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The extensive and intensive online teaching and learning during the pandemic has provided good opportunities for academic staff and students to experiment with learning and teaching using synchronous communication technology and learning platforms. This experience is highly valuable for helping higher education institutions move learning and teaching practices forward after the pandemic. Indeed, many universities are considering adopting blended learning in the new era. However, it is worth noting that a number of emerging issues related to student behaviour also appeared during online learning, such as teaching to blank screens, students' inappropriate use of social media icons, languages and their inappropriate outfits. It appears that these issues have not yet been investigated properly, and are not addressed by the existing codes of conduct, since these have been written mainly for face-to-face teaching. This study offers some important insights into students' unprofessional online behaviour from tutors' perspective, and also the experiences of academic tutors in managing such behaviour in formal online learning and teaching environments. It used semi-structured interviews to collect data, and analysed the narratives of 20 academic staff working in UK universities. The findings report and describe students' unprofessional online behaviours witnessed by academic tutors in different academic disciplines. The findings also suggest that special attention needs to be paid to policymaking regarding online learning, in particular, in the area of students' online professionalism.

Appropriate management decisions are key for sustainable and profitable beef and dairy farming. Data-driven technologies aim to provide information which can improve farmers' decision-making practices. However, data-driven technologies have resulted in the emergence of a "data divide", in which there is a gap between the generation and use of data. Our study aims to further understand the data divide by drawing on social practice theory to recognise the emergence, linkages, and reproduction of youngstock data practices on cattle farms in the UK. Eight focus groups with fifteen beef and nineteen dairy farmers were completed. The topics of discussion included data use, technology use, disease management in youngstock, and future goals for their farm. The transcribed data were analysed using reflexive thematic analysis with a social practice lens. Social practice theory uses practices as the unit of analysis, rather than focusing on individual behaviours. Practices are formed of three elements: meaning (e.g., beliefs), materials (e.g., objects), and competencies (e.g., skills) and are connected in time and space. We conceptualised the data divide as a disconnection of data collection practices and data use and interpretation practices. Consequently, we were able to generate five themes that represent these breaks in connection.Our findings suggest that a data divide exists because of meanings that de-stabilise practices, tensions in farmers' competencies to perform practices, spatial and temporal disconnects, and lack of forms of feedback on data practices. The data preparation practice, where farmers had to merge different data sources or type up handwritten data, had negative meanings attached to it and was therefore sometimes not performed. Farmers tended to associate data and technology practices with larger dairy farms, which could restrict beef and small-scale dairy farms from performing these practices. Some farmers suggested that they lacked the skills to use technologies and struggled to transform their data into meaningful outputs. Data preparation and data use and interpretation practices were often tied to an office space because of the required infrastructure, but farmers preferred to spend time outdoors and with their animals. There appeared to be no normalisation of what data should be collected or what data should be analysed, which made it difficult for farmers to benchmark their progress. Some farmers did not have access to discussion groups or veterinarians who were interested in data and therefore could not get feedback on their data practices.These results suggest that the data divide exists because of three types of disconnect: a disconnect between elements within a practice because of tensions in competencies or negative meanings to perform a practice; a disconnect between practices because of temporal or spatial differences; and a break in the reproduction of practices because of lack of feedback on their practices. Data use on farms can be improved through transformation of practices by ensuring farmers have input in the design of technologies so that they align with their values and competencies. [ABSTRACT FROM AUTHOR]

The relationship between depression and severe non-alcoholic fatty liver disease (NAFLD) has not been clearly defined. We conducted a longitudinal cohort study and a two-sample Mendelian randomization (MR) analysis to assess the association of depression with severe NAFLD risk. We used individual data from the UK Biobank study with 481,181 participants, and summary data from published genome-wide association studies. The association between depression and severe NAFLD was assessed using Cox proportional hazards regression analysis. Two-sample MR for depression with NAFLD was conducted, the principal analysis employed the inverse variance weighted (IVW) approach. In the observational study, after a median follow-up of 13.46 years, 4,563 participants had severe NAFLD. In multivariable-adjusted model, participants with depression had an increased risk of severe NAFLD (hazards ratio:1.21, 95% confidence interval (CI):1.09-1.34), as compared to those without depression. In subgroup analyses, the association between depression and severe NAFLD risk was generally observed across different subgroups. For the MR, result also showed that genetically predicted depression was causally associated with a higher risk of NAFLD (odds ratio:1.55, 95%CI:1.10-2.19) in IVW. Our study revealed a prospective association of depression with severe NAFLD, thus potentially necessitating clinical monitoring of individuals with depression for severe NAFLD., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethical approval The UK Biobank study has approval from the North West Multi-centre Research Ethics Committee, all methods were performed in accordance with the relevant guidelines and regulations, and all participants provided written informed consent. As our MR study was based on publicly available data, no additional ethical approval or consent was required., (© 2024. The Author(s).)

