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Abstract Background To investigate the association between surgical removal of tonsils and risk of COVID-19 with different severity. Methods Through a nested case–control study during January 31st to December 31st 2020, including 58,888 participants of the UK Biobank, we investigated the association of tonsillectomy with the future risk of mild and severe COVID-19, using binomial logistic regression. We further examined the associations of such surgery with blood inflammatory, lipid and metabolic biomarkers to understand potential mechanisms. Finally, we replicated the analysis of severe COVID-19 in the Swedish AMORIS Cohort (n = 451,960). Results Tonsillectomy was associated with a lower risk of mild (odds ratio [95% confidence interval]: 0.80 [0.75–0.86]) and severe (0.87 [0.77–0.98]) COVID-19 in the UK Biobank. The associations did not differ substantially by sex, age, Townsend deprivation index, or polygenic risk score for critically ill COVID-19. Levels of blood inflammatory, lipid and metabolic biomarkers did, however, not differ greatly by history of surgical removal of tonsils. An inverse association between tonsillectomy and severe COVID-19 was also observed in the AMORIS Cohort, primarily among older individuals (> 70 years) and those with ≤ 12 years of education. Conclusions Surgical removal of tonsils may be associated with a lower risk of COVID-19. This association is unlikely attributed to alterations in common blood inflammatory, lipid and metabolic biomarkers.

Abstract Background Childhood maltreatment (CM) has been indicated in adverse health outcomes across the lifespan, including severe infection-related outcomes. Yet, data are scarce on the potential role of CM in severe COVID-19-related outcomes as well as on mechanisms underlying this association. Methods We included 151,427 individuals in the UK Biobank who responded to questions on the history of CM in 2016 and 2017 and were alive on January 31, 2020. Binomial logistic regression models were performed to estimate the association between a history of CM and severe COVID-19 outcomes (i.e. hospitalization or death due to COVID-19), as well as COVID-19 diagnosis and vaccination as secondary outcomes. We then explored the potential mediating roles of socio-economic status, lifestyle and pre-pandemic comorbidities, and the effect modification by polygenic risk score for severe COVID-19 outcomes. Results The mean age of the study population at the start of the pandemic was 67.7 (SD = 7.72) years, and 56.5% were female. We found the number of CM types was associated with the risk of severe COVID-19 outcomes in a graded manner (p for trend 0.05). Mediation analysis revealed that 50.9% of the association between CM and severe COVID-19 outcomes was explained by suboptimal socio-economic status, lifestyle, and pre-pandemic diagnosis of psychiatric disorders or other chronic medical conditions. In contrast, any CM exposure was only weakly associated with COVID-19 diagnosis (1.06 [1.01–1.12]) while significantly associated with not being vaccinated for COVID-19 (1.21 [1.13–1.29]). Conclusions Our results add to the growing knowledge base indicating the role of childhood maltreatment in negative health outcomes across the lifespan, including severe COVID-19-related outcomes. The identified factors underlying this association represent potential intervention targets for mitigating the harmful effects of childhood maltreatment in COVID-19 and similar future pandemics.

Abstract Mental disorders are leading causes of disability and premature death worldwide, partly due to high comorbidity with cardiometabolic disorders. Reasons for this comorbidity are still poorly understood. We leverage nation-wide health records and near-complete genealogies of Denmark and Sweden (n = 17 million) to reveal the genetic and environmental contributions underlying the observed comorbidity between six mental disorders and 15 cardiometabolic disorders. Genetic factors contributed about 50% to the comorbidity of schizophrenia, affective disorders, and autism spectrum disorder with cardiometabolic disorders, whereas the comorbidity of attention-deficit/hyperactivity disorder and anorexia with cardiometabolic disorders was mainly or fully driven by environmental factors. In this work we provide causal insight to guide clinical and scientific initiatives directed at achieving mechanistic understanding as well as preventing and alleviating the consequences of these disorders.

Abstract Complicated associations between multiplexed environmental factors and aging are poorly understood. We manipulated aging using multidimensional metrics such as phenotypic age, brain age, and brain volumes in the UK Biobank. Weighted quantile sum regression was used to examine the relative individual contributions of multiplexed environmental factors to aging, and self-organizing maps (SOMs) were used to examine joint effects. Air pollution presented a relatively large contribution in most cases. We also found fair heterogeneities in which the same environmental factor contributed inconsistently to different aging metrics. Particulate matter contributed the most to variance in aging, while noise and green space showed considerable contribution to brain volumes. SOM identified five subpopulations with distinct environmental exposure patterns and the air pollution subpopulation had the worst aging status. This study reveals the heterogeneous associations of multiplexed environmental factors with multidimensional aging metrics and serves as a proof of concept when analyzing multifactors and multiple outcomes.

Background: While vegetation type, population density and proximity to greenspaces have been linked to human health, what type and location of greenspace matter most have remained unclear. In this context, there are question marks over investment-style metrics. Objectives: This paper aims at establishing what vegetation type may matter most in modifying heat-mortality associations, and what the optimal buffer distances of total and specific types of greenspace exposure associated with reduced heat-related mortality risks are. Methods: We conducted small-area analyses using daily mortality data for 286 Territory Planning Units (TPUs) across Hong Kong and 1 × 1 km gridded air temperature data for the summer months (2005–2018). Using a case time series design, we examined effect modifications of total and specific types of greenspaces, as well as population-weighted exposure at varying buffer distances (200–4000 m). We tested the significance of effect modifications by comparing relative risks (RRs) between the lowest and highest quartiles of each greenspace exposure metric; and explored the strength of effect modifications by calculating the ratio of RRs. Results: Forests, unlike grasslands, showed significant effect modifications on heat-mortality associations, with RRs rising from 0.98 (95 %CI: 0.92,1.05) to 1.06 (1.03, 1.10) for the highest to lowest quartiles (p-value = 0.037) The optimal distances associated with the most apparent effects were around 1 km for population-weighted exposure, with the ratio of RRs being 1.424 (1.038,1.954) for NDVI, 1.191 (1.004,1.413) for total greenspace, and 1.227 (1.024,1.470) for forests. A marked difference was observed in terms of the paired area-level and optimal distance-based exposure to total greenspace and forests under extreme heat (p-values

Abstract Background This study aimed to explore the associations between household air pollution (HAP), measured by cooking fuel use, sensory impairments (SI), and their transitions in Chinese middle-aged and older adults. Methods Participants were recruited from the 2011 China Health and Retirement Longitudinal Study (CHARLS) and were subsequently followed up until 2018. Data on SI were collected by self-reported hearing and vision impairments, which were divided into three categories: non-SI, single SI (hearing or vision impairment), and dual SI (DSI). Cooking fuels, including solid and clean fuels, are proxies for HAP. The transitions of cooking fuels and SI refer to the switching of the fuel type or SI status from baseline to follow-up. Cox proportional hazard regression models were used to explore associations, and hazard ratios (HRs) and 95% confidence intervals (CI) were used to evaluate the strength of the association. Results The prevalence of non-SI, single SI, and DSI was 59.6%, 31.8%, and 8.6%, respectively, among the 15,643 participants at baseline in this study. Over a median follow-up of 7.0 years, 5,223 worsening SI transitions were observed. In the fully adjusted model, solid fuel use for cooking was associated with a higher risk of worsening SI transitions, including from non-SI to single SI (HR = 1.08, 95% CI = 1.01–1.16) and from non-SI to DSI (HR = 1.26, 95% CI = 1.09–1.47), but not from single SI to DSI. In addition, compared to those who always used solid fuels, participants who switched from solid to clean fuel for cooking appeared to have attenuated the risk of worsening SI transitions. The statistical significance of the associations remained in the set of sensitivity analyses. Conclusion Solid fuel use was associated with higher risks of worsening SI transitions, while converting the type of cooking fuel from solid to clean fuels may reduce the risk of worsening SI transitions. Our study suggests that tailored clean fuel interventions, especially in developing countries, should be implemented to prevent sensory impairments and hence reduce the burden of sensory impairment-related disability.

