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Non-Alcoholic Fatty Liver Disease and Vitamin D in the UK Biobank: A Two-Sample Bidirectional Mendelian Randomisation Study.
Zhang, Z, Burrows, K, Fuller, H, Speliotes, EK, Abeysekera, KWM, Thorne, JL, Lewis, SJ, Zulyniak, MA, Moore, JB
Nutrients. 2023;(6)
Abstract
Evidence for a role for vitamin D in non-alcoholic fatty liver disease (NAFLD) pathogenesis is conflicting. As Mendelian randomisation (MR) avoids many limitations of conventional observational studies, this two-sample bidirectional MR analysis was conducted to determine the following: (i) whether genetically predicted 25-hydroxyvitamin D [25(OH)D] levels are a risk factor for NAFLD, and (ii) whether genetic risk for NAFLD influences 25(OH)D levels. Single-nucleotide polymorphisms (SNPs) associated with serum 25(OH)D levels were obtained from the European ancestry-derived SUNLIGHT consortium. SNPs associated with NAFLD or NASH (p-value < 1 × 10-5) were extracted from previous studies and supplemented by genome-wide association studies (GWASs) performed in the UK Biobank. These GWASs were done both without (primary analysis) and with (sensitivity analysis) the population-level exclusion of other liver diseases (e.g., alcoholic liver diseases, toxic liver diseases, viral hepatitis, etc.). Subsequently, MR analyses were performed to obtain effect estimates using inverse variance weighted (IVW) random effect models. Cochran's Q statistic, MR-Egger regression intercept, MR pleiotropy residual sum and outlier (MR-PRESSO) analyses were used to assess pleiotropy. No causal association of genetically predicted serum 25(OH)D (per standard deviation increase) with risk of NAFLD was identified in either the primary analysis: n = 2757 cases, n = 460,161 controls, odds ratio (95% confidence interval): 0.95 (0.76, -1.18), p = 0.614; or the sensitivity analysis. Reciprocally, no causal association was identified between the genetic risk of NAFLD and serum 25(OH)D levels, OR = 1.00 (0.99, 1.02, p = 0.665). In conclusion, this MR analysis found no evidence of an association between serum 25(OH)D levels and NAFLD in a large European cohort.
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[Analysis of the 1-year curative efficacy of sleeve gastrectomy, Roux-en-Y gastric bypass, single anastomosis duodenal-ileal bypass with sleeve gastrectomy and biliopancreatic diversion with duodenal switch in patients with super obesity].
Zhang, Z, Wang, L, Zhao, YH, Jiang, T, Zhang, ZZ, Wang, X, Hu, LF, Xiao, MH
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery. 2023;(9):859-865
Abstract
Objective: To evaluate the 1-year postoperative efficacy of four bariatric procedures, namely sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S), and biliopancreatic diversion with duodenal switch (BPD/DS) for treating super obesity. Methods: In this retrospective observational study, we analyzed the clinical data of 40 patients with super obesity (body mass index [BMI]≥50 kg/m2) who had undergone bariatric surgery in the China-Japan Union Hospital of Jilin University from November 2015 to December 2020. The study cohort consisted of 21 men and 19 women of average age 31.7±9.0 years. The preoperative weight and BMI were (159.2±16.9) kg and (53.4±3.0) kg/m2, respectively. Prior to the surgery, 30 individuals had hypertension, 27 hyperuricemia, 15 type 2 diabetes, 10 abnormally high total cholesterol, 20 abnormally high triglycerides, and 24 abnormally high low-density lipoprotein. We divided the participants into four groups according to the type of operation: SG group (n=16), RYGB group (n=9), SADI-S group (n=9) and BPD/DS group (n=6). We examined the following factors: weight, BMI, excess weight loss (%), total weight loss (%), and remission of preoperative metabolic diseases (including hypertension, hyperuricemia, type 2 diabetes, and hyperlipidemia) 3, 6, and 12 months after surgery. The variables assessed for hypertension were systolic and diastolic blood pressure; for type 2 diabetes, glycated hemoglobin; and for hyperlipidemia, total cholesterol, triglycerides, and low-density lipoprotein 1-year after the surgery. The safety of surgery was also assessed. Results: All patients successfully completed laparoscopic procedures, none of them requiring conversion to