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  1. Zhong N, Moon HS, Lee KH, Mahayiddin AA, Boonsawat W, Isidro MG, et al.
    Respirology, 2016 Nov;21(8):1397-1403.
    PMID: 27490162 DOI: 10.1111/resp.12856
    BACKGROUND AND OBJECTIVE: The TIOtropium Safety and Performance In Respimat (TIOSPIR) trial showed similar safety and exacerbation efficacy profiles for tiotropium Respimat and HandiHaler in patients with COPD. The TIOSPIR results for patients in Asia are presented here.
    METHODS: TIOSPIR evaluated once-daily tiotropium Respimat 5 and 2.5 µg with HandiHaler 18 µg in patients with COPD. Primary endpoints included time to death and time to first COPD exacerbation. Safety and exacerbation efficacy profiles were determined for the Asian region, and for Asia (all treatment arms pooled) versus the rest of the world (RoW).
    RESULTS: In Asia (n = 2356), time to death was similar for Respimat 5 and 2.5 µg versus HandiHaler 18 µg (hazard ratio (HR) (95% CI): 0.96 (0.67, 1.38) and 1.23 (0.87, 1.73)). Risk of COPD exacerbation was similar for Respimat 5 µg, but increased for 2.5 µg versus HandiHaler 18 µg (HR (95% CI): 0.99 (0.85, 1.15) and 1.17 (1.00, 1.35)). Time to death in Asia and RoW was similar (HR (95% CI): 1.15 (0.99, 1.35)). Time to first COPD exacerbation was longer (HR (95% CI): 0.84 (0.78, 0.89)) and exacerbation rates were lower in Asia, but severe exacerbations were more frequent than in the RoW. Risk of major adverse cardiovascular events was similar for both regions.
    CONCLUSION: Similar safety and exacerbation efficacy profiles were observed for tiotropium Respimat 5 µg and HandiHaler 18 µg in patients with COPD from Asia, analogous to the global analysis. Asian patients had lower risk of, and fewer exacerbations overall, but a higher proportion of severe exacerbations than in the RoW.
    Matched MeSH terms: Middle Aged
  2. Zheng Y, Lamoureux EL, Chiang PP, Rahman Anuar A, Wong TY
    J Public Health (Oxf), 2014 Mar;36(1):104-10.
    PMID: 23658389 DOI: 10.1093/pubmed/fdt044
    To examine whether marital status is a significant determinant of visual impairment (VI) in urban multi-ethnic Asian population.
    Matched MeSH terms: Middle Aged
  3. Zheng Y, Lamoureux E, Finkelstein E, Wu R, Lavanya R, Chua D, et al.
    Invest Ophthalmol Vis Sci, 2011;52(12):8799-805.
    PMID: 21969296 DOI: 10.1167/iovs.11-7700
    It is known that a person's socioeconomic status (SES; individual-level SES) is closely correlated with his or her degree of visual impairment. Whether there is an independent relationship between area-level measures of SES (e.g., living in a lower SES environment) and visual impairment is unclear. This study describes the associations of area-level SES with visual impairment.
    Matched MeSH terms: Middle Aged
  4. Zheng WQ, Zhan RZ
    Anal. Quant. Cytol. Histol., 1998 Feb;20(1):1-6.
    PMID: 9513685
    To clarify the correlation between apoptosis and tumor cell proliferative activity in human breast cancer and to investigate their relevance to p53 protein.
    Matched MeSH terms: Middle Aged
  5. Zheng B, Huo Y, Lee SW, Sawhney JPS, Kim HS, Krittayaphong R, et al.
    Clin Cardiol, 2020 Sep;43(9):999-1008.
    PMID: 32618009 DOI: 10.1002/clc.23400
    BACKGROUND: Despite guideline recommendations, dual antiplatelet therapy (DAPT) is frequently used for longer than 1 year after an acute coronary syndrome (ACS) event. In Asia, information on antithrombotic management patterns (AMPs), including DAPT post discharge, is sparse. This analysis evaluated real-world AMPs up to 2 years post discharge for ACS.

