Publications by authors named "Zhensheng Wang"

37 Publications

Reply to Mehravaran, et al.

Clin Infect Dis 2021 May 29. Epub 2021 May 29.

Health Services Research Center, Emory University School of Medicine, Department of Medicine, Department of Surgery, Emory University School of Medicine, and Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, United States of America.

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http://dx.doi.org/10.1093/cid/ciab499DOI Listing
May 2021

Dialysis Facility Profit Status and Early Steps in Kidney Transplantation in the Southeastern United States.

Clin J Am Soc Nephrol 2021 Jun 26;16(6):926-936. Epub 2021 May 26.

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia

Background And Objectives: Dialysis facilities in the United States play a key role in access to kidney transplantation. Previous studies reported that patients treated at for-profit facilities are less likely to be waitlisted and receive a transplant, but their effect on early steps in the transplant process is unknown. The study's objective was to determine the association between dialysis facility profit status and critical steps in the transplantation process in Georgia, North Carolina, and South Carolina.

Design, Setting, Participants, & Measurements: In this retrospective cohort study, we linked referral and evaluation data from all nine transplant centers in the Southeast with United States Renal Data System surveillance data. The cohort study included 33,651 patients with kidney failure initiating dialysis from January 1, 2012 to August 31, 2016. Patients were censored for event (date of referral, evaluation, or waitlisting), death, or end of study (August 31, 2017 for referral and March 1, 2018 for evaluation and waitlisting). The primary exposure was dialysis facility profit status: for profit versus nonprofit. The primary outcome was referral for evaluation at a transplant center after dialysis initiation. Secondary outcomes were start of evaluation at a transplant center after referral and waitlisting.

Results: Of the 33,651 patients with incident kidney failure, most received dialysis treatment at a for-profit facility (85%). For-profit (versus nonprofit) facilities had a lower cumulative incidence difference for referral within 1 year of dialysis (-4.5%; 95% confidence interval, -6.0% to -3.2%). In adjusted analyses, for-profit versus nonprofit facilities had lower referral (hazard ratio, 0.84; 95% confidence interval, 0.80 to 0.88). Start of evaluation within 6 months of referral (-1.0%; 95% confidence interval, -3.1% to 1.3%) and waitlisting within 6 months of evaluation (1.0%; 95% confidence interval, -1.2 to 3.3) did not meaningfully differ between groups.

Conclusions: Findings suggest lower access to referral among patients dialyzing in for-profit facilities in the Southeast United States, but no difference in starting the evaluation and waitlisting by facility profit status.
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http://dx.doi.org/10.2215/CJN.17691120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216615PMC
June 2021

Long-term mortality among kidney transplant recipients with and without diabetes: a nationwide cohort study in the USA.

BMJ Open Diabetes Res Care 2021 05;9(1)

Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

Introduction: Little is known about the role diabetes (type 1 (T1D) and type 2 (T2D)) plays in modifying prognosis among kidney transplant recipients. Here, we compare mortality among transplant recipients with T1D, T2D and non-diabetes-related end-stage kidney disease (ESKD).

Research Design And Methods: We included 254 188 first-time single kidney transplant recipients aged ≥18 years from the US Renal Data System (2000-2018). Diabetes status, as primary cause of ESKD, was defined using International Classification of Disease 9th and 10th Clinical Modification codes. Multivariable-adjusted Cox regression models (right-censored) computed risk of death associated with T1D and T2D relative to non-diabetes. Trends in standardized mortality ratios (SMRs) (2000-2017), relative to the general US population, were assessed using Joinpoint regression.

Results: A total of 72 175 (28.4%) deaths occurred over a median survival time of 14.6 years. 5-year survival probabilities were 88%, 85% and 77% for non-diabetes, T1D and T2D, respectively. In adjusted models, mortality was highest for T1D (HR=1.95, (95% CI: 1.88 to 2.03)) and then T2D (1.65 (1.62 to 1.69)), as compared with non-diabetes. SMRs declined for non-diabetes, T1D, and T2D. However, in 2017, SMRs were 2.38 (2.31 to 2.45), 6.55 (6.07 to 7.06), and 3.82 (3.68 to 3.98), for non-diabetes, T1D and T2D, respectively.

Conclusions: In the USA, diabetes type is an important modifier in mortality risk among kidney transplant recipients with highest rates among people with T1D-related ESKD. Development of effective interventions that reduce excess mortality in transplant recipients with diabetes is needed, especially for T1D.
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http://dx.doi.org/10.1136/bmjdrc-2020-001962DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8108684PMC
May 2021

Racial and Ethnic Differences and Clinical Outcomes of COVID-19 Patients Presenting to the Emergency Department.

Clin Infect Dis 2021 Apr 2. Epub 2021 Apr 2.

Health Services Research Center, Emory University School of Medicine, Department of Medicine, Department of Surgery, Emory University School of Medicine, and Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, United States of America.

Background: Since the introduction of remdesivir and dexamethasone for severe COVID-19 treatment, few large multi-hospital system US studies have described clinical characteristics and outcomes of minority COVID-19 patients who present to the emergency department (ED).

Methods: This cohort study from the Cerner Real World Database (87 US health systems) from December 1, 2019 to September 30, 2020 included PCR-confirmed COVID-19 patients who self-identified as non-Hispanic Black (Black), Hispanic White (Hispanic), or non-Hispanic White (White). The main outcome was hospitalization among ED patients. Secondary outcomes included mechanical ventilation, intensive care unit care, and in-hospital mortality. Descriptive statistics and Poisson regression compared sociodemographics, comorbidities, receipt of remdesivir, receipt of dexamethasone, and outcomes by racial/ethnic groups and geographic region.

Results: 94,683 COVID-19 patients presented to the ED. Blacks comprised 26.7% and Hispanics 33.6%. Nearly half (45.1%) of ED patients presented to hospitals in the South. 31.4% (n=29,687) were hospitalized. Lower proportions of Blacks were prescribed dexamethasone (29.4%; n=7,426) compared to Hispanics (40.9%; n=13,021) and Whites (37.5%; n=14,088). Hospitalization risks, compared to Whites, were similar in Blacks (Risk Ratio (RR)=0.94; 95% CI:0.82, 1.08; p=0.4)) and Hispanics RR=0.99 (95% CI:0.81, 1.21; p=0.91), but risk of in-hospital mortality was higher in Blacks, RR=1.18 (95% CI:1.06, 1.31; p=0.002) and Hispanics, RR=1.28 (95% CI: 1.13, 1.44; p < 0.001).