Background: Some pathogenic mechanisms suggest a potential relationship between gastroesophageal reflux disease (GERD) and respiratory diseases. However, evidence regarding the association between GERD and lung cancer is mixed. We aim to explore this relationship based on data from the large-scale UK Biobank study., Materials and Methods: We performed a cross-sectional and prospective cohort study in 501,569 (45.58% male) individuals included in the UK Biobank at baseline (2006-2010). The Cox proportional hazards model and logistic regression models were used to assess the relationship between GERD and lung cancer, small cell lung cancer (SCLC), lung squamous cell carcinoma (LUSC), and lung adenocarcinoma (LUAD)., Results: During a mean follow-up of 11.54 years, 3,863 (0.84%) incident lung cancer cases were identified. In the cross-sectional analysis using logistic models, significant associations were found between GERD and prevalent lung cancer cases (odds ratio [OR] = 1.87, 95% confidence interval [95% CI]: 1.45-2.38) and subtypes of lung cancer, with an OR (95% CI) of 3.19 (1.47-6.79) for SCLC, 2.08 (1.33-3.21) for LUSC, 1.85 (1.15-2.91) for LUAD. In the follow-up analysis using Cox models, GERD was associated with an increased risk of lung cancer (hazard ratio [HR] = 1.24, 95%CI: 1.14-1.34). Similar associations were also observed between GERD and SCLC (HR = 1.39, 95% CI: 1.09-1.78), LUSC (HR = 1.40, 95% CI: 1.18-1.65), and LUAD (HR = 1.17, 95% CI: 1.02-1.33). The risk of lung cancer resulting from GERD was mainly elevated in former smokers (HR = 1.38, 95% CI: 1.23-1.54) and current smokers (HR = 1.18, 95% CI: 1.04-1.34), but not in never-smokers (HR = 0.89, 95% CI: 0.70-1.14). No significant association was observed in former smokers who had quit smoking for at least 25 years., Conclusions: We found that GERD was positively associated with an increased risk of lung cancer, especially among smokers. Awareness of this association may be beneficial for prevention and treatment strategies of both diseases., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Liao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: The purpose of this study was to examine the association between refractive errors and common chronic diseases using blood biochemistry tests, and to investigate the associated modifiable risk factors, with the goal of informing and developing effective preventive strategies., Methods: A total of 116,245 participants with refractometry at baseline enrolled in the UK Biobank were included in this prospective cohort study. Restricted cubic spline and Cox proportional hazards models were used to detect associations between refractive error, blood biochemistry tests, and common chronic diseases. Interaction effects on the additive scale and effect modification analysis were used to explore excess modifiable risk factors for disease prevention., Results: Spherical equivalent significantly associated with vitamin D, sex hormone binding globulin, apolipoprotein A, blood glucose, and aspartate aminotransferase levels. Subjects with myopia demonstrated a 13% higher risk of type 2 diabetes mellitus (T2DM) incidence compared to those without myopia (hazard ratio [HR] = 1.13, 95% confidence interval [CI] = 1.08-1.19) throughout a median follow-up of 9.12 years. Interaction analysis revealed 15% (95% CI = 9%-21%) of this risk was due to myopia-obesity interaction. However, active engagement in physical activity could potentially mitigate this risk (HR = 1.06, 95% CI = 0.93-1.20)., Conclusions: Refractive errors were associated with specific blood indicators, particularly noting the association between myopia and higher T2DM incidence in middle-aged and elderly populations. This effect interacts with obesity, and promoting physical activity among myopia individuals provides greater benefits in the prevention of T2DM compared to non-myopic individuals.

