical risk score based on independent risk factors of death. The risk score included 9 variables: age, body mass index, left ventricular ejection fraction, reperfusion therapy during hospitalization, Killip classification, prescription of diuretics at discharge, heart rate, and hemoglobin and creatinine levels. The C-statistics for the risk model were 0.83 (95% confidence interval [CI]: 0.81-0.85) and 0.83 (95% CI: 0.79-0.86) in the development and validation cohorts, respectively. Mortality risk increased significantly across groups: 1.34% in the low-risk group (score: 0-58), 5.40% in intermediate group (score: 59-93), and 23.87% in high-risk group (score: ≥94).

Conclusions: The current study established and validated a practical risk score based on 9 variables to predict 24-month mortality risk in patients who survive NSTEMI. This score could help identify patients who are at high risk for future adverse events who may benefit from good adherence to guideline-recommended secondary prevention treatment.
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http://dx.doi.org/10.1253/circj.CJ-20-0509DOI Listing
October 2020

Real-World Scenario of Patients With Lung Cancer Amid the Coronavirus Disease 2019 Pandemic in the People's Republic of China.

JTO Clin Res Rep 2020 Sep 20;1(3):100053. Epub 2020 May 20.

Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China.

Introduction: The coronavirus disease 2019 (COVID-19) outbreak throughout the world has affected millions of people in many ways, putting a huge burden on the health care system. The ongoing outbreak of this respiratory disease has posed critical challenges to public health, research, and medical communities around the world. This study aimed at evaluating the impact of COVID-19 pandemic on patients with lung cancer in the People's Republic of China.

Methods: We collected data on 397 inpatients from a single center during 4 weeks of the pandemic (2020 group) and that of 2504 inpatients during the same period (4 wk) in the past 5 years (2015-2019 group). A questionnaire was used to investigate the medical demands of 803 patients with lung cancer at 65 hospitals in 20 provinces in the People's Republic of China during the pandemic. We evaluated the incidence data of COVID-19 in Guangdong to analyze the tendency of the pandemic and compared it with inpatient data.

Results: The number of hospitalizations and lung cancer-related operations had steadily increased from 2015 to 2019 but reduced by an average of 26.72% (133.8) and 57.18% (45.4) in 2020. The hospital capacity decreased by 28.00% (35 inpatient beds) during the pandemic period of infection with severe acute respiratory syndrome coronavirus 2. The pandemic caused a greater impact on medical work related to lung cancer after the Chinese New Year holiday. Patients were most concerned about long waiting times for outpatient services, inpatient beds, physical examinations, or operations (406; 50.56%); the possibility of infection with the novel coronavirus (359; 44.71%); and the difficulties in getting to a hospital owing to transportation outages (279; 34.74%). Patients in stage I and II revealed having less fear about disease progression (14 [18.18%] and four [14.81%], respectively), had lower proportions of delayed medical arrangement (15 [19.48%] and six [22.22%], respectively), and complained less about complex treatment procedures (12 [15.58%] and five [18.52%], respectively). Patients in the high-infected area (345, 56.74%) complained more frequently about longer booking periods than those in the low-infected area (61, 31.28%).

Conclusions: The treatment of patients with lung cancer has been affected by the pandemic to some extent. We provide suggestions on both clinical diagnosis and treatment strategies for lung cancer to optimize the process, given the urgency of the current circumstances. The demand for medical support among patients with lung cancer or other life-threatening diseases should be given sufficient attention, especially during the current COVID-19 outbreak.
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http://dx.doi.org/10.1016/j.jtocrr.2020.100053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239012PMC
September 2020

Modeling Car-Following Behaviors and Driving Styles with Generative Adversarial Imitation Learning.

Sensors (Basel) 2020 Sep 4;20(18). Epub 2020 Sep 4.

School of Automobile, Chang'an University, Xi'an 710064, China.

Building a human-like car-following model that can accurately simulate drivers' car-following behaviors is helpful to the development of driving assistance systems and autonomous driving. Recent studies have shown the advantages of applying reinforcement learning methods in car-following modeling. However, a problem has remained where it is difficult to manually determine the reward function. This paper proposes a novel car-following model based on generative adversarial imitation learning. The proposed model can learn the strategy from drivers' demonstrations without specifying the reward. Gated recurrent units was incorporated in the actor-critic network to enable the model to use historical information. Drivers' car-following data collected by a test vehicle equipped with a millimeter-wave radar and controller area network acquisition card was used. The participants were divided into two driving styles by K-means with time-headway and time-headway when braking used as input features. Adopting five-fold cross-validation for model evaluation, the results show that the proposed model can reproduce drivers' car-following trajectories and driving styles more accurately than the intelligent driver model and the recurrent neural network-based model, with the lowest average spacing error (19.40%) and speed validation error (5.57%), as well as the lowest Kullback-Leibler divergences of the two indicators used for driving style clustering.
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http://dx.doi.org/10.3390/s20185034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571238PMC
September 2020