• Ambulatory care management of 69 patients with acute severe ulcerative colitis in comparison to 695 inpatients: Insights from a multicentre UK cohort study

      Sebastian, Shaji; Patel, Kamal V; Segal, Jonathan P; Subramanian, Sreedhar; Conley, Thomas E; Gonzalez, Haidee A; Kent, Alexandra; Saifuddin, Aamir; Hicks, Lucy; Mehta, Shameer; et al. (BMJ, 2022-01-31)
      Introduction Acute severe ulcerative colitis (ASUC) traditionally requires inpatient hospital management for intravenous therapies and/or colectomy. Ambulatory ASUC care has not yet been evaluated in large cohorts. Aims We used data from PROTECT, a UK multicentre observational COVID-19 inflammatory bowel disease study, to report the extent, safety and effectiveness of ASUC ambulatory pathways. Methods Adults (≥18 years old) meeting Truelove and Witts criteria between 1 January 2019-1 June 2019 and 1 March 2020-30 June 2020 were recruited to PROTECT. We used demographic, disease phenotype, treatment outcomes and 3-month follow-up data. Primary outcome was rate of colectomy during the index ASUC episode. Secondary outcomes included corticosteroid response, time to and rate of rescue or primary induction therapy, response to rescue or primary induction therapy, time to colectomy, mortality, duration of inpatient treatment and hospital readmission and colectomy within 3 months of index flare. We compared outcomes in three cohorts: (1) patients treated entirely in inpatient setting; ambulatory patients subdivided into; (2) patients managed as ambulatory from diagnosis and (3) patients hospitalised and subsequently discharged to ambulatory care for continued intravenous steroids. Results 37% (22/60) participating hospitals used ambulatory pathways. Of 764 eligible patients, 695 (91%) patients received entirely inpatient care, 15 (2%) patients were managed as ambulatory from diagnosis and 54 (7%) patients were discharged to ambulatory pathways. Aside from younger age in patients treated as ambulatory from diagnosis, no significant differences in disease or patient phenotype were observed. The rate of colectomy (15.0% (104/695) vs 13.3% (2/15) vs 13.0% (7/54), respectively, p=0.96) and secondary outcomes were similar among all three cohorts. Stool culture and flexible sigmoidoscopy were less frequently performed in ambulatory cohorts. Forty per cent of patients treated as ambulatory from diagnosis required subsequent hospital admission. Conclusions In a post hoc analysis of one of the largest ASUC cohorts collected to date, we report an emerging UK ambulatory practice which challenges treatment paradigms. However, our analysis remains underpowered to detect key outcome measures and further studies exploring clinical and cost-effectiveness as well as patient and physician acceptability are needed. Trial registration number NCT04411784.
    • Associations of socioeconomic status and physical activity with obesity measures in rural Chinese adults

      Pan, M; Tu, R; Gu, J; Li, R; Liu, X; Chen, R; Yu, S; Wang, X; Mao, Z; Huo, W; et al. (Frontiers Media, 2021-01-08)
      Background: Although independent association of socioeconomic status (SES) or physical activity (PA) with obesity has been well-documented in urban settings, their independent and joint associations on obesity measures are limited in rural regions. Methods: Almost 38,000 (n = 37,922) individuals were included from the Henan Rural Cohort Study. The International Physical Activity Questionnaire (IPAQ) was used to evaluate PA. Obesity was reflected by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body fat percentage (BFP), and visceral fat index (VFI). The independent and interactive effects of SES and PA on obesity were analyzed by logistic regression models and generalized linear regression models, respectively. Results: Compared with high education level, the OR (95%CI) of obesity defined by BMI with low education level was 1.466 (1.337, 1.608), 1.064 (0.924, 1.225), and 1.853 (1.625, 2.114) in total population, men and women, respectively. Besides, the OR (95%CI) of obesity defined by BMI associated with per capita monthly income were 1.089 (1.015, 1.170), 1.192 (1.055, 1.347), 1.038 (0.951, 1.133) in total population, men and women, respectively. Similar results had been observed in other obesity measures. Negative interactive association of low education level and PA on obesity measures were observed only in women (all P < 0.05). Conclusions: This study suggests that women are more susceptible to obesity concerning low SES and that adequate PA may be a potential target for mitigating the negative effect of low SES on obesity in women. Clinical Trial Registration: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699) http://www.chictr.org.cn/showproj.aspx?proj=11375.
    • Associations of solid fuel use and ambient air pollution with estimated 10-year atherosclerotic cardiovascular disease risk

