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BACKGROUND: Gastric cancer (GC), a molecularly heterogeneous disease, is the third leading cause of cancer death worldwide. The majority of GC cases worldwide occur in East Asia, predominantly China. Mutational Signature Framework offers an elegant approach to identify mutational processes present in tumors. METHODS: To identify mutational signature patterns, we conducted whole exome sequencing (WES) analysis in Chinese patients with GC. Mutect2 and MutsigCV were used to identify significantly mutated genes in 175 Chinese GC cases using paired tumor-normal tissues. We investigated mutational signatures using Catalogue of Somatic Mutations in Cancer (COSMIC) Version 2 (V2) and Version 3 (V3). RESULTS: We identified 104 mutated genes with P

BACKGROUND: In the phase 3 EMPOWER-Cervical 1/GOG-3016/ENGOT-cx9 study, cemiplimab significantly improved overall survival (OS) versus chemotherapy for patients with recurrent or metastatic cervical cancer who progressed after first-line platinum-based chemotherapy. We present a post hoc subgroup analysis of patients enrolled in Japan. METHODS: Patients were enrolled regardless of programmed cell death-ligand 1 status and randomized 1:1 to cemiplimab 350 mg intravenously every 3 weeks or investigators choice  single-agent chemotherapy for up to 96 weeks. Primary endpoint was OS. Key secondary endpoints were progression-free survival (PFS) and objective response rate (ORR). RESULTS: Overall, 608 patients were randomized, of whom 56 (9.2%) were in Japan (cemiplimab, n = 29; chemotherapy, n = 27). The median (range) duration of follow-up was 13.6 (6.0-25.3) versus 18.2 (6.0-38.2) months for patients in Japan and for the overall population, respectively. Median OS (95% confidence interval [CI]) was 8.4 (7.0-not evaluable) and 9.4 (5.4-14.9) months for cemiplimab versus chemotherapy (hazard ratio [HR]: 0.86; 95% CI: 0.43-1.68). Median PFS (95% CI) was 4.0 (1.4-8.2) versus 3.7 (1.8-4.2) months with cemiplimab and chemotherapy (HR: 0.90; 95% CI: 0.50-1.61), respectively. ORR was 17.2% for cemiplimab and 7.4% for chemotherapy (odds ratio, 2.47; 95% CI, 0.44-13.99). Incidence of treatment-emergent adverse events at any grade was 79.3% for cemiplimab and 100% for chemotherapy. Grade ≥3 adverse events were 37.9% versus 66.7% with cemiplimab and chemotherapy, respectively. DISCUSSION: While acknowledging limitations inherent to a small subgroup analysis, the HR of 0.86 observed in Japanese patients suggests an emerging survival benefit despite a 4.6-month shorter median duration of follow-up versus the overall study population.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease affecting over 300,000 people worldwide. It is characterized by the progressive decline of the nervous system that leads to the weakening of muscles which impacts physical function. Approximately, 15% of individuals diagnosed with ALS have a known genetic variant that contributes to their disease. As therapies that slow or prevent symptoms continue to develop, such as antisense oligonucleotides, it is important to discover novel genes that could be targets for treatment. Additionally, as cohorts continue to grow, performing analyses in ALS subtypes, such as primary lateral sclerosis (PLS), becomes possible due to an increase in power. These analyses could highlight novel pathways in disease manifestation. METHODS: Building on our previous discoveries using rare variant association analyses, we conducted rare variant burden testing on a substantially larger multi-ethnic cohort of 6,970 ALS patients, 166 PLS patients, and 22,524 controls. We used intolerant domain percentiles based on sub-region Residual Variation Intolerance Score (subRVIS) that have been described previously in conjunction with gene based collapsing approaches to conduct burden testing to identify genes that associate with ALS and PLS. RESULTS: A gene based collapsing model showed significant associations with SOD1, TARDBP, and TBK1 (OR = 19.18, p = 3.67 × 10-39; OR = 4.73, p = 2 × 10-10; OR = 2.3, p = 7.49 × 10-9, respectively). These genes have been previously associated with ALS. Additionally, a significant novel control enriched gene, ALKBH3 (p = 4.88 × 10-7), was protective for ALS in this model. An intolerant domain-based collapsing model showed a significant improvement in identifying regions in TARDBP that associated with ALS (OR = 10.08, p = 3.62 × 10-16). Our PLS protein truncating variant collapsing analysis demonstrated significant case enrichment in ANTXR2 (p = 8.38 × 10-6). CONCLUSIONS: In a large multi-ethnic cohort of 6,970 ALS patients, collapsing analyses validated known ALS genes and identified a novel potentially protective gene, ALKBH3. A first-ever analysis in 166 patients with PLS found a candidate association with loss-of-function mutations in ANTXR2.

Hypoxia-inducible factor pathway genes are linked to adaptation in both human and nonhuman highland species. EPAS1, a notable target of hypoxia adaptation, is associated with relatively lower hemoglobin concentration in Tibetans. We provide evidence for an association between an adaptive EPAS1 variant (rs570553380) and the same phenotype of relatively low hematocrit in Andean highlanders. This Andean-specific missense variant is present at a modest frequency in Andeans and absent in other human populations and vertebrate species except the coelacanth. CRISPR-base-edited human cells with this variant exhibit shifts in hypoxia-regulated gene expression, while metabolomic analyses reveal both genotype and phenotype associations and validation in a lowland population. Although this genocopy of relatively lower hematocrit in Andean highlanders parallels well-replicated findings in Tibetans, it likely involves distinct pathway responses based on a protein-coding versus noncoding variants, respectively. These findings illuminate how unique variants at EPAS1 contribute to the same phenotype in Tibetans and a subset of Andean highlanders despite distinct evolutionary trajectories.

BackgroundAbout 10-20% of Kawasaki disease (KD) patients are resistant to the initial infusion of intravenous immunoglobin (IVIG). The aim of this study was to assess whether IVIG resistance in KD patients could be predicted using standard clinical and laboratory features.MethodsData were from two cohorts: a Korean cohort of 7101 KD patients from 2015 to 2017 and a cohort of 649 KD patients from San Diego enrolled from 1998 to 2021. Features included laboratory values, the worst Z-score from the initial echocardiogram or during hospitalization, and the five clinical KD signs at presentation.ResultsFive machine learning models achieved a maximum median AUC of 0.711 [IQR: 0.706-0.72] in the Korean cohort and 0.696 [IQR: 0.609-0.722] in the San Diego cohort during stratified 10-fold cross-validation using significant laboratory features identified from univariate analysis. Adding the Z-score, KD clinical signs, or both did not considerably improve the median AUC in either cohort.ConclusionsUsing commonly measured clinical laboratory data alone or in conjunction with echocardiographic findings and clinical features is not sufficient to predict IVIG resistance. Further attempts to predict IVIG resistance will need to incorporate additional data such as transcriptomics, proteomics, and genetics to achieve meaningful predictive utility.ImpactWe demonstrated that laboratory, echocardiographic, and clinical findings cannot predict intravenous immunoglobin (IVIG) resistance to a clinically meaningful extent using machine learning in a homogenous Asian or ethnically diverse population of patients with Kawasaki disease (KD). Visualizing these features using uniform manifold approximation and projection (UMAP) is an important step to evaluate predictive utility in a qualitative manner. Further attempts to predict IVIG resistance in KD patients will need to incorporate novel biomarkers or other specialized features such as genetic differences or transcriptomics to be clinically useful.

