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BACKGROUND Some studies have hypothesized that vitamin D may have a role to play in protection against influenza virus infections and illnesses, and that seasonal fluctuation in serum 25-hydroxyvitamin D [25(OH)D] may affect seasonal patterns of influenza virus infections. OBJECTIVE We aimed to investigate whether serum 25(OH)D concentrations were associated with the incidence of influenza virus infections and illnesses in children and adults in Hong Kong. METHODS In 2009-2010, 3030 children and adults of all ages from 796 households in Hong Kong were followed up to identify acute respiratory illnesses. Sera from 2694 participants were collected at baseline and after ∼1 mo, 6 mo, and 12 mo. Influenza virus infections were confirmed by reverse transcriptase-polymerase chain reaction performed on nasal and throat swab samples collected during illness episodes. Serologic evidence of influenza virus infection was measured by hemagglutination inhibition assays in unvaccinated participants. The serum 25(OH)D concentrations were measured after collection of all specimens. Each individual's baseline serum 25(OH)D concentration on 1 January 2010 was predicted by a random-effects linear regression model. RESULTS We found that, in children and adults who had not received a seasonal influenza vaccine, baseline serum 25(OH)D concentrations (

To investigate whether the CHADS2 and CHA2DS2-VASc scores have clinical utility for prediction of adverse vascular function and vascular dysfunction-mediated incident cardiovascular (CV) events among high-risk patients without atrial fibrillation (AF), and the additional value of incorporating PR prolongation to the scores.We analyzed 579 high-risk CV outpatients without clinical AF in a prospective cohort for new-onset ischemic stroke, myocardial infarction (MI), congestive heart failure (CHF), and CV death. Brachial flow-mediated dilation (FMD) and nitroglycerin-mediated dilatation (NMD), carotid intima-media thickness (IMT) and pulse wave velocity (PWV) were determined.Baseline CHADS2 score was associated with lower FMD (Pearson r = -0.16, P0.001) and NMD (r = -0.17, P0.001), higher carotid IMT (r = 0.30, P0.001) and PWV (r = 0.35, P0.001; similar for CHA2DS2-VASc score: All P0.05). After follow-up of 63 ± 11 months, 82 patients (14.2%) developed combined CV endpoint. ROC curve analysis showed that both CHADS2 and CHA2DS2-VASc scores were predictors for ischemic stroke (C-Statistic: CHADS2 0.70, P = 0.004; CHA2DS2-VASc 0.68, P = 0.010), MI (CHADS2 0.63, P = 0.030; CHA2DS2-VASc 0.70, P = 0.001), and CV death (CHADS2 0.63, P = 0.022; CHA2DS2-VASc 0.65, P = 0.011). Higher CHADS2 score was associated with reduced event-free survival from combined CV endpoints (log-rank = 16.7, P0.001) with differences potentiated if stratified by CHA2DS2-VASc score (log-rank = 29.2, P0.001). Incorporating PR prolongation, the CHA2DS2-VASc-PR score achieved the highest C-Statistic for CV death prediction (0.70, P0.001) superior to the CHADS2 score (chi-square: 12.1, P = 0.0005).The CHADS2 and CHA2DS2-VASc predict vascular dysfunction and cardiovascular events in high-risk CV patients without clinical AF, with further improved performance incorporating PR prolongation.

Summary Objectives Despite identification of important risk factors, aetiology of nasopharyngeal cancer (NPC) remained enigmatic. Oncogenic Human Papillomavirus (HPV), a cause of cervical and genital tract epithelial cancers, has recently been isolated from NPC tumour tissues, raising the question of whether HPV may play a role in NPC. Accumulating evidence showed that perinatal HPV transmission to newborns can occur through exposures to genital tract secretions, amniotic fluid, or blood during vaginal delivery in mothers with cervical HPV infection, with viral DNA fingerprint showing maternal–foetal concordance. Persistence of perinatally acquired oncogenic HPV infection presents clear biological plausibility as an aetiological agent. Co-infection of HPV and EBV may also co-operatively impact on neoplastic transformation. Our findings also suggest that regional disease burdens of oncogenic HPV strains have strong type-specific associations with regional risk of NPC. If true, this hypothesis presents immense potentials for preventive interventions through community control of HPV infection and newborn vaccination.

