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Statement of problem The comparative efficacy of antifungal drugs on oral candidiasis remains unclear. Purpose The purpose of this Bayesian network meta-analysis was to investigate the efficacy of antifungal drugs on oral candidiasis. Material and methods Databases, including PubMed, The Cochrane Library, and Web of Science, were accessed from the dates of their establishment to October, 2018, to collect randomized controlled trials (RCTs) of different antifungal drugs for oral candidiasis. A network meta-analysis was then conducted by using R and Stata 12.0 software programs. Results A total of 31 RCTs involving 4042 participants were included. The meta-analysis showed that, in the treatment of oral candidiasis in reducing the mycological cure rate, itraconazole capsules, itraconazole oral solution, miconazole buccal tablets, miconazole oral gel, clotrimazole, fluconazole, ketoconazole, nystatin, and amphotericin B were better than a placebo. Miconazole oral gel, fluconazole, and ketoconazole were better than nystatin. The network meta-analysis also showed that the effects of antifungal drugs in reducing the mycological cure rate in oral candidiasis were better than those of a placebo: itraconazole capsule (OR=1.20, 95% CrI: 1.07-1.34), itraconazole oral solution (OR=1.50, 95% CrI: 1.14-1.86), miconazole buccal tablet (OR=2.80, 95% CrI: 1.20-4.50), miconazole oral gel (OR=2.90, 95% CrI: 1.70-4.30), clotrimazole (OR=3.80, 95% CrI: 1.65-5.95), fluconazole (OR=2.40, 95% CrI: 1.10-3.80), ketoconazole (OR=3.40, 95% CrI: 1.76-7.04), nystatin (OR=2.50, 95% CrI: 1.43-3.57), and amphotericin B (OR=2.60, 95% CrI: 1.91-3.29). The SUCRA values for each antifungal drug were as follows: placebo (6.80%), itraconazole capsule (51.2%), itraconazole oral solution (75.2%), miconazole buccal tablet (34.4%), miconazole oral gel (76.9%), clotrimazole (64.8%), fluconazole (79.3%), ketoconazole (50.7%), nystatin (15.7%), and amphotericin B (44.4%). Conclusions Antifungal drugs have efficacy in the treatment of oral candidiasis. The effect of fluconazole in reducing the risk of the mycological cure rate in oral candidiasis was better than that of other drugs.

Background Numerous studies have consistently demonstrated that high body mass index (BMI) is related to elevated serum alanine aminotransferase (ALT) among adults, but little is known about the association regarding adolescents, especially in China. In this study, we aimed to investigate the association between BMI and ALT activity among Chinese adolescents. Methods A school-based cross-sectional study was performed among nine high schools in Shenzhen, China between February 2017 and June 2018. A generalized linear-regression model adjusting for age and gender was conducted, and bivariate correlation analysis between ALT and BMI was also performed. Results A total of 7,271 adolescents aged from 9 years to 17 years were enrolled. Height, weight, BMI, and ALT were higher among boys than among girls (all P Conclusions We found a significant BMI−ALT relationship. BMI at 20.5 kg/m2 may be a cut-off for evaluating serum ALT. BMIs ≥27.1 kg/m2 for boys and ≥24.9 kg/m2 for girls were linked to an elevated ALT activity for Shenzhen adolescents.

BACKGROUND Prediabetes is associated with an increased risk of cardiovascular diseases and all-cause mortality. No research in China has evaluated the prevalence of prediabetes among children and adolescents using the HbA1c criterion or the combined FPG-or-HbA1c diagnostic criterion, and researchers paid no attention to the distributions of blood glucose in Shenzhen, especially for juveniles. METHODS We conducted a school-based cross-sectional study based on the first-year students from 17 primary, middle, and high schools. Prediabetes was defined as FPG of 5.6-6.9 mmol/L or HbA1c of 5.7%-6.4%. The crude and standardized prevalence of prediabetes with 95% confidence interval (95% CI) was estimated. RESULTS A total of 7519 participants, aged 6 to 17 years, were included. For all subjects, the crude prevalence (95% CI) of prediabetes was 1.49% (1.21-1.77), 8.72% (8.08-9.36), and 9.80% (9.13-10.47) by the FPG-only, HbA1c-only, and FPG-or-HbA1c criteria, respectively. Based on the 2010 Shenzhen census population, the standardized prevalence was 1.56% (males 1.85%, females 1.19%), 11.05% (males 11.47%, females 10.53%), and 12.19% (males 13.01%, females 11.15%) by the corresponding criteria. The proportion of prediabetes was higher for males than females, and the prevalence decreased with grade for males but increased for females. The association of BMI and prediabetes was U-shaped curve, indicating higher rates of prediabetes for underweight and obesity people. CONCLUSIONS The blood glucose status of children and adolescents in Shenzhen is worrisome, and the early detection and management of prediabetes are imperative. This article is protected by copyright. All rights reserved.

