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Integrating polygenic and clinical risks to improve stroke risk stratification in prospective Chinese cohorts

Science China(Life Sciences) 2023年第7期66卷 1626-1635页

作者： Qingmei Cui Fangchao Liu Jianxin Li Xiaoge Niu Zhongying Liu Chong Shen Dongsheng Hu Keyong Huang Shufeng Chen Jie Cao Xiaoqing Liu Ling Yu Fanghong Lu Xianping Wu Liancheng Zhao Jianfeng Huang Ying Li Zhibin Hu Hongbing Shen Dongfeng Gu Xiangfeng Lu Department of Epidemiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing100037China Key Laboratory of Cardiovascular Epidemiology Chinese Academy of Medical SciencesBeijing100037China Department of Nephrology Henan Provincial Key Laboratory of Kidney Disease and ImmunologyHenan Provincial Clinical Research Center for Kidney DiseaseHenan Provincial People’s Hospital and People’s Hospital of Zhengzhou UniversityZhengzhou450053China Department of Epidemiology and Biostatistics Center for Global HealthSchool of Public HealthNanjing Medical UniversityNanjing211166China Department of Epidemiology and Health Statistics College of Public HealthZhengzhou UniversityZhengzhou450001China Department of Prevention Medicine Shenzhen University School of MedicineShenzhen518060China Division of Epidemiology Guangdong Provincial People’s Hospital and Cardiovascular InstituteGuangzhou510080China Department of Cardiology Fujian Provincial People’s HospitalFuzhou350014China Cardio-Cerebrovascular Control and Research Center Institute of Basic MedicineShandong Academy of Medical SciencesJinan250062China Sichuan Center for Disease Control and Prevention Chengdu610041China Research Units of Cohort Study on Cardiovascular Diseases and Cancers Chinese Academy of Medical SciencesBeijing100730China School of Medicine Southern University of Science and TechnologyShenzhen518055China

The utility of the polygenic risk score(PRS)to identify individuals at higher risk of stroke beyond clinical risk remains unclear,and we clarified this using Chinese population-based prospective cohorts.Cox proportional hazards models were used to estimate the 10-year risk,and Fine and Gray’s models were used for hazard ratios(HRs),their 95%confidence intervals(CIs),and the lifetime risk according to PRS and clinical risk categories.A total of 41,006 individuals aged 30–75 years with a mean follow-up of 9.0 years were included.Comparing the top versus bottom 5%of the PRS,the HR was 3.01(95%CI 2.03–4.45)in the total population,and similar findings were observed within clinical risk strata.Marked gradients in the 10-year and lifetime risk across PRS categories were also found within clinical risk categories.Notably,among individuals with intermediate clinical risk,the 10-year risk for those in the top 5%of the PRS(7.3%,95%CI 7.1%–7.5%)reached the threshold of high clinical risk(≥7.0%)for initiating preventive treatment,and this effect of the PRS on refining risk stratification was evident for ischemic stroke.Even among those in the top 10%and 20%of the PRS,the 10-year risk would also exceed this level when aged≥50 and≥60 years,respectively.Overall,the combination of the PRS with the clinical risk score improved the risk stratification within clinical risk strata and distinguished actual high-risk individuals with intermediate clinical risk.

关键词： stroke polygenic risk score clinical risk score utility stratification

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Vertical Diffusion Coefficient with stratification Effect for Silty Sediment Suspension Under Waves

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China Ocean Engineering 2023年第2期37卷 323-332页

作者： YANG Guang-yao ZHANG Qing-he State Key Laboratory of Hydraulic Engineering Simulation and Safety Tianjin UniversityTianjin 300072China