Background: We conducted this study to assess the impact of an intervention to interrupt mother-to-child transmission on the height and weight of syphilis-exposed infants after receiving penicillin prophylaxis after birth and to provide a scientific basis for further elimination of mother-to-child transmission. Methods: We recruited 419 infants born to syphilis-infected mothers from 2015 to 2020 in Changzhou, and performed 1:1 matching to infants born to syphilis-free mothers during the same period. All infants were followed up to 18 months of age. We collected height and weight data and compared them. Results: At 18 months of age, the height and weight of the syphilis-exposed infants were almost greater than the WHO reference standards. However, when compared with local unexposed infants, there were almost no differences. The boys born to mothers who received two courses of treatment had longer body lengths at 18 months of age than did those born to mothers who did not receive two courses of treatment, and the girls born to mothers who did not receive treatment had lower body weights at 3 months of age than did both treated groups. Conclusion: The growth trajectory of infants without congenital syphilis born to syphilis-infected mothers is virtually indistinguishable from that of the general local population. Syphilis-exposed newborns can receive preventive treatment as a public health intervention. [ABSTRACT FROM AUTHOR]

Abstract Background We conducted this study to assess the impact of an intervention to interrupt mother-to-child transmission on the height and weight of syphilis-exposed infants after receiving penicillin prophylaxis after birth and to provide a scientific basis for further elimination of mother-to-child transmission. Methods We recruited 419 infants born to syphilis-infected mothers from 2015 to 2020 in Changzhou, and performed 1:1 matching to infants born to syphilis-free mothers during the same period. All infants were followed up to 18 months of age. We collected height and weight data and compared them. Results At 18 months of age, the height and weight of the syphilis-exposed infants were almost greater than the WHO reference standards. However, when compared with local unexposed infants, there were almost no differences. The boys born to mothers who received two courses of treatment had longer body lengths at 18 months of age than did those born to mothers who did not receive two courses of treatment, and the girls born to mothers who did not receive treatment had lower body weights at 3 months of age than did both treated groups. Conclusion The growth trajectory of infants without congenital syphilis born to syphilis-infected mothers is virtually indistinguishable from that of the general local population. Syphilis-exposed newborns can receive preventive treatment as a public health intervention.

CONTEXT: Despite the association of advance care planning (ACP) with improved patient and caregiver outcomes, Chinese American elders have low rates of ACP. OBJECTIVES: Assess ACP facilitators/barriers in the San Francisco (SF) Chinese community and codesign, implement, and test community-based ACP-promoting pilot events. METHODS: A Chinese Community Committee (N = 19 community-based organization leaders, health system representatives, community members) conducted focus groups in Cantonese and English with Chinese older adults (age ≥55), caregivers, and community leaders. The Committee designed and implemented pilot events in-person and online. We analyzed focus group data using thematic analysis; assessed pre-to-post-event readiness to engage in ACP (validated survey; 14 scale, 4 = most ready); and assessed event acceptability. RESULTS: A total of 34 people participated in six focus groups. Themes described Chinese community-specific importance of ACP (e.g., reduces family burden), barriers (e.g., younger generations lack tools to discuss ACP with elders and vice versa), and facilitators (e.g., intergenerational events, culturally/linguistically appropriate materials). Based on focus groups findings, the Committee developed a novel ACP tool and designed intergenerational events. A total of 195 participants attended 10 events; 95% were Chinese, 90% spoke Chinese languages, 80% were women. ACP readiness increased significantly (1.66 [SD 0.84] vs. 2.03 [SD 0.85]; P < 0.001); 94% of participants were comfortable attending and 96% would recommend events. CONCLUSION: Community-developed intergenerational events that highlight the value of ACP and address barriers are acceptable and increase ACP engagement in the Chinese community.

Heating and cooling in buildings accounts for over 20% of total energy consumption in China. Therefore, it is essential to understand the thermal requirements of building occupants when establishing building energy codes that would save energy while maintaining occupants thermal comfort. This paper introduces the Chinese thermal comfort dataset, established by seven participating institutions under the leadership of Xian University of Architecture and Technology. The dataset comprises 41,977 sets of data collected from 49 cities across five climate zones in China over the past two decades. The raw data underwent careful quality control procedure, including systematic organization, to ensure its reliability. Each dataset contains environmental parameters, occupants subjective responses, building information, and personal information. The dataset has been instrumental in the development of indoor thermal environment evaluation standards and energy codes in China. It can also have broader applications, such as contributing to the international thermal comfort dataset, modeling thermal comfort and adaptive behaviors, investigating regional differences in indoor thermal conditions, and examining occupants thermal comfort responses.

Across many cultural contexts, the majority of women conduct the majority of their household labor. This gendered distribution of labor is often unequal, and thus represents one of the most frequently experienced forms of daily inequality because it occurs within ones own home. Young children are often passive observers of their familys distribution of labor, and yet little is known about the developmental onset of their perceptions of it. By the preschool age, children also show strong normative feelings about both equal resource distribution and gender stereotypes. To investigate the developmental onset of childrens recognition of the (in)equality of household labor, we interviewed 3 to 10-y-old children in two distinct cultural contexts (US and China) and surveyed their caregivers about who does more household labor across a variety of tasks. Even at the youngest ages and in both cultural contexts, childrens reports largely matched their parents, with both populations reporting that mothers do the majority of household labor. Both children and parents judged this to be generally fair, suggesting that children are observant of the gendered distribution of labor within their households, and show normalization of inequality from a young age. Our results point to preschool age as a critical developmental time period during which it is important to have parent-child discussions about structural constraints surrounding gender norms and household labor.

Asian Americans are the countrys fastest-growing racial group, and several studies have focused on the health outcomes of Asian Americans, including perceived health status. Perceived health status provides a summarized view of the health of populations for diverse domains, such as the psychological, social, and behavioral aspects. Given its multifaceted nature, perceived health status should be carefully approached when examining any variables influence because it results from interactions among many variables. A data-driven approach using machine learning provides an effective way to discover new insights when there are complex interactions among multiple variables. To date, there are not many studies available that use machine learning to examine the effects of diverse variables on the perceived health status of Chinese and Korean Americans. This study aims to develop and evaluate three prediction models using logistic regression, random forest, and support vector machines to find the predictors of perceived health status among Chinese and Korean Americans from survey data. The prediction models identified specific predictors of perceived health status. These predictors can be utilized when planning for effective interventions for the better health outcomes of Chinese and Korean Americans.

Subjective cognitive complaints (SCCs) are a crucial modifiable risk factor for dementia. There is increasing interest in the association between SCC and sleep disturbance; however, the effects of sleep disturbance on SCC development among community-dwelling elderly individuals in Japan remain unclear. We aimed to cross-sectionally investigate the association between SCC and sleep disturbance, with adjustment for multiple factors related to cognitive decline, among 241 community-dwelling elderly persons without cognitive impairment. The measures were SCCs (Kihon Checklist-Cognitive Function, KCL-CF), sleep disturbance (Japanese version of the Athens Insomnia Scale, AIS-J), general cognitive function (Mini-Mental State Examination), and depressive symptoms (five-item version of the Geriatric Depression Scale [GDS-5]). The following data were collected: sex, age, educational history, whether the participants had visited a medical institution for diseases (hypertension, diabetes, hyperlipidemia, heart disease), and the presence/absence of established risk factors (hearing loss, history of head injury, drinking habits, smoking habits, social isolation, and physical inactivity and activity). Based on the KCL-CF, 96 and 145 participants were considered to have and lack SCCs, respectively. On logistic regression analysis, the AIS-J score and smoking history were significantly associated with SCCs. Our findings suggest that sleep disturbance is associated with SCC development among community-dwelling elderly people in Japan. Evaluating and managing sleep disturbances can be important in preventing SCCs and dementia. [ABSTRACT FROM AUTHOR]

BACKGROUND: Studies have documented that utilizing peer feedback can enhance students English academic writing skills. Little is known, however, about the effects of incorporating peer feedback to enhance English as a second language (L2) medical students academic writing performance. METHODS: This longitudinal interventional study examines Chinese medical students English academic writing skills development via peer feedback in four parallel classes over an 18-week semester between the experimental and control groups (n = 124). RESULTS: Significant increases in the experimental groups performance in the post-test were found after 18-week instructions (pre- vs. post-test: overall score, p

BackgroundStudies generally show that higher acculturation is associated with greater cardiovascular disease (CVD) risk among immigrants in the United States (US). However, few studies have compared how proxies of acculturation are differentially associated with metabolic abnormalities measured using objective biomarkers, self-reported diagnosis, and medication use, particularly among East Asian Americans.MethodsSurvey data and biomarker measurements collected from random (non-fasting) blood samples of Chinese and Korean immigrants in the US (n = 328) were used to examine the associations between two proxies for acculturation (years living in the US and English speaking proficiency) with three cardiometabolic abnormalities (high triglyceride levels, diabetes, and hypercholesterolemia). Poisson regression models estimated prevalence ratios adjusted for demographic characteristics, socioeconomic factors, and body mass index. Gender, Asian subgroup, and household income were tested as potential effect modifiers.ResultsLiving longer in the US was associated with greater likelihood of having high triglycerides. In addition, living longer in the US was associated with greater likelihood of diabetes for people with lower household income and greater likelihood of hypercholesterolemia for people with higher household income. Higher level of English proficiency was less consistently associated with higher cardiometabolic risk, although there was a significant association with greater likelihood of hypercholesterolemia.ConclusionsLonger time lived in the US is associated with higher risk of cardiometabolic abnormalities among Chinese and Korean Americans. Future studies of acculturation and cardiometabolic risk should carefully consider potential mechanisms and what proxy measures of acculturation capture.Trial registration numberNCT03481296, date of registration: 3/29/2018.