    HYPOTHESIS: There is wide variability in AMP use for ACS management in Asia.

    METHODS: EPICOR Asia (NCT01361386) is a prospective observational study of patients discharged after hospitalization for an ACS in eight countries/regions in Asia, followed up for 2 years. Here, we describe AMPs used and present an exploratory analysis of characteristics and outcomes in patients who received DAPT for ≤12 months post discharge compared with >12 months.

    RESULTS: Data were available for 12 922 patients; of 11 639 patients discharged on DAPT, 2364 (20.3%) received DAPT for ≤12 months and 9275 (79.7%) for >12 months, with approximately 60% still on DAPT at 2 years. Patients who received DAPT for >12 months were more likely to be younger, obese, lower Killip class, resident in India (vs China), and to have received invasive reperfusion. Clinical event rates during year 2 of follow-up were lower in patients with DAPT >12 vs ≤12 months, but no causal association can be implied in this non-randomized study.

    CONCLUSIONS: Most ACS patients remained on DAPT up to 1 year, in accordance with current guidelines, and over half remained on DAPT at 2 years post discharge. Patients not on DAPT at 12 months are a higher risk group requiring careful monitoring.

    Matched MeSH terms: Middle Aged
  6. Zhao Y, Rokhani FZ, Shariff Ghazali S, Chew BH
    BMJ Open, 2021 02 18;11(2):e041452.
    PMID: 33602703 DOI: 10.1136/bmjopen-2020-041452
    INTRODUCTION: Smart technologies, digital health and eHealth have been shown to enhance institutional elderly care. Because of the rapidly ageing societies, information technologies in geriatric healthcare are urgently needed. A lot of innovation in smart healthcare has occurred in the past decade, and its use in nursing care assessment, daily living activities and service management is yet to be defined. More fundamentally, the concepts, definitions and scopes of a smart nursing home are still vague. Thus, this scoping review aims to examine the extent, range (variety) and nature (characteristics) of evidence on the existing smart concepts and feasible healthcare technologies, types of medical services in nursing home settings and acceptability of a smart nursing home by the elderly people ≥60 years old, their caregivers, nursing home operators and government agencies.

    METHODS AND ANALYSIS: This scoping review will be guided by the smart technology adoption behaviours of elder consumers theoretical model (Elderadopt) by Golant and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. First, we will conduct an internet search for nursing homes and websites and databases related to the stakeholders to retrieve the definitions, concepts and criteria of a smart nursing home (phase 1). Second, we will conduct an additional systematic electronic database search for published articles on any measures of technological feasibility and integration of medical services in nursing home settings and their acceptability by nursing home residents and caregivers (phase 2). The electronic database search will be carried out from 1999 to 30 September 2020 and limited to works published in English and Chinese languages. For phase 2, the selection of literature is further limited to residents of nursing homes aged ≥60 years old with or without medical needs but are not terminally ill or bed-bound. Qualitative data analysis will follow the Framework Methods and thematic analysis using combined inductive and deductive approaches, conducted by at least two reviewers.

    ETHICS AND DISSEMINATION: This protocol is registered on osf.io (URL: https://osf.io/qtwz2/). Ethical approval is not necessary as the scoping review is not a primary study, and the information is collected from selected articles that are publicly available sources. All findings will be disseminated at conferences and published in peer-reviewed journals.