To analyze previous experimental data of suspended sediment concentration for silty sediment with different sediment particle sizes due to waves, a new stratification correction coefficient is presented. The suspended sediment concentration gradient and sediment particle diameter are selected as parameters. Furthermore, a diffusion coefficient model with a stratification effect over the whole water depth for silty sediment suspension under waves is developed. The comparison between the suspended sediment concentration calculated by the presented model and several groups of experimental data shows that the model can reasonably reflect the vertical distribution of silty sediment suspension.The stratification effect calculated by the present model decreases with an increase in the sediment particle diameter,which indicates that the model can be extended to describe the suspended sediment concentration of fine to medium sand when the near-bottom sediment concentration is not very high. Although the original model needs to be iteratively solved, the approximate method without iteration is recommended for applications when the near bottom sediment concentration is between 10 and 20 kg/m~3 due to the small difference between the non-iterative and iterative solution for near bed layer suspended sediment concentration, which plays a major role in sediment transport.

关键词： stratification silty sediment suspension diffusion coefficient wave

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Phytosociology of stratification in a lowland tropical rainforest occurring north of the Tropic of Cancer in Meghalaya, India

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Plant Diversity 2019年第5期41卷 285-299页

作者： Uma Shankar Department of Botany North-Eastern Hill University

stratification in lowland rainforests of Meghalaya,India,which represent the westernmost limit of the rainforests north of the Tropic of Cancer,was studied in horizontal and vertical planes to elucidate the patterns in stacking of species diversity and community attributes,and to draw comparisons with rainforests of‘Indo-Malaya’ecozone(biogeographical realm).All individuals≥10 cm GBH(girth at breast height)were enumerated in six transects of 10 m width and up to 500 m length covering 2.45 ha area.The stratification of whole assemblage of species in vertical plane is referred to as‘storey structure’(=height class distribution),which explains structural complexity.In horizontal plane,it is typically referred to as‘stand structure’(=girth class distribution),which explains structural heterogeneity.The stratification of an individual species in vertical plane is referred to as‘loftiness’and in horizontal plane,it is frequently referred to as‘population structure’.The stand structure was characterized by a negative exponential relationship or a reverse J-shaped curve,which is typical of a well regenerating forest stand.The storey structure was characterized by the low stature of the rainforest(<30 m),subtle layering in the canopy with dearth of discrete multi-stories,narrower widths of the stories and a thick understory.The cluster analysis and‘candlestick charts’showed that the dominant species spatially segregated in canopy height to profile three strata,viz.,an understory of juveniles and shrubs below 5 m,a middle-storey of intermediate trees between 5 and 15 m,and an overstory of large trees between 15 and 25 m.Emergent trees of a few species may reach up to 30 m.The individuals tended to scatter in increasingly wider range of height classes from a lower to the next higher girth class,creating a‘torchlight scatter’pattern,with a tendency to concentrate towards smaller height classes due to stochastic factors,which potentially influence vertical growth proportionate to diametric growth.In comparison to equatorial r

关键词： Forest stratification Stand structure Storey structure Loftiness Population structure Northeast India

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Performance of risk stratification systems for gastrointestinal stromal tumors: A multicenter study

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World Journal of Gastroenterology 2019年第10期25卷 1238-1247页

作者： Tao Chen Liang-Ying Ye Xing-Yu Feng Hai-Bo Qiu Peng Zhang Yi-Xin Luo Li-Yi Yuan Xin-Hua Chen Yan-Feng Hu Hao Liu Yong Li Kai-Xiong Tao Jiang Yu Guo-Xin Li Department of General Surgery Nanfang HospitalSouthern Medical University Department of Gastroenterology Nanfang HospitalSouthern Medical University Department of General Surgery Guangdong General HospitalGuangdong Academy of Medical Sciences Department of Gastric Surgery Sun Yat-sen University Cancer CenterSun Yatsen University Department of General Surgery Wuhan Union HospitalHuazhong University of Science and Technology