Purpose: This study aimed to investigate the associations between adverse childhood experiences (ACEs) and excessive recreational screen time., Methods: Using data from the UK Millennium Cohort Study, we examined the associations of prospectively collected individual ACEs, ACE scores, and poverty with excessive recreational screen time (>4 hours) across different media types. We ran further analyses to investigate sex differences in the associations of ACEs with excessive screen time. The robustness of these associations were tested by controlling for sociodemographic factors., Results: Among the included 11,439 adolescents (49.9% boys), those who experienced three or more ACEs were more likely to partake in excessive screen time compared to those with no ACEs after adjusting for covariates. This included recreational internet time at age 14, television time at age 14, electronic game time at ages 14 and 17, and social networking time at ages 14 and 17. We found similar associations between individual ACEs and excessive screen time. For example, parental mental health problems were associated with excessive recreational internet time (odds ratio [OR]: 1.28; 95% confidence interval [CI]: 1.15, 1.42), excessive television time (OR: 1.14; 95% CI: 1.01, 1.28), and excessive electronic game time (OR: 1.34; 95% CI: 1.16, 1.56) at age 14. Boys showed stronger associations between certain ACEs and excessive screen time compared to girls., Discussion: ACEs and poverty are associated with adolescents' later excessive recreational screen time, including excessive time spent on television watching, electronic games, and social networking., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Social determinants of health (SDHs) are the primary drivers of preventable health inequities, and the associations between SDHs and health outcomes among individuals with type 2 diabetes remain unclear. This study aimed to estimate the associations of combined SDHs with life expectancy and future health risks among adults with type 2 diabetes from the UK and USA., Methods: In an analysis of two nationwide cohort studies, adults with type 2 diabetes were identified from the UK Biobank from March 13, 2006, to Oct 1, 2010 (adults aged 37-73 years) and the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 (adults aged ≥20 years). Participants with type 2 diabetes at baseline were included in our analysis. Participants without information on SDHs or follow-up were excluded. The UK Biobank assessed 17 SDHs and the US NHANES assessed ten SDHs, with each SDH dichotomised into advantaged and disadvantaged levels. The combined score of SDHs were calculated as the sum of the weighted scores for each SDH. Participants were then categorised into tertiles (favourable, medium, and unfavourable SDH groups). Primary outcomes were life expectancy and mortality in both cohorts, and incidences of cardiovascular disease, diabetes-related microvascular disease, dementia, and cancer in the UK Biobank. Outcomes were obtained from disease registries up until Dec 31, 2021, in the UK Biobank and Dec 31, 2019, in the US NHANES cohorts., Findings: We included 17 321 participants from the UK Biobank cohort (median age 61·0 years [IQR 56·0-65·0]; 6028 [34·8%] women and 11 293 [65·2%] men) and 7885 participants from the NHANES cohort (mean age 59·2 years [95% CI 58·7-59·6]; 3835 [49·1%, weighted] women and 4050 [50·9%, weighted] men) in our analysis. In the UK Biobank, 3235 deaths (median follow-up 12·3 years [IQR 11·5-13·2]), 3010 incident cardiovascular disease (12·1 years [10·8-13·0]), 1997 diabetes-related microvascular disease (8·0 years [7·1-8·9]), 773 dementia (12·6 years [11·8-13·5]), and 2259 cancer cases (11·3 years [10·4-12·2]) were documented; and the US NHANES documented 2278 deaths during a median follow-up of 7·0 years (3·7-11·2). After multivariable adjustment, compared with the favourable SDH group, the hazard ratio was 1·33 (95% CI 1·21-1·46) in the medium SDH group and 1·89 (1·72-2·07) in the unfavourable SDH group in the UK Biobank cohort; 1·51 (1·34-1·70) in the medium SDH group and 2·02 (1·75-2·33) in the unfavourable SDH group in the US NHANES cohort for all-cause mortality; 1·13 (1·04-1·24) in the medium SDH group and 1·40 (1·27-1·53) in the unfavourable SDH group for incident cardiovascular disease; 1·13 (1·01-1·27) in the medium SDH group and 1·41 (1·26-1·59) in the unfavourable SDH group for incident diabetes-related microvascular disease; 1·35 (1·11-1·64) in the medium SDH group and 1·76 (1·46-2·13) in the unfavourable SDH group for incident dementia; and 1·02 (0·92-1·13) in the medium SDH group and 1·17 (1·05-1·30) in the unfavourable SDH group for incident cancer in the UK Biobank cohort (p trend <0·010 for each category). At the age of 45 years, the mean life expectancy of participants was 1·6 years (0·6-2·3) shorter in the medium SDH group and 4·4 years (3·3-5·4) shorter in the unfavourable SDH group than in the favourable SDH group in the UK Biobank. In the US NHAHES cohort, the life expectancy was 1·7 years (0·6-2·7) shorter in the medium SDH group and 3·0 years (1·8-4·3) shorter in the unfavourable SDH group, compared with the favourable group., Interpretation: Combined unfavourable SDHs were associated with a greater loss of life expectancy and higher risks of developing future adverse health outcomes among adults with type 2 diabetes. These associations were similar across two nationwide cohorts from varied social contexts, and were largely consistent across populations with different demographic, lifestyle, and clinical features. Thus, assessing the combined SDHs of individuals with type 2 diabetes might be a promising approach to incorporate into diabetes care to identify socially vulnerable groups and reduce disease burden., Funding: The National Natural Science Foundation of China, the National Key R&D Program of China, and the Fundamental Research Funds for the Central