Conclusions: Minority patients were overrepresented among COVID-19 ED patients, and while they had similar risks of hospitalization as Whites, in-hospital mortality risk was higher. Interventions targeting upstream social determinants of health are needed to reduce racial/ethnic disparities in COVID-19.
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http://dx.doi.org/10.1093/cid/ciab290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083480PMC
April 2021

Differences in Outpatient Dermatology Encounter Work Relative Value Units and Net Payments by Patient Race, Sex, and Age.

JAMA Dermatol 2021 Apr;157(4):406-412

Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.

Importance: Clinical productivity measures may be factors in financial incentives for providing care to specific patient populations and thus may perpetuate inequitable health care.

Objective: To identify the association of patient race, age, and sex with work relative value units (wRVUs) generated by outpatient dermatology encounters.

Design, Setting, And Participants: This cross-sectional study obtained demographic and billing data for outpatient dermatology encounters (ie, an encounter performed within a department of dermatology) from September 1, 2016, to March 31, 2020, at the Emory Clinic, an academic dermatologic practice in Atlanta, Georgia. Participants included adults aged 18 years or older with available age, race, and sex data in the electronic health record system.

Main Outcomes And Measures: The primary outcome was wRVUs generated per encounter.

Results: A total of 66 463 encounters among 30 036 unique patients were included. Patients had a mean (SD) age of 55.9 (18.5) years and were predominantly White (46 575 [70.1%]) and female (39 598 [59.6%]) individuals. In the general dermatologic practice, the mean (SD) wRVUs per encounter was 1.40 (0.71). In adjusted analysis, Black, Asian, and other races (eg, American Indian or Native American, Native Hawaiian or Other Pacific Islander, and multiple races); female sex; and younger age were associated with fewer wRVUs per outpatient dermatology encounter. Compared with general dermatologic visits with White patients, visits with Black patients generated 0.27 (95% CI, 0.25-0.28) fewer wRVUs per encounter, visits with Asian patients generated 0.22 (95% CI, 0.20-0.25) fewer wRVUs per encounter, and visits with patients of other race generated 0.19 (95% CI, 0.14-0.24) fewer wRVUs per encounter. Female sex was also associated with 0.11 (95% CI, 0.10-0.12) fewer wRVUs per encounter, and wRVUs per encounter increased by 0.006 (95% CI, 0.006-0.006) with each 1-year increase in age. In the general dermatologic practice excluding Mohs surgeons, destruction of premalignant lesions and biopsies were mediators for the observed differences in race (56.2% [95% CI, 53.1%-59.3%] for Black race, 53.2% [95% CI, 45.6%-63.8%] for Asian race, and 53.6% [95% CI, 40.4%-77.4%] for other races), age (65.6%; 95% CI, 60.5%-71.4%), and sex (82.3%; 95% CI, 72.7%-93.1%). In a data set including encounters with Mohs surgeons, the race, age, and sex differences in wRVUs per encounter were greater than in the general dermatologic data set. Mohs surgery for basal cell and squamous cell carcinomas was a mediator for the observed differences in race (46.0% [95% CI, 42.6%-49.4%] for Black race, 41.9% [95% CI, 35.5%-49.2%] for Asian race, and 34.6% [95% CI, 13.8%-51.5%] for other races), age (49.2%; 95% CI, 44.9%-53.7%), and sex (47.9%; 95% CI, 42.0%-54.6%).

Conclusions And Relevance: This cross-sectional study found that dermatology encounters with racial minority groups, women, and younger patients generated fewer wRVUs than encounters with older White male patients. This finding suggests that physician compensation based on wRVUs may encourage the provision of services that exacerbate disparities in access to dermatologic care.
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http://dx.doi.org/10.1001/jamadermatol.2020.5823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7890528PMC
April 2021

Managing COVID-19-positive Solid Organ Transplant Recipients in the Community: What a Community Healthcare Provider Needs to Know.

Transplant Direct 2020 Dec 16;6(12):e633. Epub 2020 Nov 16.

Emory Transplant Center, Emory University School of Medicine, Atlanta, GA.

Background: The current surge of coronavirus 2019 (COVID-19) cases in certain parts of the country has burdened the healthcare system, limiting access to tertiary centers for many. As a result, COVID-19-positive Solid Organ Transplant (SOT) recipients are increasingly being managed by local healthcare providers. It is crucial for community providers to understand disease severity and know if COVID-19-impacted SOT recipients have a different clinical course compared with COVID-19-negative SOT recipients with a similar presentation.

Methods: We conducted a retrospective analysis on SOT recipients suspected to have COVID-19 infection tested during March 14, 2020-April 30, 2020. Patients were followed from time of testing to May 31, 2020.

Results: One hundred sixty SOT recipients underwent testing: 22 COVID-19 positive and 138 COVID-19 negative. COVID-19-positive patients were more likely to have rapid progression of symptoms (median 3 vs 6 d, = 0.002), greater hospitalizations (78% vs 64%, < 0.017), and need for intensive care unit care (45% vs 17%, < 0.001) Severe COVID-19 infection was not observed in patients on Belatacept for immunosuppression (30% vs 87%, = 0.001). COVID- 19 positive patients in the intensive care unit were more likely to have multifocal opacities on radiological imaging in comparison to those admitted to the medical floor (90% vs 11%). Survival probability was similar in both cohorts.

Conclusion: COVID-19-infected SOT recipients have a propensity for rapid clinical decompensation. Local providers need to be work closely with transplant centers to appropriately triage and manage COVID-19 SOT recipients in the community.
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http://dx.doi.org/10.1097/TXD.0000000000001074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673773PMC
December 2020

Increasing Incidence of Advanced Non-cardia Gastric Cancers Among Younger Hispanics in the USA.

Dig Dis Sci 2021 May 16;66(5):1669-1672. Epub 2020 Jun 16.

Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.

Background: Recent findings indicate a shift in the epidemiology of non-cardia gastric cancer in the USA. In particular, an uprising trend in incidence rates among non-Hispanic whites aged < 50 years.

Aim: To examine secular trends in the incidence of non-cardia gastric cancer among adults aged < 50 years in the USA by race/ethnicity and stage at diagnosis.

Methods: Age-adjusted incidence rates and trends in adults aged < 50 years and ≥ 50 years were calculated using data from all 50 states in the National Program of Cancer Registries and the SEER program. We used joinpoint regression to compute average annual percent change (AAPC) in cancer incidence rates.

