Objective To examine and quantify the potential dose-response relation between fruit and vegetable consumption and risk of all cause, cardiovascular, and cancer mortality.Data sources Medline, Embase, and the Cochrane library searched up to 30 August 2013 without language restrictions. Reference lists of retrieved articles.Study selection Prospective cohort studies that reported risk estimates for all cause, cardiovascular, and cancer mortality by levels of fruit and vegetable consumption.Data synthesis Random effects models were used to calculate pooled hazard ratios and 95% confidence intervals and to incorporate variation between studies. The linear and non-linear dose-response relations were evaluated with data from categories of fruit and vegetable consumption in each study.Results Sixteen prospective cohort studies were eligible in this meta-analysis. During follow-up periods ranging from 4.6 to 26 years there were 56 423 deaths (11 512 from cardiovascular disease and 16 817 from cancer) among 833 234 participants. Higher consumption of fruit and vegetables was significantly associated with a lower risk of all cause mortality. Pooled hazard ratios of all cause mortality were 0.95 (95% confidence interval 0.92 to 0.98) for an increment of one serving a day of fruit and vegetables (P=0.001), 0.94 (0.90 to 0.98) for fruit (P=0.002), and 0.95 (0.92 to 0.99) for vegetables (P=0.006). There was a threshold around five servings of fruit and vegetables a day, after which the risk of all cause mortality did not reduce further. A significant inverse association was observed for cardiovascular mortality (hazard ratio for each additional serving a day of fruit and vegetables 0.96, 95% confidence interval 0.92 to 0.99), while higher consumption of fruit and vegetables was not appreciably associated with risk of cancer mortality.Conclusions This meta-analysis provides further evidence that a higher consumption of fruit and vegetables is associated with a lower risk of all cause mortality, particularly cardiovascular mortality.

vascular dementia (vad) is deemed as the second most prevalent type of dementia 1 . Subcortical ischemic vascular disease (Sivd) comprises leukoaraiosis (la) and lacunar infarction (li), which is caused by chronic hypo-perfusion or small vascular occlusion. Subcortical ischemic vascular disease is the most common cause of vad 2 and is associated with the risk of stroke 3 . With this background, the diagnosis and interference of Sivd has received extensive attention. increasing evidence ABSTRACT: Objective: We aimed to examine changes in serum bilirubin and uric acid (ua) levels in subcortical ischemic vascular disease (Sivd). in addition, we investigated if altered serum bilirubin and ua levels correlate with the subtypes of Sivd as well as the severity of leukoaraiosis (la). Methods: this cross-sectional study included 1098 consecutive patients with slight symptoms, such as dizziness, vertigo etc. according to magnetic resonance imaging (Mri) appearances, they were divided into either Sivd group or controls (Cn), and the Sivd group was further grouped in lacunar infarction (li) and la subtypes, as well as different grades. Serum bilirubin and ua levels were determined by the vanadate oxidase method and enzymatic method respectively, after at least an eight hour overnight fasting, in all subjects. Results: the bilirubin level was obviously lower while the ua level was significantly higher in the Sivd group when compared with the controls. Moreover, the la subgroup presented more significant changes in bilirubin and ua when compared to the li subgroup in both males and females. the correlation was positive between the ua levels and the la severity (r=0.134, p=0.006). Multivariate regression analysis revealed that the odds ratio (95% Ci) for Sivd in the lowest tertile of total bilirubin (tbil<9.58μmol/l) and highest tertile of ua (ua>339μmol/l) were 2.702(1.936-3.770) and 2.135(1.521-2.996) respectively after adjusting for confounding variables. Conclusion: Serum bilirubin levels were lower, whereas ua levels were higher in Sivd patients when compared with controls in both males and females, especially in la patients. Moreover, serum ua levels positively correlated to la severity. RÉSUMÉ: Niveaux sériques d'antioxydants associés à la maladie vasculaire ischémique sous-corticale. Objectif : le but de l'étude était d'examiner les changements de niveaux de la bilirubine sérique et de l'acide urique chez les patients atteints d'une maladie vasculaire ischémique souscorticale (MviS). de plus, nous avons cherché à déterminer si une perturbation des niveaux de bilirubine sérique et d'acide urique était corrélée aux sous-types de MviS ainsi qu'à la sévérité de la leucoaraïose. Méthode : Mille quatre-vingt-dix-huit patients consécutifs présentant des symptômes légers comme des étourdissements, du vertige et d'autres symptômes de cette nature ont été inclus dans cette étude transversale. les patients ont été répartis en 2 groupes, soit le groupe témoin et le groupe MviS selon les constatations faites à l'imagerie par résona...

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Purpose: This phase 1b/2 trial investigated pembrolizumab-containing trimodality therapy in patients with gastroesophageal junction (GEJ) adenocarcinoma. Patients and methods: Patients with GEJ adenocarcinoma (cT1-3NanyM0)received neoadjuvant pembrolizumab-containing chemoradiation (CROSS regimen) followed by surgical resection and adjuvant pembrolizumab. The primary endpoints were tolerability in the first 16 patients and pathologic complete response (pCR [ypT0N0]). Secondary endpoints included progression-free survival (PFS) and overall survival (OS). An independent propensity-score-matched cohort (treated with CROSS without immunotherapy) was used for comparison. Exploratory analyses included immune biomarkers in the tumor microenvironment (TME) and plasma. Results: We enrolled 31 eligible patients, of whom 29 received all expected doses of neoadjuvant pembrolizumab and 28 underwent R0 resection. Safety endpoints were met. The primary efficacy endpoint was not met (7/31 [22.6%] achieved pCR). Patients with high (ie, combined positive score [CPS] {greater than or equal to}10) baseline expression of PD-L1 in the TME had a significantly higher pCR rate than those with low expression (50.0% [4/8] vs 13.6% [3/22]; P=.046). Patients with high PD-L1 expression also experienced longer PFS and OS than propensity-score-matched patients. Among trial patients with PD-L1 CPS &lt;10, unprespecified analysis explored whether extracellular vesicles (EVs) could identify further responders: an elevated plasma level of PD-L1-expressing EVs was significantly associated with higher pCR. Conclusions:Adding pembrolizumab to trimodality therapy showed acceptable tolerability but did not meet the pre-specified pCR endpoint. Exploratory analyses suggested that high PD-L1 expression in the TME and/or on EVs may identify patients most likely to achieve tumor response.

The prevalence of diabetes mellitus is increasing globally. Probiotics have been shown to be an effective intervention for diabetes. This study focused on the relieving effects and possible mechanisms of 16 strains of two dominant Bifidobacterium species (B. bifidum and B. adolescentis, which exist in the human gut at different life stages) on type 2 diabetes (T2D). The results indicated that more B. adolescentis strains appeared to be superior in alleviating T2D symptoms than B. bifidum strains. This effect was closely related to the ability of B. adolescentis to restore the homeostasis of the gut microbiota, increase the abundance of short-chain fatty acid-producing flora, and alleviate inflammation in mice with T2D. In addition, compared with B. bifidum, B. adolescentis had a higher number of core genes, and these genes were more evolutionarily stable, including unique environmental tolerance, carbon and nitrogen utilization genes, and a blood sugar regulation gene, glgP. This may be one of the reasons why B. adolescentis is more likely to colonize in the adult gut and show a superior ability to relieve T2D. This study provides insights into future studies aimed at investigating probiotics for the treatment of metabolic diseases.