laparotomy. The amount of blood loss during surgery was less than 50 mL. Postoperative hospital stay was 6-16 days. There were no deaths during the perioperative period. However, two postoperative complications occurred in the RYGB group, namely bleeding and anastomotic leakage. No complications were detected in the other groups. At 3, 6, and 12 months after surgery, percentage of excess weight loss was 36.6±11.0, 62.4±15.7, and 68.2±16.0 (F=21.830, P<0.001) in the SG group; 30.6±6.9, 42.5±5.8, and 50.6±11.1 (F=13.222, P<0.001) in the RYGB group; 39.7±7.8, 54.6±12.7, and 81.9±12.0 (F=33.821, P<0.001) in the SADI-S group; and 40.2±4.8, 57.7±11.8, and 82.8±14.9 (F=21.552, P<0.001), respectively, in the BPD/DS group. The percentage of excess weight loss increased significantly over the 12-month observation period in all groups . Compared with before surgery, hypertension and hyperuricemia in the SG, SADI-S, and BPD-DS groups showed significant improvement after one year (all P<0.05). However, only the SADI-S group exhibited a significant decrease in glycosylated hemoglobin concentrations (P=0.038). Only the BPD-DS group showed significant decreases in various indicators of hyperlipidemia (all P<0.05). The improvements in obesity-related complication indexes did not reach statistical significance in the RYGB group (all P>0.05). Conclusion: SG, RYGB, SADI-S and BPD/DS are all safe and effective treatments for super obesity. All of these procedures can improve the associated metabolic diseases to a certain extent.
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Effectiveness of kumquat decoction for the improvement of cough caused by SARS-CoV-2 Omicron variants, a multicentre, prospective observational study.
Hua, Q, Tang, L, Shui, J, Liu, Y, Zhang, G, Xu, X, Yang, C, Gao, W, Liao, G, Liu, Q, et al
Phytomedicine : international journal of phytotherapy and phytopharmacology. 2023;:155008
Abstract
BACKGROUND Kumquat decoction is a traditional Chinese medicine formula and has been widely used to alleviate the coronavirus disease 2019 (COVID-19)-related cough in China. However, the effectiveness and safety of kumquat decoction remain unclear. PURPOSE To assess the effectiveness and safety of kumquat decoction for COVID-19-related cough. STUDY DESIGN A multicentre, prospective observational study. METHODS We enrolled consecutive patients with mild-to-moderate COVID-19 from December 31, 2022, to January 3, 2023, during the Omicron phase in Yangshuo County, China. The primary outcome was the time from study baseline to sustained cough resolution by the last follow-up day on January 31, 2023. The effectiveness was evaluated by Cox proportional hazards models based on propensity score analyses. The secondary outcomes were the resolution of cough and other COVID-19-related symptoms by Days 3, 5, and 7. RESULTS Of 1434 patients, 671 patients were excluded from the analysis of cough resolution. Among the remaining 763 patients, 481 (63.04%) received kumquat decoction, and 282 (36.96%) received usual care. The median age was 38.0 (interquartile range [IQR] 29.0, 50.0) years, and 55.7% were women. During a median follow-up of 7.000 days, 68.2% of patients in the kumquat group achieved sustained cough resolution (93.77 per 1000 person-days) compared to 39.7% in the usual care group (72.94 per 1000 person-days). The differences in restricted mean survival time (RMST) (kumquat decoction minus usual care group) for cough resolution were -0.742 days (95% CI, -1.235 to -0.250, P = 0.003) on Day 7. In the main analysis using propensity-score matching, the adjusted hazard ratio (HR) for cough resolution (kumquat decoction vs. usual care group) was 1.94 (95% CI, 1.48 to 2.53, P < 0.001). Similar findings were found in multiple sensitivity analyses. In addition, the use of kumquat decoction was associated with the resolution of cough, and a stuffy nose on Days 5 and 7, as well as the resolution of sore throat on Day 7 following medication. CONCLUSION In this study among patients with COVID-19-related cough, receiving kumquat decoction was associated with an earlier resolution of cough symptoms.
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Evaluation of retinal vascular density and related factors using OCTA in children and adolescents with myopia without maculopathy.