Results: Overall, we found an increasing trend of non-cardia gastric cancer among non-Hispanic whites aged < 50 years between 2001 and 2014 (AAPC = 1.24, 95% CI 0.49, 1.99). However, among non-Hispanic whites aged < 50 years, the rates of localized disease increased (AAPC = 5.28, 95% CI 3.94, 6.64), whereas the rates of distant stage non-cardia gastric cancer remained unchanged (AAPC = 0.68, 95% CI - 0.63, 2.00). Conversely, we found a significant increase in rates of distant stage non-cardia gastric cancer among Hispanics aged < 50 years (AAPC = 1.78, 95% CI 0.66, 2.91). Non-cardia gastric cancer incidence rates decreased over the study period among non-Hispanic whites and Hispanics aged ≥ 50 years.

Conclusion: Given the rapid growth of the young Hispanic population in the USA, preventative strategies for non-cardia gastric cancer cannot neglect this population.
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http://dx.doi.org/10.1007/s10620-020-06397-xDOI Listing
May 2021

Development the method of pipeline bending strain measurement based on microelectromechanical systems inertial measurement unit.

Sci Prog 2020 Apr-Jun;103(2):36850420925231

Petrochina Pipeline Company, Langfang, China.

With the development of pipeline construction, the additional stress and strain becomes the key factor to induce the damage for oil and gas pipeline. The in-line inspection of pipeline bending strain which is based on high-end tactical-grade inertial measurement unit has become routine practice for the oil and gas pipelines over recent years. However, these accurate inertial measurement units are large size and high cost limit to use in small diameter pipelines of bending strain inspection. Microelectromechanical systems-based inertial navigation has been applied to mapping the centerline of the small size pipeline, and the accurate trajectory and attitude information become key factors to calculate the bending strain of pipelines. This article proposed a method not only to calculate the pipeline bending strain but also to improve the accuracy for the bending strain based on the wavelet analysis. Tests show that this method can be effectively used in the calculation and optimization of the bending strain, and it will increase the accuracy to within 19.1% of the actual bending strain.
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http://dx.doi.org/10.1177/0036850420925231DOI Listing
June 2020

Dialysis facility referral and start of evaluation for kidney transplantation among patients treated with dialysis in the Southeastern United States.

Am J Transplant 2020 08 11;20(8):2113-2125. Epub 2020 Feb 11.

Emory Transplant Center, Atlanta, Georgia, USA.

Variability in transplant access exists, but barriers to referral and evaluation are underexplored due to lack of national surveillance data. We examined referral for kidney transplantation evaluation and start of the evaluation among 34 857 incident, adult (18-79 years) end-stage kidney disease patients from 690 dialysis facilities in the United States Renal Data System from January 1, 2012 through August 31, 2016, followed through February 2018 and linked data to referral and evaluation data from nine transplant centers in Georgia, North Carolina, and South Carolina. Multivariable-adjusted competing risk analysis examined each outcome. The median within-facility cumulative percentage of patients referred for kidney transplantation within 1 year of dialysis at the 690 dialysis facilities in Network 6 was 33.7% (interquartile range [IQR]: 25.3%-43.1%). Only 48.3% of referred patients started the transplant evaluation within 6 months of referral. In multivariable analyses, factors associated with referral vs evaluation start among those referred at any time differed. For example, black, non-Hispanic patients had a higher rate of referral (hazard ratio [HR]: 1.22; 95% confidence interval [CI]: 1.18-1.27), but lower evaluation start among those referred (HR: 0.93; 95% CI: 0.88-0.98), vs white non-Hispanic patients. Barriers to transplant varied by step, and national surveillance data should be collected on early transplant steps to improve transplant access.
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http://dx.doi.org/10.1111/ajt.15791DOI Listing
August 2020

Association Between Dialysis Facility Ownership and Access to Kidney Transplantation.

JAMA 2019 09;322(10):957-973

Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.

Importance: For-profit (vs nonprofit) dialysis facilities have historically had lower kidney transplantation rates, but it is unknown if the pattern holds for living donor and deceased donor kidney transplantation, varies by facility ownership, or has persisted over time in a nationally representative population.

Objective: To determine the association between dialysis facility ownership and placement on the deceased donor kidney transplantation waiting list, receipt of a living donor kidney transplant, or receipt of a deceased donor kidney transplant.

Design, Setting, And Participants: Retrospective cohort study that included 1 478 564 patients treated at 6511 US dialysis facilities. Adult patients with incident end-stage kidney disease from the US Renal Data System (2000-2016) were linked with facility ownership (Dialysis Facility Compare) and characteristics (Dialysis Facility Report).

Exposures: The primary exposure was dialysis facility ownership, which was categorized as nonprofit small chains, nonprofit independent facilities, for-profit large chains (>1000 facilities), for-profit small chains (<1000 facilities), and for-profit independent facilities.

Main Outcomes And Measures: Access to kidney transplantation was defined as time from initiation of dialysis to placement on the deceased donor kidney transplantation waiting list, receipt of a living donor kidney transplant, or receipt of a deceased donor kidney transplant. Cumulative incidence differences and multivariable Cox models assessed the association between dialysis facility ownership and each outcome.

Results: Among 1 478 564 patients, the median age was 66 years (interquartile range, 55-76 years), with 55.3% male, and 28.1% non-Hispanic black patients. Eighty-seven percent of patients received care at a for-profit dialysis facility. A total of 109 030 patients (7.4%) received care at 435 nonprofit small chain facilities; 78 287 (5.3%) at 324 nonprofit independent facilities; 483 988 (32.7%) at 2239 facilities of large for-profit chain 1; 482 689 (32.6%) at 2082 facilities of large for-profit chain 2; 225 890 (15.3%) at 997 for-profit small chain facilities; and 98 680 (6.7%) at 434 for-profit independent facilities. During the study period, 121 680 patients (8.2%) were placed on the deceased donor waiting list, 23 762 (1.6%) received a living donor kidney transplant, and 49 290 (3.3%) received a deceased donor kidney transplant. For-profit facilities had lower 5-year cumulative incidence differences for each outcome vs nonprofit facilities (deceased donor waiting list: -13.2% [95% CI, -13.4% to -13.0%]; receipt of a living donor kidney transplant: -2.3% [95% CI, -2.4% to -2.3%]; and receipt of a deceased donor kidney transplant: -4.3% [95% CI, -4.4% to -4.2%]). Adjusted Cox analyses showed lower relative rates for each outcome among patients treated at all for-profit vs all nonprofit dialysis facilities: deceased donor waiting list (hazard ratio [HR], 0.36 [95% CI, 0.35 to 0.36]); receipt of a living donor kidney transplant (HR, 0.52 [95% CI, 0.51 to 0.54]); and receipt of a deceased donor kidney transplant (HR, 0.44 [95% CI, 0.44 to 0.45]).

