BACKGROUND:Diagnostic panels based on multiple biomarkers and clinical characteristics are considered more favorable than individual biomarker to diagnose hepatocellular carcinoma (HCC). Based on age, sex, alpha-fetoprotein (AFP), and protein induced by vitamin K absence II (PIVKA-II) with/without AFP-L3, ASAP and GALAD models are potential diagnostic panels. The diagnostic performances of these two panels were compared relative to HCC detection among patients with various etiologies of chronic liver diseases (CLDs). METHODS:A multicenter case-control study recruited CLDs patients with and without HCC from 14 Chinese hospitals. The etiologies of CLDs included hepatitis B virus (HBV), hepatitis C virus (HCV), alcoholic liver disease (ALD), and nonalcoholic fatty liver disease (NAFLD). Using area under the receiver operating characteristic curve (AUC) values, the diagnostic performances of ASAP and GALAD models were compared to detect HCC among patients with various etiologies of CLDs. RESULTS:Among 248 HCC patients and 722 CLD controls, the ASAP model demonstrated the highest AUC (0.886) to detect HCC at any stage, outperforming the GALAD model (0.853, P = 0.001), as well as any individual biomarker (0.687-0.799, all P < 0.001). In the subgroup analysis of various CLDs etiologies, the ASAP model outperformed the GALAD model to HCC independent of CLDs etiology. In addition, the ASAP model performed better in detecting early-stage (BCLC stage 0/A) HCC versus the GALAD model. CONCLUSIONS:Despite using one less laboratory variable (AFP-L3), the ASAP model demonstrated better diagnostic performance than the GALAD model to detect all-stage HCC among patients with various etiologies of CLDs-related HCC.

筛查是降低结直肠癌发病率和死亡率的有效方式。与传统的愈创木酯法及胶体金法便隐血技术相比，定量免疫法粪便隐血试验技术不易受饮食的影响，数据可定量分析，且阳性阈值可调，对结直肠癌筛查准确性高。美国、欧洲、日本、韩国等发达国家，已经广泛应用该技术，目前国内也逐步在应用该技术进行结直肠癌筛查。其中中国健康促进基金会于2018年12月组织开展了“体检人群结直肠癌早期筛查项目——定量FIT技术筛查结直肠癌多中心应用研究”的课题，目前课题已取得一定的研究成果及经验。课题组对定量免疫法粪便隐血试验技术原理及适用人群、技术规范化操作、检测流程以及技术的质量控制建议等方面进行总结并制定该技术的规范指导建议；为规范定量免疫法粪便隐血试验技术在我国结直肠癌筛查中的应用，确保技术检测的准确性，更好地在我国推广该技术提供理论支持。

目的 探究A20、主要组织相容性复合物Ⅰ类链相关基因A(MⅠCA)、MⅠCB在脂肪变肝星状细胞(HSC)中的表达及作用.方法 实验组采用0.5 mmol/L混合脂肪酸(FFA)刺激人HSC LX-2细胞24 h,以诱导其发生脂肪变,对照组LX-2细胞不予FFA刺激,两组细胞均予油红O染色.应用实时荧光定量PCR(real-time qPCR)法检测实验组和对照组LX-2细胞内A20、α-平滑肌肌动蛋白(α-SMA)、Ⅲ型胶原、MⅠCA、MⅠCB的mRNA表达水平.结果 实验组油红O染色见细胞质内有明显的红色脂质颗粒沉积.实验组 α-SMA、Ⅲ型胶原mRNA的表达水平均较对照组明显升高(P=0.035、P=0.041),分别为对照组的1.53倍、2.40倍.实验组A20 mRNA的表达水平较对照组明显升高(P=0.027),为对照组的3.32倍.实验组MⅠCA、MⅠCB mRNA的表达水平均较对照组明显升高(P=0.049、P=0.008),分别为对照组的3.09倍、16.50倍.结论 A20、MⅠCA、MⅠCB在脂肪变HSC中表达升高,可能在肝纤维化的过程中发挥协同作用,具体机制有待进一步阐明.

