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Articles by X. Yang
Total Records ( 8 ) for X. Yang
  P. C. Y. Tong , A. P. Kong , W Y. So , X. Yang , M C. Y. Ng , C S. Ho , R C. W. Ma , R. Ozaki , V. Ng , C C. Chow , C W. K. Lam , J C. N. Chan and C S. Cockram

Aims  To examine the effect of albuminuria and retinopathy on the risk of cardiovascular and renal events, and all-cause mortality in patients with Type 2 diabetes.

Methods  A post-hoc analysis of 4416 Chinese patients without macrovascular complications at baseline (age 57.6 ± 13.3 years). Glomerular filtration rate (eGFR) was estimated by the abbreviated Modification of Diet in Renal Disease Study Group Formula, further adjusted for Chinese ethnicity. Clinical end points were all-cause mortality, cardiovascular events (heart failure or angina, myocardial infarction, lower limb amputation, re-vascularization procedures and stroke) and renal end points (reduction in eGFR by more than 50% or eGFR < 15 ml/min/1.73 m2 or death as a result of renal causes or need for dialysis).

Results  Compared with individuals without complications, subjects with retinopathy and macroalbuminuria had higher rates of cardiovascular events (14.1 vs. 2.4%), renal events (40.0 vs. 0.8%) and death (9.3 vs. 1.7%, P < 0.001). For composite event of death, cardiovascular and renal events, the presence of retinopathy, microalbuminuria alone, macroalbuminuria alone, retinopathy with microalbuminuria or retinopathy with macroalbuminuria increased the risk [hazard ratio (95% CI)] by 1.61 (1.05 to 2.47; P = 0.04), 1.93 (1.38 to 2.69; P < 0.001), 4.34 (3.02 to 6.22; P < 0.001), 2.59 [1.76 to 3.81; P < 0.001) and 6.83 (4.89 to 9.55; P < 0.001) fold, respectively. The relative excess risk as a result of interaction between retinopathy and macroalbuminuria was 15.31, implying biological interaction in the development of renal events.

Conclusions  In Chinese patients with Type 2 diabetes, retinopathy interacts with macroalbuminuria to increase the risk of composite cardio-renal events.

  Y. Wang , A. O. Y. Luk , R. C. W. Ma , W. Y. So , C. H. T. Tam , M. C. Y. Ng , X. Yang , L. Baum , V. Lam , P. C. Y. Tong and J. C. N. Chan

Aims To examine the independent and joint effects of multiple genetic variants on a cardiac end-point in an 8-year prospective study of a Chinese diabetic cohort.

Methods Seventy-seven single nucleotide polymorphisms (SNPs) of 53 candidate genes for inflammation, thrombosis, vascular tone regulation and lipid metabolism were genotyped in 1297 Chinese patients with no prior history of coronary heart disease (CHD) or heart failure at baseline. Cardiac end-point was defined by the occurrence of CHD and/or heart failure.

Results In Cox regression model, after adjustment for baseline confounding variables including age, sex, smoking status, duration of diabetes, glycaemic control, lipid levels, waist circumference, blood pressure, albuminuria and estimated glomerular filtration rate, genetic variants, including Ala/Ala of SCYA11 (eotaxin) Ala23Thr, Cys/Cys or Cys/Ser of PON2 (paraoxonase2) Ser311Cys and Arg/Arg of ADRB33-adrenergic receptor) Trp64Arg, were independently associated with incident cardiac end-point, with respective hazard ratios (95% confidence interval) of 1.70 (1.10–2.61, P=0.037), 1.42 (1.08–1.88, P=0.013) and 3.84 (1.18–12.50, P=0.025). Analysis of the joint effect of the risk alleles showed significant increased risk of the cardiac end-point with increasing number of risk alleles (P<0.001). The adjusted risk for the cardiac end-point was 4.11 (P=0.002) for patients carrying four risk alleles compared with those carrying one or no risk allele.

Conclusions The independent risk conferred by genetic variants encoding pathways such as inflammation and lipid metabolism, not adequately reflected by conventional biomarkers, may identify high-risk individuals for intensified control of modifiable risk factors.