      Pan, M; Li, S; Tu, R; Li, R; Liu, X; Chen, Ruoling; Yu, S; Mao, Z; Huo, W; Yin, S; et al. (Elsevier, 2021-09-09)
      Background Although exposure to ambient air pollution (AAP) increases the risk for arteriosclerotic cardiovascular disease (ASCVD), evidence on the association of solid fuel use with ASCVD and its association modified by ambient air pollution remains limited. Methods A total of 16,779 adults were derived from the Henan Rural Cohort Study. Concentrations of ambient air pollutants (PM1, PM2.5, PM10, and NO2) were estimated by a spatiotemporal model based on satellites data. Solid fuel use was assessed by a self-reported questionnaire. The associations of solid fuel use with high 10-year ASCVD risk and the modified association by exposure to air pollutants were explored using logistic regression models. Results There were positive associations of AAP exposure with high 10-year ASCVD risk among individuals with self-cooking. The joint associations between high AAP exposures and solid fuel use with high 10-year ASCVD risk were found. Compared to clean fuel user with low PM2.5 exposure, the odds ratios (ORs) and 95% confidence intervals (CIs) of high 10-year ASCVD risk was 1.25 (1.09, 1.42) for solid fuel user with low PM2.5 exposure, 1.93 (1.75, 2.12) for clean fuel user with high PM2.5 exposure, and 3.08 (2.67, 3.54) for solid fuel user with high PM2.5 exposure, respectively. Their additive effect on high 10-year ASCVD risk was observed (relative excess risk due to interaction (RERI): 0.90 (95 %CI: 0.50, 1.30), attributable proportion due to interaction (AP): 0.29 (95 %CI: 0.19, 0.40), and synergy index (SI): 1.77 (95 %CI: 1.38, 2.26)). Conclusion This study showed a synergistic effect of AAP and household air pollution reflected by solid fuel use on high 10-year ASCVD risk, suggesting that reducing solid cooking fuels and controlling air pollution may have a joint effect on public health improvement.
    • Cohort profile: Anhui Maternal-Child Health Study in China

      Yin, Jiaqian; Cao, Yunxia; Liang, Chunmei; Peng, Xiaoqing; Xu, Xiaofeng; Zhou, Weiju; Khutan, Ranjit; Tao, Fangbiao; Chen, Ruoling; Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China. (BMJ, 2022-06-28)
      Purpose The Anhui Maternal-Child Health Study (AMCHS) aims to examine determinants of reproduction, pregnancy and postpartum maternal and child health outcomes in Chinese women who received assisted reproductive technology (ART). Study design and participants AMCHS is an ongoing cohort study starting from May 2017. AMCHS recruits participants from all couples who sought ART treatment in the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China. The participants are interviewed to document baseline sociodemography, lifestyles, dietary intake and environmental exposure. Their clinical characteristics are obtained from hospital records. Samples of blood, follicular fluid and semen are collected at the clinic. Participants receive a standard long pituitary downregulation or a short protocol with an antagonist for the treatment. They are followed up from preconception to delivery, or discontinuation of ART treatment. Details of their children's health are documented through a questionnaire focusing on developmental status and anthropometry measurement. Findings to date Until April 2021, AMCHS had recruited 2042 couples in the study. 111 women withdrew from the study and 19 failed to retrieve oocytes. Among the 1475 confirmed pregnancies, 146 had miscarriages or terminated their pregnancies, 9 had stillbirths and 263 were ongoing pregnancies. The implantation failure increased with maternal age; adjusted OR was 1.43 (95% CI 1.16 to 1.77) in the age of 31-35 years, 1.97 (95% CI 1.46 to 2.66) in 35-39 years and 6.52 (95% CI 3.35 to 12.68) in ≥40 years compared with those aged 20-30 years. Among the 1057 couples with successful ART who were followed up for delivering babies, 576 had their children examined at age 30-42 days, 459 at 6 months and 375 at 12 months. Future plans The AMCHS will identify comprehensive risk factors for poor ART outcomes and explore potential interaction effects of multiple factors including sociopsychological aspects of environmental exposure, dietary intake and genetics on maternal and child health.
    • Development of an accelerometer-based multivariate model to predict free-living energy expenditure in a large military cohort.

      Horner, Fleur; Bilzon, James L; Rayson, Mark; Blacker, Sam; Richmond, Victoria; Carter, James; Wright, Anthony; Nevill, Alan M. (2013)
      This study developed a multivariate model to predict free-living energy expenditure (EE) in independent military cohorts. Two hundred and eighty-eight individuals (20.6 ± 3.9 years, 67.9 ± 12.0 kg, 1.71 ± 0.10 m) from 10 cohorts wore accelerometers during observation periods of 7 or 10 days. Accelerometer counts (PAC) were recorded at 1-minute epochs. Total energy expenditure (TEE) and physical activity energy expenditure (PAEE) were derived using the doubly labelled water technique. Data were reduced to n = 155 based on wear-time. Associations between PAC and EE were assessed using allometric modelling. Models were derived using multiple log-linear regression analysis and gender differences assessed using analysis of covariance. In all models PAC, height and body mass were related to TEE (P < 0.01). For models predicting TEE (r (2) = 0.65, SE = 462 kcal · d(-1) (13.0%)), PAC explained 4% of the variance. For models predicting PAEE (r (2) = 0.41, SE = 490 kcal · d(-1) (32.0%)), PAC accounted for 6% of the variance. Accelerometry increases the accuracy of EE estimation in military populations. However, the unique nature of military life means accurate prediction of individual free-living EE is highly dependent on anthropometric measurements.
    • Diode laser cyclophotocoagulation: role in the management of refractory pediatric glaucomas.