Objective We aimed to evaluate the association between the shift of metabolic status and future risk of carotid artery plaque (CAP) in community-based Chinese adults. Methods The current study included 9836 Chinese adults (4085 males and 5751 females, mean age 35.8 years) with metabolically healthy status at baseline (2013). Metabolically healthy status was defined as no self-reported history of metabolic diseases and cancer, and normal blood pressure, fasting blood glucose, glycated hemoglobin A1c level, and lipid profiles. Metabolically unhealthy status was defined if any of the following metabolic abnormalities were confirmed twice during follow up: high blood pressure, impaired glucose regulation, high triglycerides, high total cholesterol, high low-density lipoprotein cholesterols, or low high-density lipoprotein cholesterols. The transition was confirmed if participants’ metabolic status shifted from baseline healthy to unhealthy status during follow up (2014–2018). Results We have identified 133 incident cases of CAP during follow up. Compared to those who remained metabolically healthy, the transition to high blood pressure, high total cholesterol, and high low-density lipoprotein cholesterols, were associated with high risk of developing carotid artery plaque (Hazards ratios (HRs) ranged from 1.69 to 2.34; p < 0.05 for all). The transition to impaired glucose regulation, high total triglycerides, and low high-density lipoprotein cholesterols, were associated with high risk of carotid artery plaque only in participants with metabolically healthy overweight at baseline (HR ranged from 1.95 to 4.62; p < 0.05 for all). Conclusion The transition from baseline metabolically healthy status to unhealth status was associated with high risk of incident CAP.

目的 研究胆管结扎(BDL)所致肝纤维化模型小鼠肝脏中A20 及炎性因子的表达情况,在细胞水平探讨A20的作用机制.方法 建立BDL所致小鼠肝纤维化模型,BDL组结扎胆管后关腹,对照组不结扎胆管直接关腹,10 d后处死小鼠,留取肝脏行H-E染色并观察.应用蛋白质印迹法(Western blotting)检测两组小鼠肝脏中α-平滑肌肌动蛋白(α-SMA)及A20蛋白的表达.应用实时荧光PCR法(Real-time PCR)检测两组小鼠肝脏中炎性反应相关指标mRNA的表达.在体外使用脂多糖(LPS)处理人肝星状细胞(HSC)LX-2细胞,观察A20及炎性反应信号通路因子的变化.结果 BDL组小鼠肝脏组织H-E染色显示肝细胞片状坏死,大胆管增生,肝纤维化明显.BDL组小鼠肝脏中α-SMA蛋白表达为对照组的2.1 1 倍(P＜0.05),A20蛋白表达为对照组的2.47倍(P＜0 .0 1 ).BDL组小鼠肝脏中转化生长因子-β(TGF-β)、I L-6 、I L-1β、单核细胞趋化蛋白-1 (MCP-1 )、Toll样受体4 (TLR4 )的mRNA相对表达量较对照组明显升高,分别为对照组的1 .94倍、5.50 倍、2.47 倍、37.59 倍、4.50 倍(P＝ 0.032 8、P＝ 0.001 0、P＝0.004 6、P＜0.000 1、P＝ 0.014 6).使用LPS(0.1 μg/L)处理LX-2细胞(0、5、10、15、30、60 min),NF-κB抑制因子α(IκBα)、磷酸化IκBα蛋白的表达水平在处理15 min时到达高峰,随后开始下降;A20蛋白的表达水平在处理30 min时开始逐渐上升.结论 A20可能参与了BDL所致肝纤维化模型小鼠的炎性反应,在LX-2细胞内的炎性反应通路中发挥负向调节作用,但A20在炎性反应通路中的具体作用机制有待进一步研究.