BackgroundColorectal cancer is a leading cause of morbidity and mortality across U.S. racial/ethnic groups. Existing studies often focus on a particular race/ethnicity or single domain within the care continuum. Granular exploration of disparities among different racial/ethnic groups across the entire colon cancer care continuum is needed. We aimed to characterize differences in colon cancer outcomes by race/ethnicity across each stage of the care continuum.MethodsWe used the 2010-2017 National Cancer Database to examine differences in outcomes by race/ethnicity across six domains: clinical stage at presentation; timing of surgery; access to minimally invasive surgery; post-operative outcomes; utilization of chemotherapy; and cumulative incidence of death. Analysis was via multivariable logistic or median regression, with select demographics, hospital factors, and treatment details as covariates.Results326,003 patients (49.6% female, 24.0% non-White, including 12.7% Black, 6.1% Hispanic/Spanish, 1.3% East Asian, 0.9% Southeast Asian, 0.4% South Asian, 0.3% AIAE, and 0.2% NHOPI) met inclusion criteria. Relative to non-Hispanic White patients: Southeast Asian (OR 1.39, p

ObjectivesHeavy demands upon dementia caregivers can lead to a number of poor health outcomes including declines in physical, mental, and brain health. Although dementia affects people from all backgrounds, research in the US has largely focused on European American caregivers. This has made providing culturally-competent care more difficult. This study begins to address this issue by empirically examining how culturally-shaped beliefs can influence loneliness in family caregivers of people with dementia.MethodsWe conducted a preliminary questionnaire study with Chinese American and European American family caregivers of people with dementia (N = 72).ResultsChinese American caregivers were more concerned than European American caregivers about losing face, which in turn, was associated with greater loneliness. This pattern remained when accounting for caregiver gender, age, and relationship to the person with dementia.ConclusionsThese preliminary findings highlight the role that cultural beliefs can play in adverse caregiver outcomes, and suggest that addressing concerns about losing face may be an important way for healthcare providers to help reduce loneliness among Chinese American caregivers.Clinical implicationsUnderstanding how cultural beliefs influence caregiver outcomes is critical as healthcare professionals work to provide culturally-competent care and design culturally-sensitive interventions.

Drawing from two waves (∼1.5-2.5 years apart) of longitudinal data, the current study investigated the bidirectional associations between self-regulatory skills and mathematics achievement among a socioeconomically diverse sample of school-age Chinese American children from immigrant families (N = 258; 48.1% girls; ages 5.8-9.1 years; first to third grades at Wave 1). Childrens self-regulatory skills were assessed with task-based measures of attention focusing, inhibitory control, behavioral persistence, and comprehensive executive function as well as parent- and teacher-reported effortful control. Multiple regressions showed that behavioral persistence and parent-reported effortful control positively predicted math achievement over time. Math achievement positively predicted comprehensive executive function over time. These effects were found when controlling for child age, sex, generation status, family socioeconomic status, parents cultural orientations, and prior levels of math achievement or self-regulation. The prospective relation of math achievement predicting comprehensive executive function remained significant after a false discovery rate correction.

Previous studies of emotion regulation in young children commonly used between-person approaches, which limit our understanding of dynamic and temporal relations between emotion expressions and strategy use. Further, previous work has mainly focused on temperamental reactivity among White children, and it is unclear whether these findings can generalize to children of Asian and Latinx origins. In the current study, we examined the within-person temporal associations between emotion expressions and strategy use among 3- to 5-year-old children in low-income Chinese American (CA) and Mexican American (MA) families. Children's emotion expressions (positive and negative) and strategy use (gaze aversion, self-soothing, fidgeting, and language) during an unfair social interaction task were coded by 10-s epoch. Executive functions were examined as between-person level predictors of strategy use. Multilevel modeling was conducted to examine whether positive and negative emotion expressions at one epoch (t-1) predicted strategy use at the following epoch (t). The results indicate that positive emotion expressions predicted an increase in fidgeting at the next epoch (β = .34, p < .01). Executive functions were unrelated to strategy use. Cultural group differences were found: CA children displayed lower intensity of positive emotion and fewer strategy use compared with MA children. The present findings inform theories on the dynamics of emotion regulation in young children and have implications for interventions with underrepresented immigrant populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

BackgroundPersonal care products may contain many chemicals, some of which are suspected endocrine disrupters. This is an important source of chemical exposure for women, but little is known about how chemical exposure differs among different races/ethnicities.ObjectiveThis study examines differences in personal care product use among Black, Latina, Vietnamese, Mixed Race, and White women in California.MethodsWe used a community-based participatory process to create and administer a personal care product usage survey to 321 Black, Latina, Vietnamese, Mixed Race, and White women. We used multivariate regression models with pairwise comparisons to examine the frequency of product use by race/ethnicity.ResultsWe found distinct trends of personal care product use by race/ethnicity: Latina women typically used makeup most frequently; Black women used certain hair products or styles most frequently; and Vietnamese women were most likely to use facial cleansing products compared to other races/ethnicities. Latina and Vietnamese women were less likely to try to avoid certain ingredients in their products.SignificanceThese findings can help estimate disparities in chemical exposure from personal care product use and complement future research on health inequities due to chemical exposures in the larger environmental and social context.

A new concept called complex multimorbidity provides a more reliable measure of disease burden than multimorbidity based on a simple count of diseases, by categorizing diseases according to the body system they affect. This study examined associations between sleep measures and complex multimorbidity among Chinese and Korean Americans in the Baltimore-Washington DC Metropolitan Area, using cross-sectional data (n = 400) from the Screening to Prevent Colorectal Cancer study (2018-2020). Sleep disturbance was measured using the 8-item Patient Reported Outcomes Measurement Information System Sleep Disturbance scale and sleep apnea risk was assessed using the Berlin questionnaire. Complex multimorbidity was defined as the coexistence of 3 or more of body system disorders assessed by self-report of physician-diagnosed diseases. Poisson regression models with adjustments indicated that individuals with sleep disturbance had 2.15 times the prevalence of having complex multimorbidity (95% confidence interval (CI): 1.07, 4.29). Individuals with a high risk of sleep apnea had 1.19 times the prevalence of having complex multimorbidity (95% CI: 0.47, 3.01). These findings suggest a need for interventions to increase awareness of the importance of sleep among health-care providers and the public and to educate them about causes, signs, and treatment of sleep disturbance and sleep apnea.

BACKGROUND: Expressive writing interventions confer mental health benefits for non-Hispanic Whites. However, research is lacking in adapting this paradigm for minoritized groups. This study evaluated the impacts of two culturally adapted expressive writing interventions on depressive and anxiety symptoms and potential mediators (perceived stress and intrusive thoughts) among Chinese American breast cancer survivors (CABCS). METHODS AND RESULTS: CABCS (N = 136) were randomly assigned to one of three conditions to write three weekly essays: enhanced self-regulation condition (ESR) to write about stress and coping (Week 1), deepest feelings (Week 2), and finding benefits (Week 3); self-regulation condition (SR) to write about deepest feelings (Week 1), stress and coping (Week 2), and finding benefits (Week 3); and control condition to write about facts relevant to their cancer experience (Weeks 1-3). Compared with the control condition, the ESR but not SR, reduced depressive and anxiety symptoms at all follow-up time points (1, 3, and 6-months) through reductions in perceived stress. CONCLUSION: A cultural adaptation altering the order of expressive writing prompts resulted in the greatest benefit for CABCS depressive and anxiety symptoms. Research testing both the content and ordering of components may be vital to advance cultural adaptation science and optimize intervention efficacy. CLINICAL TRIAL REGISTRATION NUMBER: NCT02946619.

Genetic studies on attention have mainly focused on children with attention-deficit/hyperactivity disorder (ADHD), so little systematic research has been conducted on genetic correlates of attention performance and their potential brain mechanisms among healthy individuals. The current study included a genome-wide association study (GWAS, N = 1145 healthy young adults) aimed to identify genes associated with sustained attention and an imaging genetics study (an independent sample of 483 healthy young adults) to examine any identified genes' influences on brain function. The GWAS found that TTLL11 showed genome-wide significant associations with sustained attention, with rs13298112 as the most significant SNP and the GG homozygotes showing more impulsive but also more focused responses than the A allele carriers. A retrospective examination of previously published ADHD GWAS results confirmed an un-reported, small but statistically significant effect of TTLL11 on ADHD. The imaging genetics study replicated this association and showed that the TTLL11 gene was associated with resting state activity and connectivity of the somatomoter network, and can be predicted by dorsal attention network connectivity. Specifically, the GG homozygotes showed lower brain activity, weaker brain network connectivity, and non-significant brain-attention association compared to the A allele carriers. Expression database showed that expression of this gene is enriched in the brain and that the G allele is associated with lower expression level than the A allele. These results suggest that TTLL11 may play a major role in healthy individuals' attention performance and may also contribute to the etiology of ADHD.