    Matched MeSH terms: Middle Aged
  7. Zhao Y, Sazlina SG, Rokhani FZ, Su J, Chew BH
    PLoS One, 2021;16(8):e0255865.
    PMID: 34424931 DOI: 10.1371/journal.pone.0255865
    Nursing homes integrated with smart information such as the Internet of Things, cloud computing, artificial intelligence, and digital health could improve not only the quality of care but also benefit the residents and health professionals by providing effective care and efficient medical services. However, a clear concept of a smart nursing home, the expectations and acceptability from the perspectives of the elderly people and their family members are still unclear. In addition, instruments to measure the expectations and acceptability of a smart nursing home are also lacking. The study aims to explore and determine the levels of these expectations, acceptability and the associated sociodemographic factors. This exploratory sequential mixed methods study comprises a qualitative study which will be conducted through a semi-structured interview to explore the expectations and acceptability of a smart nursing home among Chinese elderly people and their family members (Phase I). Next, a questionnaire will be developed and validated based on the results of a qualitative study in Phase I and a preceding scoping review on smart nursing homes by the same authors (Phase II). Lastly, a nationwide survey will be carried out to examine the levels of expectations and acceptability, and the associated sociodemographic factors with the different categories of expectations and acceptability (Phase III). With a better understanding of the Chinese elderly people's expectations and acceptability of smart technologies in nursing homes, a feasible smart nursing home model that incorporates appropriate technologies, integrates needed medical services and business concepts could be formulated and tested as a solution for the rapidly ageing societies in many developed and developing countries.
    Matched MeSH terms: Middle Aged
  8. Zhao S, Zhang J, Liu Y, Ji H, Lew B
    J Affect Disord, 2020 01 01;260:105-110.
    PMID: 31494361 DOI: 10.1016/j.jad.2019.09.006
    BACKGROUND: Previous research on the relationship between life satisfaction and its influencing factors has mainly focused on the work domain. Psychological strains, which result from these stress-related outcomes, have not been paid enough attention to explain how it correlates negatively with life satisfaction.

    METHOD: A cross-sectional study was conducted, using questionnaires sent to selected medical staff in a public hospital in Shandong, China (N = 1012). Multiple regression analysis was used to investigate how psychological strains influencing life satisfactions among medical staff.

    RESULTS: The findings indicate that aspiration strain and deprivation strain have significantly negative impact on medical staff's life satisfaction even with other variables controlled for. Weekly working hour was a significant predictor for life satisfaction. Family factors, such as marital status and kids in the family as well as social support were important factors in influencing individuals' life satisfaction.

    CONCLUSION: The current study highlights the negative associations between aspiration strain, deprivation strain and life satisfaction. The result underlines the importance of actions taken to prevent and combat psychological strains. It also provides some evidence for policy makers to improve the work environment for medical staff, such as reduce weekly working hours and enhance social support in order to increase medical staff's life satisfaction.

    Matched MeSH terms: Middle Aged
  9. Zhao J, Virani S, Sriplung H
    Health Policy Plan, 2017 Apr 01;32(3):430-436.
    PMID: 27935803 DOI: 10.1093/heapol/czw145
    Background: The national cervical cancer screening program in Thailand has been successful in reducing overall burden from this disease. However, evaluation on spatial and temporal scales is needed to assess the efficacy of this program in smaller regions. Here, we geographically assess incidence in a province with a uniquely heterogeneous distribution of lifestyle factors associated with religiosity.

    Methods: Cervical cancer cases were extracted from the provincial cancer registry from 1989 to 2013. Age-adjusted incidence rates were calculated using population statistics from the census bureau and adjusted to the Segi world standard population. Bayesian hierarchical modelling was employed to spatiotemporally map cervical cancer incidence trends in Songkhla province in 5-year period.

    Results: Overall, the incidence of cervical cancer decreased in Songkhla province. The three districts with a Muslim population of greater than 70% had consistently lower cervical cancer rates from 1989 to 2013 compared with the rest of the predominantly Buddhist districts. Hotspots of incidence were identified in Sadao, Hat Yai and the juncture of Mueang Songkhla and Singhanakhon in each 5-year period.