      Kirwan, James F.; Shah, Peter; Khaw, Peng T. (Elsevier Science Direct, 2002)
      PURPOSE: To report the efficacy and complications of diode laser cyclophotocoagulation (cyclodiode) in the management of refractory pediatric glaucomas. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Pediatric patients with uncontrolled glaucoma. Seventy-seven eyes of 61 patients underwent cyclodiode. Mean age was 7.4 years (range, 0.4-17 years). MAIN OUTCOME MEASURES: Intraocular pressure (IOP), visual acuity, complications. RESULTS: Diagnoses included aphakic glaucoma, congenital glaucoma, juvenile chronic arthritis, aniridia, anterior segment dysgenesis, and Sturge-Weber syndrome. Sixty percent of eyes were aphakic, and 64% had undergone at least one previous surgical procedure for glaucoma. Patients underwent a mean of 2.3 treatment sessions per eye (maximum, 8 sessions). Mean pretreatment IOP was 32.0 mmHg. After one treatment session, 62% had a clinically useful reduction in IOP (<22 mmHg or by 30%), but this had fallen to 37% by 12 months. With repeat cyclodiode, 72% had a clinically useful reduction in IOP for a year or more (mean, 8.4-month interval between treatments). Aphakic eyes had a more sustained IOP reduction (P < 0.01 log rank test). Of treatment failures, 13% had no useful IOP response, and three eyes developed subsequent retinal detachment and loss of vision. No other eyes lost vision because of cyclodiode-related complications. In 5.5% of the treatment sessions there was a significant posttreatment inflammatory episode. Cyclodiode treatment did not enable a reduction in the number of medications. CONCLUSIONS: With repeated treatment, cyclodiode can provide effective control of IOP. However, the success rate is lower than with adults, and younger eyes may recover from treatment more rapidly. Although response may be temporary, cyclodiode has a lower rate of severe adverse effects than surgical modalities and has roles as a temporizing measure, as an adjunct to surgery, or in managing selected patients in whom surgery is undesirable because of a high risk of surgical complications.
    • Enhancing the efficacy of the 20 m multistage shuttle run test

      Flouris, Andreas D.; Metsios, Giorgos S.; Koutedakis, Yiannis (BMJ Publishing Group Ltd, 2005)
      OBJECTIVE: Maximal oxygen uptake (Vo(2max)) of 44 ml kg(-1) min(-1) is an accepted criterion (Vo(2CR)) below which health and fitness for young male adults may be compromised. New algorithms validated for Vo(2CR) screening using the 20 m multistage shuttle run test (20mMST) were developed. METHODS: Vo(2max) was assessed in 110 males using a stationary gas analyser in a treadmill test (TT) and in 40 of these subjects using a portable gas analyser in the 20mMST. Vo(2max) predicted from the 20mMST in 70 subjects was used for cross validation. Two equations predicting Vo(2max) during 20mMST (EQ(MST)) and TT (EQ(TT)) were developed. RESULTS: Significant energy cost variance (EC(V)) was detected between TT and 20mMST (p<0.001), correlated significantly with subject height, and was a significant predictor of Vo(2max) differences between TT and 20mMST. The r(2) of EQ(MST) was 0.92 (p<0.001). Predicted Vo(2max) values from EQ(MST) correlated with directly measured 20mMST Vo(2max) at r = 0.96 (p<0.001). ANOVA detected no mean difference (p>0.05) between predicted and measured values. Prevalence of low fitness based on Vo(2CR) was 0.37. McNemar chi(2) indicated significant differences in sensitivity (p<0.001) and specificity (p<0.05) between the original 20mMST equation (EQ(LEG)) and EQ(TT), regarding Vo(2CR) screening. Cohen's kappa demonstrated higher agreement with TT Vo(2max) for EQ(TT) (p<0.001) than EQ(LEG) (p<0.05). TT Vo(2max) correlated with the end result of both EQ(LEG) and EQ(TT) at r = 0.75 (p<0.001). Unlike EQ(TT) (p>0.05), mean predicted Vo(2max) from EQ(LEG) was significantly higher compared to TT Vo(2max) (p<0.001). CONCLUSION: These algorithms increase the efficacy of 20mMST to accurately evaluate aspects of health and fitness.
    • Impact of air pollution on cognitive impairment in older people: A cohort study in rural and suburban China