Background Ambient PM1 (particulate matter with aerodynamic diameter ≤1 μm) is an important contribution of PM2.5 mass. However, little is known worldwide regarding the PM1-associated health effects due to a wide lack of ground-based PM1 measurements from air monitoring stations. Methods We collected daily records of hospital admission for respiratory diseases and station-based measurements of air pollution and weather conditions in Shenzhen, China, 2015–2016. Time-stratified case-crossover design and conditional logistic regression models were adopted to estimate hospitalization risks associated with short-term exposures to PM1 and PM2.5. Results PM1 and PM2.5 showed significant adverse effects on respiratory disease hospitalizations, while no evident associations with PM1–2.5 were identified. Admission risks for total respiratory diseases were 1.09 (95% confidence interval: 1.04 to 1.14) and 1.06 (1.02 to 1.10), corresponding to per 10 μg/m3 rise in exposure to PM1 and PM2.5 at lag 0–2 days, respectively. Both PM1 and PM2.5 were strongly associated with increased admission for pneumonia and chronic obstructive pulmonary diseases, but exhibited no effects on asthma and upper respiratory tract infection. Largely comparable risk estimates were observed between male and female patients. Groups aged 0–14 years and 45–74 years were significantly affected by PM1- and PM2.5-associated risks. PM-hospitalization associations exhibited a clear seasonal pattern, with significantly larger risks in cold season than those in warm season among some subgroups. Conclusions Our study suggested that PM1 rather than PM1–2.5 contributed to PM2.5-induced risks of hospitalization for respiratory diseases and effects of PM1 and PM2.5 mainly occurred in cold season.

Background Screening for elevated serum alanine aminotransferase (ALAT) can help identifying individuals at the risks of chronic and metabolic diseases, but blood collection is invasive and cannot be widely used for investigations. Considered as simple and inexpensive screening indices, individual characteristics and anthropometric measurements can be measured in a large crowd and may be important surrogate markers for ALAT levels. This study aimed to examine the diagnostic performance of individual characteristics and anthropometric parameters as predictive factors for discerning an elevated ALAT activity among Shenzhen children and adolescents. Methods A school-based screening study was performed from 9 high schools in Shenzhen during February 2017 and June 2018. Receiver operating characteristic curve was used to examine the diagnostic performance of each variable for detecting elevated ALAT. Results Altogether 7271 students aged 9–17 years were involved. The proportion of elevated ALAT greatly increased with increasing classification of BMI-z. By the sex-specific cut-offs for elevated ALAT (30 U/L boys; 19 U/L girls), BMI showed the highest area under the curve of 0.789 (95% CI 0.765–0.812) and followed by weight (0.779 [0.755–0.802]), BMI-z (0.747 [0.722–0.772]), height (0.622 [0.597–0.647]), and age (0.608 [0.584–0.632]), while height-z was not capable. With the cut-off of 67.8 kg for weight and 22.6 kg/m2 for BMI, the accuracy to identify elevated ALAT was 87.1% for weight and 82.9% for BMI. Conclusions The presence of elevated ALAT was more common in overweight or obese children and adolescents. BMI and weight had the superiority of detecting elevated ALAT, followed by BMI-z, height, and age.