Universities., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To investigate the associations of tea, coffee, and red wine intakes with health risks among individuals with hypertension., Methods: This prospective cohort study included participants with hypertension from the UK Biobank cohort. Study exposures included self-reported intakes of coffee, tea, and red wine. The primary outcome was all-cause mortality, and the secondary outcomes were cardiovascular mortality and cardiovascular disease. The associations of beverage intake with outcomes were analyzed using Cox regression models. The hazard ratios and 95% confidence intervals were estimated., Results: A total of 187 708 participants with hypertension were included. The median follow-up period was 13.8 years. In individuals with hypertension, drinking one to two cups/day of coffee or three to four cups/day of tea was significantly associated with the lowest risk of all-cause mortality compared with less than one cup/day [hazard ratio for coffee, 0.943 (95% confidence interval, 0.908-0.979); hazard ratio for tea, 0.882 (95% confidence interval, 0.841-0.924)]. Red wine intake was inversely associated with all-cause mortality risk. Dose-response analysis revealed that high coffee intake (approximately greater than or equal to six cups/day) was significantly associated with increased risks of cardiovascular mortality and cardiovascular disease, but high tea and red wine intakes were not. Furthermore, replacing plain water with tea, but not coffee, significantly reduced the risks of all-cause mortality and cardiovascular disease. Replacing other alcoholic beverages with red wine also significantly reduced the risks of all three outcomes., Conclusions: These findings suggest that tea and red wine, but not coffee, can be part of a healthy diet for the hypertensive population., (© The Author(s) 2024. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Although it is widely acknowledged that long-term exposure to ambient air pollution is closely related to the risk of mortality, there were inconsistencies in terms of cause-specific mortality and it is still unknown whether lifestyle and genetic susceptibility could modify the association., Methods: This population-based prospective cohort study involved 461,112 participants from the UK Biobank. The land-use regression model was used to estimate the concentrations of particulate matter (PM 2.5 , PM coarse , PM 10 ), and nitrogen oxides (NO 2 and NO x ). The association between air pollution and mortality was evaluated using Cox proportional hazard models. Furthermore, a lifestyle score incorporated with smoking status, physical activity, alcohol consumption, and diet behaviors, and polygenic risk score using 12 genetic variants, were developed to assess the modifying effect of air pollution on mortality outcomes., Results: During a median follow-up of 14.0 years, 33,903 deaths were recorded, including 17,083 (2835; 14,248), 6970, 2429, and 1287 deaths due to cancer (lung cancer, non-lung cancer), cardiovascular disease (CVD), respiratory and digestive disease, respectively. Each interquartile range (IQR) increase in PM 2.5 , NO 2 and NO x was associated with 7 %, 6 % and 5 % higher risk of all-cause mortality, respectively. Specifically, for cause-specific mortality, each IQR increase in PM 2.5 , NO 2 and NO x was also linked to mortality due to cancer (lung cancer and non-lung cancer), CVD, respiratory and digestive disease. Furthermore, additive and multiplicative interactions were identified between high ambient air pollution and unhealthy lifestyle on mortality. In addition, associations between air pollution and mortality were modified by lifestyle behaviors., Conclusion: Long-term exposure to air pollutants increased the risk of all-cause and cause-specific mortality, which was modified by lifestyle behaviors. In addition, we also revealed a synergistically detrimental effect between air pollution and an unhealthy lifestyle, suggesting the significance of joint air pollution management and adherence to a healthy lifestyle on public health., Competing Interests: Declaration of competing interest The authors declare they have nothing to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Several characteristics distinguish lung cancer in female patients from that in male patients, with adenocarcinoma being more prevalent in female patients and occurring more frequently in female patients who do not smoke. Uncertainty surrounds the relationship between female-specific reproductive factors and lung cancer risk., Research Question: Are sex-specific reproductive factors associated with risk of lung cancer in different genetic risk groups and histologic types?, Study Design and Methods: A Cox proportional hazard model was used to evaluate the association between multiple reproductive factors and the risk of lung cancer developing in a prospective cohort study involving 273,190 female individuals from the UK Biobank. Subgroup analyses stratified by age, smoking status, BMI, genetic risk, and histologic subtype were conducted to emphasize the modification effects further., Results: A total of 1,182 cases of lung cancer in female patients were recorded over a median follow-up period of 12.0 years in the cohort study. In multivariable-adjusted models, early menarche (age ≤ 11 years: hazard ratio [HR], 1.22; 95% CI, 1.03-1.46), early menopause (age ≤ 46 years: HR, 1.49; 95% CI, 1.19-1.86), a shorter reproductive span (≤ 32 years: HR, 1.42; 95% CI, 1.18-1.71; and 33-35 years: HR, 1.24; 95% CI, 1.00-1.53), and early age at first birth (age ≤ 20 years: HR, 1.63; 95% CI, 1.33-2.01) were associated with a higher risk of lung cancer. Stratified analysis revealed that several reproductive factors, including early age at menopause, shortened reproductive span, and early age at first birth, showed a substantially stronger relationship with an elevated risk of lung cancer, particularly of lung adenocarcinoma, in populations with