BACKGROUND Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumor type in the gastrointestinal system. Presently, various classification systems to prognosticate GISTs have been proposed.AIM To evaluate the application value of four different risk stratification systems for GISTs.METHODS Patients who were diagnosed with GISTs and underwent surgical resection at four hospitals from 1998 to 2015 were identified from a database. Risk of recurrence was stratified by the modified National Institute of Health(NIH)criteria, the Armed Forces Institute of Pathology(AFIP) criteria, the Memorial Sloan Kettering Cancer Center(MSKCC) prognostic nomogram, and the contour maps. Receiver operating characteristic(ROC) curves were established to compare the four abovementioned risk stratification systems based on the area under the curve(AUC).RESULTS A total of 1303 patients were included in the study. The mean age of the patients was 55.77 ± 13.70 yr; 52.3% of the patients were male. The mean follow-up period was 64.91 ± 35.79 mo. Approximately 67.0% the tumors were located in the stomach, and 59.5% were smaller than 5 cm; 67.3% of the patients had a mitotic count ≤ 5/50 high-power fields(HPFs). Thirty-four tumors ruptured before and during surgery. Univariate analysis demonstrated that tumor size > 5 cm(P 5/50 HPFs(P < 0.05), non-gastric location(P < 0.05), and tumor rupture(P < 0.05) were significantly associated with increased recurrence rates. According to the ROC curve, the AFIP criteria showed the largest AUC(0.754).CONCLUSION According to our data, the AFIP criteria were associated with a larger AUC than the NIH modified criteria, the MSKCC nomogram, and the contour maps, which might indicate that the AFIP criteria have better accuracy to support therapeutic decision-making for patients with GISTs.

关键词： Gastrointestinal stromal tumors Risk stratification Prognosis Modified National Institute of Health criteria Armed Forces Institute of Pathology criteria Memorial Sloan Kettering Cancer Center prognostic nomogram Contour maps Gastrointestinal tumors

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Effects of Preoperative Risk stratification on Direct In-hospital Costs for Chinese Patients with Coronary Artery Bypass Graft:A Single Center Analysis

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Current Medical Science 2018年第6期38卷 1075-1080页

作者： Mei YANG Jia HAO Zhao JIAN Ying-bin XIAO Lai-xin ZHOU Department of Cardiovascular Surgery Xinqiao HospitalArmy Medical UniversityChongqing 400037China Southwest Hospital Army Medical UniversityChongqing 400038China

The purpose of this study was to analyze the components of inpatient costs for coronary artery bypass graft(CABG)according to preoperative risk stratification and to provide evidence for improvement of diagnosis-related groups(DRGs)payment.All patients(n=458)receiving an isolated CABG between January 2014 and December 2016 in a tertiary referral center,in southwest China,were analyzed.Hospital mortality was predicted by the EuroSCORE Ⅱ for each patient. The patients were subdivided into two groups according to the observed mortality(1.97%,9/458):a high-risk group(group H,predicted mortality≥1.97%)and a low-risk group(group L,predicted mortalitystratification;hospital costs;medical insurance

关键词： coronary artery bypass graft risk stratification hospital costs medical insurance payment

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Establishment and Application of Early Risk stratification Method for Acute Abdominal Pain in Adults

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Chinese Medical Journal 2017年第5期130卷 530-535页

作者： Yu Wang Hong Zhao Zhen Zhou Ci Tian Hong-Li Xiao Bao-En Wang Department of Emergency Medicine Beijing Tongren Hospital Capital Medical University Beijing 100730 China Department of Biomedical Informatics School of Biomedical Engineering Capital Medical University Beijing 100069 China Department of Emergency Medicine Peking University Third Hospital Capital Medical University Beijing 100191 China Department of Emergency Medicine Beijing Friendship Hospital Capital Medical University Beijing 100050 China Department of Gastroenterology Beijing Friendship Hospital Capital Medical University Beijing 100050 China