    Conclusions: Distinct cervical cancer incidence trends by religion over time indicate differences in sexual habits, lifestyle and religion-associated culture between Muslims and Buddhists, and suggest divergent risk factor profiles for these groups. The high incidence rates in Sadao and Hat Yai is likely explained by the main road to Malaysia, which runs across these two areas and has frequent commercial sex trade. Female sex workers should be targeted as a vulnerable population for screening efforts to address this continuing burden of cervical cancer.

    Matched MeSH terms: Middle Aged
  10. Zhao H, Zhou Y, Che CC, Chong MC, Zheng Y, Hou Y, et al.
    JMIR Res Protoc, 2024 Apr 29;13:e55102.
    PMID: 38684089 DOI: 10.2196/55102
    BACKGROUND: Patients with gastric cancer experience different degrees of fear of cancer recurrence. The fear of cancer recurrence can cause and worsen many physical and psychological problems. We considered the "intimacy and relationship processes in couples' psychosocial adaptation" model.

    OBJECTIVE: The study aims to examine the effectiveness of a marital self-disclosure intervention for improving the level of fear of cancer recurrence and the dyadic coping ability among gastric cancer survivors and their spouses.

    METHODS: This is a quasiexperimental study with a nonequivalent (pretest-posttest) control group design. The study will be conducted at 2 tertiary hospitals in Taizhou City, Jiangsu Province, China. A total of 42 patients with gastric cancer undergoing chemotherapy and their spouses will be recruited from each hospital. Participants from Jingjiang People's Hospital will be assigned to an experimental group, while participants from Taizhou People's Hospital will be assigned to a control group. The participants in the experimental group will be involved in 4 phases of the marital self-disclosure (different topics, face-to-face) intervention. Patients will be evaluated at baseline after a diagnosis of gastric cancer and reassessed 2 to 4 months after baseline. The primary outcome is the score of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) for patients. The secondary outcomes are the scores of the FoP-Q-SF for partners and the Dyadic Coping Inventory.

    RESULTS: Research activities began in October 2022. Participant enrollment and data collection began in February 2023 and are expected to be completed in 12 months. The primary results of this study are anticipated to be announced in June 2024.

    CONCLUSIONS: This study aims to assess a marital self-disclosure intervention for improving the fear of cancer recurrence in Chinese patients with gastric cancer and their spouses. The study is likely to yield desirable positive outcomes as marital self-disclosure is formulated based on evidence and inputs obtained through stakeholder interviews and expert consultation. The study process will be carried out by nurses who have received psychological training, and the quality of the intervention will be strictly controlled.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT05606549; https://clinicaltrials.gov/study/NCT05606549.

    INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55102.

    Matched MeSH terms: Middle Aged
  11. Zhao D, Kim MH, Pastor-Barriuso R, Chang Y, Ryu S, Zhang Y, et al.
    PLoS One, 2016;11(1):e0146057.
    PMID: 26731527 DOI: 10.1371/journal.pone.0146057
    IMPORTANCE: Intraocular pressure (IOP) reduction or stabilization is the only proven method for glaucoma management. Identifying risk factors for IOP is crucial to understand the pathophysiology of glaucoma.

    OBJECTIVE: To examine the associations of change in body mass index (BMI), waist circumference, and percent fat mass with change in intraocular pressure (IOP) in a large sample of Korean adults.

    DESIGN, SETTING AND PARTICIPANTS: Cohort study of 274,064 young and middle age Korean adults with normal fundoscopic findings who attended annual or biennial health exams from January 1, 2002 to Feb 28, 2010 (577,981 screening visits).

    EXPOSURES: BMI, waist circumference, and percent fat mass.

    MAIN OUTCOME MEASURE(S): At each visit, IOP was measured in both eyes with automated noncontact tonometers.

    RESULTS: In multivariable-adjusted models, the average increase in IOP (95% confidence intervals) over time per interquartile increase in BMI (1.26 kg/m2), waist circumference (6.20 cm), and percent fat mass (3.40%) were 0.18 mmHg (0.17 to 0.19), 0.27 mmHg (0.26 to 0.29), and 0.10 mmHg (0.09 to 0.11), respectively (all P < 0.001). The association was stronger in men compared to women (P < 0.001) and it was only slightly attenuated after including diabetes and hypertension as potential mediators in the model.