Abstract BackgroundStudies have reported the adverse effects of cold events on influenza. However, the role of critical factors, such as characteristics of cold spells, and regional variations remain unresolved. ObjectiveWe aimed to systematically evaluate the association between cold spells and influenza incidence in mainland China. MethodsThis time series analysis used surveillance data of daily influenza from 325 sites in China in the 2014‐2019 period. A total of 15 definitions of cold spells were adopted based on combinations of temperature thresholds and days of duration. A distributed lag linear model was used to estimate the short-term effects of cold spells on influenza incidence during the cool seasons (November to March), and we further explored the potential impact of cold spell characteristics (ie, intensity, duration, and timing during the season) on the estimated associations. Meta-regressions were used to evaluate the modification effect of city-level socioeconomic indicators. ResultsThe overall effect of cold spells on influenza incidence increased with the temperature threshold used to define cold spells, whereas the added effects were generally small and not statistically significant. The relative risk of influenza-associated with cold spells was 3.35 (95% CI 2.89‐3.88), and the estimated effects were stronger during the middle period of cool seasons. The health effects of cold spells varied geographically and residents in Jiangnan region were vulnerable groups (relative risk 7.36, 95% CI 5.44‐9.95). The overall effects of cold spells were positively correlated with the urban population density, population size, gross domestic product per capita, and urbanization rate, indicating a sterner response to cold spells in metropolises. ConclusionsCold spells create a substantial health burden on seasonal influenza in China. Findings on regional and socioeconomic differences in the health effects of cold spells on seasonal influenza may be useful in formulating region-specific public health policies to address the hazardous effects of cold spells.

Green-blue spaces (GBS) are pivotal in mitigating thermal discomfort. However, their management lacks guidelines rooted in epidemiological evidence for specific planning and design. Here we show how various GBS types modify the link between non-optimal temperatures and cardiovascular mortality across different thermal extremes. We merged fine-scale population density and GBS data to create novel GBS exposure index. A case time series approach was employed to analyse temperature-cardiovascular mortality association and the effect modifications of type-specific GBSs across 1085 subdistricts in south-eastern China. Our findings indicate that both green and blue spaces may significantly reduce high-temperature-related cardiovascular mortality risks (e.g., for low (5%) vs. high (95%) level of overall green spaces at 99th vs. minimum mortality temperature (MMT), Ratio of relative risk (RRR) = 1.14 (95% CI: 1.07, 1.21); for overall blue spaces, RRR = 1.20 (95% CI: 1.12, 1.29)), while specific blue space types offer protection against cold temperatures (e.g., for the rivers at 1st vs MMT, RRR = 1.17 (95% CI: 1.07, 1.28)). Notably, forests, parks, nature reserves, street greenery, and lakes are linked with lower heat-related cardiovascular mortality, whereas rivers and coasts mitigate cold-related cardiovascular mortality. Blue spaces provide greater benefits than green spaces. The severity of temperature extremes further amplifies GBS's protective effects. This study enhances our understanding of how type-specific GBS influences health risks associated with non-optimal temperatures, offering valuable insights for integrating GBS into climate adaptation strategies for maximal health benefits.

The characterization of neural signatures within the somatosensory pathway is essential for elucidating the pathogenic mechanisms of central post-stroke pain (CPSP) and developing more effective treatments such as deep brain stimulation (DBS). We explored the characteristics of thalamic neural oscillations in response to varying pain levels under multi-day local field potential (LFP) recordings and examined the influences of continuous DBS on these thalamic activities. We recorded LFPs from the left ventral posterolateral thalamus (VPL) of a patient with CPSP in the resting state under both off- and on-stimulation conditions. We observed significant differences in the power spectral density (PSD) of different pain levels in the delta, theta and gamma frequency bands of the left VPL; 75Hz DBS significantly increased the PSD of delta and decreased the PSD of low-beta, while 130Hz DBS significantly reduced the PSD of theta and low-beta. Thalamic stimulation modulated the neural oscillations related to pain, and the changes in neural activities in response to stimulation could serve as quantitative indicators for pain relief.

Abstract Background Peripheral vertigo is often comorbid with psychiatric disorders. However, no longitudinal study has quantified the association between peripheral vertigo and risk of psychiatric disorders. Furthermore, it remains unknown how the white matter integrity of frontal-limbic network relates to the putative peripheral vertigo-psychiatric disorder link. Methods We conducted a cohort study including 452,053 participants of the UK Biobank with a follow-up from 2006 through 2021. We assessed the risks of depression and anxiety disorders in relation to a hospitalization episode involving peripheral vertigo using Cox proportional hazards models. We also examined the associations of peripheral vertigo, depression, and anxiety with MRI fractional anisotropy (FA) in a subsample with brain MRI data (N = 36,087), using multivariable linear regression. Results Individuals with an inpatient diagnosis of peripheral vertigo had elevated risks of incident depression (hazard ratio (HR) 2.18; 95% confidence interval (CI) 1.79–2.67) and anxiety (HR 2.11; 95% CI 1.71–2.61), compared to others, particularly within 2 years after hospitalization (HR for depression 2.91; 95% CI 2.04–4.15; HR for anxiety 4.92; 95% CI 3.62–6.69). Depression was associated with lower FA in most studied white matter regions, whereas anxiety and peripheral vertigo did not show statistically significant associations with FA. Conclusions Individuals with an inpatient diagnosis of peripheral vertigo have increased subsequent risks of depression and anxiety disorders, especially within 2 years after hospitalization. Our findings further indicate a link between depression and lower microstructural connectivity as well as integrity beyond the frontal-limbic network.

Background Hearing loss and tinnitus have been proposed as potential indicators of impaired mental health and brain morphological changes. Aims To assess the associations of hearing loss and tinnitus with the risk of depression and anxiety and with brain volume. Method We conducted a community-based cohort study including 129 610 participants aged 40−69 years at recruitment to the UK Biobank with a follow-up period during 2006–2021 to estimate the risk of depression and anxiety after detection of hearing loss and reported tinnitus. We also assessed the associations of hearing loss and tinnitus with brain volume in a subsample with available brain magnetic resonance imaging data (N = 5222). Results We observed an increased risk of depression among individuals with hearing loss (hazard ratio [HR] 1.14, 95% CI 1.03–1.26), tinnitus (HR 1.30, 95% CI 1.21–1.41) or both (HR 1.32, 95% CI 1.15–1.52), compared with individuals with neither hearing loss nor tinnitus. Similar results were noted for anxiety (HR 1.18, 95% CI 1.07–1.30 for hearing loss; HR 1.32, 95% CI 1.22–1.43 for tinnitus; and HR 1.48, 95% CI 1.30–1.68 for both). Hearing loss was associated with decreased overall brain volume as well as decreased volume of different brain regions. The latter associations disappeared after adjustment for whole intracranial volume. Tinnitus was associated with greater left accumbens and right occipital pole volume after adjustment for the whole intracranial volume. Conclusions Individuals with tinnitus are at increased risk of depression and anxiety. Hearing loss, on the other hand, is associated with both mood disorders and altered brain morphology.

A growing number of urban dwellers are being exposed to excessively bright artificial night light induced by the development of high-intensity, high-density cities around the world. The adverse health effects of artificial light at night (ALAN) are increasingly becoming a global public health issue. Investigating the effects of built environment, especially ALAN, on public health has progressively developed into a cross-disciplinary research hotspot since the World Health Organization launched the Healthy Cities Project. Numerous studies found the links between ALAN and multiple negative health outcomes. However, to date, no review has summarized the health impacts of ALAN in China. This article systematically outlined the progress of research on the health effects of indoor and outdoor ALAN, including sleep disorders, obesity, cancers, cardiovascular diseases, metabolic diseases, cognitive function, and mental health. We pointed out the limitations of current research such as errors in exposure assessment, lack of research in developing countries, weak causal argument, and difficulty in controlling confounding factors. Future research should improve study design, conduct quantitative studies, and explore potential mechanisms, so as to provide scientific evidence for improving urban lighting planning and urban architectural design.