Conclusions And Relevance: Among US patients with end-stage kidney disease, receiving dialysis at for-profit facilities compared with nonprofit facilities was associated with a lower likelihood of accessing kidney transplantation. Further research is needed to understand the mechanisms behind this association.
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http://dx.doi.org/10.1001/jama.2019.12803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737748PMC
September 2019

Measuring Spatial Patterns of Health Care Facilities and Their Relationships with Hypertension Inpatients in a Network-Constrained Urban System.

Int J Environ Res Public Health 2019 09 2;16(17). Epub 2019 Sep 2.

Key Laboratory of Urban Land Resources Monitoring and Simulation, Ministry of Land and Resources of China, Shenzhen 518034, China.

There is evidence of a strong correlation between inequality in health care access and disparities in chronic health conditions. Equal access to health care is an important indicator for overall population health, and the urban road network has a significant influence on the spatial distribution of urban service facilities. In this study, the network kernel density estimation was applied to detect the hot spots of health care service along the road network of Shenzhen, and we further explored the influences of population and road density on the aggregate intensity distributions at the community level, using spatial stratified heterogeneity analyses. Then, we measured the spatial clustering patterns of health care facilities in each of the ten districts of Shenzhen using the network K-function, and the interrelationships between health care facilities and hypertension patients. The results can be used to examine the reasonability of the existing health care system, which would be valuable for developing more effective prevention, control, and treatment of chronic health conditions. Further research should consider the influence of nonspatial factors on health care service access.
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http://dx.doi.org/10.3390/ijerph16173204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747080PMC
September 2019

Dietary quality and the colonic mucosa-associated gut microbiome in humans.

Am J Clin Nutr 2019 09;110(3):701-712

Department of Medicine, Baylor College of Medicine (BCM), Houston, TX, USA.

Background: Despite tremendous interest in modulating the microbiome to improve health, the association between diet and the colonic mucosa-associated gut microbiome in healthy individuals has not been examined.

Objective: To investigate the associations between Healthy Eating Index (HEI)-2005 and the colonic mucosa-associated microbiota.

Methods: In this cross-sectional observational study, we analyzed bacterial community composition and structure using 16S rRNA gene (V4 region) sequencing of 97 colonic mucosal biopsies obtained endoscopically from different colon segments of 34 polyp-free participants. Dietary consumption was ascertained using an FFQ. Differences in α- and β-diversity and taxonomic relative abundances between the higher and lower score of total HEI and its components were compared, followed by multivariable analyses.

Results: The structure of the microbiota significantly differed by the scores for total HEI, total and whole fruits (HEI 1 and HEI 2), whole grains (HEI 6), milk products and soy beverages (HEI 7), and solid fat, alcohol, and added sugar (HEI 12). A lower score for total HEI and HEIs 2, 7, and 12 was associated with significantly lower richness. A lower score for total HEI was associated with significantly reduced relative abundance of Parabacteroides, Roseburia, and Subdoligranulum but higher Fusobacterium. A lower score for HEI 2 was associated with lower Roseburia but higher Bacteroides. A lower score for HEI 7 was associated with lower Faecalibacterium and Fusobacterium but higher Bacteroides. A lower score for HEI 12 was associated with lower Subdoligranulum but higher Escherichia and Fusobacterium (false discovery rate-adjusted P values <0.05). The findings were confirmed by multivariate analysis. Less abundant bacteria such as Alistipes, Odoribacter, Bilophila, and Tyzzerella were also associated with dietary quality.

Conclusions: A lower score for total HEI-2005 was significantly associated with reduced relative abundance of potentially beneficial bacteria but increased potentially harmful bacteria in the colonic mucosa of endoscopically normal individuals.
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http://dx.doi.org/10.1093/ajcn/nqz139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736447PMC
September 2019

Factors associated with favorable survival outcomes for Asians with hepatocellular carcinoma: A sequential matching cohort study.

PLoS One 2019 3;14(4):e0214721. Epub 2019 Apr 3.

Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America.

Background: Overall 5-year survival rates for patients diagnosed with hepatocellular carcinoma (HCC) are poor, but vary by race/ethnicity. We undertook a comprehensive assessment of underlying contributing factors to the favorable survival outcomes of HCC among Asians compared with non-Hispanic whites (NHW).

Methods: We identified 1,284 Asian and 7,072 NHW patients newly diagnosed with HCC between 1994 and 2011 in the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. We used a novel three-step sequential matching approach to identify demographic, presentation and treatment factors that may explain survival differences between Asians and NHWs. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for the association between Asian race and risk of HCC-related mortality were estimated using Cox proportional hazards models.

Results: The absolute difference in 5-year survival rates between Asians and NHWs was 8.4% (95% CI: 4.6%-12.0%) in the demographics match analysis. The disparity remained unchanged after additionally matching on stage, grade and comorbidities in the presentation match analysis. However, in the treatment match analysis, which accounts for differences in demographic, presentation and treatment factors, the absolute difference in 5-year survival rates was reduced to 5.8% (95% CI: 2.6%-9.3%). Treatment differences explained more of survival disparity in Asian and NHW patients with localized disease than for those with regional or distant stage HCC.

Conclusions: Asian patients with HCC continue to have more favorable survival outcomes than NHWs with HCC. This persistent disparity seems to be more related to treatment differences than to differences in presentation characteristics including stage.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214721PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447218PMC
January 2020

Dietary Nutrients Involved in One-Carbon Metabolism and Colonic Mucosa-Associated Gut Microbiome in Individuals with an Endoscopically Normal Colon.

Nutrients 2019 Mar 13;11(3). Epub 2019 Mar 13.

Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.

One carbon (1C) metabolism nutrients influence epigenetic regulation and they are supplied by diet and synthesized by gut microbiota. We examined the association between dietary consumption of methyl donors (methionine, betaine and choline) and B vitamins (folate, B2, B6, and B12) and the community composition and structure of the colonic mucosa-associated gut microbiota determined by 16S rRNA gene sequencing in 97 colonic biopsies of 35 men. We used the food frequency questionnaire to assess daily consumption of nutrients, and the UPARSE and SILVA databases for operational taxonomic unit classification. The difference in bacterial diversity and taxonomic relative abundance were compared between low versus high consumption of these nutrients. False discover rate (FDR) adjusted value < 0.05 indicated statistical significance. The bacterial richness and composition differed significantly by the consumption of folate and B vitamins ( < 0.001). Compared with higher consumption, a lower consumption of these nutrients was associated with a lower abundance of (folate), (vitamin B2), and (vitamins B2, B6, and B12) but a higher abundance of (vitamin B2) (FDR values < 0.05). The community composition and structure of the colonic bacteria differed significantly by dietary consumption of folate and B vitamins.
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http://dx.doi.org/10.3390/nu11030613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6470629PMC
March 2019

Genome-wide identification and characterization of transfer RNA-derived small RNAs in Plasmodium falciparum.