Background and aims: We performed the current study to evaluate the association between dynamic change in estimated glomerular filtration rate (eGFR) and the risk of carotid artery plaque (CAP) in a community-based population. Methods and results: A total number of 37,093 Chinese adults (21,790 men and 15,303 women, aged 42.6 +/- 11.6 years) free of chronic kidney diseases were enrolled. The change in eGFR was calculated based on two measurements in 2013 and 2014 (mean interval: 1.2 y). Participants were further classified into three groups based on the change in eGFR: fast-decrease (>= 3.3%), stable (from-3.3% to 3.3%), and fast-increase (3.3%). CAP was annually assessed by ultrasound B model throughout the study (2013-2018). We have identified 1,624 new cases of CAP (16.0 per 1000 person-year) during follow up. Compared to participants with stable eGFR, participants in both fast-decrease and fast-increase groups were associated with 1.99 folds (HR = 1.99, 95% CI: 1.54, 2.57) and 3.15 folds (HR = 3.15, 95% CI: 2.38, 4.16) higher likelihood of developing CAP. The association between continuous change in eGFR and the risk of CAP demonstrate a "U" shape. Sensitivity analysis generated similar results with main analysis. Conclusions: Both fast decrease and increase in eGFR were associated with the risk of developing CAP in Chinese adults. (C) 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

OBJECTIVE:We performed the cohort study to evaluate the association between BMI, high-sensitivity C-reactive protein (hs-CRP) and the conversion from metabolically healthy to unhealthy phenotype in Chinese adults.DESIGN:Metabolically healthy was defined as participants without history of metabolic diseases and with normal fasting blood glucose level, glycated Hb A1c level, blood pressure, lipid profile, serum uric acid level and liver ultrasonographic findings at baseline. Participants were either classified into normal weight (18·5 ≤ BMI < 24·0 kg/m2) and overweight (BMI ≥ 24·0 kg/m2) based on baseline BMI, or low (<1 mg/l) and high (≥1 mg/l) groups based on baseline hs-CRP. The conversion from metabolically healthy to unhealthy phenotype was deemed if any of the metabolic abnormalities had been confirmed twice or more during 5 years of follow-up.RESULTS:Included were 4855 (1942 men and 2913 women, aged 36·0 ± 8·9 years) metabolically healthy Chinese adults. We identified 1692 participants who converted to metabolically unhealthy phenotype during the follow-up. Compared with their counterparts, the adjusted hazards ratio of the conversion was 1·19 (95 % CI 1·07, 1·33) for participants with overweight, while it was 1·15 (95 % CI 1·03, 1·29) for those with high hs-CRP level (≥1 mg/l). Further adjustment of hs-CRP did not materially change the association between BMI and the conversion. However, the association between hs-CRP and the conversion was not significant after further adjustment of BMI. The sensitivity analysis generated similar results to main analysis.CONCLUSION:BMI was associated with the risk of the conversion from metabolically healthy to unhealthy status in Chinese adults.

BACKGROUND:Previous studies reported the controvertible association between red blood cell distribution width (RDW) and diabetes. The aim of this study is to explore whether RDW is associated with incident diabetes.METHODS:We performed this cohort study in 16,971 Chinese adults (9,956 men and 7,015 women, aged 43.3 ± 12.8 years). The level of RDW was measured at baseline (2014). All the participants were further classified into four quartile groups based on baseline RDW. Fasting blood glucose (FBG) and glycated hemoglobin A1c (HbA1c) were measured annually during follow-up (2014-2019). Diabetes was diagnosed if either FBG ≥ 7.0 mmol/L or HbA1c ≥ 6.5%. We used the Cox proportional hazards regression model to evaluate the association between baseline RDW and incident diabetes.RESULTS:We identified 2,703 new cases of diabetes during five-year follow-up. The incidence was 15.9%. Comparing with participants in the lowest quartile group (reference group), the adjusted hazard ratios (HR) for the risk of diabetes were 1.31 (95% CI: 1.16, 1.48) for the highest quartile group (p trend < 0.001), after adjustment for potential confounders. Further adjusting baseline FBG and HbA1c did not materially change the association between RDW and incident diabetes. Each unit increase of RDW was associated with a 16% higher risk of incident diabetes (HR = 1.16, 95% CI: 1.06, 1.26) in a fully adjusted model. Sensitivity analysis generated similar results with prospective analyses after excluding aged participants, participants who are overweight and with obesity, participants with elevated blood pressure, participants with decreased eGFR, and those with anemia at baseline.CONCLUSIONS:High RDW was associated with high risk of developing diabetes in Chinese adults. As RDW is an inexpensive, noninvasive, and convenient indicator, RDW might be considered for inclusion in the risk assessment of high-risk groups of diabetes.