Lin, L, Zhang, X, Huang, C, Zhang, Z
The Journal of international medical research. 2023;(1):3000605221150136
Abstract
BACKGROUND Myopia is the most common ophthalmic condition worldwide with a rapidly increasing prevalence. This study aimed to compare the retinal microvasculature in the superficial capillary plexus (SCP) in children and adolescents with mild and moderate/high myopia using optical coherence tomography angiography, determine the relationship between retinal parameters and axial length (AL), and understand the occurrence and progression of myopia in microcirculation. METHODS This prospective observational study included 39 participants with mild myopia and 33 participants with moderate/high myopia. Vessel density (VD) and perfusion density (PD) in the SCP, the foveal avascular zone (FAZ), and AL were compared between the groups and the relationship between these retinal parameters and AL was assessed. RESULTS No difference in SCP VD or PD was observed between the two groups. The FAZ did not differ significantly between groups whereas significant differences in age, height, refractive status, and AL were observed. Significantly shorter AL was observed in participants with mild myopia compared with the moderate/high myopia group. Age was positively correlated with height (r = 0.852) and refractive status was negatively correlated with AL (r = -0.588). AL was positively correlated with VD (r = 0.317) and PD (r = 0.308) in the SCP and AL was negatively correlated with the FAZ (r = -0.434). CONCLUSIONS This study revealed that superficial foveal microvessel density was unaffected in children and adolescents without pathological myopia. However, myopia progression was associated with a change in AL, and an AL increase altered macular blood flow.
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Combination of Nicorandil and Beta-Adrenergic Receptor Blockers in Patients with Coronary Artery Disease: A Real-World Observational Study.
Cheng, J, Qiu, L, Zhang, Z, Li, N, Shu, H, Xiao, Z, Zhou, N
Journal of cardiovascular pharmacology and therapeutics. 2023;:10742484231197559
Abstract
BACKGROUND The effect of combined nicorandil and beta-adrenergic receptor blockers (BBs) compared with that of BBs alone on long-term clinical outcomes in patients with coronary artery disease (CAD) remains undetermined. METHODS A multicenter retrospective cohort study was performed. Adult patients who had been hospitalized for CAD and treated for angina with a combination of nicorandil and BBs or BBs alone were included. The effect of different treatments on the cumulative incidence of major adverse cardiovascular event (MACE) and their components within a follow-up duration of 2.5 years were analyzed using Kaplan-Meier survival curves. An inverse probability of treatment weighting (IPTW) method was used to adjust for the possible effect of confounding factors. RESULTS A total of 137,714 patients were screened, of whom 16,912 individuals (mean age: 61.5 years, men: 67.1%) were successfully enrolled. Among the enrolled participants, 4669 received the combined treatment of nicorandil and BBs, while 12,243 received BBs alone. After IPTW, the results demonstrated that the combined treatment was associated with a significantly reduced incidence of MACE (hazard ratio [HR] 0.79, 95% conidence interval [CI] 0.72-0.87) and stroke (HR 0.48, 95% CI 0.42-0.54) but not of MI (HR 1.03, 95% CI 0.92-1.15) or all-cause mortality (HR 0.93, 95% CI 0.64-1.37). Sensitivity analyses revealed similar results. CONCLUSIONS A combined antiangina treatment of nicorandil and BBs may be more effective than treatment of BBs alone in reducing the long-term incidence of MACE in patients with CAD.
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The association between lifestyles and health conditions and the choice of traditional Chinese medical treatment in China: A latent class analysis.