  J. Chan , W. So , G. Ko , P. Tong , X. Yang , R. Ma , A. Kong , R. Wong , F. Le Coguiec , B. Tamesis , T. Wolthers , G. Lyubomirsky and P. Chow
  Aims  The Joint Asia Diabetes Evaluation (JADE) Program is the first web-based program incorporating a comprehensive risk engine, care protocols, clinical decision and self-management support to improve ambulatory diabetes care. The aim was to validate the risk stratification system of the JADE Program using a large prospective cohort.

Methods  The JADE interactive risk engine stratifies patients into different risk levels using results from an annual comprehensive assessment of complications and risk factors. We used a prospective registry consisting of 7534 Type 2 diabetic patients [45.6% men, median (range) age 57 years (13-92)] to perform internal validation of the risk engine.

Results  The JADE Risk Engine categorized patients into four risk levels (from low to high): level 1, n = 4520 (6%); level 2, n = 1468 (19.5%); level 3, n = 4476 (59.4%); and level 4, n = 1138 (15.1%). After a median follow-up period of 5.5 years (mean ± sd 5.4 ± 2.81 years), 763 (10.1%) died, 1129 (14.9%) developed cardiovascular disease (CVD), 282 (3.7%) developed end-stage renal disease and 1400 (18.6%) had at least one of these events. Compared with risk level 1, levels 2, 3 and 4 were associated with 2.8-, 4.7- and 8.6-fold increased risk of clinical end-points. Risk levels 3 and 4 were, respectively, associated with 2.2- and 3.9-fold increased risk for all-cause death and 4.8- and 12.1-fold increased CVD risks.

Conclusion  Based on results from a comprehensive assessment, the JADE Risk Engine successfully categorizes patients into different risk levels to guide clinical management.

  X. Liang , Q. Wang , X. Yang , J. Cao , J. Chen , X. Mo , J. Huang , L. Wang and D. Gu
  Aims  To assess the effect of mobile phone intervention on glycaemic control in diabetes self-management. Methods We searched three electronic databases (PubMed, EMBASE and Cochrane Library) using the following terms: diabetes or diabetes mellitus and mobile phone or cellular phone, or text message. We also manually searched reference lists of relevant papers to identify additional studies. Clinical studies that used mobile phone intervention and reported changes in glycosylated haemoglobin (HbA1c) values in patients with diabetes were reviewed. The study design, intervention methods, sample size and clinical outcomes were extracted from each trial. The results of the HbA1c change in the trials were pooled using meta-analysis methods.

Results  A total of 22 trials were selected for the review. Meta-analysis among 1657 participants showed that mobile phone interventions for diabetes self-management reduced HbA1c values by a mean of 0.5% [6 mmol/mol; 95% confidence interval, 0.3-0.7% (4-8 mmol/mol)] over a median of 6 months follow-up duration. In subgroup analysis, 11 studies among Type 2 diabetes patients reported significantly greater reduction in HbA1c than studies among Type 1 diabetes patients [0.8 (9 mmol/mol) vs. 0.3% (3 mmol/mol); P = 0.02]. The effect of mobile phone intervention did not significantly differ by other participant characteristics or intervention strategies.

Conclusions  Results pooled from the included trials provided strong evidence that mobile phone intervention led to statistically significant improvement in glycaemic control and self-management in diabetes care, especially for Type 2 diabetes patients.

  F. Zhang , L. Dong , C. P. Zhang , B. Li , J. Wen , W. Gao , S. Sun , F. Lv , H. Tian , J. Tuomilehto , L. Qi , C. L. Zhang , Z. Yu , X. Yang and G. Hu
  Aims  To investigate the trend in the prevalence of gestational diabetes mellitus during 1999-2008 in women living in urban Tianjin, China.