Background： Acute abdominal pain is a common symptom of emergency patients. The severity was always evaluated based on physicians＇ clinical experience. The aim of this study was to establish an early risk stratification method （ERSM） for addressing adults with acute abdominal pain, which would gnide physicians to take appropriate and timely measures following the established health-care policies. Methods： In Cohort 1, the records of 490 patients with acute abdominal pain that developed within the past 72 h were enrolled in this study. Measurement data and numeration data were compared with analysis of variance and Chi-square test, respectively. Multiple regression analysis calculated odd ratio （OR） value. P and OR values showed the impacts of factors. ERSM was established by clinical experts and statistical experts according to Youden index. In Cohort 2, data from 305 patients with acute abdominal pain were enrolled to validate the accuracy of the ERSM. Then, ERSM was prospectively used in clinical practice. Results： The ERSM was established based on the scores of the patient＇s clinical characteristics： right lower abdominal pain ＋ 3 × diffuse abdominal pain ＋ 3 ×cutting abdominal pain ＋ 3 × pain frequency ＋ 3 × pain duration ＋ fever ＋ 2 × vomiting ＋ 5 × stop defecation ＋ 3 - history of abdominal surgery ＋ hypertension history ＋ diabetes history ＋ hyperlipidemia history ＋ pulse ＋ 2 - skin yellowing ＋ 2 × sclera yellowing ＋ 2 × double lung rale ＋ 10 × unconsciousness ＋ 2 ×right lower abdominal tenderness ＋ 5 x diffuse abdominal tenderness ＋ 4 x peritoneal irritation ＋ 4 × bowel sounds abnormal ＋ 10 × suspicious diagnosis ＋ white blood cell count ＋ hematocrit ＋ glucose ＋ 2 × blood urea nitrogen ＋ 3 × creatine ＋ 4× serum albumin ＋ alanine aminotransferase ＋ total bilirubin ＋ 3 × conjugated bilirubin ＋ amylase. When the score was 〈18, the patient did not need hospitalization. A score of≥18 and 〈38 indicated that the patient should be under observation or hospitalized. A score of≥38 and 〈50 indicated the need for an e

关键词： Acute Abdominal Pain Emergency Risk Factor stratification

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Effect of stratification on current hydrodynamics over Louisiana shelf during Hurricane Katrina

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Water Science and Engineering 2017年第2期10卷 154-165页

作者： Mohammad Nabi Allahdadi Chunyan Li Department of Oceanography and Coastal Sciences College of the Coast and Environment Louisiana State University Baton Rouge 70803 USA

Numerical experiments were conducted using the finite volume community ocean model(FVCOM) to study the impact of the initial density stratification on simulated currents over the Louisiana shelf during Hurricane Katrina. Model results for two simulation scenarios, including an initially stratified shelf and an initially non-stratified shelf, were examined. Comparison of two simulations for two-dimensional(2D) currents,the time series of current speed, and variations of cross-shore currents across different sections showed that the smallest differences between simulated currents for these two scenarios occurred over highly mixed regions within 1 radius of maximum wind(RMW) under the hurricane.For areas farther from the mixed zone, differences increased, reaching the maximum values off Terrebonne Bay. These large discrepancies correspond to significant differences between calculated vertical eddy viscosities for the two scenarios. The differences were addressed based on the contradictory behavior of turbulence in a stratified fluid, as compared to a non-stratified fluid. Incorporation of this behavior in the MellorYamada turbulent closure model established a Richardson number-based stability function that was used for estimation of the vertical eddy viscosity from the turbulent energy and macroscale. The results of this study demonstrate the necessity for inclusion of shelf stratification when circulation modeling is conducted using three-dimensional(3D) baroclinic models. To achieve high-accuracy currents, the parameters associated with the turbulence closures should be calibrated with field measurements of currents at different depths.