Parasit Vectors 2019 Jan 15;12(1):36. Epub 2019 Jan 15.

Department of Microbiology and Parasitology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, 5# Dong Dan San Tiao, Beijing, 100005, People's Republic of China.

Background: Transfer RNA (tRNA)-derived fragments (tRFs) have been widely identified in nature, functioning in diverse biological and pathological situations. Yet, the presence of these small RNAs in Plasmodium spp. remains unknown. Systematic identification and characterization of tRFs is therefore highly needed to understand further their roles in Plasmodium parasites, particularly in the virulent Plasmodium falciparum parasite.

Results: Genome-wide small RNAs with sizes ranging from 18-30 nucleotides from P. falciparum were deep-sequenced via Illumina HiSeq 2000 technology. In-depth analysis revealed the presence of a vast number of small RNAs originating from tRNA-coding genes, responsible for 22.4% of the total reads as the second predominant group. Three P. falciparum-derived tRF types (ptRFs) were identified as 5'ptRFs, mid-ptRFs and 3'ptRFs. The majority (90%) of ptRFs were derived from tRNAs that coded eight amino acids: Pro, Phe, Asn, Gly, Cys, Gln, His and Ala. Stem-loop reverse transcription polymerase chain reaction further confirmed the presence of tRFs in the blood stages of P. falciparum. Four new motifs with an enriched G/C feature were determined at cleavage sites that might guide the generation of ptRFs.

Conclusions: To our knowledge, this is the first report of a genome-wide investigation of ptRFs from Plasmodium species. The identification of ptRFs reveals a complex small RNA system manipulated by the malaria parasite, and might promote research on the function of tRFs in the pathogenesis of Plasmodium infections.
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http://dx.doi.org/10.1186/s13071-019-3301-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6332904PMC
January 2019

Helicobacter pylori Infection and Gastroesophageal Reflux Disease-Barrett's Esophagus-Esophageal Adenocarcinoma Sequence: Reply From Authors.

Am J Gastroenterol 2018 11 17;113(11):1724-1725. Epub 2018 Oct 17.

Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA. Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA.

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http://dx.doi.org/10.1038/s41395-018-0356-5DOI Listing
November 2018

Anti-Hypertensive Medication Use, Soluble Receptor for Glycation End Products and Risk of Pancreatic Cancer in the Women's Health Initiative Study.

J Clin Med 2018 Aug 2;7(8). Epub 2018 Aug 2.

Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.

Pancreatic cancer is the fourth leading cause of cancer death. Soluble receptor for glycation end products (sRAGE), which is modulated by anti-hypertensive (HT) medications, has been inversely associated with pancreatic cancer. However, the association between commonly used anti-HT medications and risk of pancreatic cancer is unknown. A total of 145,551 postmenopausal women from the Women Health Initiative (WHI) Study were included in analysis. Use of angiotensin converting enzyme inhibitors (ACEi), β-blockers, calcium channel blockers (CCBs) and diuretics was ascertained at baseline (1993⁻1998). Baseline sRAGE levels were measured among a subset of 2104 participants using an immunoassay. Multivariable Cox proportional hazard regression model was performed to estimate hazard ratios (HRs) and its 95% confidence intervals (CIs) for pancreatic cancer in association with anti-HT medications. Increased risk of pancreatic cancer was found among users of short-acting CCB (HR = 1.66, 95% CI: 1.20⁻2.28) and long-term (≥3 years) users of short-acting CCB (HR = 2.07, 95% CI: 1.42⁻3.02) compared to users of other anti-HT medications. Average sRAGE levels were lower in short-acting CCB users than users of other anti-HT medications (1173 versus 1454 pg/mL, = 0.038). Non-statistically significant reduced risk of pancreatic cancer was found among users of β-blockers (HR = 0.80, 95% CI: 0.60⁻1.07). Average sRAGE levels were higher in β-blockers users than users of other anti-HT medications (1692 versus 1454 pg/mL, > 0.05). Future studies are warranted to confirm these findings and elucidate potential mechanisms by which anti-HT medications influence development of pancreatic cancer.
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http://dx.doi.org/10.3390/jcm7080197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111748PMC
August 2018

Helicobacter pylori Infection Is Associated With Reduced Risk of Barrett's Esophagus: An Analysis of the Barrett's and Esophageal Adenocarcinoma Consortium.

Am J Gastroenterol 2018 08 8;113(8):1148-1155. Epub 2018 Jun 8.

Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA. QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland. Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA. San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, USA. Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA. Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA. Barrett's Esophagus Program, Division of Gastroenterology Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.

Objectives: Epidemiological studies of Helicobacter pylori infection and risk of Barrett's esophagus (BE) have reported conflicting results. We examined the association between H. pylori infection and BE and sought to determine whether the association is mediated by gastroesophageal reflux disease (GERD) and to identify potential effect modifiers.

Methods: We used individual level data from 1308 patients with BE (cases), 1388 population-based controls, and 1775 GERD controls in the Barrett's and Esophageal Adenocarcinoma Consortium (BEACON). We estimated study-specific odds ratios (ORs) and 95% CIs using multivariable logistic regression models and obtained summary risk estimates using a random-effects meta-analytic approach. We examined potential effect modification by waist-to-hip ratio (WHR), body mass index (BMI), and smoking status by conducting stratified analyses.

Results: For comparisons with population-based controls, H. pylori infection was inversely associated with the risk of BE (adjusted OR = 0.44, 95% CI = 0.36-0.55), with no evidence of between-study heterogeneity (I = 0%). A stronger inverse association between H. pylori and BE was observed among individuals with the CagA-positive strain (P for interaction = 0.017). We found no evidence of interaction between WHR, BMI, smoking status, and H. pylori infection on the risk of BE. There was no association between H. pylori infection and BE for comparisons with GERD controls (OR = 0.96, 95% CI = 0.67-1.37; I = 48%).

Conclusions: This study provides the strongest evidence yet that H. pylori infection is strongly inversely associated with BE. This effect is probably mediated by a decrease in GERD in infected patients, since the protective effect disappears in patients with GERD symptoms.
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http://dx.doi.org/10.1038/s41395-018-0070-3DOI Listing
August 2018

Incidence of gastric cancer in the USA during 1999 to 2013: a 50-state analysis.