    CONCLUSIONS AND RELEVANCE: Increases in adiposity were significantly associated with an increase in IOP in a large cohort of Korean adults attending health screening visits, an association that was stronger for central obesity. Further research is needed to understand better the underlying mechanisms of this association, and to establish the role of weight gain in increasing IOP and the risk of glaucoma and its complications.

    Matched MeSH terms: Middle Aged
  12. Zhao D, Kim MH, Pastor-Barriuso R, Chang Y, Ryu S, Zhang Y, et al.
    Invest Ophthalmol Vis Sci, 2014 Oct;55(10):6244-50.
    PMID: 25183763 DOI: 10.1167/iovs.14-14151
    To examine the longitudinal association between age and intraocular pressure (IOP) in a large sample of Korean men and women.
    Matched MeSH terms: Middle Aged
  13. Zhao C, Wong L, Zhu Q, Yang H
    PLoS One, 2018;13(6):e0199006.
    PMID: 29902222 DOI: 10.1371/journal.pone.0199006
    BACKGROUND: The escalating problem of multiple chronic conditions among older adults in China draws public health attention due to increasing proportion of the elderly population. This study sought to assess the prevalence of and factors associated with four chronic diseases in older adults in Haikou, the capital city of Hainan Province, China.

    METHOD: In this cross-sectional study, 9432 community-dwelling elderly people aged 60 years and older living in rural or urban areas in Haikou were investigated. The interviews collected self-reported information on the presence of four major chronic diseases, as well as socio-demographic characteristics, lifestyle factors and self-reported height and weight.

    FINDINGS: Overall, 31.7% (2961/9344) reported at least one of the four chronic diseases. The prevalence of hypertension, diabetes mellitus, COPD, and stroke was 26.0% (2449/9407), 8.0% (749/9371), 1.0% (95/9360), and 1.9% (175/9382), respectively. Common correlates of the four major chronic diseases were older age, being engaged in intellectual work, currently being a smoker and obesity. Gender, locality of residence, and alcohol consumptions were also found to be associated to some of the chronic conditions.

    CONCLUSION: This finding indicates that multiple chronic conditions among elderly people in Haikou are prevalent and warrant special attention to reduce diseases burden and align health care services to cater the holistic elderly patients' need.