      He, Fan; Tang, JJ; Zhang, Tao; Lin, J; Li, F; Gu, X; Chen, Ruoling; Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China. (IOS Press, 2020-10-13)
      Background: The impact of air pollution on cognitive impairment in older people has not been fully understood. It is unclear which air pollutants are the culprit. Objective: We assessed the associations of six air pollutants and air quality index (AQI) with cognitive impairment. Methods: We examined 7,311 participants aged ≥60 years from the ZJMPHS cohort in China. They were interviewed for baseline socio-demographic and disease risk factors in 2014, and re-interviewed in 2015 and 2016, respectively. The presence of cognitive impairment was determined by the Chinese version of the Mini-Mental State Examination. Daily area-level data monitored for air pollution during 2013-2015 was then examined for associations with cognitive impairment in logistic regression models. Results: Over the two years follow-up, 1,652 participants developed cognitive impairment, of which 917 were severe cases. Continuous air pollution data showed the risk of cognitive impairment increased with exposure to PM2.5 (fully adjusted odds ratio [aOR] 1.04, 95% CI 1.01-1.08), PM10 (1.03, 1.001-1.06), and SO2 (1.04, 1.01-1.08), but not with NO2, CO, O3, and AQI. Categorized data analysis for low, middle, and high level exposure demonstrated that the aOR increased with PM2.5 and AQI, somehow with PM10 and CO, but not significantly with SO2 and NO2, and decreased with O3. The patterns for these associations with severe cognitive impairment were stronger. Conclusion: Lowering PM2.5, PM10, SO2, and CO level could reduce the risk of cognitive impairment in older Chinese. Strategies to target most important air pollutants should be an integral component of cognitive interventions.
    • Impacts of undetected and inadequately treated hypertension on incident stroke in China

      Han, Thang S.; Wang, Harry H.X.; Wei, Li; Pan, Yuesong; Ma, Ying; Wang, Yu; Wang, Jiaji; Hu, Zhi; Sharma, Pankaj; Chen, Ruoling; et al. (BMJ, 2017-10-08)
      © Article author(s) 2017. Objectives China carries the greatest burden of stroke given its largest volume of people with hypertension. This study assessed the impacts of suboptimal controls of hypertension on incident stroke and projected the number of patients with stroke saved after the control of blood pressure improved in population. Setting Anhui, China. Participants We examined data from the Anhui cohort of 2001-2011, consisting of 3336 participants aged ≥60 years who were randomly recruited from the urban and rural Anhui. 2852 participants (89.2%) had hypertensive status measured and no stroke at baseline, and were followed up until 2011 in three surveys using a standard method of interview. Results At baseline, 1646 participants (57.7%) were identified to have hypertension, among whom 912 (55.4%) were previously undetected, 115 (7.0%) detected but not treated, 452 (27.5%) treated but not controlled and only 127 (7.7%) controlled. During the 10-year follow-up, 211 incident stroke cases (12.8/1000 person-years) occurred. Compared with normotensive individuals at baseline, multivariate adjusted HR for having stroke increased in those with undetected hypertension by 1.63 (95%CI 1.15 to 2.32), untreated by 2.21 (1.26-3.85) and uncontrolled hypertension by 3.34 (2.28-4.88), but did not differ from those with controlled hypertension (1.34; 0.60-2.99). Based on a two-fold increase in the detection and management of current levels of hypertension and algorithms on the current situation in China, approximately 250 000 incident stroke cases could be prevented annually. Conclusions In China, hypertension is frequently undetected or inadequately treated. With appropriate management of hypertension, a substantial number of people could be saved form stroke.
    • Instruments to assess secondhand smoke exposure in large cohorts of never smokers: The smoke scales

      Misailidi, M; Tzatzarakis, MN; Kavvalakis, MP; Koutedakis, Y; Tsatsakis, AM; Flouris, AD; FAME Laboratory, Centre for Research and Technology Hellas, Trikala, Greece ; Department of Exercise Sciences, University of Thessaly, Trikala, Greece ; Regional Directorate of Primary and Secondary Education of Western Greece, Patras, Greece. (Public Library of Science (PLoS), 2014-01-21)
      The objectives of this study were to: (i) to develop questionnaires that can identify never-smoking children and adults experiencing increased exposure to secondhand smoke (SHS+), (ii) to determine their validity against hair nicotine, and (iii) assess their reliability. A sample of 191 children (85 males; 106 females; 7-18 years) and 95 adult (23 males; 72 females; 18- 62 years) never-smokers consented to hair nicotine analysis and answered a large number of questions assessing all sources of SHS. A randomly-selected 30% answered the questions again after 20-30 days. Prevalence of SHS+ in children and adults was 0.52±0.07 and 0.67±0.10, respectively (p<0.05). The Smoke Scale for Children (SS-C) and the Smoke Scale for Adults (SS-A) were developed via factor analysis and included nine questions each. Positivity criteria for SS-C and SS-A via receiver operating characteristics curve analysis were identified at >16.5 and >16, respectively. Significant Kappa agreement (p<0.05) was confirmed when comparing the SS-C and SS-A to hair nicotine concentration. Reliability analyses demonstrated that the SS-C and SS-A scores obtained on two different days are highly correlated (p<0.001) and not significantly different (p>0.05). Area under the curve and McNemar's Chi-square showed no pair-wise differences in sensitivity and specificity at the cutoff point between the two different days for SS-C and SS-A (p>0.05). We conclude that the SS-C and the SS-A represent valid, reliable, practical, and inexpensive instruments to identify children and adult never-smokers exposed to increased SHS. Future research should aim to further increase the validity of the two questionnaires. © 2014 Misailidi et al.
    • Long-term exposure to medium-dose glucocorticoid therapy associates with hypertension in patients with rheumatoid arthritis