Methods  A universal screening for gestational diabetes mellitus has become an integral part of the antenatal care in Tianjin, China from 1998. A total of 105 473 pregnant women living in the six urban districts of Tianjin, China, participated in the gestational diabetes mellitus screening programme between December 1998 and December 2008. The screening test consisted of a 50-g 1-h glucose test. Women who had a glucose reading ≥ 7.8 mmol/l at the initial screening were invited to undergo the standard 2-h oral glucose tolerance test with a 75-g glucose load. Gestational diabetes mellitus was confirmed using the World Health Organization's diagnostic criteria.

Results  The adjusted prevalence of gestational diabetes mellitus increased by 2.8 times during 1999-2008, from 2.4 to 6.8% (P < 0.0001 for linear trend). In 2008, the age-specific prevalence of gestational diabetes mellitus was the highest among women aged 30-34 years (11.3%) and lowest among women aged 25 and under (1.2%). In women aged 35 years and more, the prevalence was 5.3%.

Conclusions  The prevalence of gestational diabetes mellitus has markedly been increasing in a universally screened urban Chinese female population and has become an important public health problem in China.

  G. E. Tutino , W. H. Tam , X. Yang , J. C. N. Chan , T. T. H. Lao and R. C. W. Ma
  There has been a marked increase in the prevalence of diabetes in Asia over recent years. Diabetes complicating pregnancy, in particular gestational diabetes, has also increased markedly in the region. Multi-ethnic studies have highlighted the increased risk of gestational diabetes mellitus among the different Asian populations. Prevalence of gestational diabetes in Asian countries varies substantially according to the screening strategy and diagnostic criteria applied, and ranges from 1% to 20%, with evidence of an increasing trend over recent years. The International Association for Diabetes in Pregnancy Study group criteria have been adopted by some Asian countries, although they present significant challenges in implementation, especially in low-resource settings. Studies on offspring of mothers with gestational diabetes have reported adverse cardiometabolic profiles and increased risk of diabetes and obesity. Gestational diabetes is likely to be a significant factor contributing to the epidemic of diabetes and other non-communicable diseases in the Asian region. In recognition of this, several large-scale prevention and intervention programmes are currently being implemented in different Asian countries in order to improve glucose control during pregnancy, as well as overall maternal health. Lessons emerging from gestational diabetes studies in Asia may help inform and provide insights on the overall burden and treatment strategies to target gestational diabetes, with the ultimate aim to reduce its adverse short- and long-term consequences.
  X. Yang

It is a long-standing view that the circadian clock functions to proactively align internal physiology with the 24-h rotation of the earth. Recent studies, including one by Schmutz and colleagues (pp. 345–357) in the February 15, 2010, issue of Genes & Development, delineate strikingly complex connections between molecular clocks and nuclear receptor signaling pathways, implying the existence of a large-scale circadian regulatory network coordinating a diverse array of physiological processes to maintain dynamic homeostasis.

  Y. Wang , T. Liang , X. Yang and D. Zhang
  In this study, we develop and analyze the Cluster Based Location-Aware Routing Protocol for Large Scale Heterogeneous Mobile Ad Hoc Networks (CBLARHM), a low-complexity routing algorithm for mobile ad hoc networks (MANET). CBLARHM runs on top of an adaptive cluster cover of the network, which can be created and maintained using, for instance, the weight-based distributed algorithm. The weighted clustering algorithm we proposed takes into consideration node degree difference, battery power, average link stability and average dependency probability of mobile nodes. The hierarchical structure stabilizes the end-to-end communication paths and improves the networks scalability such that the routing overhead does not become tremendous in large scale MANET. Furthermore, it is fascinating and important to investigate that how to control the total number of nodes involved in a routing establishment process so as to improve the network layer performance of MANET. CBLARHM is to use geographical location information provided by Global Position System (GPS) to assist routing. The location information of destination node is used to predict a smaller rectangle, isosceles triangle, or circle request zone, which is selected according to the relative location of the source and the destination, that covers the estimated region the destination may locates. Thus, instead of searching the route in the entire network blindly, CBLARHM confines the route searching space into a much smaller estimated range. Simulation results have shown that CBLARHM outperforms other protocols significantly in route setup time, routing overhead, mean delay and packet collision and simultaneously maintains low average end-to-end delay, high success delivery ratio, low control overhead, as well as low route discovery frequency.
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