    Matched MeSH terms: Middle Aged
  14. Zhao B, Lee EJ, Yeoh PN, Gong NH
    Pharmacogenetics, 1998 Aug;8(4):299-304.
    PMID: 9731716
    The xenobiotic metabolizing enzymes N-acetyltransferases (NATs) are important for the biotransformation and/or bioactivation of drugs and carcinogens. NATs are coded for in humans by two distinct genes, designated NAT1 and NAT2. NAT1, which was originally thought to be monomorphic, was recently reported to exhibit variation in human populations. Recent studies suggested that a genetic polymorphism of NAT1 may be associated with colorectal cancer risk. The distributions of NAT1 allele and genotype frequencies in unrelated individuals among Indian (n = 140), Malay (n = 122) and Chinese (n = 181) populations in Singapore were characterized by polymerase chain reaction-restriction fragment length polymorphism and allele-specific-polymerase chain reaction. The allelic frequencies of NAT1*3, NAT1*4, NAT1*10 and NAT1*11 among Indians were 0.3, 0.51, 0.17 and 0.02, respectively. The corresponding NAT1 allelic frequencies in Malays were 0.29, 0.30, 0.39 and 0.02, respectively, and were similar to those in Chinese in the region. The allelic frequencies of NAT1*3, NAT1*4, NAT1*10 and NAT1*11 among Chinese were 0.33, 0.35, 0.30 and 0.02, respectively. These findings are of importance for the determination of cancer risk in these populations. In addition, nucleotide changes at positions 350-351 (GG to CC) and 497-499 (GGG to CCC) of the NAT1 gene were not found in the alleles of the populations studied.
    Matched MeSH terms: Middle Aged
  15. Zhang Z, Alomirah H, Cho HS, Li YF, Liao C, Minh TB, et al.
    Environ Sci Technol, 2011 Aug 15;45(16):7044-50.
    PMID: 21732633 DOI: 10.1021/es200976k
    Bisphenol A (BPA) is an industrial chemical used in the manufacture of polycarbonate plastics and epoxy resins. Due to the potential of this compound to disrupt normal endocrinal functions, concerns over human exposure to BPA have been raised. Although several studies have reported human exposure to BPA in Western nations, little is known about exposure in Asian countries. In this study, we determined total urinary BPA concentrations (free plus conjugated) in 296 urine samples (male/female: 153/143) collected from the general population in seven Asian countries, China, India, Japan, Korea, Kuwait, Malaysia, and Vietnam, using high-performance liquid chromatography (HPLC) tandem mass spectrometry (MS/MS). On the basis of urinary BPA concentrations, we estimated the total daily intake. The results indicated that BPA was detected in 94.3% of the samples analyzed, at concentrations ranging from <0.1 to 30.1 ng/mL. The geometric mean concentration of BPA for the entire sample set from seven countries was 1.20 ng/mL. The highest concentration of BPA was found in samples from Kuwait (median: 3.05 ng/mL, 2.45 μg/g creatinine), followed by Korea (2.17 ng/mL, 2.40 μg/g), India (1.71 ng/mL, 2.09 μg/g), Vietnam (1.18 ng/mL, 1.15 μg/g), China (1.10 ng/mL, 1.38 μg/g), Malaysia (1.06 ng/mL, 2.31 μg/g), and Japan (0.95 ng/mL, 0.58 μg/g). Among the five age groups studied (≤ 19, 20-29, 30-39, 40-49, and ≥ 50 years), the highest median concentration of BPA was found in urine samples from the age group of ≤ 19 years. There was no significant difference in BPA concentrations between genders (male and female) or domicile of residence (rural and urban). The estimated median daily intakes of BPA for the populations in Kuwait, Korea, India, China, Vietnam, Malaysia, and Japan were 5.19, 3.69, 2.90, 2.13, 2.01, 1.80, and 1.61 μg/day, respectively. The estimated daily intake of BPA in the seven Asian countries was significantly lower than the tolerable daily intake recommended by the U.S. Environmental Protection Agency. This is the first study to document the occurrence of and human exposure to BPA in several Asian countries.
    Matched MeSH terms: Middle Aged
  16. Zhang Y, Chang Y, Ryu S, Cho J, Lee WY, Rhee EJ, et al.
    J Clin Endocrinol Metab, 2014 Jul;99(7):2467-76.
    PMID: 24708095 DOI: 10.1210/jc.2013-3832
    CONTEXT: Hyperthyroidism and hypothyroidism, both overt and subclinical, are associated with all-cause and cardiovascular mortality. The association between thyroid hormones and mortality in euthyroid individuals, however, is unclear.
    OBJECTIVE: To examine the prospective association between thyroid hormones levels within normal ranges and mortality endpoints.
    SETTING AND DESIGN: A prospective cohort study of 212 456 middle-aged South Korean men and women who had normal thyroid hormone levels and no history of thyroid disease at baseline from January 1, 2002 to December 31, 2009. Free T4 (FT4), free T3 (FT3), and TSH levels were measured by RIA. Vital status and cause of death ascertainment were based on linkage to the National Death Index death certificate records.
    RESULTS: After a median follow-up of 4.3 years, 730 participants died (335 deaths from cancer and 112 cardiovascular-related deaths). FT4 was inversely associated with all-cause mortality (HR = 0.77, 95% confidence interval 0.63-0.95, comparing the highest vs lowest quartile of FT4; P for linear trend = .01), and FT3 was inversely associated cancer mortality (HR = 0.62, 95% confidence interval 0.45-0.85; P for linear trend = .001). TSH was not associated with mortality endpoints.
    CONCLUSIONS: In a large cohort of euthyroid men and women, FT4 and FT3 levels within the normal range were inversely associated with the risk of all-cause mortality and cancer mortality, particularly liver cancer mortality.