high genetic risk and more detrimental behaviors., Interpretation: Early age at menopause, a shortened reproductive life span, and early age at first birth were associated with higher risks of lung cancer, particularly of lung adenocarcinoma, in a subpopulation with higher genetic susceptibility and detrimental behaviors. The evidence provided by this study emphasizes the significance of screening for multiple reproductive factors to prevent lung cancer among female individuals., Competing Interests: Financial/Nonfinancial Disclosures None declared., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Assisted reproductive technologies (ART) have increased the incidence of multiple births, which can have a negative impact on maternal and offspring health. The study aimed to investigate the association between genetically predicted multiple birth and the risk of 42 common diseases of the nervous, psychiatric, cardiovascular, respiratory, digestive, and endocrine systems., Methods: The study utilized two-sample Mendelian randomization (MR) analysis to explore the potential causal relationship between genetically predicted multiple birth and the genetically predicted risk of diseases. The study used the FinnGen and UK Biobank datasets for analysis., Results: The study found no significant causal relationship between multiple birth and psychiatric disorders. However, the lower limits of the 95% confidence intervals for bipolar affective disorder and anxiety disorders were not robust, indicating a need for further investigation. The study found that multiple birth may be a strong risk factor for infantile cerebral palsy, and caution is necessary in both natural and ART multiple births. The study revealed a potential causal relationship between multiple birth and coronary heart disease, ischemic heart disease, and deep vein thrombosis, which may be related to abnormal intrauterine environments in multiple pregnancies. Surprisingly, multiple birth appears to have a protective effect against some respiratory diseases, such as chronic obstructive pulmonary disease and asthma., Conclusions: The study highlights the need for caution regarding the risk of infantile cerebral palsy, cardiovascular diseases, and psychiatric disorders in multiple birth. Our study can lead to the development of preventive strategies and improved clinical management for affected infants., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objectives: The association between sleep pattern and chronic kidney disease (CKD) incidence, and whether the association is dependent on the genetic backgrounds has not been addressed. We sought to investigate the association of multidimensional sleep pattern with CKD in consideration of genetic polymorphisms., Methods: In this prospective cohort study of 157,175 participants from the UK Biobank, sleep patterns were derived by multiple correspondence analysis (MCA) and k-means clustering of individual sleep traits (sleep duration, insomnia, chronotype, daytime sleepiness, snoring, and night shift status). Cox proportional hazard regression was used to estimate the association between sleep patterns and CKD incidence. Gene-environment-wide interaction study (GEWIS) was performed to detect whether gene polymorphisms were modifiers on this association., Results: Compared with "healthy sleep" pattern, increased CKD incidence was observed in the clusters with "long sleep duration" (hazard ratios (HR) 1.42, 95% confidence intervals (CI), 1.18-1.72) and "night shift" (HR 1.23, 95% CI, 1.05-1.45) patterns, but not with the "short sleep duration" pattern. By GEWIS, we identified 167 SNPs as suggestive effect modifiers that interacted with unhealthy sleep patterns and affected the risk of CKD., Conclusions: Unhealthy sleep patterns, with features of long sleep duration and night shift, may increase the risk of CKD. The study highlights the interaction of sleep and individual genetic risk to affect health outcomes., Competing Interests: Declaration of Competing Interest All authors declare no competing interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: This study aimed to analyze the progression and trends of multimorbidity in the elderly in China and internationally from a bibliometric perspective, and compare their differences on hotspots and research fronts., Methods: Publications between January 2001 and August 2021 were retrieved from WOS and CNKI databases. Endnote 20 and VOSviewer 1.6.8 were used to summarize bibliometric features, including publication years, journals, and keywords, and the co-occurrence map of countries, institutions, and keywords was drawn., Results: 3857 research papers in English and 664 research papers in Chinese were included in this study. The development trends of multimorbidity in the elderly are fully synchronized in China and other countries. They were divided into germination period, development period, and prosperity period. Research literature in English was found to be mainly focused on public health, and the IF of the literature is high; In China, however, most research papers are in general medicine and geriatrics with fewer core journals. Co-occurrence analysis based on countries and institutions showed that the most productive areas were the United States, Canada, the United Kingdom, and Australia, while the Chinese researchers have made little contribution. The clustering analysis of high-frequency keywords in China and around the globe shows that the hotspots have shifted from individual multimorbidity to group multimorbidity management. Sorting out the top 10 highly cited articles and highly cited authors, Barnett, K's article published in Lancet in 2012 is regarded as a milestone in the field., Conclusion: Multimorbidity in the elderly leads to more attention in the world. Although China lags behind global research the research fronts from disease-centered to patient-centered, and individual management to population management is consistent.