Int J Epidemiol 2018 Jun;47(3):966-975

Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine.

Background: The incidence of gastric cancer, while declining in many places worldwide, is characterized by considerable geographical variability. The USA has large racial, ethnic and regional variation; we collected data from all 50 states to better characterize recent changes in gastric cancer incidence nationwide.

Methods: Annual gastric cancer incidence rates from 1999 to 2013 were extracted from the United States Cancer Statistics (USCS) registry. Secular trends of gastric cancer incidence were examined overall and by sociodemographic factors and states. We used Joinpoint regression to compute annual percent change (APC) and average annual percent change (AAPC) and corresponding 95% confidence intervals (CIs). SEER 13 registries data were extracted to examine the secular trends by cardia and non-cardia gastric cancers.

Results: Overall gastric cancer incidence decreased until 2007 (APC = -1.55, 95% CI: -1.88, -1.21), and remained stable thereafter (APC = -0.32, 95% CI: -0.84, 0.20). However, rates increased among persons <50 years of age (AAPC = 0.89, 95% CI: 0.61, 1.16), especially among non-Hispanic white females and Hispanic females. Incidence of non-cardia gastric cancer increased among persons <50 years of age (AAPC = 0.69, 95% CI: -0.06, 1.44), whereas rates of gastric cardia cancer remained unchanged. States with rapid increases in high-risk population groups (e.g. Hispanic females aged <50), including California and Texas, had highest annual increases in gastric cancer incidence.

Conclusions: Divergent trends for gastric cancer incidence were observed in the USA. Incidence rates, particularly for non-cardia gastric cancer, were stable or increasing among persons aged  <50 years.
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http://dx.doi.org/10.1093/ije/dyy055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005108PMC
June 2018

Probabilistic Matching of Deidentified Data From a Trauma Registry and a Traumatic Brain Injury Model System Center: A Follow-up Validation Study.

Am J Phys Med Rehabil 2018 04;97(4):236-241

From the Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania (RGK, ZW, AKW); Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (RGK, ZW); Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, North Carolina (MN, JPN); Acute Care Trauma Surgery, Carolinas Healthcare, Charlotte, North Carolina (TTH); Department of Trauma, University of Pittsburgh, Pittsburgh, Pennsylvania (MRK, JLS); Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania (AKW); Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania (AKW); and Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania (AKW).

In a previous study, individuals from a single Traumatic Brain Injury Model Systems and trauma center were matched using a novel probabilistic matching algorithm. The Traumatic Brain Injury Model Systems is a multicenter prospective cohort study containing more than 14,000 participants with traumatic brain injury, following them from inpatient rehabilitation to the community over the remainder of their lifetime. The National Trauma Databank is the largest aggregation of trauma data in the United States, including more than 6 million records. Linking these two databases offers a broad range of opportunities to explore research questions not otherwise possible. Our objective was to refine and validate the previous protocol at another independent center. An algorithm generation and validation data set were created, and potential matches were blocked by age, sex, and year of injury; total probabilistic weight was calculated based on of 12 common data fields. Validity metrics were calculated using a minimum probabilistic weight of 3. The positive predictive value was 98.2% and 97.4% and sensitivity was 74.1% and 76.3%, in the algorithm generation and validation set, respectively. These metrics were similar to the previous study. Future work will apply the refined probabilistic matching algorithm to the Traumatic Brain Injury Model Systems and the National Trauma Databank to generate a merged data set for clinical traumatic brain injury research use.
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http://dx.doi.org/10.1097/PHM.0000000000000838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863735PMC
April 2018

Gongylonema pulchrum infection in the human oral cavity: A case report and literature review.

Oral Surg Oral Med Oral Pathol Oral Radiol 2018 03 8;125(3):e49-e53. Epub 2017 Dec 8.

Department of Oral Medicine, School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University, Beijing, China. Electronic address:

Gongylonema infection is a zoonotic disease occurring throughout the world and is mainly caused by consumption of contaminated water and raw food. Adult Gongylonema worms can exist as parasites in the human body for up to 10 years and cause symptoms of local irritation in the oral cavity, esophagus, and pharynx. Herein, we report a rare case in which live Gongylonema pulchrum was detected and extracted from the oral cavity of a woman. The pathogen was confirmed as G. pulchrum on the basis of microscopic examination and morphologic analysis. The patient's symptoms resolved immediately after surgical removal of the parasite, and the patient has been advised not to drink water that has not been boiled and to avoid consuming unwashed raw vegetables.
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http://dx.doi.org/10.1016/j.oooo.2017.11.019DOI Listing
March 2018

Telomere length and risk of developing gastric adenocarcinoma: The Singapore Chinese Health Study.

Gastric Cancer 2018 07 7;21(4):598-605. Epub 2017 Dec 7.

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Background: Extreme telomere length has been previously reported to be associated with increased risk of gastric cancer. However, evidence from prospective studies on a relative large sample size with long-term follow-up to further corroborate previous study findings is meager.

Methods: The association between peripheral blood leukocyte telomere length and risk of gastric adenocarcinoma was prospectively examined in a cohort of 26,540 middle-aged or older Chinese nested in the Singapore Chinese Health Study. Telomere length was determined using a validated qPCR-based method. The Cox proportional regression method was used to estimate hazard ratio (HR) and its 95% confidence interval (CI) of gastric adenocarcinoma associated with telomere length after adjustment for potential confounders. Restricted cubic spline analysis was applied to assess the nonlinear relationship between telomere length and gastric cancer risk.

Results: A U-shaped association was found between telomere length and risk of gastric adenocarcinoma (P  = 0.020). Compared with the second quintile of telomere length, a statistically significant higher risk of gastric adenocarcinoma was associated with either the lowest quintile (HR = 1.63, 95% CI, 1.07-2.47) or the highest quintile (HR = 1.55, 95% CI, 0.97-2.47) of telomere length. This U-shaped relationship was more apparent in men and younger individuals.

Conclusions: This is the first prospective study demonstrating a higher risk of gastric cancer to be associated with either extremely short or extremely long telomere length. Short and long telomere length may function differently in the early and late stages of gastric carcinogenesis.
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http://dx.doi.org/10.1007/s10120-017-0783-9DOI Listing
July 2018

Red blood cells release microparticles containing human argonaute 2 and miRNAs to target genes of Plasmodium falciparum.

Emerg Microbes Infect 2017 Aug 23;6(8):e75. Epub 2017 Aug 23.

Department of Microbiology and Parasitology, Institute of Basic Medical Sciences/Chinese Academy of Medical Sciences, School of Basic Medicine/Peking Union Medical College, Beijing 100005, China.