    Matched MeSH terms: Middle Aged
  17. Zhang Y, Kim BK, Chang Y, Ryu S, Cho J, Lee WY, et al.
    Arterioscler Thromb Vasc Biol, 2014 Sep;34(9):2128-34.
    PMID: 25060795 DOI: 10.1161/ATVBAHA.114.303889
    OBJECTIVE: Overt and subclinical hypothyroidism are risk factors for atherosclerosis. It is unclear whether thyroid hormone levels within the normal range are also associated with atherosclerosis measured by coronary artery calcium (CAC).
    APPROACH AND RESULTS: We conducted a cross-sectional study of 41 403 apparently healthy young and middle-aged men and women with normal thyroid hormone levels. Free thyroxin, free triiodothyronine, and thyroid-stimulating hormone levels were measured by electrochemiluminescent immunoassay. CAC score was measured by multidetector computed tomography. The multivariable adjusted CAC ratios comparing the highest versus the lowest quartile of thyroid hormones were 0.74 (95% confidence interval, 0.60-0.91; P for trend <0.001) for free thyroxin, 0.81 (0.66-1.00; P for trend=0.05) for free triiodothyronine, and 0.78 (0.64-0.95; P for trend=0.01) for thyroid-stimulating hormone. Similarly, the odds ratios for detectable CAC (CAC >0) comparing the highest versus the lowest quartiles of thyroid hormones were 0.87 (0.79-0.96; P for linear trend <0.001) for free thyroxin, 0.90 (0.82-0.99; P for linear trend=0.02) for free triiodothyronine, and 0.91 (0.83-1.00; P for linear trend=0.03) for thyroid-stimulating hormone.
    CONCLUSIONS: In a large cohort of apparently healthy young and middle-aged euthyroid men and women, low-normal free thyroxin and thyroid-stimulating hormone were associated with a higher prevalence of subclinical coronary artery disease and with a greater degree of coronary calcification.
    KEYWORDS: thyroid hormones; thyrotropin; thyroxine; triiodothyronine
    Matched MeSH terms: Middle Aged
  18. Zhang XC, Wang J, Shao GG, Wang Q, Qu X, Wang B, et al.
    Nat Commun, 2019 04 16;10(1):1772.
    PMID: 30992440 DOI: 10.1038/s41467-019-09762-1
    Deep understanding of the genomic and immunological differences between Chinese and Western lung cancer patients is of great importance for target therapy selection and development for Chinese patients. Here we report an extensive molecular and immune profiling study of 245 Chinese patients with non-small cell lung cancer. Tumor-infiltrating lymphocyte estimated using immune cell signatures is found to be significantly higher in adenocarcinoma (ADC, 72.5%) compared with squamous cell carcinoma (SQCC, 54.4%). The correlation of genomic alterations with immune signatures reveals that low immune infiltration was associated with EGFR mutations in ADC samples, PI3K and/or WNT pathway activation in SQCC. While KRAS mutations are found to be significantly associated with T cell infiltration in ADC samples. The SQCC patients with high antigen presentation machinery and cytotoxic T cell signature scores are found to have a prolonged overall survival time.
    Matched MeSH terms: Middle Aged
  19. Zhang X, Liu JJ, Sum CF, Ying YL, Tavintharan S, Ng XW, et al.
    Atherosclerosis, 2015 Sep;242(1):22-8.
    PMID: 26162317 DOI: 10.1016/j.atherosclerosis.2015.06.019
    OBJECTIVE: We previously reported ethnic disparity in adverse outcomes among Asians with type 2 diabetes (T2DM) in Singapore. Central arterial stiffness can aggravate systemic vasculopathy by propagating elevated systolic and pulse pressures forward, thereby accentuating global vascular injury. We aim to study ethnic disparity in central arterial stiffness and its determinants in a multi-ethnic T2DM Asian cohort.
    METHODS: Arterial stiffness was estimated by carotid-femoral pulse wave velocity (PWV) and augmentation index (AI) using applanation tonometry method in Chinese (N = 1045), Malays (N = 458) and Indians (N = 468). Linear regression model was used to evaluate predictors of PWV and AI.
    RESULTS: PWV was higher in Malays (10.1 ± 3.0 m/s) than Chinese (9.7 ± 2.8 m/s) and Indians (9.6 ± 3.1 m/s) (P = 0.018). AI was higher in Indians (28.1 ± 10.8%) than Malays (25.9 ± 10.1%) and Chinese (26.1 ± 10.7%) (P < 0.001). Malays remain associated with higher PWV (β = 0.299, P = 0.048) post-adjustment for age, gender, duration of diabetes, hemoglobin A1c, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), soluble receptor for advanced glycation end-products, urinary albumin-to-creatinine ratio, and insulin usage, which were all independent predictors of PWV. Indians remain associated with higher AI (β = 2.776, P < 0.001) post-adjustment for age, gender, BMI, SBP, DBP, and height, which were independent predictors of AI. These variables explained 27.7% and 33.4% of the variance in PWV and AI respectively.
    CONCLUSIONS: Malays and Indians with T2DM have higher central arterial stiffness, which may explain their higher risk for adverse outcomes. Modifying traditional major vascular risk factors may partially alleviate their excess cardiovascular risk through modulating arterial stiffness.
    KEYWORDS: Arterial stiffness; Augmentation index; Pulse wave velocity; Type 2 diabetes
    Matched MeSH terms: Middle Aged
  20. Zhang X, Goh GB, Chan WK, Wong GL, Fan JG, Seto WK, et al.
    Liver Int, 2020 11;40(11):2719-2731.
    PMID: 32799384 DOI: 10.1111/liv.14638
    BACKGROUND & AIMS: Lifestyle modification is the cornerstone for the management of non-alcoholic fatty liver disease (NAFLD). We aim to understand lifestyle habits of NAFLD patients, compare across Asian regions and identify area of deficiency.