IntroductionDisturbed sleep may be a factor that links stress with poor health, especially among groups experiencing high levels of stress caused by racial and ethnic minority and nativity status. The objective of this study was to describe the potential mediating role of sleep disturbance in the associations between various types of stress and self-rated health among Chinese and Korean Americans.MethodsOur cross-sectional study consisted of 400 Chinese and Korean immigrants aged 50 to 75 years recruited from August 2018 through June 2020 from physicians' clinics in the Baltimore-Washington, DC, metropolitan area. We used the Patient Reported Outcomes Measurement Information System (PROMIS) short-form questionnaire to measure sleep disturbance. Linear regression analyses examined associations between 3 types of stress (acculturative stress, perceived stress, and distress) and self-rated health, accounting for demographic, socioeconomic, and health insurance factors. The Karlson-Holm-Breen method was used to estimate the total and direct effects of stresses on self-rated health and the indirect effects of stresses on health through sleep disturbance.ResultsGreater acculturative stress (β = 0.08; 95% CI, 0.01-0.14), perceived stress (β = 0.05; 95% CI, 0.03-0.08), and distress (β = 0.09; 95% CI, 0.05-0.13) were all associated with poorer self-rated health. Sleep disturbance was a partial mediator, with sleep disturbance accounting for 21.7%, 14.9%, and 18.7% of the associations between acculturative stress, perceived stress, and distress and self-rated health, respectively.ConclusionBecause sleep disturbance partially mediates the associations between stress and poor self-rated health, future interventions and research may consider mitigating sleep disturbances and stress among racial and ethnic minority populations to address health disparities.

Adolescents from immigrant families are at risk for psychological health issues due to acculturative stress and the marked increases in internalizing and externalizing problems accompanying adolescence. Emotion Regulation (ER) may be an important protective resource for these adolescents. The present study tested the links between ER and internalizing and externalizing problems in 131 first- and second-generation Chinese American adolescents. Adolescents' reappraisal was associated with less internalizing and externalizing problems; adolescents' suppression was associated with more internalizing and externalizing problems. These links were somewhat more pronounced in adolescents high in American cultural orientation as well as in adolescents low in Chinese cultural orientation. Our results advance our understanding of the links between ER and psychological health in Chinese American youth.

Passive smoking is considered a major public health issue in China. Prospective evidence regarding the link between secondhand smoke (SHS) and ischemic stroke in China is scarce. The China Kadoorie Biobank (CKB) study in Liuzhou City recruited 50,174 participants during 2004–2008. Of these 30,456 never-smokers were included in our study. The median follow-up period was 10.7 years. The incidence of ischemic stroke was obtained through the China Disease Surveillance Points (DSP) system and the Health Insurance (HI) database. Cox proportional risk models were used to evaluate the association between SHS exposure and ischemic stroke. During 320,678 person-years of follow-up, there were 2059 patients with ischemic stroke observed and the incidence of ischemic stroke was 6.42 per thousand person-years. Participants exposed to SHS daily faced a 21 % higher risk of ischemic stroke (HR = 1.21, 95 % CI : 1.09–1.34) compared to those exposed to SHS less than once a week. Subgroup analyses revealed that daily SHS exposure was linked to heightened risk of ischemic stroke among women, non-employed, and non-weekly tea drinkers. Daily SHS exposure was associated with higher risks of ischemic stroke. Proactive tobacco control strategies are necessary to decrease the risk of ischemic stroke in never smokers. [ABSTRACT FROM AUTHOR]

Background: Although many observational studies have demonstrated significant relationships between obesity and cardiometabolic traits, the causality of these relationships in East Asians remains to be elucidated. Methods: We conducted individual-level Mendelian randomization (MR) analyses targeting 14,083 participants in the Japan Multi-Institutional Collaborative Cohort Study and two-sample MR analyses using summary statistics based on genome-wide association study data from 173,430 Japanese. Using 83 body mass index (BMI)-related loci, genetic risk scores (GRS) for BMI were calculated, and the effects of BMI on cardiometabolic traits were examined for individual-level MR analyses using the two-stage least squares estimator method. The β-coefficients and standard errors for the per-allele association of each single-nucleotide polymorphism as well as all outcomes, or odds ratios with 95% confidence intervals were calculated in the two-sample MR analyses. Results: In individual-level MR analyses, the GRS of BMI was not significantly associated with any cardiometabolic traits. In two-sample MR analyses, higher BMI was associated with increased risks of higher blood pressure, triglycerides, and uric acid, as well as lower high-density-lipoprotein cholesterol and eGFR. The associations of BMI with type 2 diabetes in two-sample MR analyses were inconsistent using different methods, including the directions. Conclusion: The results of this study suggest that, even among the Japanese, an East Asian population with low levels of obesity, higher BMI could be causally associated with the development of a variety of cardiometabolic traits. Causality in those associations should be clarified in future studies with larger populations, especially those of BMI with type 2 diabetes.

Modified maxillomandibular advancement (MMMA) has been proposed as an alternative to the classic maxillomandibular advancement (MMA) in East and Southeast Asian populations in which bimaxillary protrusion is a prevalent trait. The key difference between MMMA and MMA is the inclusion of anterior segmental osteotomies to reduce the protrusion of the perioral region. The aim of this scoping review was to identify the variations in MMMA and treatment outcomes. A search was conducted in the PubMed, Embase, and Cochrane electronic databases for articles published up to January 2023. Ten articles were included in this review. Three variations of MMMA have been reported in the literature. Treatment outcomes have mostly been favourable for all of these variations. Mandibular advancement of >10 mm and a greater than 50% reduction in the apnoea–hypopnoea index (AHI) have been well reported. Improvements in other outcome measures, such as enlargement of the airway dimension on computed tomography and the Epworth Sleepiness Scale score, have also been shown. Despite additional surgical procedures, complications have been uncommon and mostly minor in nature. It is necessary to be cognizant of MMMA and its variations when providing sleep surgery for East and Southeast Asian patients, tailoring this to the patient's profile and needs. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the sensitivity and specificity of the Deep Fundus, an artificial intelligence program for diabetic retinopathy screening, in Chinese patients with diabetes. Methods: Fundus photographs of Chinese patients with diabetes aged 50 to 90 years who attended Pamela Youde Nethersole Eastern Hospital, Hong Kong between December 2020 and June 2021 during the public diabetic retinopathy screening period were retrospectively retrieved in February 2022. Two ophthalmologists independently graded the fundus photographs for diabetic retinopathy (according to the recommendations in the 2017 International Council of Ophthalmology Guidelines for Diabetic Eye Care) and any concomitant eye pathology such as cataracts or macular diseases. On 27 February 2022, the photographs were uploaded to the Deep Fundus website. Fundus images were classified into referable or non-referable diabetic retinopathy in accordance with the abovementioned Guidelines. Sensitivity and specificity of the Deep Fundus were determined. Results: Of 202 eyes screened, 96 eyes were included in the analysis. There was no discordance between the two ophthalmologists in the diabetic retinopathy gradings. 57 (59.4%) eyes were graded to have positive diabetic retinopathy findings. Using gradings of the two ophthalmologists as the gold standard, sensitivity and specificity of the Deep Fundus were 62.3% and 90.7%, respectively. The positive and negative predictive values were 89.2% and 66.1%, respectively. Conclusions: The sensitivity and specificity of the Deep Fundus for diabetic retinopathy screening in a Chinese population were 62.3% and 90.7%, respectively. Further real-world validation studies are needed to assess the artificial intelligence model, particularly among Chinese patients with cataracts, myopia, diabetic macular edema, or proliferative diabetic retinopathy. [ABSTRACT FROM AUTHOR]