Purpose: To describe the novel technique of photoselective sharp enucleation of the prostate (PSEP) with a front-firing 532-nm laser and evaluate its efficacy and safety., Methods: A seven-step standardized surgical procedure was established, and PSEP was performed in an en bloc or lobulate manner according to the size of the middle lobe of the prostate. The following clinical data of 583 patients who underwent PSEP in our center from November 2016 to May 2018 were retrospectively reviewed: maximum flow rate (Q max ), International Prostate Symptom Score (IPSS), quality of life score (Q ols ), post-void residual volume (PVR), prostate volume, operation time, serum prostate-specific antigen (PSA) concentration, and complications at 1, 6, and 12 months postoperatively., Results: Of the 583 patients, 475 had complete clinical information and were included in the study. The median operation time was 39 min. There were significant improvements in the Q max , IPSS, Q ols , PVR and PSA concentration at each follow-up time point postoperatively. Postoperative hemorrhage occurred in 22 patients (4.6%), urinary retention in 29 (6.1%), urinary tract infection in 55 (11.6%), bladder neck contracture in 8 (1.7%), urethral strictures in 11 (2.3%), and stress urinary incontinence in 9 (1.9%)., Conclusions: PSEP is effective and safe for the treatment of benign prostatic hyperplasia. The innovative technique integrates the excellent hemostatic property of the 532-nm laser and the high efficiency of enucleation. It decreases the occurrence of postoperative incontinence associated with "blunt" enucleation of 532-nm laser and eliminates the lack of tissue samples problem associated with photoselective vaporization of the prostate., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

Background: Pulmonary arterial hypertension (PAH) is a lethal vasculopathy characterized by pathogenic remodeling of pulmonary arterioles leading to increased pulmonary pressures, right ventricular hypertrophy, and heart failure. PAH can be associated with other diseases (APAH: connective tissue diseases, congenital heart disease, and others) but often the etiology is idiopathic (IPAH). Mutations in bone morphogenetic protein receptor 2 (BMPR2) are the cause of most heritable cases but the vast majority of other cases are genetically undefined., Methods: To identify new risk genes, we utilized an international consortium of 4241 PAH cases with exome or genome sequencing data from the National Biological Sample and Data Repository for PAH, Columbia University Irving Medical Center, and the UK NIHR BioResource - Rare Diseases Study. The strength of this combined cohort is a doubling of the number of IPAH cases compared to either national cohort alone. We identified protein-coding variants and performed rare variant association analyses in unrelated participants of European ancestry, including 1647 IPAH cases and 18,819 controls. We also analyzed de novo variants in 124 pediatric trios enriched for IPAH and APAH-CHD., Results: Seven genes with rare deleterious variants were associated with IPAH with false discovery rate smaller than 0.1: three known genes (BMPR2, GDF2, and TBX4), two recently identified candidate genes (SOX17, KDR), and two new candidate genes (fibulin 2, FBLN2; platelet-derived growth factor D, PDGFD). The new genes were identified based solely on rare deleterious missense variants, a variant type that could not be adequately assessed in either cohort alone. The candidate genes exhibit expression patterns in lung and heart similar to that of known PAH risk genes, and most variants occur in conserved protein domains. For pediatric PAH, predicted deleterious de novo variants exhibited a significant burden compared to the background mutation rate (2.45×, p = 2.5e-5). At least eight novel pediatric candidate genes carrying de novo variants have plausible roles in lung/heart development., Conclusions: Rare variant analysis of a large international consortium identified two new candidate genes-FBLN2 and PDGFD. The new genes have known functions in vasculogenesis and remodeling. Trio analysis predicted that ~ 15% of pediatric IPAH may be explained by de novo variants.

Background: In recent years, many reports have highlighted that metabolic surgery may ameliorate the cardiovascular risk in morbidly obese patients with or without type 2 diabetes (T2D). However, few studies have evaluated the long-term cardiovascular disease (CVD) risk after metabolic surgery in T2D patients with a low body mass index (BMI)., Objectives: To use the Prediction for ASCVD Risk in China (China-PAR) equations and United Kingdom Prospective Diabetes Study (UKPDS) risk engine to assess the 10-year CVD risk in low-BMI T2D patients after metabolic surgery., Setting: University hospital, China., Methods: We retrospectively reviewed our prospectively collected data of T2D patients who underwent metabolic surgery at our hospital between 2010 and 2018. We included patients who met the criteria for calculating a 10-year cardiovascular risk score by the China-PAR equations and UKPDS risk engine. Demographic characteristics, anthropometric variables, and glycolipid metabolic parameters were assessed preoperatively and during a 4-year follow-up period. Patients with a BMI < 30 kg/m 2 were compared with those with a BMI > 30 kg/m 2 ., Results: We evaluated 117 patients, of whom 62 (53%) had a BMI < 30 kg/m 2 and 55 (47%) had a BMI > 30 kg/m 2 . Patients with a BMI < 30 kg/m 2 were significantly older and had a longer duration of diabetes. The rate of complete T2D remission in the group of patients with BMIs < 30 kg/m 2 was significantly lower than that in the group with BMIs > 30 kg/m 2 (35.2% versus 56.1%, respectively; P = .042). The overall 10-year and lifetime atherosclerotic cardiovascular disease risks were reduced from 4.2% to 2.3% and 25.3% to 13.9%, respectively (both P < .05), at 1 year postoperatively using the China-PAR equation. The overall 10-year coronary heart disease (CHD) and fatal CHD risks were reduced by 48.1% and 53.1%, respectively, at 1 year after surgery using the UKPDS risk engine. The advantages of metabolic surgery in reducing CVD risks are similar in both BMI groups, whether using the China-PAR equation or the UKPDS risk engine., Conclusion: The 10-year CVD risk in T2D patients with BMIs < 30 kg/m 2 and BMIs > 30 kg/m 2 were significantly reduced after metabolic surgery, although the rate of complete T2D remission T2Din patients with BMIs < 30 kg/m 2 was lower than that in patients with BMIs > 30 kg/m 2 . The China-PAR equation is a reliable and useful clinical tool for CVD risk evaluation in Chinese patients after metabolic surgery., (Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