Background: Greenness surrounding residential places has been found to significantly reduce the risk of diseases such as hypertension, obesity, and metabolic syndrome (MetS). However, it is unclear whether visible greenness exposure at the workplace has any impact on the risk of MetS. Methods: Visible greenness exposure was assessed using a Green View Index (GVI) based on street view images through a convolutional neural network model. We utilized logistic regression to examine the cross-sectional association between GVI and MetS as well as its components among 51,552 adults aged 18–60 in the city of Hangzhou, China, from January 2018 to December 2021. Stratified analyses were conducted by age and sex groups. Furthermore, a scenario analysis was conducted to investigate the risks of having MetS among adults in different GVI scenarios. Results: The mean age of the participants was 40.1, and 38.5% were women. We found a statistically significant association between GVI and having MetS. Compared to the lowest quartile of GVI, participants in the highest quartile of GVI had a 17% (95% CI: 11–23%) lower odds of having MetS. The protective association was stronger in the males, but we did not observe such differences in different age groups. Furthermore, we found inverse associations between GVI and the odds of hypertension, low high-density lipoprotein cholesterol, obesity, and high levels of FPG. Conclusions: Higher exposure to outdoor visible greenness in the workplace environment might have a protective effect against MetS.

Introduction Heatwave is a major global health concern. Many countries including China suffered a record-breaking heatwave during the summer of 2022, which may have a significant effect on population health or health information-seeking behaviours but is yet to be examined.Methods We derived health information-seeking data from the Baidu search engine (similar to Google search engine). The data included city-specific daily search queries (also referred to Baidu Search Index) for heat-sensitive diseases from 2021 to 2022, including heatstroke, hospital visits, cardiovascular diseases and diabetes, respiratory diseases, mental health and urological diseases. For each city, the record-breaking heatwave days in 2022 were matched to days in the same calendar month in 2021.Results The 2022 record-breaking heatwave hit most cities (83.64%) in Mainland China. The average heatwave duration was 13 days and the maximum temperature was 3.60°C higher than that in 2021 (p

Objectives: The aim of this study was to explore whether indoor or outdoor relative humidity (RH) modulates the influenza epidemic transmission in temperate and subtropical climates. Methods: In this study, the daily temperature and RH in 1558 households from March 2017 to January 2019 in five cities across both temperate and subtropical regions in China were collected. City-level outdoor temperature and RH from 2013 to 2019 were collected from the weather stations. We first estimated the effective reproduction number (Rt) of influenza and then used time-series analyses to explore the relationship between indoor/outdoor RH/absolute humidity and the Rt of influenza. Furthermore, we expanded the measured 1-year indoor temperature and the RH data into 5 years and used the same method to examine the relationship between indoor/outdoor RH and the Rt of influenza. Results: Indoor RH displayed a seasonal pattern, with highs during the summer months and lows during the winter months, whereas outdoor RH fluctuated with no consistent pattern in subtropical regions. The Rt of influenza followed a U-shaped relationship with indoor RH in both temperate and subtropical regions, whereas a U-shaped relationship was not observed between outdoor RH and Rt. In addition, indoor RH may be a better indicator for Rt of influenza than indoor absolute humidity. Conclusion: The findings indicated that indoor RH may be the driver of influenza seasonality in both temperate and subtropical locations in China.

Emerging epidemiological studies suggest that long-term ozone (O3) exposure may increase the risk of mortality, while pre-existing evidence is mixed and has been generated predominantly in North America and Europe. In this study, we investigated the impact of long-term O3 exposure on all-cause mortality in a national cohort in China. A dynamic cohort of 20882 participants aged ≥40 years was recruited between 2011 and 2018 from four waves of the China Health and Retirement Longitudinal Study. A Cox proportional hazard regression model with time-varying exposures on an annual scale was used to estimate the mortality risk associated with warm-season (April–September) O3 exposure. The annual average level of participant exposure to warm-season O3 concentrations was 100 μg m−3 (range: 61–142 μg m−3). An increase of 10 μg m−3 in O3 was associated with a hazard ratio (HR) of 1.18 (95% confidence interval [CI]: 1.13–1.23) for all-cause mortality. Compared with the first exposure quartile of O3, HRs of mortality associated with the second, third, and highest exposure quartiles were 1.09 (95% CI: 0.95–1.25), 1.02 (95% CI: 0.88–1.19), and 1.56 (95% CI: 1.34–1.82), respectively. A J-shaped concentration–response association was observed, revealing a non-significant increase in risk below a concentration of approximately 110 μg m−3. Low-temperature-exposure residents had a higher risk of mortality associated with long-term O3 exposure. This study expands current epidemiological evidence from China and reveals that high-concentration O3 exposure curtails the long-term survival of middle-aged and older adults.

Infectious diarrhea imposes substantial disease burden in China, with local climate identified as a key risk factor. In this study, we aimed to explore the association between hydrometeorological conditions and the incidence of infectious diarrhea, and investigate the modification effect of urbanization, which remained unclear previously. Monthly data were collected from 1 January 2021 to 31 December 2022 from each city of mainland China on cases of infectious diarrhea other than cholera, dysentery, typhoid and paratyphoid (i.e. other infectious diarrhea, OID), temperature and precipitation. We used Palmer drought severity index (PDSI) to represent local hydrometeorological conditions (dry and wet). A spatiotemporal Bayesian hierarchical model combined with distributed lag nonlinear model was specified to explore the association between PDSI and the relative risk of OID. The effect size of hydrometeorological conditions at different urbanization levels were quantified through a linear interaction term. A total of 1999 947 OID cases were included. There was a N-shaped cumulative association between PDSI and OID incidence over a maximum lag of 4 months. The effect of extreme dry conditions persisted over lag 1–3 months and peaked at the 2-month lag (RR = 2.67, 95%CI: 2.44–2.91). By contrast, the relative risk of OID increased immediately under extreme wet conditions (RR = 1.97, 95%CI: 1.68–2.32 at lag 0 month). Children and the older population were particularly susceptible to extreme dry and wet conditions, respectively. Areas with lower urbanization rate, healthcare resources and economic levels, and higher population density showed a higher risk of OID related to extreme dry conditions. While the modification effects of these urbanization characteristics were limited for extreme wet conditions. There was a nonlinear and lagged association between hydrometeorological conditions and the incidence of OID in mainland China, which may be modified in diverse patterns by urbanization indicators. Our findings will provide valuable reference for better prevention and control of OID.

Abstract Background Experimental studies indicate that neuroendocrine pathways might play a role in progression of breast cancer. We aim to test the hypothesis that somatic mutations in the genes of neuroendocrine pathways influence breast cancer prognosis, through dysregulated gene expression in tumor tissue. Methods We conducted an extreme case–control study including 208 breast cancer patients with poor invasive disease-free survival (iDFS) and 208 patients with favorable iDFS who were individually matched on molecular subtype from the Breast Cancer Cohort at West China Hospital (WCH; N = 192) and The Cancer Genome Atlas (TCGA; N = 224). Whole exome sequencing and RNA sequencing of tumor and paired normal breast tissues were performed. Adrenergic, glucocorticoid, dopaminergic, serotonergic, and cholinergic pathways were assessed for differences in mutation burden and gene expression in relation to breast cancer iDFS using the logistic regression and global test, respectively. Results In the pooled analysis, presence of any somatic mutation (odds ratio = 1.66, 95% CI: 1.07–2.58) of the glucocorticoid pathway was associated with poor iDFS and a two-fold increase of tumor mutation burden was associated with 17% elevated odds (95% CI: 2–35%), after adjustment for cohort membership, age, menopausal status, molecular subtype, and tumor stage. Differential expression of genes in the glucocorticoid pathway in tumor tissue (P = 0.028), but not normal tissue (P = 0.701), was associated with poor iDFS. Somatic mutation of the adrenergic and cholinergic pathways was significantly associated with iDFS in WCH, but not in TCGA. Conclusion Glucocorticoid pathway may play a role in breast cancer prognosis through differential mutations and expression. Further characterization of its functional role may open new avenues for the development of novel therapeutic targets for breast cancer.