Ma, X, Wang, M, Ma, J, Zhang, Z, Hao, Y, Yan, N
Medicine. 2022;(51):e32422
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Abstract
Traditional Chinese medicine (TCM) plays a major role in preventing and treating the disease, however, it is also facing a slice of challenges as fewer choices of TCM treatment. Although lifestyles and health conditions might be paramount influencing factors for the choice of TCM treatment, the relative evidence is scarce. The current observational study was designed to evaluate this association. A total of 24,173 Chinese individuals with a mean age of 47.3 years from the Chinese Family Panel Studies 2014 were selected. The choice of TCM treatment was acquired by the self-report questionnaire. Latent class analysis was employed to identify clusters of lifestyles and health conditions. The binary logistic regression model was employed to examine the association between lifestyles, health conditions and the choice of TCM treatment. Lifestyles and health conditions were classified into 3 classes with latent class analysis, healthy group, unhealthy behavior group, and physical inactivity group. After controlling for potential confounding factors, the results showed individuals in unhealthy behavior group (odds ratio = 1.51, 95% confidence interval: 1.35-1.68, P < .001) or physical inactivity group (odds ratio = 1.11, 95% confidence interval: 1.02-1.22, P = .019) were more likely to visit TCM doctors than healthy group. Sex-specific difference was observed, the relationship still existed among the males. The current study revealed the relationship between lifestyles, health conditions and the choice of TCM treatment. This will provide evidence for the TCM development and provide support for further research.
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Prognosis assessment model based on low serum calcium in patients with acute pulmonary thromboembolism.
Yang, YQ, Wang, X, Zhang, YJ, Chen, YF, Wang, L, Hu, XW, Niu, L, Pu, HM, Zhang, X, Zhang, Z, et al
Respirology (Carlton, Vic.). 2022;(8):645-652
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BACKGROUND AND OBJECTIVE The pulmonary embolism severity index (PESI) and simplified PESI (sPESI) are recommended to recognize patients with acute pulmonary thromboembolism (PTE) with low prognosis risk, which is of great significance for treatment. This study aims to verify the influence of hypocalcaemia on the prognosis of patients with PTE and to establish a new prognosis assessment model. METHODS This is an observational, multicentre study enrolling patients with PTE from February 2010 to June 2020 across 12 Chinese hospitals. Variables in PESI, serum calcium levels and patient survival status as of 5 July 2020 were collected. The area under the curve of the receiver operating characteristic curve, sensitivity, specificity and Youden index were used to evaluate model performance. RESULTS In the cohort of 4196 patients with PTE, independent associations existed between hypocalcaemia and mid- and long-term mortalities (p <0.05). By including hypocalcaemia, the new 30-day death risk prediction rule, Peking Union Medical College Hospital rule (PUMCH rule), showed significantly higher specificity (0.622 [0.582, 0.661]; p <0.001) than the PESI (0.514 [0.473, 0.554]) and sPESI (0.484 [0.444, 0.525]) and similar sensitivity (0.963 [0.810, 0.999]; p = 0.161) with PESI (0.889 [0.708, 0.976]) and sPESI (0.963 [0.810, 0.999]) in the internal validation cohort. Well-performing predictive validity was also verified on a constructed external validation cohort. CONCLUSION Hypocalcaemia is independently associated with mid- and long-term PTE mortalities. The PUMCH rule showed significantly higher specificity than the PESI and sPESI and similar sensitivity, which may be used as a prognostic assessment tool for patients with acute PTE.
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Mendelian randomization analyses support causal relationships between blood metabolites and the gut microbiome.
Liu, X, Tong, X, Zou, Y, Lin, X, Zhao, H, Tian, L, Jie, Z, Wang, Q, Zhang, Z, Lu, H, et al
Nature genetics. 2022;(1):52-61
Abstract
The gut microbiome has been implicated in a variety of physiological states, but controversy over causality remains unresolved. Here, we performed bidirectional Mendelian randomization analyses on 3,432 Chinese individuals with whole-genome, whole-metagenome, anthropometric and blood metabolic trait data. We identified 58 causal relationships between the gut microbiome and blood metabolites, and replicated 43 of them. Increased relative abundances of fecal Oscillibacter and Alistipes were causally linked to decreased triglyceride concentration. Conversely, blood metabolites such as glutamic acid appeared to decrease fecal Oxalobacter, and members of Proteobacteria were influenced by metabolites such as 5-methyltetrahydrofolic acid, alanine, glutamate and selenium. Two-sample Mendelian randomization with data from Biobank Japan partly corroborated results with triglyceride and with uric acid, and also provided causal support for published fecal bacterial markers for cancer and cardiovascular diseases. This study illustrates the value of human genetic information to help prioritize gut microbial features for mechanistic and clinical studies.
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Rivaroxaban versus Vitamin K Antagonists (warfarin) based on the triple therapy for left ventricular thrombus after ST-Elevation myocardial infarction.