      Panoulas, Vasileios F.; Douglas, Karen M. J.; Milionis, Haralampos J.; Metsios, Giorgos S.; Stavropoulos-Kalinoglou, Antonios; Nightingale, Peter; Kita, Marina D.; Elisaf, Moses S.; Kitas, George D. (Oxford University Press, 2008)
      OBJECTIVE: Rheumatoid arthritis (RA) associates with increased cardiovascular morbidity and mortality that is due to both traditional and novel cardiovascular risk factors. Hypertension (HT), one of the most common risk factors for cardiovascular disease, is highly prevalent in RA. The effects of long-term glucocorticoid (GC) therapy on blood pressure have not been established yet. This study examined whether GC exposure associates with HT in patients with RA. METHODS: Four hundred consecutive RA patients with detailed clinical and laboratory assessments were categorized into three groups according to GC exposure: no or limited exposure (N/L-E); a low-dose (< 7.5 mg) long-term exposure (LD/LT-E); and medium-dose (> or = 7.5 mg) long-term exposure (MD/LT-E). The association of GC exposure with HT was evaluated using logistic regression analysis. RESULTS: HT was more prevalent in the MD/LT-E group (84.7%) than the LD/LT-E or N/L-E groups (70.7 and 67.3%, respectively, P = 0.028). Logistic regression revealed increased odds for HT when comparing MD/LT-E with N/L-E, after adjustment for HT risk factors [odds ratio (OR) = 2.57, 95% CI 1.01-6.56, P = 0.049] and RA disease characteristics (OR = 3.64, 95% CI: 1.36-9.77, P = 0.01). CONCLUSIONS: MD/LT GC exposure associates with a very high prevalence of HT. This appears to be independent of other risk factors for HT or of channelling bias due to disease severity, even though the latter cannot be excluded given the cross-sectional nature of our study. RA patients in this GC exposure group should be particularly targeted for early identification and aggressive management of HT.
    • Neurobehavioral assessment predicts differential outcome between VLBW and ELBW preterm infants.

      Constantinou, Janet C.; Adamson-Macedo, Elvidina N.; Mirmiran, Majid; Ariagno, Ronald L.; Fleisher, Barry E. (Nature Publishing Group, 2005)
      OBJECTIVE: To evaluate the impact of birth weight on development of very low birth weight (VLBW) infants using the Neurobehavioral Assessment of the Preterm Infant (NAPI) before hospital discharge, and to show the relation to follow-up outcomes at 12, 18 and 30 months of age. STUDY DESIGN: In total, 113 preterm infants were assessed with the NAPI at 36 weeks postmenstrual age. Later, neurodevelopment was examined using the Bayley Infant Neurodevelopmental Screener (BINS) at 12 months and the Bayley Scales of Infant Development, at 18 and 30 months. The cohort was divided into two groups, based on birth weight, extremely low birth weight (ELBW) (<1000 g) and VLBW (1000 to 1500 g). RESULTS: ELBW infants showed significantly lower NAPI scores compared with VLBW infants at 36 weeks. The predischarge NAPI scores correlated with the 12, 18 and 30 months scores when the ELBW infants continue to have lower performance than the VLBW infants. In all, 14 infants developed cerebral palsy. These infants had significantly lower NAPI, BINS and Bayley scores compared with all other preterm infants. CONCLUSION: NAPI before discharge provides clinically meaningful information related to later neurodevelopmental outcome.
    • No correlation between circulating ACE activity and VO2max or mechanical efficiency in women.

      Day, Stephen H.; Gohlke, Peter; Dhamrait, Sukhbir S.; Williams, Alun G. (Springer, 2007)
      The insertion (I) variant of the angiotensin-1 converting enzyme (ACE) I/D genetic polymorphism is associated with lower circulating and tissue ACE activity. Some studies have also suggested associations of ACE I/D genotype with endurance phenotypes. This study assessed the relationships between circulating ACE activity, ACE I/D genotype, mechanical efficiency and the maximal rate of oxygen uptake in sedentary individuals. Sixty-two untrained women were tested for mechanical efficiency during submaximal cycle ergometry (delta and gross efficiencies during exercise between 40 and 80 W) and the maximal rate of oxygen uptake during incremental treadmill running. Respiratory variables were measured using indirect calorimetry. Venous blood was obtained for direct assay of circulating ACE activity, allowing for the assessment of correlations between two continuous variables, rather than a categorical analysis of endurance phenotype by genotype alone. ACE I/D genotype was also determined, and was strongly associated with circulating ACE activity (P < 0.0005). Neither circulating ACE activity (27.4 +/- 8.4 nM His-Leu-ml(-1)) nor ACE genotype showed a statistically significant association with any of the endurance phenotypes measured. The weak correlations observed included r = -0.122 (P = 0.229) for the relationship between delta efficiency (23.9 +/- 2.5%) and circulating ACE activity and r = 0.134 (P > 0.6) for the relationship between maximal aerobic power (149.1 +/- 22.9 ml kg(-2/3) min(-1)) and circulating ACE activity. The data do not support a role for systemic ACE activity in the regulation of endurance performance in sedentary individuals, extending this observation to a large female cohort.
    • Pathways of association between maternal haemoglobin and stillbirth: Path-analysis of maternity data from two hospitals in England