Red blood cells (RBCs) are known to function as a refuge for providing food resources and as a shelter against the host's immune system after malaria parasite (Plasmodium) infection. Recent studies have reported significant production of extracellular vesicles (microparticles, MPs) in the circulation of malaria patients. However, it is unclear how these extracellular vesicles are generated and what their biological functions are. In this study, we isolated the MPs from a culture medium of normal RBCs and malaria parasite-infected RBCs (iRBCs), compared their quantity and origins, and profiled their miRNAs by deep sequencing. We found a much larger number of MPs released in the culture of iRBCs than in the culture of normal RBCs. Further investigation indicated that, in these MPs, human argonaute 2 (hAgo2) was found to bind to hundreds of miRNAs. These hAgo2-miRNA complexes were transferred into the parasites, and the expression of an essential malaria antigen, PfEMP1, was downregulated by miR-451/140 through its binding to the A and B subgroups of var genes, a family of genes encoding PfEMP1. Our data suggest for the first time that, through the release of MPs, mature RBCs present an innate resistance to malaria infection. These studies also shed new light on the reason why RBCs' genetic mutation occurs mainly in populations living in intensive malaria endemic areas and on the possibility of using miRNAs as novel medicines for malaria patients.
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http://dx.doi.org/10.1038/emi.2017.63DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583671PMC
August 2017

Cerebrospinal Fluid Cortisol Mediates Brain-Derived Neurotrophic Factor Relationships to Mortality after Severe TBI: A Prospective Cohort Study.

Front Mol Neurosci 2017 9;10:44. Epub 2017 Mar 9.

Department of Physical Medicine and Rehabilitation, University of PittsburghPittsburgh, PA, USA; Safar Center for Resuscitation Research, University of PittsburghPittsburgh, PA, USA; Department of Neuroscience, University of PittsburghPittsburgh, PA, USA; Center for Neuroscience, University of PittsburghPittsburgh, PA, USA.

Distinct regulatory signaling mechanisms exist between cortisol and brain derived neurotrophic factor (BDNF) that may influence secondary injury cascades associated with traumatic brain injury (TBI) and predict outcome. We investigated concurrent CSF BDNF and cortisol relationships in 117 patients sampled days 0-6 after severe TBI while accounting for BDNF genetics and age. We also determined associations between CSF BDNF and cortisol with 6-month mortality. variants, rs6265 and rs7124442, were used to create a gene risk score (GRS) in reference to previously published hypothesized risk for mortality in "younger patients" (<48 years) and hypothesized BDNF production/secretion capacity with these variants. Group based trajectory analysis (TRAJ) was used to create two cortisol groups (high and low trajectories). A Bayesian estimation approach informed the mediation models. Results show CSF BDNF predicted patient cortisol TRAJ group ( = 0.001). Also, GRS moderated BDNF associations with cortisol TRAJ group. Additionally, cortisol TRAJ predicted 6-month mortality ( = 0.001). In a mediation analysis, BDNF predicted mortality, with cortisol acting as the mediator ( = 0.011), yielding a mediation percentage of 29.92%. Mediation effects increased to 45.45% among younger patients. A BDNFGRS interaction predicted mortality in younger patients ( = 0.004). Thus, we conclude 6-month mortality after severe TBI can be predicted through a mediation model with CSF cortisol and BDNF, suggesting a regulatory role for cortisol with BDNF's contribution to TBI pathophysiology and mortality, particularly among younger individuals with severe TBI. Based on the literature, cortisol modulated BDNF effects on mortality after TBI may be related to known hormone and neurotrophin relationships to neurological injury severity and autonomic nervous system imbalance.
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http://dx.doi.org/10.3389/fnmol.2017.00044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343043PMC
March 2017

Composite protective lifestyle factors and risk of developing gastric adenocarcinoma: the Singapore Chinese Health Study.

Br J Cancer 2017 Feb 26;116(5):679-687. Epub 2017 Jan 26.

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261, USA.

Background: Incidence of gastric cancer is the highest in Eastern Asia. Multiple modifiable lifestyle factors have been identified as risk factors for gastric cancer. However, their aggregated effect on the risk of gastric cancer has not been examined among populations with high prevalence of Helicobacter pylori.

Methods: A study was conducted to examine the association between multiple lifestyle factors together and the risk of developing gastric adenocarcinoma in the Singapore Chinese Health Study, a prospective cohort of 63 257 men and women between 45 and 74 years enroled during 1993-1998. Composite score of cigarette smoking, alcohol consumption, obesity, dietary pattern, and sodium intake at baseline was assessed with hazard ratio (HR) and 95% confidence interval (CI) of gastric adenocarcinoma using Cox regression method.

Results: Higher healthy composite lifestyle scores were significantly associated with reduced risk of gastric adenocarcinoma in a dose-dependent manner. Hazard ratios (95% CIs) for total, cardia, and non-cardia gastric adenocarcinoma for the highest (score 5) vs lowest composite score (score 0/1/2) were 0.42 (0.31-0.57), 0.22 (0.10-0.47), and 0.55 (0.39-0.78), respectively (all P<0.001). These lifestyles together accounted for 48% of total gastric adenocarcinoma cases in the study population. The inverse association was observed in both genders, and remained after exclusion of first 5 years of follow-up.

Conclusions: The inverse association between the aggregated healthy lifestyle factors and the risk of gastric adenocarcinoma is in dose-dependent manner in this highly H. pylori-exposed population. These lifestyle factors together may account for up to half of disease burden in this study population.
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http://dx.doi.org/10.1038/bjc.2017.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344300PMC
February 2017

Epidemiology of Comorbid Conditions Among Adults 50 Years and Older With Traumatic Brain Injury.

J Head Trauma Rehabil 2018 Jan/Feb;33(1):15-24

University of Pittsburgh Department of Physical Medicine and Rehabilitation, Pittsburgh, Pennsylvania (Messrs Kumar and Wang and Drs Juengst, Arenth, and Wagner); University of Pittsburgh Department of Epidemiology, Pittsburgh, Pennsylvania (Messrs Kumar and Wang); Icahn School of Medicine at Mount Sinai, New York, NY (Dr Dams-O'Connor); University of Washington Department of Rehabilitation Medicine, Seattle (Dr Dikmen); Northeastern University Department of Communication Sciences and Disorders, Boston, Massachusetts (Dr O'Neil-Pirozzi); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts (Dr O'Neil-Pirozzi); Baylor Scott & White Health Medical Center - Plano, TX; Baylor Institute for Rehabilitation, Dallas, TX (Dr Dahdah); Indiana University School of Medicine Department of Physical Medicine and Rehabilitation, Indianapolis, Indiana (Dr Hammond); University of Miami Department of Physical Medicine and Rehabilitation, Miami, Florida (Dr Felix); and University of Pittsburgh Center for Neuroscience, University of Pittsburgh Safar Center for Resuscitation Research, and University of Pittsburgh Department of Neuroscience, Pittsburgh, Pennsylvania (Dr Wagner).