To facilitate scientific collaboration on polygenic risk scores (PRSs) research, we created an extensive PRS online repository for 35 common cancer traits integrating freely available genome-wide association studies (GWASs) summary statistics from three sources: published GWASs, the NHGRI-EBI GWAS Catalog, and UK Biobank-based GWASs. Our framework condenses these summary statistics into PRSs using various approaches such as linkage disequilibrium pruning/p value thresholding (fixed or data-adaptively optimized thresholds) and penalized, genome-wide effect size weighting. We evaluated the PRSs in two biobanks: the Michigan Genomics Initiative (MGI), a longitudinal biorepository effort at Michigan Medicine, and the population-based UK Biobank (UKB). For each PRS construct, we provide measures on predictive performance and discrimination. Besides PRS evaluation, the Cancer-PRSweb platform features construct downloads and phenome-wide PRS association study results (PRS-PheWAS) for predictive PRSs. We expect this integrated platform to accelerate PRS-related cancer research., (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)

Polygenic risk scores are emerging as a potentially powerful tool to predict future phenotypes of target individuals, typically using unrelated individuals, thereby devaluing information from relatives. Here, for 50 traits from the UK Biobank data, we show that a design of 5,000 individuals with first-degree relatives of target individuals can achieve a prediction accuracy similar to that of around 220,000 unrelated individuals (mean prediction accuracy = 0.26 vs. 0.24, mean fold-change = 1.06 (95% CI: 0.99-1.13), P-value = 0.08), despite a 44-fold difference in sample size. For lifestyle traits, the prediction accuracy with 5,000 individuals including first-degree relatives of target individuals is significantly higher than that with 220,000 unrelated individuals (mean prediction accuracy = 0.22 vs. 0.16, mean fold-change = 1.40 (1.17-1.62), P-value = 0.025). Our findings suggest that polygenic prediction integrating family information may help to accelerate precision health and clinical intervention.

Accurate construction of polygenic scores (PGS) can enable early diagnosis of diseases and facilitate the development of personalized medicine. Accurate PGS construction requires prediction models that are both adaptive to different genetic architectures and scalable to biobank scale datasets with millions of individuals and tens of millions of genetic variants. Here, we develop such a method called Deterministic Bayesian Sparse Linear Mixed Model (DBSLMM). DBSLMM relies on a flexible modeling assumption on the effect size distribution to achieve robust and accurate prediction performance across a range of genetic architectures. DBSLMM also relies on a simple deterministic search algorithm to yield an approximate analytic estimation solution using summary statistics only. The deterministic search algorithm, when paired with further algebraic innovations, results in substantial computational savings. With simulations, we show that DBSLMM achieves scalable and accurate prediction performance across a range of realistic genetic architectures. We then apply DBSLMM to analyze 25 traits in UK Biobank. For these traits, compared to existing approaches, DBSLMM achieves an average of 2.03%-101.09% accuracy gain in internal cross-validations. In external validations on two separate datasets, including one from BioBank Japan, DBSLMM achieves an average of 14.74%-522.74% accuracy gain. In these real data applications, DBSLMM is 1.03-28.11 times faster and uses only 7.4%-24.8% of physical memory as compared to other multiple regression-based PGS methods. Overall, DBSLMM represents an accurate and scalable method for constructing PGS in biobank scale datasets., (Copyright © 2020 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.)

Background Both genetic and nongenetic factors can predispose individuals to cardiovascular risk. Finding ways to alter these predispositions is important for cardiovascular disease prevention. Methods and Results We used a novel whole-genome approach to estimate the genetic and nongenetic effects on-and hence their predispositions to-cardiovascular risk and determined whether they vary with respect to lifestyle factors such as physical activity, smoking, alcohol consumption, and dietary intake. We performed analyses on the ARIC (Atherosclerosis Risk in Communities) Study (N=6896-7180) and validated findings using the UKBB (UK Biobank, N=14 076-34 538). Lifestyle modulation was evident for many cardiovascular traits such as body mass index and resting heart rate. For example, alcohol consumption modulated both genetic and nongenetic effects on body mass index, whereas smoking modulated nongenetic effects on heart rate, pulse pressure, and white blood cell count. We also stratified individuals according to estimated genetic and nongenetic effects that are modulated by lifestyle factors and showed distinct phenotype-lifestyle relationships across the stratified groups. Finally, we showed that neglecting lifestyle modulations of cardiovascular traits would on average reduce single nucleotide polymorphism heritability estimates of these traits by a small yet significant amount, primarily owing to the overestimation of residual variance. Conclusions Lifestyle changes are relevant to cardiovascular disease prevention. Individual differences in the genetic and nongenetic effects that are modulated by lifestyle factors, as shown by the stratified group analyses, implies a need for personalized lifestyle interventions. In addition, single nucleotide polymorphism-based heritability of cardiovascular traits without accounting for lifestyle modulations could be underestimated.