Accumulation of bile acids (BAs) contributes significantly to the pathogenesis of primary biliary cholangitis (PBC). Here, we sought to systematically characterize the serum and fecal BA profiles and the linkage between BAs and gut microbiota in PBC. The serum and fecal BAs were compared between 65 UDCA treatment-naive PBC and 109 healthy controls using UPLC-MS in cross-sectional study. In a prospective study, a subgroup of patients was enrolled for BA and microbiota analysis before and after UDCA therapy. BA compositions in serum and feces significantly differed between treatment-naive PBC and controls. Particularly, PBC was associated with decreased conversions of conjugated to unconjugated, and primary to secondary BAs, indicating impaired microbial metabolism of BAs. PBC patients at advanced stage exhibited a more abnormal BA profile compared with early-stage patients. UDCA treatment led to a decreased level of taurine-conjugated BAs, thereby reversing the conjugated/unconjugated ratio in PBC. Moreover, the level of secondary BAs such as DCA and conjugated DCA inversely correlated with PBC-enriched gut microbes (e.g., Veillonella, Klebsiella), while positively correlated with control-enriched microbes (e.g., Faecalibacterium, Oscillospira). Microbiota analysis also revealed a significant increase of taurine-metabolizing bacteria Bilophila spp. in patients after UDCA, which was strongly correlated with decreased taurine-conjugated BAs. In addition, serum FGF19 was remarkably increased in treatment-naïve PBC and decreased after UDCA. Our study established specific alterations of BA compositions in serum and feces of PBC, suggesting the potential for using BAs for diagnosis, and highlighting the possibility of modulating BA profile by altering gut microbiota. Graphical Abstract.

Meta回归是循证医学研究中一种重要的统计方法,可以用于分析异质性过大的原因,进而发现与筛检异质性的来源;也可以用于预测因变量与自变量的变化关系.本研究主要介绍了Meta回归的数学模型以及如何运用Stata软件建立Meta回归模型,寻找合并效应异质性过大的原因,并通过亚组分析来降低Meta分析中的异质性.另外,还介绍了如何应用回归模型自身性质来评估预测因变量与自变量之间的变化关系,并对Stata软件分析结果进行了解读.通过案例分析让读者可以重复文中Meta结果,验证文献中最终结果的产生过程.掌握回归方法在Meta分析中的应用与实现对于处理Meta分析中的各种问题具有重要价值.

目的 研究体检人群中代谢健康型超重和肥胖检出率及5年随访期间内代谢健康型超重和肥胖的演变情况.方法 以2013-2018年间在上海交通大学医学院附属仁济医院体检中心进行体检的人群作为研究对象.采集身高、体重并计算BMI,测量血压,收集糖代谢指标、脂代谢指标、超敏C反应蛋白、血清尿酸和肝脏B超结果.代谢健康型定义为血压、糖代谢、脂代谢、血清尿酸均正常且无脂肪肝.所有代谢健康型人群进一步根据基线时(2013年)BMI分为体重和代谢均正常、代谢健康型超重和代谢健康型肥胖3组.结果 共64 164人(男性38 134人,女性26 030人)纳入本研究.平均年龄(42.0±12.0)岁,BMI为(23.8±3.2) kg/m2.本组人群中代谢健康型检出率28.7％(18 448人),其中代谢和BMI均正常占78.9％、代谢健康型超重占19.0％,代谢健康型肥胖2.1％.5年随访期间内,代谢健康型的人群中共9 318人转变为代谢不健康型(50.5％).在控制多种混杂因素后,与体重和代谢均正常的人群相比,代谢健康型超重和代谢健康型肥胖的人群转化为代谢不健康型的危险性分别增加11.0％(HR=1.11;95％CI: 1.05～ 1.18)和16.0％ (HR=1.16;95％CI: 1.01～1.33).结论 代谢健康型超重和肥胖的合计检出率为6.1％.与代谢与BMI均正常的人群相比,代谢健康型超重和肥胖转化为不健康的危险性显著增加.