Abstract Background Freezing of gait is a debilitating symptom of Parkinson’s disease associated with high risks of falls and poor quality of life. While productive therapy for FoG is still underway, early prediction of FoG could help high-risk PD patients to take preventive measures. In this study, we predicted the onset of FoG in de novo PD patients using a battery of risk factors from patients enrolled in PPMI cohort. Methods Baseline characteristics were compared between subjects who developed FoG (68 patients, 37.2%, pre-FoG group) during the five-year follow up and subjects who did not (115 patients, 62.8%, non-FoG group). A multivariate logistic regression model was built based on backward stepwise selection of factors that were associated with FoG onset in the univariate analysis. ROC curves were used to assess sensitivity and specificity of the predictive model. Results At baseline, age, PIGD score, cognitive functions, autonomic functions, sleep behavior, fatigue and striatal DAT uptake were significantly different in the pre-FoG group relative to the non-FoG group. However, there was no difference in genetic characteristics between the two patient sets. Univariate analysis showed several motor and non-motor factors that correlated with FoG, including PIGD score, MDS-UPDRS part II score, SDMT score, HVLT Immediate/Total Recall, MOCA, Epworth Sleepiness Scale, fatigue, SCOPA-AUT gastrointestinal score, SCOPA-AUT urinary score and CSF biomarker Abeta42. Multivariate logistic analysis stressed that high PIGD score, fatigue, worse SDMT performance and low levels of Abeta42 were independent risk factors for FoG onset in PD patients. Conclusions Combining motor and non-motor features including PIGD score, poor cognitive functions and CSF Abeta can identify PD patients with high risk of FoG onset.

IntroductionExcess copper induces cell death by binding to lipoylated components of the tricarboxylic acid cycle. Although a few studies have examined the relationship between cuproptosis-related genes (CRGs) and breast cancer prognosis, reports on estrogen receptor-positive (ER+) breast cancer are lacking. Herein, we aimed to analyze the relationship between CRGs and outcomes in patients with ER+ early breast cancer (EBC).MethodsWe conducted a case-control study among patients with ER+ EBC presenting poor and favorable invasive disease-free survival (iDFS) at West China Hospital. Logistic regression analysis was performed to establish the association between CRG expression and iDFS. A cohort study was performed using pooled data from three publicly available microarray datasets in the Gene Expression Omnibus database. Subsequently, we constructed a CRG score model and a nomogram to predict relapse-free survival (RFS). Finally, the prediction performance of the two models was verified using training and validation sets.ResultsIn this case-control study, high expression of LIAS, LIPT1, and ATP7B and low CDKN2A expression were associated with favorable iDFS. In the cohort study, high expression of FDX1, LIAS, LIPT1, DLD, PDHB, and ATP7B and low CDKN2A expression were associated with favorable RFS. Using LASSO-Cox analysis, a CRG score was developed using the seven identified CRGs. Patients in the low CRG score group had a reduced risk of relapse in both training and validation sets. The nomogram included the CRG score, lymph node status, and age. The area under the receiver operating characteristic (ROC) curve (AUC) of the nomogram was significantly higher than the AUC of the CRG score at 7 years.ConclusionsThe CRG score, combined with other clinical features, could afford a practical long-term outcome predictor in patients with ER+ EBC.

Highlights The success rate of the lower leg salvage is high, reach the percentage of 91.8% (90/98). External fixation is less invasive, with achieving adequate stability to repair the arterial injury timely, can lower the ischemic time, and beneficial for the following bone or soft tissue repair. Treating the patients with external fixators timely is beneficial to the following vascular anticoagulation, bone defect and vein graft, as a result, the protection of lower limb can be improved.

Background: The occurrence of compound hot extreme (CHE) events in China is increasingly frequent. This study aimed to investigate the association between CHEs and all-cause mortality in Shandong Province and to estimate the attributable excess deaths. Methods: We collected daily data on weather, air pollution, and all-cause mortality at the subdistrict level in Shandong Province from 2013 to 2018. A CHE was defined as both daily maximum and minimum temperatures being higher than their historical 90th percentiles during 2013–2018 hot seasons. A case time-series analysis with a distributed lagged non-linear model was applied to analyze the subdistrict-specific association between different hot extremes and mortality risk, which were then pooled at the province level using meta-analysis. Results: Hot nights (RR = 1.44, 95%CI: 1.35–1.53) and CHEs (RR = 1.77, 95%CI: 1.64–1.90) were significantly associated with an increased mortality risk. CHEs had a greater effect for females (RR = 1.99, 95%CI: 1.81–2.19) and the elderly (>74 years) (RR = 2.14, 95%CI: 1.93–2.38) than their counterparts, respectively. Cardiovascular and respiratory deaths were more susceptible to CHEs than other deaths. Each year, 4888 (95%CI: 4133–5811) excess deaths in Shandong Province were attributable to CHEs, accounting for 2.60% (95%CI: 2.20–3.10%) of all-cause deaths and equating to 50 (95%CI: 42–58) deaths per 1,000,000 residents. The CHE-related mortality burden varied across subdistricts, with the highest occurring in the southeastern area and the lowest occurring in the northeastern and southwestern regions. Conclusion: CHEs and hot nights were substantially associated with excess deaths in Shandong Province, especially for females, the elderly, and residents living in the southeastern area. Our findings may facilitate the development of a heat alert warning system and preventive measures for vulnerable populations.

IntroductionNumerous studies have reported the modification of particulate matters (PMs) on the association between cold temperature and health. However, it remains uncertain whether the modification effect may vary by size of PMs, especially in Shandong Province, China where the disease burdens associated with cold temperature and PMs are both substantial. This study aimed to examine various interactive effects of cold exposure and ambient PMs with diameters ≤1/2.5 μm (PM1 and PM2.5) on premature deaths in Shandong Province, China.MethodsIn the 2013-2018 cold seasons, data on daily mortality, PM1 and PM2.5, and weather conditions were collected from the 1822 sub-districts of Shandong Province. A time-stratified case-crossover study design was performed to quantify the cumulative association between ambient cold and mortality over lag 0-12 days, with a linear interactive term between temperature and PM1 and PM2.5 additionally added into the model.ResultsThe mortality risk increased with temperature decline, with the cumulative OR of extreme cold (−16.9°C, the 1st percentile of temperature range) being 1.83 (95% CI: 1.66, 2.02), compared with the minimum mortality temperature. The cold-related mortality risk was 2.20 (95%CI: 1.83, 2.64) and 2.24 (95%CI: 1.78, 2.81) on high PM1 and PM2.5 days, which dropped to 1.60 (95%CI: 1.39, 1.84) and 1.60 (95%CI: 1.37, 1.88) on low PM1 and PM2.5 days. PM1 showed greater modification effect for per unit concentration increase than PM2.5. For example, for each 10?g/m3 increase in PM1 and PM2.5, the mortality risk associated with extreme cold temperature increased by 7.6% (95% CI: 1.3%, 14.2%) and 2.6% (95% CI: −0.7%, 5.9%), respectively.DiscussionThe increment of smaller PMs' modification effect varied by population subgroups, which was particularly strong in the elderly aged over 75 years and individuals with middle school education and below. Specific health promotion strategies should be developed towards the greater modification effect of smaller PMs on cold effect.

