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Whether there is an association between dietary quality and sleep disorder in American adults is unclear. We conducted this study to analyze whether dietary quality, using the Healthy Eating Index-2015 (HEI-2015) scores as the measure, was associated with self-reported sleep disorders. Data came from the National Health and Nutrition Examination Survey (2005-2014). Step-weighted logistic regression models were performed to explore the relationships between the HEI-2015 scores and sleep disorder. Weighted quantile sum regression model was used to identify the HEI-2015 components most strongly associated with sleep disorders. According to quartiles, HEI scores were categorized into inadequate (<25%), average (25%-75%), and optimal (>75%). Compared to inadequate HEI status, average HEI status (OR: 0.961, 95%CI: 0.959-0.962) and optimal HEI status (OR: 0.913, 95% CI: 0.912-0.915) were associated with reduced risk of sleep disorder after multivariable adjustments. Greens and beans, added sugars, saturated fats, total vegetables and total protein foods were the top five important components for sleep disorders. Our results suggest that there is a statistically significant association between better dietary quality and reduced risk of sleep disorder among United States adults.

Aim: We aimed to assess and compare secular trends in type 2 diabetes mortality attributable to particulate matter pollution in China and U.S., Methods: We performed an age-period-cohort (APC) analysis to estimate the independent effects of age, period, and cohort on mortality of type 2 diabetes attributable to particulate matter pollution. We collected age-standardized and age-specific mortality rates (1990-2017) from the Global Burden of Disease 2017 Study for China and the U.S., Results: During the period 1990-2017, the age-standardized mortality rates of type 2 diabetes attributable to particulate matter pollution in China showed a general increasing trend, while that in U.S. showed an increase before 2002 and subsequently a decrease. The age effect increased markedly in China compared with the U.S. The period effect showed a substantially increase in China while that in the U.S. increased during 1990-2007 and tended to be stable during 2007-2017. The cohort effect peaked in birth cohort born in 1902-1906 in both China and U.S. and declined consistently in the cohort born in 1992-1996., Conclusions: The age-standardized mortality rates of type 2 diabetes attributable to particulate matter pollution, the age, and period effect in China have been increasing in both sexes from 1990 to 2017. The overall mortality in the U.S. began to decrease since 2003, and the period effect showed a tendency to stabilize. Consequently, it is necessary to educate the nation with the correct knowledge and adopting policies on pollutant emission and techniques to reduce air pollution in China., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2020 Xiaoxue Liu et al.)

The optimal number of examined lymph nodes (ELN) for staging and impact of nodal status on survival following total pancreatectomy (TP) for pancreatic ductal adenocarcinoma (PDAC) is unclear. The aim of this study was to evaluate the prognostic impact of different lymph node status after TP for PDAC.The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients who underwent TP for PDAC from 2004 to 2015. We calculated overall survival (OS) of these patients using Kaplan-Meier analysis and Cox proportional hazards model.Overall, 1291 patients were included in the study, with 869 node-positive patients (49.5%). A cut-off points analysis revealed that 19, 19, and 13 lymph nodes best discriminated OS for all patients, node-negative patients, and node-positive patients, respectively. Higher number of ELN than the corresponding cut-off points was an independent predictor for better prognosis [all patients: hazard ratios (HR) 0.786, P = .002; node-negative patients: HR 0.714, P = .043; node-positive patients: HR 0.678, P < .001]. For node-positive patients, 1 to 3 positive lymph nodes (PLN) correlated independently with better survival compared with those with 4 or more PLN (HR 1.433, P = .002). Moreover, when analyzed in node-positive patients with less than 13 ELN, neither the number of PLN nor lymph node ratio (LNR) was associated with survival. However, when limited node-positive patients with at least 13 ELN, univariate analyses showed that both the number of PLN and LNR were associated with survival, whereas multivariate analyses demonstrated that only number of PLN was consistently associated with survival (HR 1.556, P = .004).Evaluation at least 19 lymph nodes should be considered as quality metric of surgery in patients who underwent TP for PDAC. For node-negative patients, a minimal number of 19 lymph nodes is adequate to avoid stage migration. For node-positive patients, PLN is superior to LNR in predicting survival after TP, predominantly for those with high number of ELN.

Background: Trichlorophenols (TCPs) are organochlorine compounds which are ubiquitous in the environment and well known for their carcinogenic effects. However, little is known about their neurotoxicity in humans., Objectives: Our goal was to examine the association between body burden of TCPs (ie, 2,4,5-TCP and 2,4,6-TCP) and attention deficit hyperactivity disorder (ADHD)., Methods: We calculated ORs and 95% CIs from logistic regression analyses using data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) to evaluate the association between urinary TCPs and parent-reported ADHD among 2546 children aged 6-15 years., Results: Children with low levels (<3.58 μg/g) and high levels (≥3.58 μg/g) of urinary 2,4,6-TCP had a higher risk of parent-reported ADHD compared to children with levels below the limit of detection (OR 1.54, 95% CI 0.97 to 2.43 and OR 1.77, 95% CI 1.18 to 2.66, respectively; p for trend=0.006) after adjusting for covariates. No association was found between urinary 2,4,5-TCP and parent-reported ADHD., Conclusion: Exposure to TCP may increase the risk of behavioural impairment in children. The potential neurotoxicity of these chemicals should be considered in public health efforts to reduce environmental exposures/contamination, especially in countries where organochlorine pesticides are still commonly used.

Background: In the practice of percutaneous coronary intervention, post-dilation often is performed after stent deployment to improve stent expansion. However, aggressive mechanical expansion is a risk factor of distal embolization and microvascular injury, especially for patients with acute myocardial infarction (AMI). Few studies have investigated the effects of post-dilation on medium-term clinical outcomes., Methods and Results: Patients enrolled in the multicenter NHLBI Dynamic Registry between 2001 and 2006 were evaluated. Patients who were treated with ≥ 1 stent were studied. Patients with cardiogenic shock or history of coronary artery bypass graft surgery were excluded. Patients were followed up to 1 year. Because of the significant statistical interaction (P = .02) between post-dilation and AMI status on the hazard of death/myocardial infarction (MI), post-dilation effects were estimated separately for patients who did and did not present with an AMI. Among the 1,358 patients who presented with an AMI, post-dilation was associated with a significantly higher risk of death/MI (hazard ratio [HR] = 1.78, 95% CI 1.12-2.83, P = .01), not associated with the risk of repeat revascularization (HR = 1.15, 95% CI 0.81-1.62, P = .43). Among the 3,001 patients who did not present with AMI, post-dilation was not associated with risks of death/MI (HR = 1.08, 95% CI 0.77-1.50, P = .67) or repeat revascularization (HR = 1.17, 95% CI 0.93-1.47, P = .19). Similar effects were observed for the restricted analysis with additional adjustment for lesion characteristics among the 1,039 AMI patients and 2,179 non-AMI patients with a single lesion treated., Conclusions: Stent post-dilation is associated with an increased risk of death/MI in AMI patients but not in non-AMI patients. Further investigation is warranted., (Copyright © 2010 Mosby, Inc. All rights reserved.)