    METHODS: In the multi-centre controlled attenuation parameter (CAP)-Asia study, we collected clinical data and lifestyle habit data of NAFLD patients from Singapore, mainland China, Hong Kong, Taiwan and Malaysia. Physical activity was assessed using the International Physical Activity Questionnaire.

    RESULTS: A total of 555 patients were included in the final analysis (mean age 54.5 ± 11.2 years, 54.1% men and median liver stiffness 6.7 kPa). More patients from mainland China (27.4%) and Taipei (25.0%) were smokers. Modest drinking was more common in Taiwan (25.0%) and Hong Kong (18.2%); only 1.3% had binge drinking. Majority of patients drank coffee (64.0%) and tea (80.2%), with varying amounts and durations in different regions. Soft drinks consumption was most common in Singapore (62.2%) and Malaysia (57.7%). Only 29.7% of patients met the Physical Activity Guidelines Recommendations, with no major differences across regions. Patients with liver stiffness <10 kPa were more likely to report any vigorous activity, and sitting time was an independent factor associated with high CAP. Tea and coffee consumption were independently associated with high CAP and liver stiffness, respectively.

    CONCLUSIONS: Despite some heterogeneity, unhealthy lifestyle and physical inactivity are common across Asian regions. Patients with liver stiffness <10 kPa were more likely to report any vigorous activity. Healthcare providers may use the comparative data to identify areas of deficiency.

    Matched MeSH terms: Middle Aged
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