Background. Serum alanine aminotransferase (ALT) activity was measured not only to detect liver disease, but also to monitor overall health. The purpose of this study was to obtain the prevalence of elevated ALT levels among adolescents. Methods. In a school-based cross-sectional study, a representative sample was analyzed from 9 middle and high schools in Shenzhen, China, during 2017 to 2018. Elevated ALT was defined as diagnostic criterion I (>30 U/L for boys and >19 U/L for girls) and diagnostic criterion II (>40 U/L). Results. From the adolescent population, a total of 7281 students (boys, 4014, and girls, 3267) aged from 10 to 17 years were collected. The prevalence of elevated ALT was 7.11% (6.88% for boys and 7.41% for girls) by criterion I and 2.72% (3.96% for boys and 1.19% for girls) by criterion II. Based on the Shenzhen census and Chinese national census population, the adjusted prevalence of elevated ALT was 7.65% (boys 7.19% and girls 8.21%) and 6.79% (boys 6.07% and girls 7.56%) by criterion I and 2.85% (boys 4.20% and girls 1.16%) and 2.43% (boys 3.49% and girls 1.29%) by criterion II. For age, the overall trends were increasing progressively, regardless of the use of diagnostic criteria for an elevated ALT activity. Conclusions. This study supplements the gap that the prevalence of elevated ALT levels differed in gender, age, and criteria among adolescents of Shenzhen. We should take the prevalence as a predictor and continue to play a warning and preventive role in preparation for further intervention.

We aimed to explore whether there were cold and heat temperature adverse effects on years of life lost (YLL) for non-accidental mortality in Yuxi, a southwest plateau region of China. From data for 89,467 non-accidental deaths over an 8-year study period, we used a general linear regression model combined with a distributed lag non-linear model to assess the burden of disease non-accidental mortality due to ambient temperature with the YLL indicator. We estimated the mean YLL change per 1 °C decrease from the 25th to 1st percentile mean temperature as the cold effect and per 1 °C increase from the 75th to 99th percentile as the heat effect. The 95% empirical confidence intervals (eCIs) were calculated by using a bootstrap simulation method. The exposure–response curve between average temperature and YLL was U-shaped. The cold effect peaked at the first day after exposure and disappeared at 2 weeks, and the heat effect only lasted for the first 3 days. A per 1 °C decrease from the 25th to 1st mean temperature percentile was associated with an increase of 15.6 (95% eCI: 2.4, 22.9) in YLL for non-accidental diseases, and the cumulative effects due to cold were stronger in contrast to that attributed by heat. Cold temperature had a significant impact on YLL among the subgroups, with higher YLL in cardiovascular disease, stroke, males, Han nationality, married, and those engaged in agriculture than their corresponding categories. An increasing death burden of non-accidental in Yuxi of China due to cold temperature was demonstrated, and the association was also modified by specific disease causes and individual features.

ObjectiveTo examine the total non-accidental mortality burden attributable to ambient temperatures and assess the effect modification of the burden by specific causes of death and individual characteristics in a high plateau area in southwest China.MethodsUsing daily mortality and meteorological data from 2009 to 2016, we applied a quasi-Poisson model combined with a distributed lag non-linear model to estimate the temperature–mortality association with the assessment of attributable fraction and number. We calculated attributable fractions and deaths with 95% empirical CIs (eCIs), that were due to cold and heat, defined as temperatures below and above the median temperature, and for mild and extreme temperatures, defined by cut-offs at the 2.5th and 97.5th temperature percentiles.ResultsWe analysed 89 467 non-accidental deaths; 4131 were attributable to overall temperatures, with an attributable fraction of 4.75% (95% eCI 2.33% to 6.79%). Most of the mortality burden was caused by cold (4.08%; 0.86% to 7.12%), whereas the burden due to heat was low and non-significant (0.67%; −2.44% to 3.64%). Extreme cold (1.17%; 0.58% to 1.69%) was responsible for 24.6% (ie, 1.17% divided by 4.75%) of the total death burden. In the stratification analyses, attributable risk due to cold was higher for cardiovascular than respiratory disease (6.18% vs 3.50%). We found a trend of risk of increased death due to ambient temperatures with increasing age, with attributable fractions of 1.83%, 2.27% and 6.87% for age ≤64, 65–74 and ≥75 years old, respectively. The cold-related burden was slightly greater for females, farmers, ethnic minorities and non-married individuals than their corresponding categories.ConclusionsMost of the burden of death was attributable to cold, and specific causes and individual characteristics might modify the mortality burden attributable to ambient temperatures. The results may help make preventive measures to confront climate change for susceptible population in this region.