Background: Zellweger Syndrome (ZS), or cerebrohepatorenal syndrome, is a rare disorder due to PEX gene mutations affecting peroxisome function. While PEX6 coding mutations are known to cause ZS, the impact of noncoding mutations is less clear., Methods: A Chinese neonate and his family were subjected to whole exome sequencing (WES) and bioinformatics to assess variant pathogenicity. A minigene assay was also performed for detailed splicing variant analysis., Results: WES identified compound heterozygous PEX6 variants: c.315G>A (p. Trp105Ter) and c.2095-3 T>G. Minigene assays indicated that the latter variant led to abnormal mRNA splicing and the loss of exon 11 in PEX6 expression, potentially causing nonsense-mediated mRNA decay (NMD) or truncated protein structure., Conclusion: The study suggests that PEX6: c.2095-3 T>G might be a genetic contributor to the patient's condition, broadening the known mutation spectrum of PEX6. These insights lay groundwork for potential gene therapy for such variants., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background and Purpose: Genetic factors play an important role in the pathogenesis of stroke(S). This study aimed to screen the loci associated with S risk in northwestern Chinese population by genome-wide association analysis (GWAS)., Methods: A total of 1394 subjects, including 682 S patients and 692 controls, were enrolled in this study. SPSS 25.0 software was used for statistical analysis, and the independent sample t-test as well as Chi-square test were used to analyze the differences in age and gender between the case and control groups. The Precision Medicine Diversity Array (PMDA) genotyping chip was used in this study. The genotyping platform was the Gene Titan multi-channel instrument, and the Axiom Analysis Suite 6.0 software was used for the data analyzing. Besides, the LASSO analysis, SNP-SNP and GO/KEGG analysis were conducted to analyze the association between significant loci and S risk., Results: A total of 30 SNPs were found to be associated with the S risk based on additive model (p < 5 × 10 -8 ). After the LASSO screening, 22 SNPs showed the diagnostic value in S. The SNPs interaction analysis further screened the SNP-SNP interaction groups associated with the S risk(p < 0.05). Finally, the GO/KEGG analysis discovered the suggestive significance loci could be involved in the S development mainly by immune-related functions and pathways., Conclusion: This study discovered 30 S related SNPs and analyzed the potential pathways associated with genes located on the 30 SNPs, which were beneficial for enriching the genetic mechanism analysis of S in northwestern Chinese population., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Hereditary coagulation factor VII (FVII) deficiency is a rare autosomal recessive bleeding disorder. The aims of this study were to identify and verify the pathogenic mutation sites in a family with hereditary coagulation FVII deficiency, and preliminarily explore the underlying mechanisms. We identified a novel combination of compound heterozygous mutations, c.572-1G>A and c.1037A>C in F7 gene, associated with FVII deficiency. The splice site mutation c.572-1G>A led to a truncation, resulting in the loss of the essential catalytic domain of the FVII protein. The c.1037A>C missense mutation has not been previously reported. Our study revealed that this mutation leads to steric hindrance between residues, causing significant changes in the energy and structure of the FVII protein, ultimately affecting its function. These changes disrupt the normal function of the FVII protein, accelerating the development of inherited FVII deficiency. Moreover, the mRNA expression of the F7 gene and the protein expression of the FVII antigen (FVII: Ag) were significantly lower in the proband, as well as in the proband's parents, compared to the healthy control (P<0.05). Our findings not only elucidate the genetic underpinning of FVII deficiency in the family studied but also contribute a new mutation to the known disease spectrum, potentially assisting in future diagnostic and therapeutic approaches., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Previous studies have documented the impact of intergenerational contact on cognitive function in Chinese adults, however, few have focused on the possible mediating pathways. This study aimed to test a hypothetical model in which functional disability and depressive symptoms mediate the association between intergenerational contact and cognitive function., Methods: This longitudinal study included data of 3666 participants aged 45 years or older (mean age: 60.2 years) from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015. Intergenerational contact was measured as the frequency of contact with children and categorized as frequent (≥ 1 time/week) or infrequent (< 1 time/week). Cognitive function was measured in two dimensions: episodic memory and executive function. Depressive symptoms and functional disability were assessed as continuous variables using the 10-item Center for Epidemiological Studies Depression Scale, Activities of Daily Living, and Instrumental Activities of Daily Living Scales. The mediating pathways were quantified using the SPSS PROCESS macro., Results: Frequent intergenerational contact correlated with a better cognitive function (coefficient: 0.73, 95%CI: 0.39 to 1.06), with plausible mediated pathways via functional disability without depressive symptoms (coefficient: 0.03, 95%CI: 0 to 0.06, proportion mediated: 4.11%), depressive symptoms without functional disability (coefficient: 0.04, 95%CI: 0.01 to 0.08, proportion mediated: 5.48%), and functional disability and depressive symptoms in a chain (coefficient: 0.01, 95%CI: 0 to 0.02, proportion mediated: 1.37%)., Conclusion: Functional disability and depressive symptoms may partly explain the association between intergenerational contact and cognitive function. Further research is needed to explore the mechanisms underlying the association between intergenerational contact and cognitive function., Competing Interests: Declarations. Ethics approval and consent to participate: All interviewees were required to sign informed consent, and ethics approval for the data collection in CHARLS was obtained from the Biomedical Ethics Review Committee of Peking University (IRB00001052-11015). All procedures of the study were performed in accordance with approved guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Hepatocellular carcinoma (HCC) is often detected at advanced stages among patients with hepatitis B virus (HBV), underscoring the urgency for more precise surveillance tests. Here, we compare the clinical performance of the novel - GAAD (gender [biological sex], age, alpha-fetoprotein [AFP], protein-induced by vitamin K absence-II [PIVKA-II]) and GALAD (gender [biological sex], age, AFP, Lens-culinaris AFP [AFP-L3]), PIVKA-II) algorithms to assess the utility of AFP-L3 for distinguishing HCC from benign chronic liver disease (CLD) in Chinese patients with predominantly chronic HBV infection. Eligible adults were enrolled, and biomarkers were measured using Elecsys (Cobas) or µTASWAKO assays. In total, 411 participants provided serum samples (HCC, n = 176 [early-stage, n = 110]; CLD, n = 136; specificity n = 101). HBV was the underlying disease etiology for most participants (HCC, 95%; benign CLD, 72%). For GAAD (Cobas), GALAD (Cobas), and GALAD (µTASWAKO), AUCs were 93.1% (95% CI: 90.0-96.2), 93.2% (90.0-96.3), and 92.7% (88.4-96.9) for early-stage, and 95.6% (93.6-97.6), 95.6% (93.6-97.7), and 95.8% (93.2-98.3) for all-stage HCC, versus CLD, respectively. Interestingly, both GAAD and GALAD algorithms demonstrated comparable diagnostic performance regardless of disease etiology (HBV vs. non-HBV), presence of cirrhosis, geographic region, and within pan-tumor specificity panels (p < 0.001), indicating AFP-L3 may have a negligible role in HCC surveillance., Competing Interests: Declarations. Competing interests: HLYC reports consultancy fees from Arbutus Biopharma, Gilead Sciences, Glaxo-Smith-Kline, Roche, Vir Biotechnology, Aligos Therapeutics, Vaccitech, and Virion Therapeutics; and speaker’s bureau participation for Echosens, Gilead Sciences, Roche, and Viatris. YH has no conflicts of interest to declare. KMad, KK, and AS are employees of Roche Diagnostics International AG. KMal is an employee of Microcoat Biotechnologie, contracted by Roche Diagnostics. JH reports speaker’s bureau participation for Glaxo-Smith-Kline, Gilead Sciences, and Roche Diagnostics; has received grant/research support from Gilead Sciences and BMS; and has served on an advisory committee or review panel for Aligos, Assembly, Glaxo-Smith-Kline, Gilead Sciences, Johnson Pharmaceutica, and Roche., (© 2024. The Author(s).)

The management of pulmonary nodules involves self-management. This study, conducted in China between September and October 2022, explored the knowledge, attitude, and practice (KAP) towards pulmonary nodules among Chinese adults. The participants were enrolled through convenience sampling when they visited the hospital. The KAP questionnaire was developed by the investigators. Participants who received scores of ≥ 75% of the total score for each dimension were defined as good or positive, 50-75% as moderate, and ≤ 50% as poor or negative. A total of 1209 participants, with an average age of 38.7 years, completed a self-administered online questionnaire. The knowledge, attitude, and practice scores were 5.95 ± 3.54/12, 29.05 ± 4.04/40, and 23.72 ± 6.08/45, respectively, indicating poor knowledge, moderate attitude, and moderate practice regarding pulmonary nodules. The multivariable analyses showed significant associations among knowledge, attitudes, and practice. The mediation analysis indicated that knowledge, education, income, smoking habits, and awareness of pulmonary nodules influenced participants' practices. In conclusion, a significant population of adults in China had inadequate knowledge, attitude, and practice towards pulmonary nodules. Sufficient knowledge was associated with appropriate practices toward pulmonary nodules. Therefore, health education programs aimed at improving knowledge about pulmonary nodules may be helpful for encouraging appropriate attitudes and maintaining healthy practices., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The research was carried out in accordance with the Declaration of Helsinki. This study was ethically approved by the Medical Ethics Committee of the First Affiliated Hospital of Jinzhou Medical University (#202258), and oral informed consent was obtained from all participants., (© 2024. The Author(s).)