关键词： Hurricane Katrina Louisiana shelf Hydrodynamics Baroclinic and barotropic models stratification

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Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics

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Stroke & Vascular Neurology 2023年第1期8卷 77-85页

作者： Xuan Tian Hui Fang Linfang Lan Hing Lung Ip Jill Abrigo Haipeng Liu Lina Zheng Florence S Y Fan Sze Ho Ma Bonaventure Ip Bo Song Yuming Xu Jingwei Li Bing Zhang Yun Xu Yannie O Y Soo Vincent Mok Ka Sing Wong Thomas W Leung Xinyi Leng Department of Medicine and Therapeutics The Chinese UniversityHong KongChina Department of Neurology The First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina Department of Neurology The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongChina Department of Imaging and Interventional The Chinese UniversityHong KongChina Research Centre of Intelligent Healthcare Faculty of Health and Life ScienceCoventry UniversityCoventryUK Department of Neurology Nanjing University Medical School Affiliated Nanjing Drum Tower HospitalNanjingJiangsuChina Department of Radiology Nanjing University Medical School Affiliated Nanjing Drum Tower HospitalNanjingJiangsuChina

Background and purpose Symptomatic intracranial atherosclerotic stenosis(sICAS)is associated with a considerable risk of recurrent stroke despite contemporarily optimal medical treatment.Severity of luminal stenosis in sICAS and its haemodynamic significance quantified with computational fluid dynamics(CFD)models were associated with the risk of stroke recurrence.We aimed to develop and compare stroke risk prediction nomograms in sICAS,based on vascular risk factors and these metrics.Methods Patients with 50%-99%sICAS confirmed in CT angiography(CTA)were enrolled.Conventional vascular risk factors were collected.Severity of luminal stenosis in sICAS was dichotomised as moderate(50%-69%)and severe(70%-99%).Translesional pressure ratio(PR)and wall shear stress ratio(WSSR)were quantified via CTA-based CFD modelling;the haemodynamic status of sICAS was classified as normal(normal PR&WSSR),intermediate(otherwise)and abnormal(abnormal PR&WSSR).All patients received guideline-recommended medical treatment.We developed and compared performance of nomograms composed of these variables and independent predictors identified in multivariate logistic regression,in predicting the primary outcome,recurrent ischaemic stroke in the same territory(SIT)within 1 year.Results Among 245 sICAS patients,20(8.2%)had SIT.The D2H2A nomogram,incorporating diabetes,dyslipidaemia,haemodynamic status of sICAS,hypertension and age≥50 years,showed good calibration(P for Hosmer-Lemeshow test=0.560)and discrimination(C-statistic 0.73,95%CI 0.60 to 0.85).It also had better performance in risk reclassification and provided larger net benefits in decision curve analysis,compared with nomograms composed of conventional vascular risk factors only,and plus the severity of luminal stenosis in sICAS.Sensitivity analysis in patients with anterior-circulation sICAS showed similar results.Conclusions The D2H2A nomogram,incorporating conventional vascular risk factors and the haemodynamic significance of sICAS as assessed in CFD models,could be a useful tool

关键词： intracranial otherwise stratification

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Malaria epidemiology and stratification of incidence in the malaria elimination setting in Harari Region,Eastern Ethiopia

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Infectious Diseases of Poverty 2020年第6期9卷 102-103页

作者： Endashaw Esayas Asefa Tufa Fekadu Massebo Abdulhamid Ahemed Ibssa Ibrahim Dereje Dillu Eyuel Asemahegn Bogale Solomon Yared Kebede Deribe 不详 Malaria and Neglected Tropical Diseases Research Directorate Armauer Hansen Research InstituteAddis AbabaEthiopia