Background Breakfast is commonly described as the most important meal of the day; however, we have little information regarding its relevance for childhood overweight and obesity in southern mainland China. This study aimed to assess the association between breakfast preferences, consumption location and overweight and obesity for children in Shenzhen. Methods Among 6126 children (median age 7.2 years) at primary schools, 3504 were finally included after a questionnaire survey and physical examination. Ten commonly consumed foods/beverages for breakfast in southern China were exposure variables, and consumption location, total energy demographic and other dietary characteristics were covariates in logistic regression to determine the effect of breakfast preferences on overweight and obesity, estimating odds ratios (ORs) and 95% confidence intervals (CIs). Results Probability of overweight/general obesity was inversely associated with children eating plain congee for breakfast (adjusted OR 0.689, 95% CI 0.566–0.838), restricted to boys after stratification. Probability of overweight/general obesity and central obesity was positively associated with usually eating steamed rice roll for breakfast (OR 1.309, 95% CI 1.090–1.571 and OR 1.351, 95% CI 1.064–1.717, respectively), but the effect on overweight/obesity remained statistically significant for only boys after stratification. Eating steamed rice roll for breakfast and eating out for breakfast had an additive interaction on overweight/obesity. Additionally, eating bread for breakfast had a mild favorable effect on overweight/obesity but only for girls. Conclusions Keeping a healthy weight might benefit children who eat plain congee or bread for breakfast in China. However, frequent consumption of steamed rice roll for breakfast and especially eating out could contribute to overweight and obesity. Thus, we need to promote a healthier breakfast pattern among children in southern China to reduce the odds of obesity.

Background Consistent evidence has shown excess mortality associated with cold temperature, but some important details of the cold–mortality association (e.g. slope and threshold) have not been adequately investigated and few studies focused on the cold effect in high-altitude areas of developing countries. We attempted to quantify the cold effect on mortality, identify the details, and evaluate effect modification in the distinct subtropical plateau monsoon climate of Yuxi, a high plateau region in southwest China. Methods From daily mortality and meteorological data during 2009–2014, we used a quasi-Poisson model combined with a “natural cubic spline–natural cubic spline” distributed lag non-linear model to estimate the temperature–mortality relationship and then a simpler “hockey-stick” model to investigate the cold effect and details. Results Cold temperature was associated with increased mortality, and the relative risk of cold effect (1st relative to 10th temperature percentile) on non-accidental, cardiovascular, and respiratory mortality for lag 0–21 days was 1.40 (95% confidence interval: 1.19–1.66), 1.61 (1.28–2.02), and 1.13 (0.78–1.64), respectively. A 1 °C decrease below a cold threshold of 9.1 °C (8th percentile) for lags 0–21 was associated with a 7.35% (3.75–11.09%) increase in non-accidental mortality. The cold–mortality association was not significantly affected by cause-specific mortality, gender, age, marital status, ethnicity, occupation, or previous history of hypertension. Conclusions There is an adverse impact of cold on mortality in Yuxi, China, and a temperature of 9.1 °C is an important cut-off for cold-related mortality for residents.