Background: Traditional Chinese exercise (TCE) is used as a therapeutic method in patients with postmenopausal osteoporosis. A meta-analysis was performed to evaluate the efficacy of TCE and provide reliable clinical evidence., Methods: Eight databases, including the Cochrane Library, PubMed, Embase, Web of Science, Chinese Science Citation Database, Wanfang, China National Knowledge Infrastructure, and Chinese Medical Journal full-text databases, were searched for randomized controlled trials. Meta-analysis was performed using the RevMan (version 5.4) software., Results: Sixteen studies involving 1,288 patients were included. Compared with conventional treatment alone, TCE improved patients' bone mineral density, decreased pain, improved balance, improved quality of life, and decreased deoxypyridinoline levels. However, the intervention effects on the biochemical indexes of bone metabolism, including blood calcium, blood phosphorus, osteocalcin, and alkaline phosphatase levels, were not statistically significant., Conclusion: TCE has a significant effect on postmenopausal patients with osteoporosis and can be used as a non-pharmacological treatment. The results of this study should be interpreted with caution because of the large heterogeneity for some indicators., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Chronological age (CA) does not reflect individual variation in the aging process. However, existing biological age predictors are mostly based on European populations and overlook the widespread nonlinear effects of clinical biomarkers., Methods: Using data from the prospective Dongfeng-Tongji (DFTJ) cohort of elderly Chinese, we propose a physiological aging index (PAI) based on 36 routine clinical biomarkers to measure aging progress. We first determined the optimal level of each biomarker by restricted cubic spline Cox models. For biomarkers with a U-shaped relationship with mortality, we derived new variables to model their distinct effects below and above the optimal levels. We defined PAI as a weighted sum of variables predictive of mortality selected by a LASSO Cox model. To measure aging acceleration, we defined ΔPAI as the residual of PAI after regressing on CA. We evaluated the predictive value of ΔPAI on cardiovascular diseases (CVD) in the DFTJ cohort, as well as nine major chronic diseases in the UK Biobank (UKB)., Results: In the DFTJ training set (n = 12,769, median follow-up: 10.38 years), we identified 25 biomarkers with significant nonlinear associations with mortality, of which 11 showed insignificant linear associations. By incorporating nonlinear effects, we selected CA and 17 clinical biomarkers to calculate PAI. In the DFTJ testing set (n = 15,904, 5.87 years), PAI predict mortality with a concordance index (C-index) of 0.816 (95% confidence interval, [0.796, 0.837]), better than CA (C-index = 0.771 [0.755, 0.788]) and PhenoAge (0.799 [0.784, 0.814]). ΔPAI was predictive of incident CVD and its subtypes, independent of traditional risk factors. In the external validation set of UKB (n = 296,931, 12.80 years), PAI achieved a C-index of 0.749 (0.746, 0.752) to predict mortality, remaining better than CA (0.706 [0.702, 0.709]) and PhenoAge (0.743 [0.739, 0.746]). In both DFTJ and UKB, PAI calibrated better than PhenoAge when comparing the predicted and observed survival probabilities. Furthermore, ΔPAI outperformed any single biomarker to predict incident risks of eight age-related chronic diseases., Conclusions: Our results highlight the potential of PAI and ΔPAI as integrative biomarkers to evaluate aging acceleration and facilitate the development of targeted intervention strategies for healthy aging., Competing Interests: Declarations. Ethics approval and consent to participate: All participants from the Dongfeng-Tongji cohort provided written informed consent. The study protocol was approved by the Medical Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (2012–10). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Aims: To document longitudinal changes in spherical equivalent refraction (SER) and related biometric factors during early refractive development., Methods: This was a prospective cohort study of Chinese children, starting in 2018 with annual follow-ups. At each visit, children received cycloplegic autorefraction and ocular biometry measurements. Lens power (LP) was calculated using Bennett's formula. Children were divided into eight groups based on baseline age: the 3-year-old (n=426, 49.77% girls), 4-year-old (n=834, 47.36% girls), 6-year-old (n=292, 46.58% girls), 7-year-old (n=964, 43.46% girls), 9-year-old (n=981, 46.18% girls), 10-year-old (n=1181, 46.32% girls), 12-year-old (n=504, 49.01%) and 13-year-old (n=644, 42.70%) age groups., Results: This study included right-eye data from 5826 children. The 3-year-old and 4-year-old age groups demonstrated an inflection point in longitudinal SER changes at a mild hyperopic baseline SER (+1 to +2 D), with children with more myopic SER showing hyperopic refractive shifts while those with more hyperopic SER showing myopic shifts. The hyperopic shift in SER was mainly attributed to rapid LP loss and was rarely seen in the older age groups. Axial elongation accelerated in the premyopia stage, accompanied by a partially counter-balancing acceleration of LP loss. For children aged 3-7 years, those with annual SER changes <0.25 D were all mildly hyperopic at baseline (mean: 1.23 D, 95% CI 1.20 to 1.27 D)., Conclusion: Our findings suggest that during early refractive development, refractions cluster around or above +1.00 D. There is a pushback process in which increases in the rate of LP occur in parallel with increases in axial elongation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To investigate the association between the triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance and the risk of kidney stones (KSs) in a Chinese population., Design: Case-control study., Setting: Three Physical Examination Centers in Shanghai, China, between January 2020 and December 2022., Participants: A total of 117 757 Chinese adults underwent health check-ups during the study period., Primary and Secondary Outcome Measures: The association between the TyG index and the risk of KS was assessed using multivariable logistic regression analysis. The dose-response relationship between the TyG index and KS risk was evaluated with a restricted cubic spline (RCS) analysis. Stratified analyses were conducted to explore whether factors such as age, sex, obesity, hypertension and diabetes modify the association between the TyG index and KS risk., Results: Out Of the 117 757 participants, 11 645 (9.9%) were diagnosed with KS using ultrasound. Individuals with KS had significantly higher TyG values than controls (p<0.001). The multivariable-adjusted ORs for KS increased across TyG quartiles, with the highest quartile showing an OR of 1.28 (95% CI 1.20 to 1.36) compared with the lowest quartile. Each SD increase in the TyG index was associated with a 10% higher risk of KS (OR: 1.10, 95% CI 1.08 to 1.13). RCS analysis revealed a significant positive and linear association between TyG index and KS (p overall<0.001, p non-linear=0.136). The positive association persisted across the subgroup and sensitivity analyses., Conclusions: The TyG index was positively associated with the risk of prevalent KS, suggesting that insulin resistance may be a risk factor for KS in the Chinese population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Oral microbial dysbiosis contributes to the development of schizophrenia (SZ). While numerous studies have investigated alterations in the oral bacterial microbiota among SZ patients, investigations into the fungal microbiota, another integral component of the oral microbiota, are scarce. In this cross-sectional study, we enrolled 118 Chinese patients with SZ and 97 age-matched healthy controls (HCs) to evaluate the oral fungal microbiota from tongue coating samples using internal transcribed spacer 1 amplicon sequencing and assess host immunity via multiplex immunoassays. Our findings revealed that SZ patients exhibited reduced fungal richness and significant differences in β-diversity compared to HCs. Within the oral fungal communities, we identified two distinct fungal clusters (mycotypes): Candida and Malassezia, with SZ patients showing increased Malassezia and decreased Candida levels. These key functional oral fungi may serve as potential diagnostic biomarkers for SZ. Furthermore, SZ patients displayed signs of immunological dysfunction, characterized by elevated levels of pro-inflammatory cytokines such as IL-6 and TNF-α, and chemokines including MIP-1α and MCP-1. Importantly, Malassezia mycotype correlated positively with peripheral pro-inflammatory cytokines, while Candida mycotype exhibited a negative correlation with these cytokines. In conclusion, we have demonstrated, for the first time, the presence of altered oral fungal communities and systemic immune dysfunction in Chinese SZ patients compared to HCs, providing novel insights into the potential role of oral fungi as biomarkers and the broader implications for understanding SZ pathogenesis., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Globally, adolescent depression is prevalent. There is, however, a dearth of studies investigating behavioral intention to professional help-seeking regarding mental health problems among adolescents having probable depression. Based on the Stress Coping Theory, the hypothesis that personal resources and active coping would mediate between interpersonal resources and behavioral intention to professional help-seeking was investigated., Methods: Students from five junior middle schools, three senior high schools, and one vocational school were selected to participate in the survey from February to March 2022 via convenient sampling. The questionnaire collected participants' characteristics, depression, peer acceptance/support, resilience, self-compassion, active coping, and behavioral intention to professional help-seeking. The final sample included 1,425 Chinese adolescents having probable depression (Patient Health Questionnaire score ≥ 10). SPSS 23.0 and Mplus 8.3 were employed to analyze the data., Results: The prevalence of behavioral intention to professional help-seeking was 15.4%. Adjusted for background factors, peer acceptance, resilience, self-compassion, and active coping were significantly associated with behavioral intention to professional help-seeking (ORa ranged from 1.05 to 1.31). The indirect effects via active coping (β = 0.020) and a serial indirect effect via personal resources and active coping (β = 0.029) were statistically significant. The direct effect from interpersonal resources to behavioral intention to professional help-seeking was non-significant., Conclusion: The prevalence of behavioral intention to professional help-seeking among adolescents with probable depression was low and might render early detection/intervention ineffective. It is important to increase the intention to seek help from professionals. One possibility is to enhance interpersonal/personal resources and active coping., Competing Interests: Declarations. Ethics approval and consent to participant: This study was approved by the Medical Research Ethics Committee of the Affiliated Wenzhou Kangning Hospital of Wenzhou Medical University (No. KNLL-20211011002). Informed consent was obtained from all participants and their parents. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