Abstract Background We performed a cohort study to evaluate the association between the CRP trajectory and incident diabetes in Chinese adults. Methods Included were 6439 adults (4111 men and 2249 women; aged 46.6 ± 11.9 years). The concentration of high sensitivity CRP (hs-CRP) was measured in 2013 (baseline), 2014, and 2015. The hs-CRP trajectory was identified based the above three measurements by latent mixture modeling. Incident diabetes cases were diagnosed by fasting blood glucose (≥126 mg/dl) or Hb A1c (≥6.5%) during subsequent 3 years (2016–2018). Results Hs-CRP concentration during 2013–2015 was classified into 3 levels: low (< 1.0 mg/L), moderate (1.0–3.0 mg/L), and high (≥3.0 mg/L) based on a statement by American Heart Association. We named four hs-CRP trajectories as following: “low-stable” (low in 2013 and maintained at low concentration in 2014 and 2015), “moderate-fluctuated” (moderate in 2013, then increased to high concentration in 2014, and decreased to low concentration in 2015), “high-decreased” (high in 2013 but decreased to moderate concentration in 2014 and 2015), and “moderate-increased (moderate in 2013 and increased to high concentration in 2014 and 2015)”. We identified 235 incident diabetes during subsequent 3 years. The adjusted HR for incident diabetes was 1.71 (95% CI: 1.02, 2.87) comparing the moderate-increased and the low-stable group, after adjusting for potential confounders. In the secondary analyses, two single-measured hs-CRP concentration (in 2013 or in 2015) and the average of hs-CRP were associated with high risk of diabetes (P-trend< 0.01 for all). Conclusions The hs-CRP trajectory pattern was associated with altered incident diabetes in Chinese adults.

Whether metabolically healthy obesity (MHO) is associated with longitudinal changes in high-density lipoprotein cholesterol (HDL-C) remains unclear. MHO was defined as participants with overweight and obesity (BMI ≥ 24.0 kg/m2, n = 2921), free of history of metabolic diseases, and without abnormalities of blood pressure, fasting blood glucose, hemoglobin A1c, lipid profile, carotid artery and liver ultrasonographic findings at baseline. Metabolically healthy normal weight (MHN) was defined as participants with normal weight (BMI < 24.0 kg/m2, n = 9578) and without above-mentioned abnormalities. HDL-C, fasting blood glucose, hemoglobin A1c, and blood pressure were assessed annually. Glucose abnormality was considered if either FBG ≥ 5.6 mmol/L or HbA1c ≥ 5.7%; while, high blood pressure (HBP) was considered if either systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 80 mmHg during 5 years of follow-up. Compared with the MHN group, the adjusted mean difference in HDL-C change rate was − 0.005 mmol/L per year [95% confidence interval (CI) − 0.007, − 0.003] for MHO after adjustment for a series of potential confounders. Furthermore, transiting to abnormality of blood glucose, but not high blood pressure, was associated with lower cumulative average of HDL-C in MHN group, compared with those remained in metabolically healthy status. MHO and transiting from metabolically healthy to abnormality of blood glucose were associated with HDL-C in Chinese adults. III, cohort study.

目的 探索运动处方在非酒精性脂肪性肝病(NAFLD)患者治疗中的作用和安全性.方法 纳入59例NAFLD患者,33例被分配到运动干预组,给予有氧运动和抗阻运动,26例为对照组,未进行特别的运动指导和监督.使用全套“健民4型国民体质测试”设备进行运动前后筛查.使用FibroTouch检测肝内脂肪含量和肝脏硬度.结果 在干预组,在干预三个月末,受试者体质量、体质指数、脂肪含量和腰围分别从(81.9±10.4) kg、(28.5±2.4) kg/m2、(25.4±4.9)kg和(92.2±6.5)cm下降至[(75.8±9.8)kg、(26.4±1.8) kg/m2、(19.9±4.7) kg和(87.9±4.6) cm,P＜0.05],肝脏脂肪受控衰减参数由(281.5±15.4)dB/m下降至[(258.7±12.2) dB/m,P＜0.05],而对照组各项指标无显著变化.结论 初步研究提示运用运动处方干预NAFLD患者,可收到显著的治疗效果,且安全.

BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a risk factor for carotid plaque in the general population; however, whether NAFLD is associated with carotid plaque in aged population remains unknown. This cross-sectional study was conducted to evaluate the association between NAFLD and carotid plaque in a Chinese aged population. METHODS A total number of 12,990 Chinese aged adults (7,685 men and 5,305 women) were included. NAFLD was diagnosed based on the recommendation of Asia-Pacific Working Party on NAFLD and Chinese Association for the Study of Liver Disease and excessive alcohol consumption (weekly alcohol consumption ≤210 g in men and ≤140 g in women) was excluded. Carotid plaque was confirmed by ultrasonography. Potential confounders and biochemical findings were collected at baseline. Logistic regression model was employed to evaluate the association between NAFLD and carotid plaque. RESULTS The prevalence of carotid plaque was significantly higher in aged participants with NAFLD than in those without NAFLD (22.4% vs. 16.3%, P<0.001). NAFLD is associated with carotid plaque [odd ratio (OR) =1.89, 95% confidence interval (CI): 1.59-2.24], after adjusting for age, gender, BMI, liver and kidney function, glucose level, lipid profiles, and white blood cell (WBC) count. The association between NAFLD and carotid plaque was attenuated when participants with elevated ALT (≥75 IU/L), a history of cardiovascular diseases (CVDs) and obesity were censored although the significant association remained. CONCLUSIONS NAFLD is associated with carotid plaque in Chinese aged population.

非酒精性脂肪性肝病(NAFLD)是世界范围内最常见的慢性肝病病因,且发病率逐渐上升,是多种心血管疾病、糖尿病和慢性肾病的危险因素,因此,非酒精性脂肪性肝病的防治非常重要.虽然运动疗法作为一种治疗手段已被证实对非酒精性脂肪性肝病的相关危险因素有改善作用,但不同的运动疗法对非酒精性脂肪性肝病的作用还需更多证据.进一步的研究和实践应基于运动处方的制定,探索不同运动处方治疗非酒精性脂肪性肝病的安全性和疗效.

HomeStrokeVol. 50, No. 11Response by Xu and Fan to Letter Regarding Article, "High-Sensitivity CRP (C-Reactive Protein) Is Associated With Incident Carotid Artery Plaque in Chinese Aged Adults" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse by Xu and Fan to Letter Regarding Article, "High-Sensitivity CRP (C-Reactive Protein) Is Associated With Incident Carotid Artery Plaque in Chinese Aged Adults" Renying Xu, MD, PhD Zhuping Fan, MD, PhD Renying XuRenying Xu Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China Zhuping FanZhuping Fan Department of Digestion, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China Originally published18 Oct 2019https://doi.org/10.1161/STROKEAHA.119.027041Stroke. 2019;50:e324Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: October 18, 2019: Ahead of Print In Response:Thanks for interest by Dr Kazushi Tsuada about our article.1 The link in between high-sensitivity CRP [C-reactive protein] (hs-CRP) and cognitive decline could be explained by chronic inflammation. However, current evidence is inconclusive regarding if hs-CRP could be served as a biomarker for cognitive decline. One cohort study concluded that hs-CRP was associated with impaired cognitive function among elderly women,2 but the same is not true for the other one.3 It is of concern that only the women were included in the abovementioned studies. Zheng et al4 conducted a longitudinal study in 5257 elderly participants (54.9% women, aged 65.4±9.4 years). They found that hs-CRP is significantly associated with cognitive decline. In terms of carotid artery plaque, it can lead to impaired cognitive function because of ischemic brain injury.Having said this, we do agree with Dr Kazushi Tsuada that hs-CRP could be associated with endothelial dysfunction. Among people with metabolic disorders, hs-CRP was found to be involved in all stages of atherosclerosis development, starting from endothelial dysfunction to atherothrombotic complications.5 However, so far, the underlying mechanism is also not well understood. Hence, future study should focus more on these areas.Renying Xu, MD, PhDDepartment of Clinical NutritionRen Ji HospitalShanghai Jiao Tong University School of MedicineChinaZhuping Fan, MD, PhDDepartment of DigestionRen Ji HospitalShanghai Jiao Tong University School of MedicineChinaDisclosuresNone.FootnotesStroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 4 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited.References1. Xu R, Zhang Y, Gao X, Wan Y, Fan Z. High-sensitivity CRP (C-reactive protein) is associated with incident carotid artery plaque in Chinese aged adults.Stroke. 2019; 50:1655–1660.LinkGoogle Scholar2. Komulainen P, Lakka TA, Kivipelto M, Hassinen M, Penttilä IM, Helkala EL, et al. Serum high sensitivity C-reactive protein and cognitive function in elderly women.Age Ageing. 2007; 36:443–448. doi: 10.1093/ageing/afm051Google Scholar3. Weuve J, Ridker PM, Cook NR, Buring JE, Grodstein F. High-sensitivity C-reactive protein and cognitive function in older women.Epidemiology. 2006; 17:183–189. doi: 10.1097/01.ede.0000198183.60572.c9Google Scholar4. Zheng F, Xie W. High-sensitivity C-reactive protein and cognitive decline: the English Longitudinal Study of Ageing.Psychol Med. 2018; 48:1381–1389. doi: 10.1017/S0033291717003130Google Scholar5. Rietzschel E, De Buyzere M. High-sensitive C-reactive protein: universal prognostic and causative biomarker in heart disease?Biomark Med. 2012; 6:19–34. doi: 10.2217/bmm.11.108Google Scholar Previous Back to top Next FiguresReferencesRelatedDetails November 2019Vol 50, Issue 11 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.119.027041PMID: 31623549 Originally publishedOctober 18, 2019 PDF download Advertisement SubjectsAtherosclerosis