Background Temperature variability (TV) is closely associated with climate change, but there is no unified TV definition worldwide. Two novel composite TV indexes were developed recently by calculating the standard deviations of several days’ daily maximum and minimum temperatures (TVdaily), or hourly mean temperatures (TVhourly). Objectives This study aimed to compare the mortality risks and burden associated with TVdaily and TVhourly using large time-series datasets collected from multiple locations in China, United Kingdom and United States. Methods We collected daily mortality and hourly temperature data through 1987 to 2012 from 63 locations in China (8 communities, 2006–2012), United Kingdom (10 regions, 1990–2012), and USA (45 cities, 1987–2000). TV-mortality associations were investigated using a three-stage analytic approach separately for China, UK, and USA. First, we applied a time-series regression for each location to derive location-specific TV-mortality curves. A second-stage meta-analysis was then performed to pool these estimated associations for each country. Finally, we calculated mortality fraction attributable to TV based on above-described location-specific and pooled estimates. Results Our dataset totally consisted of 23, 089, 328 all-cause death cases, including 93, 750 from China, 7,573,716 from UK and 15, 421, 862 from USA, respectively. In despite of a relatively wide uncertainty in China, approximately linear relationships were consistently identified for TVdaily and TVhourly. In the three countries, generally similar lag patterns of TV effects were consistently observed for TVdaily and TVhourly. A 1 °C rise in TVdaily and TVhourly at lag 0–7 days was associated with mortality increases of 0.93% (95% confidence interval [CI]: 0.12, 1.74) and 0.97% (0.18, 1.77) in China, 0.33% (0.15, 0.51) and 0.41% (0.21, 0.60) in UK, and 0.55% (0.41, 0.70) and 0.51% (0.35, 0.66) in USA, respectively. Larger attributable fractions were estimated using TVdaily than those using TVhourly, with estimates at 0–10 days of 3.69% (0.51, 6.75) vs. 2.59% (0.10, 5.01) in China, 1.14% (0.54, 1.74) vs. 0.98% (0.55, 1.42) in UK, and 2.57% (1.97, 3.16) vs. 1.67% (1.15, 2.18) in USA, respectively. Our meta-regression analyses indicated higher vulnerability to TV-induced mortality risks in warmer locations. Conclusions Our study added multi-country evidence for increased mortality risk associated with short-term exposure to large temperature variability. Daily and hourly TV exposure metrics produced generally comparable risk effects, but the attributable mortality burden tended to be higher using TVdaily instead of TVhourly.

OBJECTIVEIntracerebral hemorrhage (ICH) is associated with a poor prognosis and high mortality, but no study has elucidated the association between glycemic variability (GV) and functional outcome in ICH. The authors of this study aimed to determine whether GV is a predictor of 30-day functional outcome in ICH patients.METHODSThe study recruited 366 patients with first-ever acute-onset ICH in the period during 2014 and 2015. Fasting blood glucose was assessed on admission and with 7-day continuous monitoring. Glycemic variability was calculated and expressed by the standard deviation (GluSD) and coefficient of variation (GluCV). Patients were divided into groups of those with diabetes mellitus (DM), stress hyperglycemia (SHG), and normal glucose (NG). Functional outcome was measured using the modified Rankin Scale.RESULTSThe numbers of patients with DM, SHG, and NG were 108 (29.5%), 127 (34.7%), and 131 (35.8%), respectively. As compared with the DM patients, those with SHG had higher mortality (29.9% vs 15.7%, p < 0.05) and a poorer prognosis (64.6% vs 52.8%, p < 0.05). Poor prognosis was associated with both high GluSD (OR 1.54, 95% CI 1.19–1.99) and high GluCV (1.05, 1.02–1.09), especially in the DM group. The area under the receiver operating characteristic curve was greater for the GluSD (OR 0.929, 95% CI 0.902–0.956) and the GluCV (0.932, 0.906–0.958) model than the original model (0.860, 0.823–0.898) in predicting a poor outcome.CONCLUSIONSStress hyperglycemia may be associated with increased mortality and a poor outcome in ICH, and increased GV may be independently associated with a poor outcome, particularly in ICH patients with DM.

The existing definitions of metabolic syndrome (MetS) may not be fully appropriate for the Shantou population because of ethnic and regional differences. We sought to establish a 95% multivariate medical reference range (MMRR) model for diagnosing MetS in Shantou adults and to evaluate the prevalence of MetS by the MMRR, JCDCG (the Chinese Guidelines) and International Diabetes Federation (IDF) criteria. A total of 4,580 participants were recruited in Shantou, southern China. We developed a MMRR model based on the combinatorial indicatrixes method for three categorized indicatrixes. According to the developed MMRR criteria, men (women) in Shantou have MetS by meeting 3 or more of the following: waist circumference ≥89 (81) cm; triglycerides level ≥1.73 (1.64) mmol/L; high-density lipoprotein cholesterol level ≤1.07 (1.05) mmol/L; blood pressure ≥138/89 (136/85) mmHg; and fasting plasma glucose ≥5.8 (5.7) mmol/L. The agreement of the MMRR with JCDCG and IDF criteria was “substantial” (both κ > 0.68), but the recommended reference values and proportion of individual components of MetS defined by the 3 criteria differed. The population-based MMRR criteria may be appropriate for diagnosing MetS in Shantou population and the model might be useful for generalization to other geographic regions.