The study investigated cross-cultural differences in variability and average performance in arithmetic, mathematical reasoning, symbolic and non-symbolic magnitude processing, intelligence, spatial ability, and mathematical anxiety in 890 6- to 9-year-old children from the United Kingdom, Russia, and China. Cross-cultural differences explained 28% of the variance in arithmetic and 17.3% of the variance in mathematical reasoning, with Chinese children outperforming the other two groups. No cross-cultural differences were observed for spatial ability and mathematical anxiety. In all samples, symbolic magnitude processing and mathematical reasoning were independently related to early arithmetic. Other factors, such as non-symbolic magnitude processing, mental rotation, intelligence, and mathematical anxiety, produced differential patterns across the populations. The results are discussed in relation to potential influences of parental practice, school readiness, and linguistic factors on individual differences in early mathematics. Statement of contribution What is already known on this subject? Cross-cultural differences in mathematical ability are present in preschool children. Similar mechanisms of mathematical development operate in preschool children from the United Kingdom, Russia, and China. Tasks that require understanding of numbers are best predictors of arithmetic in preschool children. What does this study add? Cross-cultural differences in mathematical ability become greater with age/years of formal education. Similar mechanisms of mathematical development operate in early primary school children from the United Kingdom, Russia, and China. Symbolic number magnitude and mathematical reasoning are the main predictors of arithmetic in all three populations., (© 2018 The Authors British Journal of Developmental Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Background: There has been increased interest in using multiple observational databases to understand the safety profile of medical products during the postmarketing period. However, it is challenging to perform analyses across these heterogeneous data sources. The Observational Medical Outcome Partnership (OMOP) provides a Common Data Model (CDM) for organizing and standardizing databases. OMOP's work with the CDM has primarily focused on US databases. As a participant in the OMOP Extended Consortium, we implemented the OMOP CDM on the UK Electronic Healthcare Record database-The Health Improvement Network (THIN)., Objective: The aim of the study was to evaluate the implementation of the THIN database in the OMOP CDM and explore its use for active drug safety surveillance., Methods: Following the OMOP CDM specification, the raw THIN database was mapped into a CDM THIN database. Ten Drugs of Interest (DOI) and nine Health Outcomes of Interest (HOI), defined and focused by the OMOP, were created using the CDM THIN database. Quantitative comparison of raw THIN to CDM THIN was performed by execution and analysis of OMOP standardized reports and additional analyses. The practical value of CDM THIN for drug safety and pharmacoepidemiological research was assessed by implementing three analysis methods: Proportional Reporting Ratio (PRR), Univariate Self-Case Control Series (USCCS) and High-Dimensional Propensity Score (HDPS). A published study using raw THIN data was selected to examine the external validity of CDM THIN., Results: Overall demographic characteristics were the same in both databases. Mapping medical and drug codes into the OMOP terminology dictionary was incomplete: 25 % medical codes and 55 % drug codes in raw THIN were not listed in the OMOP terminology dictionary, representing 6 % condition occurrence counts, 4 % procedure occurrence counts and 7 % drug exposure counts in raw THIN. Seven DOIs had <0.3 % and three DOIs had 1 % of unmapped drug exposure counts; each HOI had at least one definition with no or minimal (≤0.2 %) issues with unmapped condition occurrence counts, except for the upper gastrointestinal (UGI) ulcer hospitalization cohort. The application of PRR, USCCS and HDPS found, respectively, a sensitivity of 67, 78 and 50 %, and a specificity of 68, 59 and 76 %, suggesting that safety issues defined as known by the OMOP could be identified in CDM THIN, with imperfect performance. Similar PRR scores were produced using both CDM THIN and raw THIN, while the execution time was twice as fast on CDM THIN. There was close replication of demographic distribution, death rate and prescription pattern and trend in the published study population and the cohort of CDM THIN., Conclusions: This research demonstrated that information loss due to incomplete mapping of medical and drug codes as well as data structure in the current CDM THIN limits its use for all possible epidemiological evaluation studies. Current HOIs and DOIs predefined by the OMOP were constructed with minimal loss of information and can be used for active surveillance methodological research. The OMOP CDM THIN can be a valuable tool for multiple aspects of pharmacoepidemiological research when the unique features of UK Electronic Health Records are incorporated in the OMOP library.