Summary: Background: A growing number of studies have reported an increased risk of cardiovascular disease (CVD) and respiratory disease (RD) within hours after exposure to ambient air pollution or temperature. We assemble published evidence on the sub-daily associations of CVD and RD with ambient air pollution and temperature. Methods: Databases of PubMed and Web of Science were searched for original case-crossover and time-series designs of English articles examining the intra-day effects of ambient air pollution [particulate matter with aerodynamic diameter ≤2.5 μm (PM2.5), ≤10 μm (PM10), 2.5–10μm (PM10-2.5), and < 7 μm (SPM), O3, SO2, NO2, CO, and NO] and temperatures (heat and cold) on cardiorespiratory diseases within 24 h after exposure in the general population by comparing with exposure at different exposure levels or periods. Meta-analyses were conducted to pool excess risks (ERs, absolute percentage increase in risk) of CVD and RD morbidities associated with an increase of 10 μg/m3 in particulate matters, 0.1 ppm in CO, and 10 ppb in other gaseous pollutants. Findings: Final analysis included thirty-three papers from North America, Europe, Oceania, and Asia. Meta-analysis found an increased risk of total CVD morbidity within 3 h after exposure to PM2.5 [ER%: 2.65% (95% CI: 1.00% to 4.34%)], PM10-2.5 [0.31% (0.02% to 0.59%)], O3 [1.42% (0.14% to 2.73%)], and CO [0.41% (0.01% to 0.81%)]. The risk of total RD morbidity elevated at lag 7–12 h after exposure to PM2.5 [0.69% (0.14% to 1.24%)] and PM10 [0.38% (0.02% to 0.73%)] and at lag 12–24 h after exposure to SO2 [2.68% (0.94% to 4.44%)]. Cause-specific CVD analysis observed an increased risk of myocardial infarction morbidity within 6 h after exposure to PM2.5, PM10, and NO2, and an increased risk of out-of-hospital cardiac arrest morbidity within 12 h after exposure to CO. Risk of total CVD also increased within 24 h after exposure to heat. Interpretation: This study supports a sudden risk increase of cardiorespiratory diseases within a few hours after exposure to air pollution or heat, and some acute and highly lethal diseases such as myocardial infarction and cardiac arrest could be affected within a shorter time. Funding: The National Natural Science Foundation of China (Grant No. 42105165; 81773518), the High-level Scientific Research Foundation of Anhui Medical University (Grant No. 0305044201), and the Discipline Construction of Anhui Medical University (Grant No. 0301001836).

Background: Previous studies have indicated the associations between fine particulate matter (PM2.5) exposure and diabetes or glucose levels. However, evidence linking PM2.5 constituents and diabetes or glucose levels was extensively scarce, particularly in developing countries. This study aimed to investigate the associations of exposure to PM2.5 and its five constituents (black carbon [BC], organic matter [OM], nitrate [NO3-], sulfate [SO42-], and ammonium [NH4+]) with diabetes and glucose levels among the middle-aged and elderly Chinese populations. Methods: A national cross-sectional sample of participants aged 45+ years was enrolled from 28 provinces across China’s mainland. Health examination and questionnaire survey for each respondent were performed during 2011−2012. Diabetes was determined by alternative definitions, and the main definition (MD) was self-report diabetes or antidiabetic medicine use or HbA1c ≥6.5 or fasting glucose ≥7 mmol/L or random glucose ≥11.1 mmol/L. Monthly exposure to PM2.5 mass and its five constituents (BC, OM, NO3-, SO42-, and NH4+) for each participant at residence were estimated using satellite-based spatiotemporal prediction models. Generalized linear models and linear mixed-effects models were used to assess the effects of exposure to PM2.5 and its constituents on diabetes or glucose levels, respectively. Stratification analyses were done by sex and age. Results: We included a total of 17,326 adults over 45 years in this study. The 3-year mean (interquartile range [IQR]) concentrations of PM2.5, BC, OM, NO3-, SO42-, and NH4+ were 47.9 (27.4) µg/m3, 2.9 (2.2) µg/m3, 9.2 (6.6) µg/m3, 10.2 (9.4) µg/m3, 11.0 (5.2) µg/m3, and 7.1 (4.4) µg/m3, respectively. Per IQR rise in exposure to PM2.5 was significantly associated with an increase of 0.133 mmol/L (95% confidence interval, 0.048−0.219) in glucose concentrations. Similar positive associations were observed for BC (0.097 mmol/L [0.012−0.181]), OM (0.160 mmol/L [0.065−0.256]), NO3- (0.145 mmol/L [0.039−0.251]), SO42- (0.111 mmol/L [0.026−0.196]), and NH4+ (0.135 mmol/L [0.041−0.230]). Under different diabetes definitions, PM2.5 mass and selected constituents with the exception of SO42- were all associated with a higher risk of prevalent diabetes. In MD-based analysis, similar positive associations were observed for four constituents, with corresponding odds ratios of 1.180 (1.097−1.270) for PM2.5, 1.154 (1.079−1.235) for BC, 1.170 (1.079−1.270) for OM, 1.200 (1.098−1.312) for NO3-, and 1.123 (1.037−1.215) for NH4+. Stratified analyses showed a significantly higher risk of diabetes in males (1.225 [1.064−1.411]) than females (1.024 [0.923−1.136]) when exposed to PM2.5. Participants under 65 years were generally more vulnerable to diabetes hazards related to PM2.5 constituents exposure. Conclusions: Exposures to PM2.5 and its constituents (i.e., BC, OM, NO3-, and NH4+) were positively associated with increased risks of prevalent diabetes and elevated glucose levels in middle-aged and older adults.

Abstract Background Cancer survivors who develop breast cancer as a second malignancy (BCa-2) are common. Yet, little is known about the prognosis of BCa-2 compared to first primary breast cancer (BCa-1). Methods Using the Surveillance, Epidemiology, and End Results database, we conducted a population-based cohort study including 883,881 patients with BCa-1 and 36,313 patients with BCa-2 during 1990–2015. Compared with patients with BCa-1, we calculated hazard ratios (HRs) of breast cancer-specific mortality among patients with BCa-2, using multivariable Cox regression. Results During the follow-up (median 5.5 years), 114,964 and 3829 breast cancer-specific deaths were identified among BCa-1 and BCa-2 patients, respectively. Patients with BCa-2 had more favorable tumor characteristics and received less intensive treatment e.g., surgery and chemo−/radio-therapy, compared to patients with BCa-1. When adjusting for demographic factors, patients with BCa-2 were at similar risk of breast cancer-specific mortality (HR 1.00, 95% CI 0.97–1.03) compared to patients with BCa-1. However, when additionally controlling for tumor characteristics and treatment modes, BCa-2 patients were at an increased risk of breast cancer-specific mortality (HR 1.11, 95% CI 1.08–1.15). The risk elevation was particularly greater when the first malignancy was lung, bladder, ovarian or blood malignancy (HRs 1.16–1.85), or when the first malignancy was treated with chemotherapy and radiotherapy (HR 1.44, 95% CI 1.28–1.63). Conclusions Overall, patients with BCa-2 have worse breast cancer-specific survival, compared with their BCa-1 counterparts, although the risk elevation is mild. High-risk subgroups based on first malignancy’s characteristics may be considered for active clinical management.

Abstract Background Multiple myeloma (MM) is a major health concern. Understanding the different burden and tendency of MM in different regions is crucial for formulating specific local strategies. Therefore, we evaluated the epidemiologic patterns and explored the risk factors for MM death. Methods Data on MM were collected from the 2019 Global Burden of Disease study. We used incidence, mortality, and disability adjusted life-years to estimate the global, regional, and national burden of MM. Results In 2019, there were 155,688 (95% UI, 136,585 – 172,577) MM cases worldwide, of which 84,516 (54.3%, 70,924 – 94,910) were of men. The age-standardized incidence rate (ASIR) was 1.72/100,000 persons (95% UI, 1.59–1.93) in 1990 and 1.92/100,000 persons (95% UI, 1.68–2.12) in 2019. The number of MM deaths increased 1.19-fold from 51,862 (95% UI, 47,710–58,979) in 1990 to 113,474 (95% UI, 99,527 – 121,735) in 2019; the age-standardized death rate (ASDR) was 1.42/100,000 persons (95% UI, 1.24–1.52) in 2019. In recent 15 years, ASDR showed a steady tendency for men, and a downward tendency for women. Countries with high social-demographic indexes exhibited a higher ASIR and ASDR. Australasia, North America, and Western Europe had the highest ASIR and ASDR, with 46.3% incident cases and 41.8% death cases. Monaco had the highest ASIR and ASDR, which was almost half as high as the second highest country Barbados. In addition, United Arab Emirates and Qatar had the largest growth multiple in ASIR and ASDR, which was twice the third country Djibouti. Conclusions Globally, incident and death MM cases have more than doubled over the past 30 years. The increasing global burden may continue with population aging, whereas mortality may continue to decrease with the progression of medical technology. The global burden pattern of MM was diverse, therefore specific local strategies based on different burden patterns for MM are necessary.