Zhang, Z, Si, D, Zhang, Q, Qu, M, Yu, M, Jiang, Z, Li, D, Yang, P, Zhang, W
Heart and vessels. 2022;(3):374-384
Abstract
BACKGROUND Left ventricular thrombus (LVT) can complicate ST-Elevation myocardial infarction (STEMI) and is associated with poor outcomes. Conventional triple anticoagulation [Vitamin K Antagonists (VKA) plus dual-antiplatelet therapy (DAPT)] is the first-line therapy for LVT after STEMI. In patients with LVT following STEMI, contemporary data of triple therapy with rivaroxaban are lacking. METHODS We conducted a retrospective cohort study involving 1335 STEMI patients who underwent primary percutaneous coronary intervention (PCI). Among patients who developed LVT after STEMI, we observed differences in efficacy between rivaroxaban plus DAPT therapy and VKA plus DAPT. The time of LVT resolution was also evaluated, as well as net clinical adverse events, and rates of bleeding events. RESULTS In 1335 patients with STEMI, a total of 77 (5.7%) developed LVT over the follow-up period (median 25.0 months). Of the patients diagnosed with LVT, 31 patients were started on triple therapy with VKA, 33 patients on triple therapy with rivaroxaban. There was a consistent similarity in LVT resolution with rivaroxaban application compared to VKA application during the follow-up period [HR (log-rank test) 1.57(95% CI 0.89-2.77), p = 0.096; Adjusted HR 1.70(95% CI 0.90-3.22), p = 0.104]. Triple therapy with rivaroxaban showed quicker resolution than with VKA (6 months: p = 0.049; 12 months: p = 0.044; 18 months: p = 0.045). Similar risks of ISTH bleeding were not significantly different between the 2 groups [VKA 9.7% vs Rivaroxaban 6.1%, Adjusted HR 0.48 (95% CI 0.73-3.20); p = 0.444)]. Fewer net adverse clinical events (NACE) were observed in the rivaroxaban group [VKA 58.1% vs Rivaroxaban 24.2%; HR (log-rank test) 0.31(95% CI 0.14-0.68), p = 0.003; Adjusted HR 0.23(95% CI 0.09-0.57), p = 0.001]. CONCLUSION In the observational study, triple therapy with rivaroxaban has similar and quicker LVT resolution in patients with LVT after STEMI, compared with triple therapy with VKA, and perhaps was associated with a better clinical benefit. Larger sample sizes and randomized controlled trials are needed to confirm this observation.
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Alterations in the Serum Urate Concentrations after Bariatric Surgery: a Short-Term Prospective Observational Study.
Li, M, Liu, Y, Zeng, N, Liu, J, Bian, S, Tian, P, Lv, H, Zhang, M, Zhang, P, Zhang, Z
Obesity surgery. 2021;(4):1688-1695
Abstract
BACKGROUND Bariatric surgery is associated with a reduced incidence of hyperuricaemia during the long follow-up time. However, few studies have elucidated the alterations in serum urate (SU) levels in the short-term post-surgery period. PURPOSE To identify the alterations in SU concentrations in individuals with obesity at 1 week, 1 month, and 3 months after bariatric surgery and determine the risk factors for alterations during the first 3 post-surgery months. METHODS Thirty-four patients were enrolled. Pre- and post-operative variables were collected at baseline and at each follow-up point. A paired t-test was applied to investigate the relationship between the major parameters. A linear mixed model was performed to analyse the variations of SU concentrations with time. RESULTS Compared with baseline levels, SU levels significantly increased at 1 week, then declined significantly at 1 month after surgery (P < 0.05). At the 3-month follow-up, a significant decrease in SU levels was detected compared with that in baseline levels (P < 0.001). In univariate regression analysis, age, sex, weight, body mass index, triglyceride (TG), total cholesterol (TC), creatinine (Cr), and medications were all risk factors for alterations in SU concentrations post-surgery. In the final model, sex, weight, Cr, age, TC, Cr * age, and Cr * TC were established. CONCLUSIONS Surgeons should be cognizant of the significant increase in SU levels in the first postoperative week. Alterations in SU concentrations during the first 3 post-operative months were associated with sex, age, weight, Cr, and TC levels at baseline.