      Nair, Manisha; Knight, Marian; Robinson, Susan; Nelson-Piercy, Cathy; Stanworth, Simon J; Churchill, David; National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK. (BMJ, 2018-04-07)
      © 2018 Article author(s) (or their employer(s) unless otherwise stated in the text of the article). Objective To investigate the mechanisms that link maternal haemoglobin concentration with stillbirth. Design A retrospective cohort analysis using anonymised maternity data from two hospitals in England. Setting The Royal Wolverhampton NHS Trust and Guy's and St Thomas' NHS Foundation Trust. Study population 12 636 women with singleton pregnancies ≥24 weeks of gestation giving birth in the two hospitals during 2013-2015. Method A conceptual framework of hypothesised pathways through birth weight-for-gestational age and maternal infection including potential confounders and other risk factors was developed and examined using path-analysis. Path-analysis was performed by fitting a set of regression equations using weighted least squares adjusted for mean and variance. Goodness-of-fit indices were estimated. Main outcome measures Coefficient of association (β) for relationship between each parameter, and direct, indirect and total effects via the postulated pathways. Results The path-model showed a significant adjusted indirect negative effect of maternal haemoglobin on stillbirth mediated via birth weight-for-gestational age (standardised estimate (SE)=-0.01; 95% CI=-0.01 to-0.001; P=0.028). The effect through maternal infection was not significant at P<0.05 (SE=0.001; 95% CI=-0.004 to 0.01; P=0.610). There was a residual direct negative effect of maternal haemoglobin on stillbirth (SE=-0.12; 95% CI-0.23 to-0.02; P=0.020) after accounting for the two pathways. Total indirect SE=-0.004; 95% CI-0.01 to 0.003; P=0.267; total direct and indirect SE=-0.13; 95% CI-0.23 to-0.02; P=0.016. The goodness-of-fit indices showed a good fit between the model and the data. Conclusion While some of the influence on risk of stillbirth acts through low birth weight-for-gestational age, the majority does not. Several new mechanisms have been suggested for how haemoglobin may be exerting its influence on the risk of stillbirth possibly involving genetic, epigenetic and/or alternative obstetric and nutritional pathologies, but much more research is needed.
    • Physical activity attenuated the association of air pollutants with telomere length in rural Chinese adults

      Li, R; Li, S; Pan, M; Chen, H; Liu, X; Chen, G; Chen, Ruoling; Mao, Z; Huo, W; Wang, X; et al. (Elsevier, 2021-01-06)
      Background: Exposure to air pollutants (nitrogen dioxide (NO2) and particulate matters (PMs)) or physical inactivity is linked to telomere length (TL) shortening. However, there is a lack of research on combined effects of either NO2 or PMs and physical activity (PA) on TL. This study aimed to explore the joint associations of air pollutants (NO2 or PMs) and PA with relative TL in rural Chinese adults. Methods: This study was conducted among 2704 participants aged 18–79 years in rural China. Concentrations of NO2 and PMs (PM with an aerodynamics diameter ≤ 1.0 μm (PM1), ≤2.5 μm (PM2.5) or ≤10 μm (PM10)) were estimated using random forest models incorporated with satellites data, meteorological data, and land use information. Relative TL of each participant was measured by a quantitative real-time polymerase chain reaction. Linear regression models were applied to examine the independent associations between PA, NO2 or PMs and relative TL. Interaction plots were used to depict the altered associations between NO2, PM1, PM2.5, or PM10 and relative TL along with increasing PA levels. Results: Each 1 μg/m3 increment in NO2, PM1, PM2.5, or PM10 was associated with a 0.038 (95% confidence intervals (CI): −0.044, −0.033), 0.036 (95% CI: −0.041, −0.031), 0.052 (95% CI: −0.059, −0.045), or 0.022 (95% CI: −0.025, −0.019) decrease in relative TL among all participants; similar findings were observed among normal glucose tolerance or impaired fasting glucose (IFG) participants as well as type 2 diabetes mellitus (T2DM) patients. PA at certain levels counteracted the association of air pollutants (NO2, PM1, PM2.5, and PM10) with relative TL among IFG participants or T2DM patients. Conclusions: Long-term exposure to NO2 and PMs was associated with relative TL shortening and these effects may be counteracted by PA at certain levels in IFG participants or T2DM patients.
    • Physical activity counteracted associations of exposure to mixture of air pollutants with mitochondrial DNA copy number among rural Chinese adults