Abstract Ultrasonic wave is a powerful tool for many applications, such as structural health monitoring, medical diagnosis and partial discharges (PDs) detection. The fiber optic extrinsic Fabry–Perot interferometric (EFPI) sensor has become an ideal candidate for detecting weak ultrasonic signals due to its inherent advantages, and each time with a performance enhancement, it can bring great application potential in broadened fields. Herein, an EFPI ultrasonic sensor for PDs detection is proposed. The sensing diaphragm uses a 5-μm-thickness and beam-supported structure to improve the responsive sensitivity of the sensor at the resonant frequency. Furthermore, the ability of the sensor to detect characteristic ultrasonic signal of PDs is further enhanced by assembling a Fresnel-zone-plate (FZP)-based ultrasonic lens with the sensing probe to amplify the ultrasonic wave before it excites the sensing diaphragm. The final testing results show that the originally developed sensor owns the sensitivity of − 19.8 dB re. 1 V/Pa at resonant frequency. While, when the FZP is assembled with the probe, the sensitivity reaches to − 12.4 dB re. 1 V/Pa, and leads to a narrower frequency band, which indicates that the proposed method has a great potential to enhance the detection ability of sensor to characteristic ultrasonic wave of PDs.

With the development of gas-steam combined cycle power generation technology, the requirements of generator capacity and parameters are constantly improving. The generators of H class gas-steam combined cycle generator unit need to have more stable, efficient and safe starting requirements. It also stimulates improvement of static frequency converter (SFC) technology facing more challenge. SFC technology has displayed its advantages in controlling accurately, flexibly and efficiently. Meanwhile, SFC brings more harmonic components to influence the quality of power system. SFC start-up simulation model of H class gas turbine generator was built by Matlab/Simulink to simulate the generator start-up process, the evolvement of various parameters was researched and the proportion of harmonic components during the generator starting was analyzed. The simulation results show that the SFC start-up can increase the speed of the generator flexibly by adjusting the frequency and amplitude of the output current, and the impact of the generator start-up is small. However, large numbers of nonlinear electrical components built in SFC will cause higher proportion of harmonic components appear in power system and influence power quality. Therefore, two optimization schemes for SFC access were proposed to suppress harmonic effects, which are the scheme of adding input reactor before SFC and the scheme of changing generator end of input power supply. Through the simulation, it was proved that the two schemes can effectively suppress or reduce the harmonic effect and meet the requirements of power quality.

BackgroundThe burden of cataracts was substantial in the current aging world. However, few epidemiological studies have examined the associations between climate and weather conditions and cataract in older populations. We aimed to investigate the associations of air relative humidity and temperature with cataracts in older adults in China.MethodsWe used the cohort data from 2002, 2005, 2008, 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 62,595 Chinese older adults aged between 65 and 105 years were included in the analyses. City-level annual average air humidity and temperature during 2001 and 2017 (before the survey year) was used to measure population exposure. A cataract was self-reports based on the medical record or the doctor's diagnosis and 8,071 older adults had cataract. Covariates included socio-demographic, health status, lifestyles, and chronic conditions. We adopted the Generalized estimation equation (GEE) model to analyze the associations of relative humidity and temperature with cataracts.ResultsWe found that the average relative humidity (OR: 0.99; 95% CI: 0.98–0.99) in the past year was inversely associated with cataract likelihoods in older adults and a positive association between temperature (OR: 1.04; 95%CI: 1.03,1.05) in the past year and cataract likelihoods in older adults. The associations were robust in stratified analyses by sex, urban/rural residence, and education level. Furthermore, we found a nonlinear J-shaped relationship between temperature and cataract prevalence.ConclusionOur findings provide the evidence that higher temperature and low relative humidity may be associated with cataracts in older adults.

Abstract Background Recent studies regarding the effects of erythropoietin (EPO) for treating traumatic brain injury (TBI) have been inconsistent. This study conducts a meta-analysis of randomized controlled trials (RCTs) to assess the safety and efficacy of EPO for TBI patients at various follow-up time points. Methods A literature search was performed using PubMed, Web of Science, MEDLINE, Embase, Google Scholar and the Cochrane Library for RCTs studying EPO in TBI patients published through March 2019. Non-English manuscripts and non-human studies were excluded. The assessed outcomes include mortality, neurological recovery and associated adverse effects. Dichotomous variables are presented as risk ratios (RR) with a 95% confidence interval (CI). Results A total of seven RCTs involving 1197 TBI patients (611 treated with EPO, 586 treated with placebo) were included in this study. Compared to the placebo arm, treatment with EPO did not improve acute hospital mortality or short-term mortality. However, there was a significant improvement in mid-term (6 months) follow-up survival rates. EPO administration was not associated with neurological function improvement. Regarding adverse effects, EPO treatment did not increase the incidence of thromboembolic events or other associated adverse events. Conclusions This meta-analysis indicates a slight mortality benefit for TBI patients treated with EPO at mid-term follow-up. EPO does not improve in-hospital mortality, nor does it increase adverse events including thrombotic, cardiovascular and other associated complications. Our analysis did not demonstrate a significant beneficial effect of EPO intervention on the recovery of neurological function. Future RCTs are required to further characterize the use of EPO in TBI.

Abstract Background Cancer patients have a highly increased risk of psychiatric disorders following diagnosis, compared with cancer-free individuals. Inflammation is involved in the development of both cancer and psychiatric disorders. The role of non-steroidal anti-inflammatory drugs (NSAIDs) in the subsequent risk of psychiatric disorders after cancer diagnosis is however unknown. Methods We performed a cohort study of all patients diagnosed with a first primary malignancy between July 2006 and December 2013 in Sweden. Cox proportional hazards models were used to assess the association of NSAID use during the year before cancer diagnosis with the risk of depression, anxiety, and stress-related disorders during the first year after cancer diagnosis. Results Among 316,904 patients identified, 5613 patients received a diagnosis of depression, anxiety, or stress-related disorders during the year after cancer diagnosis. Compared with no use of NSAIDs, the use of aspirin alone was associated with a lower rate of depression, anxiety, and stress-related disorders (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.81 to 0.97), whereas the use of non-aspirin NSAIDs alone was associated with a higher rate (HR, 1.24; 95% CI, 1.15 to 1.32), after adjustment for sociodemographic factors, comorbidity, indications for NSAID use, and cancer characteristics. The association of aspirin with reduced rate of depression, anxiety, and stress-related disorders was strongest for current use (HR, 0.84; 95% CI, 0.75 to 0.93), low-dose use (HR, 0.88; 95% CI, 0.80 to 0.98), long-term use (HR, 0.84; 95% CI, 0.76 to 0.94), and among patients with cardiovascular disease (HR, 0.81; 95% CI, 0.68 to 0.95) or breast cancer (HR, 0.74; 95% CI, 0.56 to 0.98). Conclusion Pre-diagnostic use of aspirin was associated with a decreased risk of depression, anxiety, and stress-related disorders during the first year following cancer diagnosis.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder typically manifested by its motor symptoms. In addition, PD patients also suffer from many nonmotor symptoms (NMSs), such as apathy. Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the globus pallidus internus (GPi) are recommended as therapeutic interventions for PD, given their pronounced benefit in reducing troublesome dyskinesia. Apathy, a mood disorder recognized as a NMS of PD, has a negative impact on the prognosis of PD patients. However, the effect of STN-DBS and GPi-DBS on apathy is controversial. In the current meta-analysis, we analyzed apathy following bilateral STN-DBS and GPi-DBS in PD patients. Relevant literature was retrieved from public databases, including PubMed, Cochrane Library, and Embase. Studies were included in our analysis based on the following criterion: such studies should report apathy scores presurgery and postsurgery determined by using the Starkstein Apathy Scale or Apathy Evaluation Scale in patients receiving STN or GPi-DBS with at least three months of follow-up. Upon applying this strict criterion, a total of 13 out of 302 studies were included in our study. A mean difference (MD) and 95% confidence interval (CI) were calculated to show the change in apathy scores. We found a statistically significant difference between the presurgery and postsurgery scores in patients receiving STN-DBS (MD = 2.59, 95% CI = 2.23–2.96, P