Objectives: Aging individuals with traumatic brain injury (TBI) experience multiple comorbidities that can affect recovery from injury. The objective of this study was to describe the most commonly co-occurring comorbid conditions among adults 50 years and older with TBI.

Setting: Level I Trauma centers.

Participants: Adults 50 years and older with moderate/severe TBI enrolled in the TBI-Model Systems (TBI-MS) from 2007 to 2014 (n = 2134).

Design: A TBI-MS prospective cohort study.

Main Measures: International Classification of Disease-9th Revision codes collapsed into 45 comorbidity categories. Comorbidity prevalence estimates and trend analyses were conducted by age strata (50-54, 55-64, 65-74, 75-84, ≥85 years). A dimension reduction method, Treelet Transform, classified clusters of comorbidities that tended to co-occur.

Results: The 3 most commonly occurring comorbid categories were hypertensive disease (52.6/100 persons), other diseases of the respiratory system (51.8/100 persons), and fluid component imbalances (43.7/100 persons). Treelet Transform classified 3 clusters of comorbid codes, broadly classified as (1) acute medical diseases/infections, (2) chronic conditions, and (3) substance abuse disorders.

Conclusion: This study provides valuable insight into comorbid conditions that co-occur among adults 50 years and older with TBI and provides a foundation for future studies to explore how specific comorbidities affect TBI recovery.
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http://dx.doi.org/10.1097/HTR.0000000000000273DOI Listing
August 2019

Reproductive factors, hormone use and gastric cancer risk: The Singapore Chinese Health Study.

Int J Cancer 2016 Jun 10;138(12):2837-45. Epub 2016 Mar 10.

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.

Gastric cancer incidence varies greatly worldwide, but is consistently twice as high in men than in women. The hormone-related factors hypothesized to be associated with lower risk of gastric cancer in women have not been fully explored in populations with a high background risk of gastric cancer. The Singapore Chinese Health Study (SCHS) is a prospective cohort study in which 34,022 of the participants enrolled between 1993 and 1998 were women between 45 and 74 years of age. Information on reproductive histories, hormone replacement therapy (HRT) and oral contraceptive (OC) use was collected through in-person interviews at baseline. As of December 31, 2013, 269 incident gastric cancer cases were identified. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to evaluate gastric cancer risk associations. Older age at natural menopause (≥55 versus <45 years: HR = 0.50, 95% CI: 0.25-0.99), type of menopause (other versus natural: HR = 0.48, 95% CI: 0.27-0.87) and greater years of menstrual cycling (fourth versus first quartile: HR = 0.67, 95% CI: 0.46-0.96) were associated with a decreased risk of gastric cancer. Ever use of OCs and HRT was also associated with reduced risk of gastric cancer; the multivariable-adjusted HRs (95% CIs) were 0.40 (0.17-0.90) for use of HRT >3 years and 0.67 (0.47-0.94) for ever use of OCs, compared with never use. Reproductive factors associated with a longer window of fertility and the use of exogenous hormones were shown to reduce gastric cancer development in a cohort of Chinese women with a high background risk of gastric cancer.
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http://dx.doi.org/10.1002/ijc.30024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5912157PMC
June 2016

Short-term complete submergence of rice at the tillering stage increases yield.

PLoS One 2015 22;10(5):e0127982. Epub 2015 May 22.

School of Hydraulic, Energy and Power Engineering, Yangzhou University, Yangzhou 225009, China.

Flooding is a major threat to agricultural production. Most studies have focused on the lower water storage limit in rice fields, whereas few studies have examined the upper water storage limit. This study aimed to explore the effect of waterlogging at the rice tillering stage on rice growth and yield. The early-ripening late japonica variety Yangjing 4227 was selected for this study. The treatments included different submergence depths (submergence depth/plant height: 1/2 (waist submergence), 2/3 (neck submergence), and 1/1 (complete submergence)) and durations (1, 3, and 5 d). The control group was treated with the conventional alternation of drying and wetting. The effects of waterlogging at the tillering stage on root characteristics, dry matter production, nitrogen and phosphorus accumulation, yield, yield components, and 1-aminocyclopropane-1-carboxylic acid synthase (ACS) gene expression were explored. Compared with the control group, the 1/1 group showed significant increases in yield, seed-setting rate, photosynthetically efficient leaf area, and OS-ACS3 gene expression after 1 d of submergence. The grain number per panicle, dry weight of the aboveground and belowground parts, and number of adventitious roots also increased. Correlation analysis revealed a significant positive correlation between the panicle number and nitrogen content; however, no significant correlation was found for phosphorus content. If a decrease in rice yield of less than 10% is acceptable, half, 2/3, and complete submergence of the plants can be performed at the tillering stage for 1-3 d; this treatment will increase the space available for rice field water management/control and will improve rainfall resource utilization.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127982PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441388PMC
April 2016

Protective effect of tetramethylpyrazine on myocardial ischemia-reperfusion injury.

Evid Based Complement Alternat Med 2014 24;2014:107501. Epub 2014 Jul 24.

Department of Cardiology, Traditional Chinese Medicine Hospital of Wujin District, Affiliated Hospital of Nanjing University of Chinese Medicine, Changzhou 213161, China.

Myocardial ischemia-reperfusion injury (MIRI) is a common pathological and physiological phenomenon. Tetramethylpyrazine is the extract of the traditional Chinese medicine Chuanxiong, which can exert protective effects on MIRI in multiple ways. This paper reviewed the current research progress and evidence about the cardiovascular effects of tetramethylpyrazine, which included protecting mitochondria and improving energy metabolism, scavenging oxygen free radicals (OFRs) to inhibit lipid peroxidation, attenuating calcium (Ca(2+)) overload and maintaining Ca(2+) homeostasis in cells, inhibiting apoptosis and protecting myocardial cells, interfering with the inflammatory reaction and mitigating cell injury, interfering with cell signaling pathways, and improving function of endothelial cells and protecting myocardial cells. However, further rigorously designed randomized controlled trials are warranted.
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http://dx.doi.org/10.1155/2014/107501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4135172PMC
August 2014
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