Background and Purpose- CRP (C-reactive protein) is an inflammatory biomarker which predicts the risk of cardiovascular diseases. However, whether CRP is associated with carotid artery plaque (CAP) remains unclear. Methods- The current retrospective study was performed in 8229 Chinese aged adults (aged 65-99 years; 4677 men and 3552 women). hs-CRP (high-sensitivity CRP) concentrations were measured at baseline (2013), and further classified into 3 groups: low risk (<1.0 mg/L), intermediate risk (1.0-3.0 mg/L), and high risk (≥3.0 mg/L). Ultrasound B-mode imaging was repeatedly performed annually to detect CAP during 5-year follow-up (2013-2018). Potential confounders, including body mass index, blood pressure, fasting blood glucose, alanine transferase, aspartate transferase, alkaline phosphatase, gamma-glutamyl transferase, total bilirubin, direct bilirubin, blood urea nitrogen, creatinine, and uric acid, lipid profiles, were also collected at baseline. White blood cell was collected as well. We used a logistic regression model for the cross-sectional relation between CRP concentration and CAP status and proportional hazardous Cox model for prospective analyses. Results- Comparing to the low-risk group, the adjusted odds ratios for CAP was 1.66 (95% CI, 1.43-1.92) in the intermediate-risk group and 1.72 (95% CI, 1.39-2.13) in the high-risk group, after adjustment for potential confounders. We identified 512 incident CAP cases during 5-year follow-up. Each mg/L increase of hs-CRP was associated with a hazard ratio of 1.1 (95% CI, 1.03-1.17) to developing CAP. Sensitivity analysis generated similar results with prospective analyses after excluding participants with overweight and obesity, with elevated fasting blood glucose, LDL (low-density lipoprotein) cholesterol, and white blood cell. The association lost significant when we excluded participants with elevated blood pressure, however, few cases of CAP (n=41) was recruited in participants with normal blood pressure during follow-up. Conclusions- High hs-CRP concentration was associated with the high risk of developing CAP in Chinese aged adults.

Susan Mayor,伦敦 一系列系统综述和meta分析发现,相比低膳食纤维摄入量人群,膳食纤维和全谷物摄入量较高人群中,全因和心血管事件所致的病死率、非传染性疾病发生率的风险均要低,如冠心病、2型糖尿病. 新西兰Otago大学的研究人员Jim Mann表示,研究结果中的疾病发生率、病死率的降低,是基于对一系列广谱重要疾病相关数据的研究分析得出的,因此,我们的研究结果能为提倡增加膳食纤维摄入量、以全谷物食品替代细粮的营养指南提供有力依据.