Background: In the context of ongoing climate change, temperature variability (TV) has been considered as an important trigger of death. However, evidence of association between mortality and hourly temperature variability (HTV) is scarce at the multi-city level, and the time window of health effects of HTV is lack of investigation. This study aims at quantifying the mortality risk and burden of HTV and exploring subpopulations susceptible to HTV from a large-scale multi-city perspective. Methods: Data on daily number of deaths and meteorology were collected for 31 Chinese major cities during 2007–2013. HTV was calculated as the standard deviation of hourly temperature within a few days. The optimal exposure period of HTV was chosen according to multiple scientific criteria. A quasi-Poisson regression combined with distributed lag nonlinear model was used to assess the city-specific HTV-mortality associations. Then, meta-analysis was further applied to pool city-specific effect estimates. Finally, we calculated the fraction of mortality attributable to HTV. Stratification analyses were conducted by individual characteristics (i.e. age, sex, and educational attainment), season, and region. Results: HTV calculated in a relatively long-time window like 18 d (HTV0–17) could capture the impact of HTV adequately. Per 1 °C raise of HTV0–17 associated with 1.38% (95%CI: 0.77, 1.99) increase of non-accidental mortality. During the study period, 5.47% (95%CI: 1.06, 9.64) of non-accidental mortality could be attributed to HTV. The females, the elderly, and individuals with low education level were more susceptible to HTV than their counterparts, respectively. Moreover, a stronger HTV-mortality association was observed in individuals who live in warmer season and temperature zone. Conclusion: HTV is associated with a considerable mortality burden, which may be modified by season, geographic and individual-level factors. Our findings highlight the practical importance of establishing early warning systems and promoting health education to mitigate the impacts of temperature variability.

Abstract Background Percutaneous kyphoplasty (PKP) is a procedure performed by a spine surgeon who undergoes either orthopedic or neurosurgical training. The relationship between short-term adverse outcomes and spine specialty is presently unknown. To compare short-term adverse outcomes of single-level PKP when performed by neurosurgeons and orthopedic surgeons in order to develop more concretely preventive strategies for patients under consideration for single-level PKP. Methods We evaluated patients who underwent single-level PKP from 2012 to 2014 through the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). We used univariate analysis and multivariate logistic regression to assess the association between spine surgeon specialty and short-term adverse events, including postoperative complication and unplanned readmission, and to identify different independent risk predictors between two specialties. Results Of 2248 patients who underwent single-level PKP procedure, 1229 patients (54.7%) had their operations completed by a neurosurgeon. There were no significant differences in the development of the majority of postoperative complications and the occurrence of unplanned readmission between the neurosurgical cohort (NC) and the orthopedic cohort (OC). A difference in the postoperative blood transfusion rate (0.7% NS vs. 1.7% OC, P = 0.039) was noted and may due to the differences in comorbidities between patients. Multivariate regression analysis revealed different independent predictors of postoperative adverse events for the two spine specialties. Conclusions By comparing a large range of demographic feature, preoperative comorbidities, and intraoperative factors, we find that short-term adverse events in single-level PKP patients does not affect by spine surgeon specialty, except that the OC had higher postoperative blood transfusion rate. In addition, the different perioperative predictors of postoperative complications and unplanned readmissions were identified between the two specialties. These findings can lead to better evidence-based patient counseling and provide valuable information for medical evaluation and potentially devise methods to reduce patients’ risk.

The increased incidence of macrosomia has caused an enormous burden after the transition from the almost 40-year one-child policy to the universal two-child policy in 2015 and further to the three-child policy in 2021 in China. However, studies on risk factors of macrosomia in multipara under the new fertility policy in China are limited. We aim to explore the incidence and risk factors for macrosomia in multipara to provide the scientific basis for preventing macrosomia in multipara. A multi-center retrospective study was conducted among 6200 women who had two consecutive deliveries in the same hospital and their second newborn was delivered from January to October 2018 at one of 18 hospitals in 12 provinces in China. Macrosomia was defined as birth weight ≥ 4000 g. Logistic regression models were performed to analyze risk factors for macrosomia in multipara. The incidence of macrosomia in multipara was 7.6% (470/6200) and the recurrence rate of macrosomia in multipara was 27.2% (121/445). After adjusting for potential confounders, a higher prepregnancy BMI, higher gestational weight gain, history of macrosomia, a longer gestation in the subsequent pregnancy were independent risk factors of macrosomia in multipara (p < 0.05). Healthcare education and preconception consultation should be conducted for multipara patients with a history of macrosomia to promote maintaining optimal prepregnancy BMI and avoid excessive gestational weight gain to prevent macrosomia.

Water scarcity and water pollution are essential factors limiting coordinated regional development, especially in water-deprived regions. Industrial restructuring is an effective water management solution to alleviate water scarcity and mitigate water pollution. However, due to widely existing inexact parameter information in the water resource management system, it is challenging to allocate water resources among industrial sectors. To address these problems, an export coefficient coupled with a two-stage stochastic robust programming method (EC-TSRP) was developed through integrating an export coefficient model (ECM), two-stage stochastic programming (TSP) and robust optimization. The proposed EC-TSRP model could effectively deal with the multiple uncertainties expressed as stochastic and the intervals with fluctuation ranges, and enhance the robustness of optimal plans for supporting water resource allocation among industrial sectors under complex uncertainties. It was then applied to Bayan Nur City, in arid north-west China. The optimization alternatives indicate that wheat, sheep and services would be the most sensitive sectors among all industrial sectors, when non-point source (NPS) pollution exports are restricted. In addition, comparing the EC-TSRP results with the deterministic model, the reliability of the system could be improved significantly, while the value of the objective function would be decreased slightly. The simulation results were also compared with the historical data from 2012 to 2016. Although the total revenue of Bayan Nur City would decrease by 1.52%, the pollutant loads of total nitrogen, total phosphorus and chemical oxygen demand (TN, TP and COD) would decrease by 14.5%, 7.75% and 2.07%, respectively, and total water allocation also would decrease from 4.6 billion m3 to 4.23 billion m3.

Background: Limited evidence is available on the health effects of particulate matter with an aerodynamic diameter of

Sense of coherence (SoC) is the origin of health according to Antonovsky. The link between SoC and risk of cancer has however rarely been assessed. We performed a cohort study of 46,436 women from the Karolinska Mammography Project for Risk Prediction of Breast Cancer (Karma). Participants answered a SoC-13 questionnaire at recruitment to Karma and were subsequently followed up for incident breast cancer. Multivariate Cox models were used to assess the hazard ratios (HRs) of breast cancer in relation to SoC. We identified 771 incident cases of breast cancer during follow-up (median time: 5.2 years). No association was found between SoC, either as a categorical (strong vs. weak SoC, HR: 1.08, 95% CI: 0.90–1.29) or continuous (HR: 1.08; 95% CI: 1.00–1.17 per standard deviation increase of SoC) variable, and risk of breast cancer. In summary, we found little evidence to support an association between SoC and risk of breast cancer.