Hyperthyroidism is one of the most common reversible causes of atrial fibrillation (AF); nevertheless, the risk of ischemic stroke in patients with hyperthyroidism who present with new-onset AF is unclear.This study sought to investigate the clinical outcome of hyperthyroidism-induced AF with regard to risk of ischemic stroke risk.We prospectively studied the incidence, time course, and clinical predictors for ischemic stroke in patients with hyperthyroidism-induced AF (n = 160). They were compared with age- and sex-matched cohorts of hyperthyroid patients without AF (n = 160) and AF patients without hyperthyroidism (n = 160).Baseline characteristics were comparable among the 3 groups. At 1 year, 86 hyperthyroid patients with AF (54%) and 92 patients with nonthyroid AF (58%) had spontaneous or pharmacological sinus conversion (P = .20). Ischemic stroke was observed in 15 hyperthyroid patients with AF (9.4%) versus 5 patients with nonthyroid AF (3.1%, P = .02), and 1 hyperthyroid patient without AF (0.6%, P.001). Furthermore, the majority of ischemic stroke (70%) in patients with AF occurred within the first 30 days of presentation, whereas AF was still present. Cox regression analysis showed that hyperthyroidism (hazard ratio [HR]: 3.5, 95% confidence interval [CI]: 1.15 to 10.42, P = .03) and persistent AF (HR: 13.0, 95% CI: 2.88 to 58.80, P.01) predicted the occurrence of ischemic stroke; warfarin therapy reduced the risk of ischemic stroke (HR: 0.17, 95% CI: 0.04 to 0.79, P = .02).In hyperthyroid patients who presented with new-onset AF, there was an increased risk of ischemic stroke clustering during the initial phase of presentation. This should prompt early use of anticoagulation therapy in hyperthyroid patients with AF.

Background: Epidemiologic studies have suggested that a high phytoestrogen intake is inversely associated with cardiovascular diseaseriskfactorsandtheincidenceofcardiovascularevents.However, the relation between the intake of isoflavone, a major component of phytoestrogen, and vascular endothelial function and the atherosclerotic burden remains unclear. Objective:Weaimedtoinvestigatetheeffectsofvariousdietarysoy isoflavone intakes on brachial artery flow-mediated dilation and mean maximum carotid intima–media thickness. Design: We studied 126 consecutive patients (x SD age: 66.5 11.1 y; 69% male) at high risk of cardiovascular events (94% had documentedcoronaryarterydiseaseorstroke;44%haddiabetes).A validated food-frequency questionnaire was used to estimate their dietary intake after they achieved stable dietary patterns for 3 mo. Results: The median intakes of isoflavone and soy protein were 5.5 (range: 2.2–13.3) mg/d and 1.2 (range: 0.4–2.8) g/d, respectively. Persons in the 4th quartile of daily isoflavone intake had significantly (P 0.05) greater flow-mediated dilation—but not mean maximum carotid intima–media thickness—than did those in the lowerquartiles.Afteradjustmentforpotentialconfounders,ahigher isoflavoneintakeinthe4ththaninthe1stquartile(13.3mg/d),but not a higher intake of soy protein, predicted an absolute 2.71% increase in flow-mediated dilation (relative increase: 103%; P 0.02) and a 0.17-mm decrease in mean maximum carotid intima–media thickness (relative decrease: 14.5%; P 0.04). Conclusion: In persons at high risk of cardiovascular events, a greater isoflavone intake is associated with better vascular endothelial function and lower carotid atherosclerotic burden. Am J Clin Nutr 2007;86:938–45.