      Li, R; Li, S; Pan, M; Chen, H; Liu, X; Chen, G; Chen, R; Yin, S; Hu, K; Mao, Z; et al. (Elsevier, 2021-02-15)
      Background: Exposure to single air pollutant and physical activity (PA) were associated with an altered mitochondrial DNA copy number (mtDNA-CN). However, studies on the interactive effects of single or a mixture of air pollutants and PA on mtDNA-CN were limited. Methods: A total of 2707 Chinese adults were obtained from the Henan Rural Cohort Study. Spatiotemporal models were used to estimate particulate matter (PMs) (PM with an aerodynamic diameter ≤ 1.0 μm (PM1), ≤2.5 μm (PM2.5) or ≤ 10 μm (PM10)) and nitrogen dioxide (NO2) concentrations. Relative mtDNA-CN was measured by quantitative real-time polymerase chain reaction. Linear regression and quantile g-computation models were applied to examine associations of single or mixture of air pollutants with relative mtDNA-CN. The interactive effects of single or mixture of air pollutants and PA on relative mtDNA-CN were visualized by using Interaction plots. Results: Each 1 μg/m3 increment in PM1, PM2.5, PM10 or NO2 was associated with a 5.11% (95% confidence interval: 3.71%, 6.53%), 6.77% (4.81%, 8.76%), 3.05% (2.22%, 3.87%) or 4.99% (3.45%, 6.55%) increase in relative mtDNA-CN. Each one-quartile increment in mixture of the four air pollutants was related to a 0.053 (0.032, 0.075) increase in relative mtDNA-CN. Negative interaction effects of single or mixture of air pollutants and PA on relative mtDNA-CN were observed. Conclusions: The positive associations of single or mixture of air pollutants with relative mtDNA-CN were counteracted by PA at certain levels, implying that PA may be a costless and effective approach to decrease negative effects of air pollution on mtDNA-CN.
    • Preoperative mitomycin, ifosfamide, and cisplatin followed by esophagectomy in squamous cell carcinoma of the esophagus: pathologic complete response induced by chemotherapy leads to long-term survival.

      Darnton, S.J.; Archer, V.R.; Stocken, D.D.; Mulholland, P.J.; Casson, A.G.; Ferry, David R. (American Society of Clinical Oncology, 2003)
      PURPOSE: Squamous cell carcinoma of the esophagus remains an aggressive disease with a poor prognosis, even after curative-intent surgery. This article analyzes the impact of preoperative chemotherapy with mitomycin, ifosfamide, and cisplatin (MIC) on a cohort of 68 patients. PATIENTS AND METHODS: From 1988 to 1994, 68 patients with potentially operable squamous cell carcinoma of the esophagus were entered onto two phase II trials of neoadjuvant chemotherapy with mitomycin 6 mg/m2, ifosfamide 3 g/m2, and cisplatin 50 mg/m2 and received between two and four cycles of treatment at 3-weekly intervals. Two patients were removed from the analysis when they were found to have malignancy other than squamous cell carcinoma of the esophagus. RESULTS: Forty (61%) of 66 patients had a radiologic response to chemotherapy (18 complete responses and 22 partial responses), and 52 (79%) of 66 patients went on to have the primary tumor resected. There were nine pathologic complete responders, seven of whom remain fit and well after at least 60 months of follow-up. The overall median survival was 12.4 months (95% confidence interval, 9.6 to 18.8 months). The complete response and node-negative patients survived significantly longer than those in other categories (log-rank chi2 = 18.8; P <.001): on average 13 months longer than the node-positive or nonresected category (22.0 v 9.4 months). The toxicity of the regimen was low. CONCLUSION: MIC is an easily administered, well-tolerated, and efficacious regimen as neoadjuvant therapy for patients with squamous cell carcinoma of the esophagus. These results warrant further investigation.
    • Residential greenness attenuated associations of long-term exposure to air pollution with biomarkers of advanced fibrosis

      Hou, J; Liu, X; Zuo, T; Tu, R; Dong, X; Li, R; Pan, M; Chen, Ruoling; Yin, S; Hu, K; et al. (Springer, 2021-08-03)
      Long-term exposure to air pollutants and residential greenness related to advanced fibrosis have been sparsely studied in low- and middle-income countries. A total of 29883 participants were selected from a cross-sectional survey of the Henan Rural Cohort. Concentrations of air pollutants (particulate matter with an aerodynamic diameter ≤ 1.0 μm (PM1), ≤ 2.5 μm (PM2.5), ≤ 10 μm (PM10) and nitrogen dioxide (NO2)) for participants were predicted by using a spatiotemporal model. Residential greenness of each participant was indicated by Enhanced Vegetation Index (EVI) and Normalized Difference Vegetation Index (NDVI). Independent and joint associations of air pollutants and residential greenness indices with prevalent advanced fibrosis reflected by fibrosis-4 score (FIB4), aspartate-to-platelet-ratio index (APRI) and ALT/AST ratio were analyzed by generalized linear mixed models and their interactive effect on prevalent advanced fibrosis were visualized by using the interplot method. Long-term exposure to PM1, PM2.5, PM10 and NO2 were positively related to FIB4 or APRI as well as prevalent intermediate-high advanced fibrosis; EVI was negatively related to FIB4 or APRI as well as prevalent intermediate-high advanced fibrosis. Negative associations of residential greenness indices (EVI or NDVI) with prevalent advanced fibrosis were decreased as increased air pollutants (PM1, PM2.5, PM10 or NO2) (P < 0.05 for all). This study indicated that residential greenness may partially attenuate negative effect of long-term exposure to air pollutants related to increased prevalent intermediate-high advanced fibrosis, implying that residential greenness may be an effective strategy to reduce the burden of prevalent hepatic fibrosis and its related disease in association with exposure high levels of air pollutants. The Henan Rural Cohort study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699, http://www.chictr.org.cn/showproj.aspx?proj=11375)
    • Role of sexual behavior in the acquisition of asymptomatic Epstein-Barr virus infection: a longitudinal study.