Extreme heat is the leading cause of heat-related mortality around the world. Extracting heat vulnerability information from the urban complexity system is crucial for urban health studies. Using heat vulnerability index (HVI) is the most common approach for urban planners to locate the places with high vulnerability for intervention and protection. Previous studies have demonstrated that HVI can play a vital role in determining which areas are at risk of heat-related deaths. Both equal weight approach (EWA) and principal component analysis (PCA) are the conventional methods to aggregate indicators to HVI. However, seldom studies have compared the differences between these two approaches in estimating HVI. In this paper, we evaluated the HVIs in Hangzhou in 2013, employing EWA and PCA, and assessed the accuracies of these two HVIs by using heat-related deaths. Our results show that both HVI maps showed that areas with high vulnerability are located in the central area while those with low vulnerability are located in the suburban area. The comparison between HVIEWA and HVIPCA shows significantly different spatial distributions, which is caused by the various weight factors in EWA and PCA. The relationship between HVIEWA and heat-related deaths performs better than the relationship between HVIPCA and deaths, implying EWA could be a better method to evaluate heat vulnerability than PCA. The HVIEWA can provide a spatial distribution of heat vulnerability at intracity to direct heat adaptation and emergency capacity planning.

Background: Sudden temperature change may elevate short-term mortality and remains an important global health threat in the context of climate change. To date, however, little available temperature-mortality evidence has taken into account both intra- and inter-day temperature variability (TV), thus largely limiting the comprehensive understanding of mortality burden due to unstable weather. Moreover, seasonal and temporal patterns in TV-mortality associations were sparsely discussed, nationally and regionally. Objectives: We aimed to assess the nationwide association of all-cause mortality with hourly temperature variability (HTV), quantify HTV-attributable mortality, and further explore the temporal and seasonal variations of mortality burden due to HTV in United Kingdom. Methods: Fourteen-year time-series data on temperature and mortality were collected from 10 regions in England and Wales during 1993–2006, totally including 7,573,716 all-cause deaths. HTV was calculated from the standard deviation of hourly temperature records within two neighboring days. A three-stage analytic approach was adopted to assess HTV-associated mortality burden. We first applied a time-series quasi-Poisson regression to estimate region-specific HTV-mortality associations, then pooled these associations at the national level using a multivariate meta-analysis, and finally estimated the HTV-attributable mortality fraction and illustrated its seasonal and temporal variations by conducting season- and period-specific analyses based on time-varying distributed lag models. Results: We found strong evidence that large HTV exposure elevated short-term mortality risk in England and Wales, with a pooled estimate of 1.13% (95% confidence interval (CI): 0.88, 1.39) associated with a 1-°C increase in HTV. During the whole study period, HTV accounted for a national average attributable fraction of 2.52% (95% empirical confidence interval (eCI): 2.27, 2.76) of the total deaths. This HTV-attributable mortality estimate showed a significant temporal decrease (p

Abstract Background The increase in the frequency and intensity of extreme heat events, which are potentially associated with climate change in the near future, highlights the importance of heat health risk assessment, a significant reference for heat-related death reduction and intervention. However, a spatiotemporal mismatch exists between gridded heat hazard and human exposure in risk assessment, which hinders the identification of high-risk areas at finer scales. Methods A human settlement index integrated by nighttime light images, enhanced vegetation index, and digital elevation model data was utilized to assess the human exposure at high spatial resolution. Heat hazard and vulnerability index were generated by land surface temperature and demographic and socioeconomic census data, respectively. Spatially explicit assessment of heat health risk and its driving factors was conducted in the Yangtze River Delta (YRD), east China at 250 m pixel level. Results High-risk areas were mainly distributed in the urbanized areas of YRD, which were mostly driven by high human exposure and heat hazard index. In some less-urbanized cities and suburban and rural areas of mega-cities, the heat health risks are in second priority. The risks in some less-developed areas were high despite the low human exposure index because of high heat hazard and vulnerability index. Conclusions This study illustrated a methodology for identifying high-risk areas by combining freely available multi-source data. Highly urbanized areas were considered hotspots of high heat health risks, which were largely driven by the increasing urban heat island effects and population density in urban areas. Repercussions of overheating were weakened due to the low social vulnerability in some central areas benefitting from the low proportion of sensitive population or the high level of socioeconomic development. By contrast, high social vulnerability intensifies heat health risks in some less-urbanized cities and suburban areas of mega-cities.

BackgroundTo our knowledge, no study has assessed the association between heatwaves and risk of hospitalization and how it may change over time in Brazil. We quantified the heatwave-hospitalization association in Brazil during 2000-2015.Methods and findingsDaily data on hospitalization and temperature were collected from 1,814 cities (>78% of the national population) in the hottest five consecutive months during 2000-2015. Twelve types of heatwaves were defined with daily mean temperatures of ≥90th, 92.5th, 95th, or 97.5th percentiles of year-round temperature and durations of ≥2, 3, or 4 consecutive days. The city-specific association was estimated using a quasi-Poisson regression with constrained distributed lag model and then pooled at the national level using random-effect meta-analysis. Stratified analyses were performed by five regions, sex, 10 age groups, and nine cause categories. The temporal change in the heatwave-hospitalization association was assessed using a time-varying constrained distributed lag model. Of the 58,400,682 hospitalizations (59% women), 24%, 34%, 21%, and 19% of cases were aged ConclusionsThere are geographic, demographic, cause-specific, and temporal variations in the heatwave-hospitalization associations across the Brazilian population. Considering the projected increase in frequency, duration, and intensity of heatwaves, future strategies should be developed, such as building early warning systems, to reduce the health risk associated with heatwaves in Brazil.

Studies have shown that vitamin D could have a role in breast cancer survival; however, the evidence of the relationship between patients’ vitamin D levels and their survival has been inconsistent. This meta-analysis explores possible dose-response relationships between vitamin D levels and overall survival by allowing for differences in vitamin D levels among populations of the various studies. Studies relating vitamin D (25-OH-D [25-hydroxyvitamin D]) levels in breast cancer patients with their survival were identified by searching PubMed and Embase. A pooled HR (hazard ratio) comparing the highest with the lowest category of circulating 25-OH-D levels were synthesized using the Mantel-Haenszel method under a fixed-effects model. A two-stage fixed-effects dose-response model including both linear (a log-linear dose-response regression) and nonlinear (a restricted cubic spline regression) models were used to further explore possible dose-response relationships. Six studies with a total number of 5984 patients were identified. A pooled HR comparing the highest with the lowest category of circulating 25-OH-D levels under a fixed-effects model was 0.67 (95% confidence interval = 0.56-0.79, P < .001). Utilizing a dose-response meta-analysis, the pooled HR for overall survival in breast cancer patients was 0.994 (per 1 nmol/L), P for linear trend < .001. At or above a 23.3 nmol/L threshold, for a 10 nmol/L, 20 nmol/L, or 25 nmol/L increment in circulating 25-OH-D levels, the risk of breast cancer overall mortality decreased by 6%, 12%, and 14%, respectively. There was no significant nonlinearity in the relationship between overall survival and circulating 25-OH-D levels. Our findings suggest that there is a highly significant linear dose-response relationship between circulating 25-OH-D levels and overall survival in patients with breast cancer. However, better designed prospective cohort studies and clinical trials are needed to further confirm these findings.

To perform a meta-analysis of prospective and retrospective studies exploring the association of the modified Glasgow prognostic score (mGPS) with overall survival (OS) in patients with lung cancer.Relevant studies were identified by searching the Cochrane Library, Web of Science, Embase and PubMed until April 16, 2017. We combined hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the correlation between mGPS and OS in patients with lung cancer.Eleven studies involving 5817 participants from several countries were included in the meta-analysis. In a pooled analysis of all studies, elevated mGPS predicted poorer OS (HR = 1.77; 95% CI: 1.35-2.31; P