In China, unhealthy lifestyles, including smoking, alcohol consumption, a lack of exercise, and irrational diets, are relatively common among the elderly population. The objective of this study was to examine the specific associations between poor health-related behaviours and all-cause and cause-specific mortality in older adults. This study involved 5,015 subjects ≥ 60 years of age from the CHARLS database over a 10-year follow-up period. The average age was (67.96 ± 6.39) years. We examined whether lifestyle groups, based on adherence to non-smoking, no-alcohol, moderate exercise, and 18.5 kg/m 2  ≤ BMI< 24 kg/m 2 , were linked with subsequent mortality. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence intervals for all-cause and cause-specific mortality of maintaining a healthy lifestyle. In multivariate adjustment model, the risk of all-cause mortality was reduced by 59.2% [HR 0.408 (95% CI 0.333, 0.499)] in the moderate group compared with the unfavorable group. In addition, the risk of all-cause mortality was reduced to 80.5% [HR 0.195 (95% CI 0.150, 0.253)] in the favorable group. The risks of cardiovascular and cerebrovascular diseases, chronic respiratory disease, cancers, and diabetes increased with similar dose-response patterns. The combination of all four healthy lifestyles provided the greatest protection, reducing mortality by 84.5%. In the elderly population, adherence to a healthy lifestyle is associated with a significant reduction in the risk of all-cause and cause-specific mortality., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Consent for publication: Not applicable., (© 2024. The Author(s).)

Background: Ambrosia artemisiifolia is a highly invasive herb with deleterious effects on public health and agricultural systems. Flowering time in this species has been reported to vary along a latitudinal gradient, which may contribute to local adaptation and invasion success in China. However, the molecular basis for the flowering time differentiation remains unclear., Results: A common garden experiment confirmed a latitudinal gradient in flowering time among seven Chinese populations. Differentially expressed genes (DEGs) across sampling times and flowering time groups were identified through transcriptome sequencing and analyses of DGE and WGCNA, and were partially annotated to circadian rhythm, light response and hormone response through GO enrichment. By annotating to Flowering Interactive Database (FLOR-ID) and protein-protein interaction (PPI) databases, 53 candidate genes for flowering time differentiation were identified, with 23 of these genes linked to the photoperiod pathway. Additionally, 43 of 53 candidate genes exhibited expression correlated with latitude. Six genes, including FKF1, FT, FUL, MAF2, WNK4 and WNK5, were inferred to promote flowering, while 5 genes, FBH3, FLK, NCL(1), POL2A, and ZHD4, likely repress flowering, based on their expression patterns in relation to latitude and sampling times. Notably, NCL(1), FBH3, MAF2, and FLK may function differently in A. artemisiifolia compared to Arabidopsis thaliana., Conclusions: This study identified key candidate genes related to the differentiation of flowering time in Chinese ragweed populations, providing valuable insights into molecular mechanisms of phenological adaptation and invasive success of ragweed., Competing Interests: Declaration. Ethics approval and consent to participate: No specific permission was needed to collect Ambrosia artemisiifolia materials for research. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Resentment towards the Chinese population was perceived during the first months of the pandemic because the pandemic/disease started in that country., Objective: To determine the factors associated with the perception of resentment towards the Chinese in Latin America during the first wave of the COVID-19 pandemic., Methodology: Analytical cross-sectional study conducted during the second semester of the pandemic in more than a dozen countries. Four questions were asked about the perception of resentment towards the Chinese (Cronbach's Alpha: 0.88); those with the highest scores on the sum of the four questions were considered to have "more resentment towards the Chinese," and descriptive and analytical statistics were obtained., Results: Of the 7721 respondents, in the multivariate analysis, it was found that there was a difference according to the country; compared to Peru, those who had more resentment towards the Chinese were those residing in Paraguay (aPR: 1.29; 95%CI: 1.17-1.42; p-value < 0.001) and Bolivia (aPR: 1.52; 95%CI: 1.37-1.68; p-value < 0.001), while Chile (aPR: 0.78; 95%CI: 0.69-0.88; p-value < 0.001) had less resentment: 0.69-0.88; p-value < 0.001), Mexico (aPR: 0.68; 95%CI: 0.57-0.80; p-value < 0.001), Panama (aPR: 0.71; 95%CI: 0.59-0.86; p-value < 0.001) and Costa Rica (aPR: 0.64; 95%CI: 0.49-0.85; p-value = 0.002)., Discussion: There was a significant difference in resentment for each country., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved with resolution N°0014–2022-UPAO by the ethics committee of the Antenor Orrego Private University. Consent for publication: Since it was conducted during the pandemic, the data were collected online, which precluded informed consent; however, the purpose of the study is mentioned at the beginning of the online questionnaire. No personal details were requested from participants to ensure anonymity. The ethical principles of the Declaration of Helsinki conducted this research. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Congenitally missing permanent canines (CMPC) have a significant impact on function and aesthetics. The prevalence is low, and the availability of rigorous studies on this issue in China is limited. This study was designed to investigate the prevalence and distribution of CMPC in patients and concomitant anomalies. Additionally, we aimed to compare the prevalence of CMPC between two age groups., Methods: A total of 10,447 patient's panoramic radiograph (PR) images from August 2021 to December 2023 were reviewed and data regarding the location and number of CMPCs were recorded. Age and gender were obtained from the clinical records. Additionally, concomitant anomalies such as persistent primary canines, congenitally missing other permanent teeth, supernumerary teeth and microdontia were also recorded in patients with CMPC. 10,447 patients were divided into two groups: group A (< 121 months of age) and group B (≥ 121 months of age) to record the number of patients with CMPC. The data were presented as counts (n) and percentages (%), and statistically analysed using the Chi-square test., Results: The average age of patients with CMPC was 9.2 years, with a prevalence of 0.69% (n = 72). The difference between genders was not statistically significant (p = 0.950). The prevalence of CMPC in group B (1.08%, 26/2400) was significantly greater than that in group A (0.57%, 46/8047) (p = 0.008). 89.42% (93/104) of the missing permanent canines had visible primary canines in patients. CMPC were more likely to occur in the maxilla (91.67%) than in the mandible (6.94%) (p<0.001). No significant difference was found between the left and right sides (p = 0.844). With respect to concomitant anomalies among those with CMPC, 22 patients had 58 congenitally other permanent teeth missing, 3 patients had 3 supernumerary teeth, and 12 maxillary lateral incisors from 7 patients presented with microdontia., Conclusions: The prevalence of CMPC was 0.69%. CMPC were more likely to occur in the maxilla in the presence of persistent primary canines and were not influenced by gender or side. Early panoramic radiographs can improve the detection rate of CMPC, thereby facilitating prompt intervention and timely management., Competing Interests: Declarations. Ethics approval and consent to participate: This study, conducted in adherence to the Declaration of Helsinki, was approved by the Ethics Committee of Beijing Children’s Hospital, Capital Medical University ([2024]-E-025-R). The Beijing Children’s Hospital Ethics Committee provided an exemption from obtaining informed consent from the subjects. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Octreotide is recommended as a second-line treatment for patients with congenital hyperinsulinism (CHI), especially for those who do not respond to diazoxide or surgical intervention. Studies on the adverse effects of octreotide in large cohorts are still scarce. We evaluated the safety of octreotide in CHI patients by reviewing cases from the two largest centres in China that specialize in the management of this condition. Our study analysed adverse events in 122 CHI patients on octreotide, with a 93% success rate for the therapy alone. The mean maximum dose of octreotide was 13.1 ± 6.5 µg/kg/day, with no difference in required doses between diffuse and focal lesion patients. Common side effects were hepatobiliary injuries (20.5%), gastrointestinal symptoms (31.1%), and transient hyperglycaemia (49.2%), with one case of necrotizing enterocolitis. Adverse event rates increased in patients treated with intermediate octreotide dose to those treated with higher doses, rising from 58% at doses of 5-10 µg/kg/day to 100% at doses exceeding 20 µg/kg/day. Patients experiencing adverse events received significantly higher doses., Conclusion: Octreotide effectively maintained blood glucose levels in diazoxide-unresponsive CHI patients without serious adverse effects, across all subtypes. Our study suggests that intermediate octreotide dosing is associated with a lower incidence of adverse events. We recommend close monitoring of patients receiving octreotide, especially during the initiation phase and when higher doses are administered., What Is Known: • Octreotide is a commonly used second line treatment for patients with congenital hyperinsulinism. • The administration of octreotide is frequently associated with gastrointestinal adverse events., What Is New: • Our study indicates that octreotide is used without serious adverse effects to maintain blood glucose levels in infants with congenital hyperinsulinism who are otherwise in good health. • The incidence of adverse events in patients treated with octreotide is dose-dependent., Competing Interests: Declarations. The studies involving humans were approved by Children’s hospital of Fudan University (2017-130). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Mild and persisting gastrointestinal symptoms (MPGS) as bloating, constipation or diarrhea are widespread in older adults and often accompanied by gut microbiota dysbiosis. Nutritional interventions help to regulate and restore microbiota and gut function. In this non-randomized continuous prospective cohort study, we evaluated the effects of a 21-day intervention using a dietary dairy-based supplement (AGIJOY™) on self-reported gastrointestinal (GI) symptoms, fecal microbiota composition and short chain fatty acids (SCFA) levels in a cohort of Chinese adults (N = 46, age 27-73) suffering from MPGS. Questionnaire data and fecal samples were collected at baseline (D0), on day 7 and 21 of intervention (D7 and D21). The results showed significant improvement in the self-reported GI symptoms on D21 and a gradual shift in the fecal microbiota composition. In the first week of intervention, the relative abundance (RA) of fecal bifidobacteria significantly increased and the RA of Bacteroides and Helicobacter decreased (p < 0.05). The levels of fecal SCFA remained unchanged during the study. To our knowledge, this is the first study testing the effect of this prebiotic and postbiotic containing milk-based supplement blend on gut microbiota and MPGS among Chinese population under a real living environment., Competing Interests: Declarations Competing interests The research being reported in this publication was supported financially by Mead Johnson Nutrition (Hong Kong) LTD. K.B. is employed by Mead Johnson Nijmegen (The Netherlands) and K.B and Y. Zhu are members of the Mead Johnson NHII (Guangzhou, PR China). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. Institutional review board The study was conducted in accordance with the Declaration of Helsinki, and approved by the Chinese Academy of Science, Shenzhen Institute of Advanced Technology (SIAT) Institutional Review Board with identifier SIAT-IRB-230915-H0669. Informed consent Written informed consent was obtained from all subjects prior to the initiation of study procedures., (© 2024. The Author(s).)