      Woodman, Ciaran; Collins, Stuart; Vavrusova, Nicol; Rao, Ankit; Middeldorp, Jaap; Kolar, Zdenek; Kumari, Angela; Nelson, Paul N.; Young, Lawrence S.; Murray, Paul G. (Lippincott Williams & Wilkins, 2005)
      BACKGROUND: The natural history of Epstein-Barr virus (EBV) infection is poorly defined. We report the prevalence and subsequent incidence of EBV infection in a cohort of sexually active young women and explore the social and sexual determinants of incident infections. METHODS: The study population was drawn from a cohort of young women, who were recruited for a longitudinal study of risk factors for early cervical neoplasia. A case-control analysis, nested within the cohort of 45 women for whom the first EBV sample tested was EBV-negative and who had further follow-up, was undertaken. EBV serostatus was determined in serum with a synthetic peptide-based enzyme-linked immunosorbent assay; EBV DNA was measured in cervical smears with the use of quantitative polymerase chain reaction. RESULTS: Of 1023 women 15-19 years of age included in this analysis, 978 (95.6%) tested positive for antibodies to EBV in their first serum sample. Of 45 women who tested negative, 22 subsequently acquired an asymptomatic EBV infection; the median time to seroconversion was 25 months (range, 1-60 months), and the median age at seroconversion was 18 years (range, 16-21 years). The risk of seroconversion increased with increasing number of sexual partners [compared with 1 partner, odds ratio (OR) was 1.28 for 2 partners and 2.23 for 3 or more; chiTREND 5.02; df 1; P < 0.05] and was greatest when a new sexual partner had been acquired in the 2 years before seroconversion (OR 4.78; chi 4.62; df 1; P < 0.05). EBV DNA was detected in 9 of 14 women who seroconverted and who also provided cervical samples. CONCLUSIONS: In susceptible young women, the acquisition of EBV infection is associated with their sexual behavior.
    • Treatment adaptations and outcomes of patients experiencing inflammatory bowel disease flares during the early COVID-19 pandemic: the PREPARE-IBD multicentre cohort study

      Saifuddin, Aamir; Kent, Alexandra; Mehta, Shameer; Hicks, Lucy; Gonzalez, Haidee A; Segal, Jonathan P.; Brookes, Matthew; Subramanian, Sreedhar; Bhala, Neeraj; Conley, Thomas E; et al. (Wiley, 2022-10-05)
      Background: The COVID-19 pandemic offered a unique opportunity to understand inflammatory bowel disease (IBD) management during unexpected disruption. This could help to guide practice overall. Aims: To compare prescribing behaviour for IBD flares and outcomes during the early pandemic with pre-pandemic findings. Methods: We performed an observational cohort study comprising patients who contacted IBD teams for symptomatic flares between March and June 2020 in 60 National Health Service trusts in the United Kingdom. Data were compared with a pre-pandemic cohort after propensity-matching for age and physician global assessment of disease activity. Results: We included 1864 patients in each of the pandemic and pre-pandemic cohorts. The principal findings were reduced systemic corticosteroid prescription during the pandemic in Crohn's disease (prednisolone: pandemic 26.5% vs. 37.1%; p < 0.001) and ulcerative colitis (UC) (prednisolone: pandemic 33.5% vs. 40.7%, p < 0.001), with increases in poorly bioavailable oral corticosteroids in Crohn's (pandemic 15.6% vs. 6.8%; p < 0.001) and UC (pandemic 11.8% vs. 5.2%; p < 0.001). Ustekinumab (Crohn's and UC) and vedolizumab (UC) treatment also significantly increased. Three-month steroid-free remission in each period was similar in Crohn's (pandemic 28.4% vs. 32.1%; p = 0.17) and UC (pandemic 36.4% vs. 40.2%; p = 0.095). Patients experiencing a flare and suspected COVID-19 were more likely to have moderately-to-severely active disease at 3 months than those with a flare alone. Conclusions: Despite treatment adaptations during the pandemic, steroid-free outcomes were comparable with pre-pandemic levels, although concurrent flare and suspected COVID-19 caused worse outcomes. These findings have implications for IBD management during future pandemics and for standard practice.