Background: Ethiopia has shown notable progress in reducing the burden of malaria over the past two decades.Because of this progress,the country has shifted efforts from control to elimination of malaria.This study was conducted to analyse the malaria epidemiology and stratification of incidence in the malaria elimination setting in eastern Ethiopia.Methods:: A retrospective study was conducted to analyse the epidemiology of malaria by reviewing the district health office data from 2013 to 2019 in Harari Region.In addition,three years of sub-district level malaria data were used to stratify the malaria transmission intensity.Malaria interventions(Long-lasting insecticidal nets[LLIN]and indoor residual spraying[IRS])employed were reviewed to analyse the intervention coverage at the Regional level.Descriptive statistics were used to show the malaria transmission in terms of years,season and species of the malaria parasite.Incidence rate per 1000 population and death rate per 1000000 population at risk were computed using the total population of each year.Results: In the Harari Region,malaria incidence showed a more pronounced declining trend from 2017 to 2019.Plasmodium falciparum,P.vivax and mixed infections accounted for 69.2%,30.6%and 0.2%of the cases,respectively.There was an increment in malaria intervention coverage and improved malaria diagnosis.In the year 2019 the coverage of LLIN and IRS in the Region were 93.4%and 85.1%respectively.The annual malaria incidence rate dropped from 42.9 cases per 1000 population in 2013 to 6.7 cases per 1000 population in 2019.Malaria-related deaths decreased from 4.7 deaths per 1000000 people annually in 2013 to zero,and there have been no deaths reported since 2015.The malaria risk appears to be heterogeneous and varies between districts.A higher number of malaria cases were recorded in Erer and Jenella districts,which constitute 62%of the cases in the Region.According to the sub-district level malaria stratification,there was shrinkage in the malaria transmission map and

关键词： Malaria elimination Epidemiology Incidence Harari region Ethiopia Interventions Sub-district stratification

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Carbon Isotope Gradient of the Ediacaran Cap Carbonate in the Shennongjia Area and Its Implications for Ocean stratification and Palaeogeography

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Journal of Earth Science 2017年第2期28卷 187-195页

作者： Guangzhe Wang Jiasheng Wang Zhou Wang Can Chen Junxia Yang State Key laboratory of Biogeology and Environment Geology School of Earth Sciences China University of Geosciences Institute of Karst Geology CAGS Key Laboratory of Karst Ecosystem and Treatment of Rocky Desertification MLR

The geochemistry and paleogeography of the Doushantuo succession in the Shennongjia area have been insufficiently studied. Here, we report on the carbon and oxygen isotope compositions of Ediacaran Doushantuo cap carbonates from four sections（Longxi, Muyu, Yazikou and Songluo） in the Shennongjia area. A large C-isotopic gradient（~5‰） between the Longxi and Songluo sections, here identified for the first time, is inferred to have been dynamically maintained by photosynthesis in surface waters and anaerobic oxidation of dissolved organic carbon（DOC） in deep waters. Spatial variation in C-isotope chemostratigraphy among the four sections was related to Marinoan post-glacial sea-level elevation changes. At Longxi, a positive δ^（13）C_（carb） shift below the horizon containing tepee-like structure resulted from intense photosynthesis during early regression. A negative δ^（13）C_（carb） shift within the tepee-horizon was triggered by sulfate reduction and freshwater mixing with ^（13）C-depleted dissolved inorganic carbon（DIC） during late regression. A positive δ^（13）C_（carb） excursion in the uppermost part of the cap carbonate was related to enhance primary productivity and organic matter burial during early transgression. At Muyu, the carbon isotopic variation tendency, which is similar to that at Longxi, may have been mildly influenced by the surface water environment. At Songluo, the positive δ^（13）C_（carb） excursion, up to-4‰ in the lower part of the cap carbonate, was probably associated with methanogenesis in deep waters during late transgression to early regression and subsequently disappeared due to decomposition of methane hydrate during late regression. At Yazikou, the consistently stable δ^（13）C_（carb） values around-4‰ indicate that the cap carbonate may have deposited at intermediate water depths. As evidenced by diagnostic sedimentary characteristics of the study sections, the palaeogeographic framework of the Shennongjia area exhibited deepening from SE to NW during the Early Ediacaran Period in the aftermath

关键词： Ediacaran Doushantuo cap carbonate carbon isotope stratification palaeogeography,Shennongjia.

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