Background: We assessed the correlation between optic nerve sheath diameter (ONSD) values measured by bedside ultrasound and intracranial pressure (ICP) changes among patients under neurocritical care and evaluated the diagnostic performance of ONSD for increased ICP., Methods: Sixty-seven neurologically critical patients who were hospitalised in the intensive care unit (ICU) of Jining No.1 People's Hospital between September 2023 and March 2024 and underwent lumbar puncture were included. The ONSD was measured and recorded using bedside ultrasound before the lumbar puncture. Patients were divided into normal and increased ICP groups on the basis of the initial lumbar puncture pressure on admission, and both groups were compared. Spearman's correlation analysis was used for evaluating the correlation between ONSD values and ICP. Receiver operating characteristic (ROC) curves were employed for evaluating the diagnostic performance of ONSD for increased ICP., Result: At admission, the Glasgow Coma Scale scores of patients in the increased ICP group were significantly lower than those of patients in the normal ICP group (P < 0.05). The ONSD level of patients in the increased ICP group was significantly higher than that of patients in the normal ICP group (P < 0.05). Spearman's correlation analysis revealed that ONSD positively correlated with ICP among patients with severe neurological diseases (r = 0.777, P < 0.001). The area under the ROC curve when using ONSD for diagnosing lumbar puncture opening pressure ≥ 200 mmH 2 O was 0.896 (95% confidence interval, 0.817-0.974). When using ONSD ≥ 4.74 mm as the threshold for diagnosing lumbar puncture opening pressure ≥ 200 mmH 2 O, the sensitivity and specificity were 0.909 and 0.765, respectively., Conclusion: In patients with critical neurological illness, ONSD measured using bedside ultrasound positively correlated with ICP. Increased ICP can be diagnosed for ONSD ≥ 4.74 mm. The ONSD value measured by bedside ultrasound can be used for evaluating ICP among patients with critical neurological illness., Competing Interests: Declarations Ethics approval and consent to participate This study was approved by the Medical Ethics Committee of Jining No.1 People’s Hospital (approval number: KYLL-202308-150), and informed consent was obtained from either the patient or their adult caregivers prior to enrolment. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Internet access for adolescents is becoming more prevalent around the world. Although video game playing has been verified to be negatively related to adolescent academic achievement, the mechanisms underlying this relationship are also unknown. Using a nationally representative sample of adolescents from the China Education Panel Survey (2014-2015), this study aims to explore the parallel mediation roles of self-educational expectation and learning attitude in the link between video game playing and academic achievement, and whether the direct and indirect effects are moderated by parent-child relationship. The results indicate that video game playing in adolescents is both directly and indirectly related to their academic achievement, and self-educational expectation and learning attitude partially mediate this association. Moreover, the results reveal that parent-child relationship moderates the direct association between video game playing and academic achievement as well as the indirect association of video game playing on academic achievement via self-educational expectation, respectively. By showing empirical evidence for the usefulness of social cognitive theory to adolescents' academics in the Internet Age, our research provides a supplement to existing literature., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Gu 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.)

Introduction: Osteoporosis is a debilitating bone disease that significantly contributes to disability and a loss of autonomy among older adults. This study aimed to characterize osteoporosis and explore the feasibility of combining OSTA and BMR for osteoporosis prediction., Methods: A cross-sectional study involving 1435 participants (1300 women and 135 men) was conducted. Spearman's correlation, simple linear regression analyses, and multiple linear regression models were utilized to investigate the association between OSTA, BMR, and bone mineral density (BMD). Furthermore, the efficacy of integrating OSTA with BMR for osteoporosis screening and prediction was assessed through receiver operating characteristic (ROC) curves., Results: In the total population, the sensitivity of combination variable W was 58.63%, and the specificity was 70.90%. When OSTA and BMR were employed separately to diagnose osteoporosis, the sensitivity was 47.70% and 55.34%, respectively, while the specificity was 63.80% and 69.80%, respectively., Conclusions: The combined utilization of OSTA and BMR formula represents an effective screening method for osteoporosis., Competing Interests: Declarations Ethics approval and consent to participate The study protocol was approved by the Ethics Committee of The Second Affiliated Hospital of Xi’an Jiaotong University (No.2023264) and written informed consent was obtained from each participant. Consent for publication All authors consented to the publication of this study. The hospital committee of ethics approved the study, and informed consent was obtained from the patients/participants included in this study. Following the guidelines, the patient’s permission to publish is indicated as “Not Applicable” in this section. Figures authenticity All figures submitted have been created by the authors who confirm that the images are original with no duplication and have not been previously published in whole or in part. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)